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Lasik Surgery

Common types of laser vision surgery

Here's a rundown of the types of surgery commonly used to correct vision.

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Is Lasik Surgery a Good Option for you?

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  • Lasek (laser epithelial keratomileusis). not to be confused with Lasik .A surgeon uses alcohol to loosen and then peel back the epithelium, or outer surface of the cornea. Next, a laser is used to reshape the surface of the cornea to correct nearsightedness, farsightedness, and astigmatism (which is blurred vision due to irregularities in the curvature of the cornea or lens). Then the epithelium flap is placed back into position and a contact lens is placed temporarily on the eye as a bandage. Recovery is rapid but there may be some initial discomfort.
  • PRK (photorefractive keratectomy). A surgeon removes microthin layers of tissue from the outermost layer of the cornea with a sterile brush and uses a laser to reshape the cornea to correct either nearsightedness, farsightedness, or astigmatism. Then a contact lens is placed over the eye as a temporary bandage. There may be some discomfort as the cornea heals during the next several days.
  • Lasik (laser assisted in situ keratomileusis). Surgeons use a surgical knife, called a microkeratome, to create a flap on the surface of the cornea. Then, using a laser, the surgeon reshapes the underlying cornea to correct vision and folds the flap back into place. In wavefront, or custom Lasik, the surgeon uses a device to map the irregularities of the eye, which permits correction of subtle focusing imperfections. Lasik typically has rapid visual recovery with less discomfort.

Costs and insurance for lasik surgery

Price can vary widely

The typical national price (per eye) for laser vision surgery is $1,657, according to a Consumer Reports Health Ratings. Costs per eye vary widely, with 7 percent of the consumers saying they paid less than $499 per eye; 12 percent paid between $2,500 and $3,999 per eye; and 4 percent shelled out $4,000 or more per eye. A hefty part of our sample, 23 percent, was unsure what they paid.

The national average cash price per eye for traditional Lasik is $1,513 after discounts, sales or specials, assuming both eyes are treated. Similarly, the average national price for custom Lasik, in which the surgeon uses a wave-front sensor to guide a computer-controlled laser, is $1,822. And the average national price of Custom-Bladeless Lasik, in which the surgeon uses a laser to create the corneal flap, is $2,069. But if you're planning to go to a nearby city to have Lasik, remember to consider travel expenses, since you'll have to make several visits to the surgeon, including follow-up trips.

Payment options

Here are our payment suggestions for those contemplating the procedure.

  • Check your health insurance Consult your employee-benefits department or talk directly with your insurer to see if your health plan covers all or part of the costs of the surgery. Even if it doesn't, you may find that some Lasik providers have a negotiated discount with large insurance carriers or vision networks. You may still be entitled to an additional 5 percent to 15 percent discount if you are in a major carrier provider network. If you're not covered, ask if any complications that result from the surgery would be covered.
  • Ask about sales and packages> Many Lasik centers offer discounts to patients who request them, some offer coupons or seasonal promotions.

Before Lasik surgery: Evaluations

Two to four weeks before your baseline evaluation

If you wear contact lenses, switch to eyeglasses two to four weeks or more before your initial evaluation. That's because contact lenses change the shape of your cornea for up to several weeks after you've stopped wearing them. That could lead to inaccurate measurements that surgeons use to determine how much corneal tissue to remove, and could result in poor vision after surgery. If you wear toric soft lenses or rigid gas permeable lenses, stop wearing them for at least three weeks before your initial evaluation; stop wearing hard lenses at least four weeks before. At your baseline evaluation be sure to ask the doctor how long before you can use contacts so they won't interfere with follow-up measurements.

During your baseline evaluation

Expect to meet with an eye doctor, provide a thorough medical history, discuss your expectations and goals, and receive a thorough eye exam to determine whether you are a good candidate for laser vision-correction surgery.

To provide the most accurate information possible, bring along your eye prescription records and a written summary of your medical history and eye conditions, including dates of significant events, treatments, and tests. And bring an up-to-date list of your current medications and dosages.

Your doctor should perform a thorough eye and vision exam. He or she should dilate your pupils and examine your eyes to make sure they're healthy. That includes:

  • Assessment of dry eye
  • Tests for thickness of your cornea
  • Tests of the curvature of your cornea
  • Tests of the pupils
  • Tests for astigmatism and a cone-shaped cornea
  • Test for glaucoma
  • Retinal exam

Afterward the doctor will discuss whether you are a good candidate for laser vision-correction surgery and, if so, what procedure is most appropriate. The doctor should talk with you in detail about the potential harms and benefits, including your own expectations and goals, and whether the results are likely to meet them. The doctor should also explain what you should do before, during, and after surgery, and also discuss the alternatives to surgery.

Take notes and ask questions. Bring along a spouse or friend if possible so he or she can help make sure you ask all your questions and understand the answers. Ask how long it will take for your vision to improve after surgery or whether it will fluctuate. Ask whether follow-up laser eye surgery, called "enhancements" or "touch-ups," may be needed, what improvements might be expected, whether they are covered by your contract�the agreement that specifies the services you're paying for�or can be written into it, and for how long. Ask whether the contract covers medical care or surgery to fix complications that may arise (and ask your insurer whether your plan covers complications from laser eye surgery).

If you're not comfortable after this discussion or think you might prefer another practitioner, get a second opinion about the surgery at another practice or vision center.

After your baseline Lasik evaluation

You should not feel pressured by the doctor, a staff member, or anyone else about signing a consent form for having surgery. Give yourself plenty of time to review the form and information your doctor and the center provided, ask additional questions, and carefully consider the potential risks and benefits.

Do not sign the consent form unless you feel satisfied that you thoroughly understand the possible risks, benefits, and alternatives, and what the likely outcome will be for you. Then tell the doctor or staff member at the center whether you're signing the form and going forward with the surgery. Closer to the surgery date, eye measurements may need to be repeated.

A week before Lasik surgery

Your doctor may tell you to stop wearing makeup, lotions, perfume, and cologne for a few days before surgery since they can interfere with the laser treatment or possibly increase the risk of infection after surgery. He or she may instruct you to wash any residue or debris from your eyelashes with scrubs for several days before surgery. Talk with your doctor about whether he or she will be prescribing any preoperative antibiotics, moisturizing eye drops, or other medications, and if so, how to use them.

The day of Lasik surgery

Wear comfortable clothing (and low-heeled shoes) and be sure you are still free of makeup, perfume, cologne, hairspray or hair gel, and earrings. Lasik is an outpatient procedure, but your doctor may give you medicine to help you relax. Because your vision may be blurry after surgery, arrange for transportation to and from the facility. Generally, the surgery takes only about 10 to 15 minutes per eye, but because of preparation time and other factors, plan on spending two hours at the office. After Lasik surgery

It's helpful to keep your eyes closed for the first few hours and sleep while wearing the protective glasses provided by your doctor. You may experience a mild burning sensation for a few hours after Lasik surgery but there should be minimal pain. Do not rub your eyes. Contact your doctor immediately if you experience severe pain or irritation, or if your vision or other symptoms get worse instead of better.

Do not shower until after your postop doctor's visit, which tends to be on the next day. At that visit you can schedule the rest of your follow-up visits, usually for the following week, month, and then as directed.

Healing is fast, but you may want to take a few days off from work after surgery. Don't drive until your vision has improved enough to safely do so. You'll need to avoid getting water in the operated eye or eyes for a few days. Do not wear eye makeup, lotion, or sunscreen for a week after surgery. Avoid impact sports or similar activities for four weeks, and then use protective safety glasses. Avoid pools, hot tubs, and whirlpools for up to two months after surgery.

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