Laser surgery reshapes and changes the curvature of the cornea (the transparent front “window” of the eye) to change the way light rays enter the eye. In myopia, tissue is removed to make the cornea flatter, in hyperopia, it is more convex, and in astigmatism, it is removed to smooth out irregularities on the front surface of the cornea.

• When you want to get rid of your glasses
• You do not suffer from another chronic eye disease,
• You have a refractive problem (myopia, hyperopia, astigmatism or a combination of these) that can be corrected with laser*
• You are over 18 years old and your refractive problem has been stabilized for at least 1 year (no need to change glasses during this time)
• You are not pregnant or postpartum, because hormones can temporarily change the shape of your eye
• You do not suffer from an autoimmune disease that will affect the healing process

*The decision as to whether your refractive problem can be successfully and safely corrected is solely the decision of your ophthalmologist following extensive specialized examinations.

Recent studies have shown that the risks of contact lens wear may outweigh the risks of refractive surgery. The risk of vision loss from lifelong contact lens wear is greater than from refractive surgery. In fact, extended contact lens wear (sleeping with contact lenses) increases the risk of vision loss even further.

Refractive surgeries, with modern technological developments – faster lasers, without a “blade” (femto-LASIK), the best and extremely thorough preoperative examination – in combination with the choice of an experienced ophthalmologist surgeon, are extremely safe. Contact lenses are by definition foreign bodies in the eye that cause continuous microtrauma to the cornea due to their friction on its surface and therefore make it susceptible to infections. Also, since their placement requires contact with the eyes, they constitute a constant risk of infection. This is not the case with the use of glasses or laser surgery.

Even the best-fitting lenses and those used in the best hygienic conditions reduce the amount of oxygen reaching the cornea, which creates the conditions for corneal edema and therefore can reduce the reliability of the final measurements before refractive surgery. Contact lenses also exacerbate dry eye by affecting the tear film and therefore can adversely affect the healing process after refractive surgery. For these reasons, you should refrain from wearing contact lenses for at least 2 weeks before surgery. If you wear hard contact lenses, the period of abstinence from lenses is one month before surgery.

Your ophthalmologist will ask you extensively about your personal, ophthalmological and family history and will then perform a complete ophthalmological examination, which will include, among other things, refraction with cycloplegia (drops that cause pupil dilation) and a check for dry eye. Paraclinical tests will then be performed to take into account the results of the clinical examination, such as corneal topography and pachymetry. The findings from the clinical and paraclinical tests will be considered by your ophthalmologist and it will be decided whether you are a suitable candidate for refractive surgery.

Yes, there are basically two laser methods. One is LASIK (laser-assisted in situ keratomileusis) and the other is PRK. The preoperative examination and the architectural structure of the cornea will indicate the ideal method for you.

The final results of the two methods are comparable. What differentiates them is the speed of recovery, which is faster in LASIK since in PRK it takes 48-72 hours for the corneal epithelium to heal, as mentioned above. In PRK, the risk of infection and blurred vision is slightly increased in the first days after surgery. Patients who have undergone LASIK generally have less discomfort and their vision is restored more quickly, while in PRK the improvement in vision is gradual and the final result comes after 3-4 weeks.The PRK method, however, has some significant advantages, since no flap is created (which consists of the epithelium and the corneal layer) and therefore the entire layer is available for treatment with the excimer laser. This is an important advantage in case your cornea is very thin. Since no flap is created in PRK, there is no possibility of complications related to the flap. Therefore, the choice of the method to which you will undergo depends on the anatomy of your eye. Since it is possible to perform both methods, then the choice should be made taking into account the following:

Both LASIK and PRK are proven safe and effective procedures. Laser correction uses a cold (non-thermal) beam of light that is fully controlled by a computer. The ophthalmologist can stop the laser at any time if necessary, and there are many safeguards that reduce the possibility of error. However, no surgical procedure is without even minor risks. Studies have shown that the incidence of minor adverse events (such as dry eyes and halos around objects, especially at night) is 3-5%, while the probability of serious events (such as loss of vision) is almost non-existent.

Most ophthalmologists usually perform the laser in one session. However, if this becomes necessary or desired by the patient, the procedures can be performed one week apart.

You will not feel any pain during LASIK or PRK, as the ophthalmologist or nursing staff will instill anesthetic drops in both eyes before the procedure. In the LASIK method, you will feel a tolerable pressure for about 20 seconds when the femto or microkeratome is applied to create the flap. After the procedure, and especially after PRK, your ophthalmologist may give you any painkillers.

In both LASIK and PRK, the LASER itself takes less than a minute for each eye. The entire procedure, including preparation, takes 15 minutes for each eye.

