LASIK Eye Surgery: Factors to Consider

If you wear corrective eyeglasses or contact lenses, you may be considering undergoing refractive laser surgery with laser-assisted in situ keratomileusis (LASIK). It's appealing to be able to open your eyes in the morning and see clearly without lenses.

But before you make the leap, you want to consider the cost and possible side effects so you can ensure this is the right move to enhance your vision. You may also want to know about any alternatives to LASIK that may be preferable for you.

In this article, you will learn about how LASIK works, any risks or side effects, the procedure's costs, whether you're a candidate, where to undergo the surgery, and more.

How Does LASIK Eye Surgery Work?

LASIK corrects refractive errors, such as nearsightedness (seeing things better up close) or farsightedness (seeing things better in the distance), and astigmatism (an out-of-the-ordinary shaped cornea or lens). With these errors, light doesn't fall correctly on the light-sensitive retina at the back of the eye.

With the LASIK procedure, the eye is reshaped so that light rays are focused precisely on the retina, creating a sharp image.

In the procedure, an ophthalmologist (an eye specialist) cuts a flap in the clear tissue at the front of the eye, known as the cornea, using either a mechanical device or a laser. A hinge of tissue remains, and the flap is folded back out of the way using this hinge.

Underneath is the middle part of the cornea, known as the stroma. The ophthalmologist then applies laser pulses to the stroma to reshape this so that the light hits the retina where it should so that vision is sharp. The flap is then returned to its place.

Risks and Side Effects of LASIK Eye Surgery

Though thoughts of sharp vision without relying on spectacles or contacts are enticing, this is not for everybody, or at least it may not be for you at the moment. Factors that can put you at an increased risk of unintended effects after getting LASIK include:

• Having a condition that affects wound healing, such as diabetes, lupus, human immunodeficiency virus (HIV), or rheumatoid arthritis, or taking medications that will affect what happens after you undergo LASIK (such as steroids).
• Experiencing vision changes over the past year due to hormonal changes from pregnancy or breastfeeding, from a condition like diabetes, as a result of taking certain medication, or even your age if you're 20 or younger.
• Having very thin corneas, which may become unstable when tissue is removed to reshape them. This can result in a serious complication known as corneal ectasia.
• Having pupils that are too big. Otherwise, in darkened conditions, you may have to contend with vision issues such as glare, halos, double vision, or starbursts.
• Having dry eyes, which LASIK can make much worse.
• Experiencing blepharitis, a condition that involves flaking around the eyelashes and which can increase your risk of infection following LASIK.
  

Also, before undergoing LASIK, it's important to have a clear picture of the side effects that can occur in some cases. Here are some of the potential issues you may encounter, albeit sometimes temporarily, after undergoing LASIK:

• Feelings of dryness or foreign body sensation in the eye
• Hazy vision
• Difficulty with night driving
• Seeing halos or starburst around lights
• Sensitivity to light
• Small hemorrhages in the whites of the eyes
• Pain

Financials: Costs of LASIK Eye Surgery

Deciding if LASIK is right for you also means factoring in cost. Keep in mind this may vary depending upon your vision and how much correction you need, whether you undergo customized LASIK or regular LASIK, and the type of practice where you wish to undergo the procedure.

In 2023, the cost can range anywhere from around $1,500 to $3,000 per eye. The Refractive Surgery Council notes an average cost of $4,400 (for both eyes) in the United States as of 2022.

For the most part, LASIK is considered an elective procedure, which means that private insurance is unlikely to cover the cost. But some insurance companies may offer you a discount of around 15% to 50% if you select a provider in their network.

If you have a flexible spending account (FSA) or health savings account (HSA), you can use those funds for LASIK.

Medicare and Medicaid don't usually cover LASIK because it is elective. But if there is a medical reason that you need to undergo the procedure, you may be covered. Or, if you have a Medicare Advantage plan, it may cover some of the costs.

When medically necessary, you may have dual eligibility, by which Medicare pays for some of the cost and Medicaid pays for other portions, such as deductibles and copayments. Or, if you are only on Medicaid and LASIK is medically necessary, then this will also be covered.

Here's when Medicare or Medicaid might cover LASIK:

• If you had an eye injury that caused your refractive error
• If a previous eye surgery caused the refractive error
• If the amount of refractive error that needs correcting is severe
• If you have a physical limitation that keeps you from wearing glasses or contact lenses
• If the only way to save your vision after a traumatic injury or for a problem caused initially by cosmetic refractive surgery is with LASIK

LASIK Eye Surgery Recovery Process

In considering whether LASIK eye surgery is the right move, you may be thinking about the recovery process and how that may fit into your demanding schedule. The good news about LASIK is there is little downtime. After this outpatient procedure, you should plan on taking the day off and just going home and resting or maybe taking a nap.

