Clear vision without glasses or contacts is an appealing prospect, but surgical procedure is not suitable for everyone

Whether we see the world clearly or blurrily is often determined by a fraction of a millimetre in our eyes. Glasses or contact lenses can compensate for this defect by directing light onto the retina. However, some people find visual aids annoying, whether for practical or aesthetic reasons. Laser eye surgery is therefore becoming an attractive alternative for more and more people.

The trend toward laser surgery couldn't be clearer: the number of procedures has been increasing across Europe for years. There has been a further increase since the pandemic. One of the possible reasons is the annoying way glasses fog up when wearing masks. However, laser eye surgery is a surgical procedure and the costs are not usually covered by statutory health insurance. Anyone choosing to have surgery must pay for it themselves - and also decide which procedure is best for them.

Laser eye surgery: The different procedures

The three most common methods are Femto-LASIK, ReLex Smile and Trans-PRK.

Femto-LASIK is the most commonly used method. A high-precision laser is used to cut a thin flap in the surface of the cornea, which is then lifted like the cover of a book. Another laser is then used to reshape the cornea so that the refractive power of the eye is restored. The procedure takes only a few minutes.

The ReLex Smile method is a newer variant of the LASIK method, without needing to lift a flap. Instead, the laser cuts a tiny disc out of the cornea, which is removed through a small incision. The cornea remains largely intact on the outside, which means that dry eyes are less common after the operation. However, this procedure is only suitable for short-sightedness and astigmatism.

Trans-PRK, the oldest laser method, is used in particular for people who have an increased risk of injury to the eye, such as martial artists or police officers. Here, the top layer of the cornea is removed with a laser or a surgical instrument and the layer underneath is lasered. After the operation, the eye may be painful, which is why a soft contact lens is usually applied as a "bandage".

Not a suitable procedure for everyone

However, laser treatment is not suitable for everyone. Experts recommend Femto-LASIK only for near-sightedness up to minus eight dioptres and farsightedness up to plus three dioptres. The surgery is no longer beneficial from around the age of 50, as the lens and its refractive power change year by year. Astigmatism, a curvature of the cornea, can also only be corrected to a limited extent.

Experts recommend seeking at least two independent opinions before making a decision so that you find the right procedure for you. Consultations usually cost less than €100 or may even be offered free of charge. Responsible doctors always provide open and comprehensive advice about possible risks and side effects. Special methods that are advertised such as "wavefront-guided procedures" or "ray tracing algorithms" may sound impressive, but beware: they can often be merely marketing gimmicks and offer no real additional benefits.

Laser eye surgery: Risks and alternatives

As with any surgery, risks are associated with laser eye surgery. The procedure may not be successful, or complications may arise. Dry eyes are common after laser treatment, and sometimes too much or too little cornea is removed, with a need for corrective surgery. Almost a third of those who have had the operation report difficulties driving at night or disturbing light effects such as halos. The good news is that 95% of patients with mild myopia are satisfied. However, the rate drops rapidly in cases of severe visual impairment or astigmatism.

For some patients for whom corneal surgery is not possible or advisable, lens surgery is an option. This involves either inserting a phakic intraocular lens or completely replacing the natural lens. This is particularly useful in cases of cataracts, when the lens needs to be replaced anyway. Whether replacement is justified in the case of a healthy lens remains controversial, as many people still need glasses afterwards.

Laser eye surgery can therefore be a way to improve quality of life for many people - provided that the individual requirements are met and the risks are understood. Trustworthy professional advice is essential in all cases.

Laser eye surgery: What are the benefits and risks?