Before the operation.

The instructions given preoperatively vary from doctor to doctor, but in general, on the day of the operation you should not wear creams or makeup in the eye area. You should also avoid using perfume and wearing woolen or lint-filled clothes. It is also a good idea to have someone accompany you home after the operation and to have sunglasses with you. Usually, a medication in pill form is administered preoperatively to make you relax.

During the procedure.

You will lie on your back in a room containing the laser, which consists of a large machine and a microscope connected to a computer screen. The area around your eyes will be sterilized and an eyelid dilator will be placed to keep your eye open during the procedure. The laser beam will be placed over your eye and you will be asked to look at a green light. This is not the laser used to remove tissue from the cornea, but a light that is used to help you focus your gaze there. The laser is then applied, and you may notice new sounds and smells during this phase. The laser pulse makes a sound as the laser removes tissue from the cornea; some people have reported a smell similar to burning hair. A computer controls the amount of laser energy that hits your eye. Before the surgery begins, your doctor will have programmed the computer to remove a specific amount of tissue based on measurements taken during your initial evaluation.

In LASIK, the ophthalmologist will use a special machine to create the flap using either the Femto-LASIK method or a microkeratome. Vision will be blurred for a few seconds, and pressure will be applied during this part of the procedure. The surgeon lifts the flap, folds it back temporarily, and applies the excimer laser to the cornea. After the exact thickness of cornea required is removed, the ophthalmologist repositions the flap and the eye heals completely in just a few hours. In some cases, especially in femto-LASIK, a therapeutic contact lens is placed in the eyes for a preventive and protective purpose after the end of the surgery for 24 hours.

In the case of PRK, no flap is created, but the outer part of the cornea (epithelium) is removed, either mechanically by the ophthalmologist or with a laser (trans-PRK). The excimer laser is then applied, which will remove the appropriate thickness of tissue from the cornea. If we choose the Trans-PRK method where even the corneal epithelium is removed with the laser, no tool touches the eye and the operation is performed with infinitely greater precision and ease. It is a method for correcting myopia, hyperopia and astigmatism without the touch of a human hand. It is particularly suitable for all patients who would like the benefits of refractive surgery without the disadvantages of the Flap from Lasik and for those who are unsuitable for LASIK. From the patient’s point of view, this translates into minimal time spent in the operating room, faster recovery and restoration of vision. It has the same results as Lasik and the great advantage of this method is that there is no flap on the cornea. Trans-PRK is currently the only “No-Touch” Excimer-Laser treatment and is performed with the new SCHWIND-AMARIS Laser with which I personally operate on my patients.

After the PRK procedure (both types) is completed, a therapeutic contact lens is placed to minimize discomfort and protect the eye until the corneal epithelium heals on its own following the body’s natural healing process. It is important for you not to rub your eyes in the first few days after surgery.

After surgery

The most common symptoms are dry eyes, photosensitivity, and a foreign body sensation in the eye. All of these are expected and should not be a cause for concern. Your vision will likely be blurry for the first few hours after LASIK and for at least 3-4 days after PRK. You may also experience sensitivity to light. These symptoms will improve significantly after a few days. You will need to use artificial tears for the first few weeks to help moisturize the cornea. In addition to artificial tears, you will be instructed to use cortisone and antibiotic eye drops for 10 days after LASIK and for 3 months after PRK. You should also avoid wearing makeup around your eyes for 1 week, swimming, and using a hot tub or jacuzzi for 2 weeks. Intense contact sports, such as boxing, football, karate, etc., should not be attempted for at least two weeks after surgery. It is important to protect your eyes from anything that could damage them, especially in the first month. During the first few weeks after surgery, your vision may fluctuate. It may take three to six months for your vision to stabilize after surgery. Full vision recovery takes a few days for the trans PRK method and 24 hours for LASIK.

When you feel that your vision is sufficient to do so. This clearly refers to the period after the first 24 hours after the operation.

With LASIK, most patients return to work the next day, while with PRK, they need to take 2-3 days off work.

This is something that depends on the treating ophthalmologist. Usually, a post-operative check-up is done the day after the surgery, in one week, in 1 month and in 3 months.

It is reasonable for many patients to wonder whether their eyes will be damaged if they move during the laser application process. However, technology has taken care of this and modern machines used in refractive surgery today are equipped with an eye tracker, i.e. a system that tracks the movements of the eye being operated on. In the case of small movements of the eye, the laser follows and adapts, while in the case of large movements, the process is interrupted. Therefore, the procedure is completely safe even in the case of patient movement for any reason.