LASIK and other types of eye surgery for myopia

• LASIK eye surgery does not decrease the risk of developing eye diseases associated with myopia.
• It’s important to understand the possible complications before getting LASIK.
• Children are not suitable to undergo LASIK surgery as their eyes are still growing and changing. However, some children who have very high myopia may benefit from LASIK surgery. Currently only a few small studies have been published on this, and further data are needed.

LASIK (Laser-Assisted in Situ Keratomileusis) is a refractive surgery that can correct myopia (shortsightedness or nearsightedness), hyperopia (longsightedness or farsightedness) and astigmatism. 

This procedure uses a laser to create a corneal flap (think of it as a door) and then reshape the cornea, the clear dome at the front of the eye, to improve vision. 

After the surgery (24-48 hours), patients can typically see clearly without the need for spectacles or contact lenses.

LASIK may correct vision, but it does not cure the excessive length of the eye which usually occurs in myopia. 

A person with myopia tends to have an eyeball that is longer than average, and this increases the risk for developing eye diseases and vision impairment later on in life.¹ Since laser eye surgery corrects myopia by surgically altering the front layer of the eye, the length of the eyeball is not affected.  

An adult who has had laser surgery for myopia still has a longer eye than normal, meaning the retina at the back of the eye continues to remain under strain – even if vision is now clear without glasses or contact lenses. This means that they have the same elevated risk levels as someone who hasn't had surgery, and still require ongoing monitoring of eye health through regular eye exams.

LASIK is considered as a safe surgery. 

LASIK is an outpatient (day) procedure, meaning that patients can usually return home a few hours after the surgery. Because topical (surface) anesthesic drops are used on the eye, there is minimal pain during the surgery and postoperatively.²

Post-operative patient satisfaction is high, with research indicating that 95% are satisfied with the outcome.³

The vast majority of laser eye surgery procedures are successful. Minor post-operative events are very uncommon, but may occur.⁴ These include:

• Dry eye - It is the most common issue experienced after LASIK. However, postoperative dry eye is usually temporary and can be relieved by artificial tear (moisturizing) eye drops.
• Glare or halos - The patient may see a glow of light around objects after surgery. This is due to the healing process of the cornea. Glare and halos usually diminish over time as the cornea continues to heal.
• Under- or over-correction - This occurs when too little or too much corneal tissue is removed during the procedure. This can often be treated with enhancement procedures.

Your eye surgeon will usually conduct a follow-up assessment after the surgery, to identify and resolve any complications.⁴ Serious complications are extremely rare:

• Infection - patients can experience poor vision, pain, photophobia, and redness 1-3 days after the surgery. Patients should inform their ophthalmologist (eye surgeon) of these symptoms as soon as possible, for further treatment.
• Flap abnormalities – an eye doctor will examine the condition of the corneal flap the day after surgery. Any flap complications can typically be corrected with a secondary LASIK procedure and/or appropriate medications.

LASIK is one of the most well-known eye procedures for improving vision. To achieve the most successful outcomes, your eye surgeon may opt for a slightly different procedure to LASIK. 

There are different ways to create a flap on the cornea during the surgery, which depending on the surgeon’s preference and individual patient factors. These include:  

• Automated lamellar keratoplasty (ALK) – This is a non-laser procedure. In this surgery, a corneal flap is created using a blade (microkeratome). The underlying corneal tissue is then removed based on the patient’s prescription, and the flap is repositioned for reattachment. ALK is also used to treat certain corneal irregularities.
• Laser-assisted subepithelial keratectomy (LASEK) - The outermost layer of the cornea, the epithelium, is carefully separated from the underlying tissue. Laser ablation is performed on the exposed stromal bed, and the epithelial layer is then repositioned to cover the treated area.
• Small incision lenticule extraction (SMILE) - A laser creates a small, lens-shaped piece of tissue (lenticule) within the cornea, which is then removed through a tiny incision. Because of the minimal incision, patients typically experience less dryness and a faster recovery time.

There are also other types of refractive surgery which may be more suitable to a person, depending on their individual vision and eye shape factors. These include:

• Photorefractive keratectomy (PRK) – no corneal flap is created, and instead the outer epithelial layer is removed and the laser energy is applied directly to the top layers of the cornea
• Intracorneal ring (Intacs) - clear plastic rings that can be surgically implanted into the cornea to help change the shape beneficially
• Implantable Collamer Lens (ICL) - the implanted lens is placed behind the iris (coloured part of the eye) and in front of the natural focussing lens.

People with any of the following conditions⁵ may not be suitable for LASIK or surgery to correct vision. 

• Unstable prescription power – children and some young adults often still have changing vision and increasing prescriptions, making them unsuitable until their vision stabilizes. This can also be the case with pregnant women or those who are breastfeeding.
• Corneal or eye health conditions such as keratoconus, irregular corneal shapes, very thin corneas, cataract or glaucoma
• General health issues that slow or prevent proper healing such as diabetes or autoimmune conditions
• Severe dry eye – a common complication of LASIK is dry eye, hence it may worsen this condition
• Personalities which are too perfectionist – this means a person may be less able to withstand any possible complications of the surgery⁶

Consult an optometrist or ophthalmologist (eye doctor) to manage these conditions and discuss alternative options for vision correction.

LASIK is generally not recommended for children.

The main obstacle with refractive surgery in young individuals is that a child’s prescription is unstable. The eyeball grows and changes significantly throughout childhood, and doesn’t begin to stabilise until almost adulthood. If LASIK is performed during this period, the clear vision may only last a couple years. 

Combined with the vision considerations, a child’s experience and recovery from surgery may be different compared to adults. There are some exceptions where an ophthalmologist may consider LASIK for a child, such as complex cases.^7-11 However, only been a handful of research studies have documented these scenarios.

Yes, as long as their vision and prescription have stabilised.

Until they reach adulthood, slowing the progression of myopia throughout childhood with myopia management is the best course of action. Treatments for controlling the progression of myopia include special types of glasses, contact lenses and atropine eye drops.

A child who has myopia control treatment throughout their childhood is highly likely to enter adulthood with a lower prescription than what it would have been without myopia management. With a lower level of myopia as a young adult, your child will be more suitable for LASIK eye surgery and have a greater likelihood of a successful post-surgical outcome.¹²