Your eye is on the mend immediately after LASIK, with any pain resolving within the first 12 hours or so. You should also be able to see much more clearly right away without glasses or contacts than you could before the procedure. Still, your sight may be a little hazy.

By the day after the procedure, most people can drive and are able to return to work or school. You should be able to use a computer or tablet almost immediately, although your vision may still be a little blurry.

Though your vision should be fairly sharp from the get-go, it may take between one to three months for it to fully stabilize after LASIK. If your vision reaches the 20/20 mark, you may eventually be able to do without correction, such as glasses or contact lenses.

Am I a Candidate for LASIK Eye Surgery?

Deciding that LASIK sounds good to you is only part of the equation. You must then determine whether you are a good candidate for this because LASIK is not for everyone. Here are some criteria you must meet:

• You must be an adult who is at least 18 years old with a corrective vision prescription that hasn't recently changed.
• Your vision must not be too extreme. You should not be either too nearsighted or farsighted or have too much astigmatism.
• You must have thick enough corneas to allow for reshaping without jeopardizing corneal stability.
• You must be practical about what LASIK can actually do in your case. In some cases, your vision may improve, but you may still need glasses.

Alternatives to LASIK Eye Surgery

If for some reason you can't undergo LASIK, you may consider other procedures. Here are some alternatives that can also potentially correct your vision:

• Wavefront-guided LASIK: With the aid of a 3D map of corneal topography, this approach is customized to the anomalies in your eye and can provide a correction that surpasses what is possible with conventional LASIK or glasses or contact lenses.
• Laser epithelial keratomileusis (LASEK): This procedure may be better if you have flat or irregularly shaped corneas. A shallow cut is made in only the top layer of the cornea. An alcohol solution then loosens the epithelial cells and creates an epithelial flap. The cornea is sculpted underneath this flap and then repositioned. It is necessary to use a bandage contact lens for about four days after the flap is laid back in place.
• EpiLASIK: With this procedure, an extremely thin LASIK flap is created, and the cornea is reshaped akin to the LASIK. This extremely thin flap is laid back down, and a soft contact lens is placed over the eye, allowing the eye to heal as new epithelial cells cover the cornea.
• Refractive lens exchange: Instead of reshaping the cornea, this involves removing your natural lens and replacing it with an artificial one that can focus light rays directly on the retina. This is similar to cataract surgery. The lens is removed even though there is no cataract (clouded lens) present to make this necessary.
• Phakic intraocular lenses: This involves using an artificial lens in addition to the natural one. The lens here is placed either in front of the iris (the colored portion of the eye) or behind it. This new lens focuses light rays directly on the retina, while the natural one allows you to retain your ability to focus up close.
• Orthokeratology (ortho-k): This is a non-surgical method for correcting vision that uses specially fitted contact lenses that reshape the cornea when worn overnight. It is mostly used to correct nearsightedness. When you reach the desired correction, you wear a "retainer lens" at night to maintain the correction but need no lenses during the day.

Where to Have LASIK Eye Surgery

You may wonder if it matters where you get a LASIK procedure done. With your future vision at stake, looking at more than pricing is a good idea.

The eye surgeon's experience level can make a difference. The Refractive Surgery Council notes that LASIK surgeons may have performed 10,000 or more surgeries. Ask the surgeon about their experience and ensure they are a licensed ophthalmologist.

LASIK surgery may be highly advertised with competitive pricing. The American Academy of Ophthalmology cautions against advertising claims that promise perfect results for every case.

With a consultation, you should not feel you are under sales pressure to make a decision immediately. You should have all of the risks of the surgery and possible outcomes fully explained.

Ethical surgeons will turn away people who are at higher risk or are unlikely to get the full benefits of the procedure. This may be disappointing, but it is important to understand this when considering this permanent surgery.

Summary

The promise of LASIK, which can reshape the cornea with the aid of a laser and possibly enable some to do away with spectacles, has major appeal. This outpatient procedure can allow for fast vision correction that can enable you to promptly return to work.

But there can be a downside for some, leading to discomfort and vision issues. Also, not everybody is a candidate for LASIK. However, there are other refractive procedures that you may want to consider instead.