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Laser eye surgery

What is it?
Laser treatment to alter the shape of the cornea, improving sight permanently, and removing the need for glasses or contact lenses.

Timings
Treatment takes 15 minutes, then 2-7 days' recovery. Effect is permanent, but does not prevent further natural deterioration in sight. Patients aged 45+ may still need reading glasses.

Cost
£500-£850 per eye, depending on type of laser treatment.

What is laser eye surgery?
The shape of the cornea determines how well the eye focuses. Making the centre flatter improves short-sightedness, while making the centre more curved by trimming the edge helps long-sightedness. In this treatment, a laser beam removes tissue from the cornea to alter its shape and correct the vision.
There are two types of laser surgery:

Lasik surgery
A thin layer of the cornea is cut and lifted with the laser (rather like slicing the top off a boiled egg but leaving it hinged on one side). Recovery is quick and pain-free. Lasik is a more complicated treatment than Lasek, because it involves cutting the cornea, and so there are higher risks and more possible side-effects.

Lasek surgery
This treatment doesn't involve cutting the cornea and so is safer. However, recovery time is longer, and there may be some discomfort following treatment.

What laser eye surgery can do.
It can improve eyesight, often restoring 20/20 vision, so the patient no longer needs glasses or contact lenses. It can treat short sight, long sight and astigmatism.

What laser eye surgery can't do.
Laser surgery is unsuitable for people with high degrees of long sight (more than +2), or short sight (over -8), or for people with large pupils or eye diseases. It shouldn't be used unless the patient's eye prescription has stayed the same for several years, and isn't usually recommended for people under 21 or over 60.
It can't stop normal age-related deterioration of eyesight, which continues after treatment.

What happens during treatment?
You'll be given a range of eye tests at an assessment appointment. If you go ahead with treatment and normally wear contact lenses, you'll be asked to leave your lenses out for one to seven days before the laser treatment.
On the day, you'll lie on a reclining chair under the laser and the eye being treated will be anaesthetised with drops. The eye is then cleaned and held open with a metal ring.

Lasik treatment
The lashes are taped back and then a small flap is cut in the surface of the cornea. Vision is lost for around 20 seconds while this is done. The pre-programmed laser beam reshapes the cornea and there is sometimes a faint whiff of burning while this is done. The corneal flap is then replaced. There should be little or no pain after surgery, and full, unblurred vision should return after one to two days and be fully stabilised within one to four weeks. Dry eyes can be a problem for up to six months after surgery, requiring drops.

Lasek treatment
After preparation, the protective outer layer of cells on the cornea is softened with alcohol, and folded to one side. You'll stare at a pre-programmed red or green laser light as it reshapes the cornea, taking around 30 seconds. There may be a faint burning smell while this is done. The surface layer of the cornea is gently repositioned and a protective contact lens placed in the eye, which is worn for three to four days. After surgery you'll be sensitive to light, and the eye may be painful for the first 24 hours. Unblurred vision returns in three to six days and stabilises within one month.
For both types of treatment, you'll be asked to protect the eye overnight with a plastic shield, and be given anti-inflammatory eye drops and artificial tears to lubricate the eye. You should be able to return to work within two to seven days, but you might not be able to drive for one to two weeks. For three months you will have to wear sunglasses with UV protection when in the sun.

Results
For those with low to moderate levels of short-sightedness, results are excellent for both types of treatment, and 80-98% of patients no longer need glasses or contact lenses. Results for long-sightedness are also good, but the effect may lessen after two years.

Risks
Some clinics offer to treat both eyes at the same appointment. Although it is very unlikely that there would be serious complications with both eyes, it is not impossible. It is wiser to have one eye treated first, and wait until the results of that treatment are clear before booking another. Some people find they don't need glasses any more after treatment to one eye only.

Lasik surgery
There are growing concerns about the safety of Lasik surgery, with two American lawsuits alleging that the laser equipment is unreliable and could result in long-term damage to eyesight. Some clinics in the UK have recently stopped offering this type of treatment.
The eye may be slightly over- or under-corrected, and so patients may still need glasses or contact lenses. When patients who've had laser treatment reach their mid-40s, they may have to start wearing glasses for reading. Wearing contact lenses, if needed, may be uncomfortable, and the surface of the eye may be tender for the first few months. Night vision may be poorer, but this usually corrects itself after six months. Most patients report uncomfortably dry eyes, treatable with drops, for six months after treatment.
There is a small risk of the retina becoming detached. In a very few patients, there may be problems stemming from the cut made in the cornea during treatment, such as inflammation, damage to the flap or ingrowth beneath it.

Lasek surgery
You may experience hazy vision, although this generally disappears within the first year. Rarely, the eye can be infected during treatment, and severe infection could damage the eye permanently.

Where to get treatment
Treatment is on offer in hospitals, private clinics and elsewhere.

Lasik sugery is currently available only at private clinics, and a recent review by the National Institute for Clinical Excellence (NICE) has concluded that current evidence on the treatment's safety does not justify its widespread use on the NHS.

Some clinics offer only one type of treatment, which may not be the best for your eye correction. The Royal College of Ophthalmologists recommends that surgeons performing laser surgery should be fully trained ophthalmologists who have had specialist training in laser use, and that patients should check whether the clinic or hospital where they are considering treatment, follows the Royal College guidelines for laser refractive surgery.

Cost
This surgery costs from £500 to over £850 per eye, depending on the type of procedure.

Improving vision without laser eye surgery.
Numerous types and styles of glasses and contact lenses are available.

Laser eye surgery help and info
Channel 4 Television takes no responsibility for the content of any third-party sites.

Organisation
British Association of Aesthetic Plastic Surgeons (BAAPS)
c/o The Royal College of Surgeons of England
35-43 Lincoln's Inn Fields
London WC2A 3PE
Advice Line: 020 7405 2234
E-mail: info@baaps.org.uk
Website: www.baaps.org.uk
Offers information about aesthetic plastic surgery; its website features a search facility for accredited surgeons.

Links
Eye Surgery Deemed to Risky for NHS – 6 December 2004
www.timesonline.co.uk/article/0,,8122-1390931,00.html
This article in The Times reveals the results of a year-long review by the National Institute for Clinical Excellence (NICE) into the procedure known as Lasik. This laser eye surgery is currently available only at private clinics, but the report has concluded that current evidence on the treatment's safety does not justify its widespread use on the NHS.

Lasik Eyes
www.lasik-eyes.co.uk
Lasik stands for Laser-Assisted In Situ Keratomileusis, aka laser eye surgery. This patient-led site has a full list of clinics across the UK where surgery is carried out and where those who have had the surgery, whether successful or not, have posted their comments. There is also a forum and a pdf booklet 'Choosing a Clinic'.

London Vision Clinic
www.londonvisionclinic.com
This clinic's website has lots of useful information for anyone considering having eye surgery, with advice on questions that must be asked of any surgeon.

Royal College of Ophthalmologists
www.rcophth.ac.uk/public/laser.html
Adobe booklet on laser eye surgery. Full explanation of choice of procedures, what happens during treatment, benefits and risks.

Reading
UK Guide to Laser Eye Surgery
Tel: 0800 587 4705
Website: www.londonvisionclinic.com
Professor Dan Reinstein has created this free guide to laser eye surgery; it covers five key areas critical to patient success: safety, technology, expertise, experience and results. Order a free copy by calling the above number or via the website.

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