We’ve tried to answer as many questions as possible here, but feel free to contact us direct if there is something more specific you wish to ask.
As with any medical procedure, you have a thousand questions. Your initial consultation is about giving you the information needed to make a decision. Here are the questions we are most asked at St Paul's Laser Vision.
Before your treatment
If you wear contact lens it is a good idea to stop wearing them before the baseline evaluation. This is because, contact lenses can affect the shape of the cornea and therefore can affect some of measurements we take. For this reason you will be advised not to wear contact lens for a certain period before you come to your initial assessment. The length of time depends on type of contact lens you have been wearing. If you wear:
- Soft contact lenses (including toric and extended wear), you should stop wearing them for 2 weeks before your initial evaluation.
- Rigid Gas Permeable (RGP) lenses, you should stop wearing them for at least 4 weeks before your initial evaluation.
- True hard lenses (polymethyl methacrylate), you should stop wearing them for at least 12 weeks before your initial evaluation.
You will be assessed very carefully by the consultant who takes into account your eye health, general health as well as your life style and hobbies before recommending the best treatment option for you. The vase majority of people are suitable for LASIK or PRK/LASEK.
Here at the St Pauls Laser vision we have one of most advanced and most accurate laser technology. We are able to treat high prescriptions as high as:
- Up to -10.00D of myopia or short sight
- Up to +6.50D of hyperopia or long sight
- Up to ±6.00D of astigmatism
Do not be disheartened if your prescription is above these ranges as at St Pauls we offer a full range of other types of refractive surgeries. These include implanting an artificial lenses called ICL or performing refractive lens exchange.
You must be at least 18 years old before surgery. There is no real upper limit for laser eye surgery as long as your eyes are healthy. However, older people (especially over 60 years old) can get naturally occurring cataract and therefore may be more suitable for refractive lens exchange.
Yes. This is an option for some people who are anxious about surgery.
Laser eye surgery is one of safest operations but as you can imagine no surgery is entirely without some level of risks. Problems can occur during the operation or afterwards in the healing period. However, with over 25 years track record of improvements in laser vision correction technology and over 50 million procedures performed world-wide, laser eye surgery is one of the safest option for vision correction. Glasses are the only vision correction option which are risk free. All other vision correction options including contact lens wear have their own risks.
In expert hands, the safety of laser eye surgery is similar to that of daily contact lens wear, and even safer than extended wear contact lenses. Less than 3% of LASIK procedures results in any complications. The chance of a serious complication is less than 1% in general and probably less than 0.3% with an expert and experienced surgeon. In the rare events of complication, St Pauls Laser Vision is a very super specialised corneal centre, we have the knowledge, expertise and equipment to deal with all complications that may occur promptly thereby increasing the chance of good outcome despite the complication. More commonly, problems can be corrected with changes in medication or additional surgery. Permanent serious loss of vision is rare after laser vision correction. In the worst likely scenario, a form of corneal transplantation may be required to replace a damaged cornea. It is not possible to fully summarise all the risks associated with laser surgery here. However, at St Pauls Laser Vision you will undergo an extremely detailed process to gain informed consent for surgery and to assess your suitability for laser. The consent form and our patient information leaflet explain the risks associated with laser vision correction in more details. However below are some of the risks associated with laser eye surgery:
- Dry eyes and light scattering is relatively common side effects which is normally mild and resolve within 6 to 9 months after surgery. Permanent or severe dry eye symptoms are rare if you do not have a pre-existing problem with your eye surface, but may still occur.
- Permanent unwanted visual side effects (including starburst, halo, glare, light scatter, ghost and double images) are rare and are often, but not always, improved by repeat laser treatment. This may cause poor night vision, sensitivity to light, reduced sharpness of vision called “contrast sensitivity”, experiencing glare, halos or starbursts around lights.
- It is normal to require reading glasses from around age of 45 years with good uncorrected distance vision. This is the reason why most people who have never required glassess in past, start to wear glasses for near work once they get in their 4th decade of life and beyond. This process is not altered by the laser refractive surgery. There are effective treatment available to reduce spectacle dependance for older patients.
- It is important to have realistic expectation. Laser refractive surgery is highly effective in reducing the need for glasses wear. At minimum you should expect to be able to play sports and socialise comfortably without glasses but some patients may still require glasses for selected activities such as reading or nigh time driving. This is more common in older patients who already in reading glasses age group.
- Under or overcorrection: a small percentage of patient’s may be be under or over treated and therefore the vision may not sharp. Enhancement (retreatment) is suitable and highly effective in correcting significant residual error. The need for retreatment can often be determined in first 3-6 months. This is performed free of charge at St Paul’s Laser vision within 2 years of surgery. A very small number of patients may not be suitable for retreatment and hence may still need need glasses or contact lenses after surgery.
- Some complications, such as migration of the flap, inflammation or infection, may require another procedure and/or intensive treatment with drops. Even with aggressive therapy, such complications may lead to temporary loss of vision or even irreversible blindness.
- Malfunction of a device may rarely occur during surgery which may necessary stopping/postponing the treatment. However, in most cases the treatment can still be restarted and completed but in some instances the surgery may be changes, for example from a LASIK to surface laser treatment.
- Laser eye surgery’s results are intended to be lifelong but a small percentage of patients may encounter regression. This is when you may get long or short sighted again or some of your astigmatism may recur. At St Paul’s laser vision we provide an enhancement free of charge at any point.
Problems that can lead to the need for transplantation include scarring which can occur after infection or after abnormal healing response, and an unstable corneal shape – also called corneal ectasia. These problems occur infrequently, and can often be corrected without transplant surgery. Less than 1 in 5000 patients require a corneal transplant to restore vision after laser surgery, and good vision can normally be restored when transplantation is necessary although glasses or contact lenses may be required after such surgery
Do not wear any make up, nail vanish and perfume or after shave for at least 24h before the procedure. Make sure to thoroughly wash any old make up.
During your treatment
The actual laser will be active only for a few seconds. The full procedure will be finished within minutes.
You should not feel any pain during the procedure as your eye will be numbed with an eye drop. Most people report feeling some pressure on the eye which can be a strange sensation. This will last only for a few seconds.
Nothing as our laser machine is equipped with most advance eye tracking system. If the eye movements are small the eye tracker can still deliver the laser safely without stopping. However, if the eye or head moves significantly, the laser will automatically pause and will be restarted when the eye is centered again.
Most LASIK patients do not experience any discomfort after surgery although, it is common for the eye to be light sensitive and the vision to be blurry or hazy as if looking through a mist. This is normal and should quickly resolve within next 24h. However, after surface treatment (PRK, TransPRK, LASEK) the eye can take a few days to heal and will be uncomfortable for first 2-3 days. You will be given pain relief medication after all surface treatment to keep your eye as comfortable as possible during this period.
- Avoid any eye make up for at least 2 weeks post surgery
- Try to avoid any facial make ups for 1 week after surgery
- After 1 week you can resume wearing skin products such as foundations, concealers, lipsticks and blusher on your face
- Avoid getting any make up or make up removal products into the eye for at least 1 month
- You will be given your next appointment before you leave the clinic
- We often discharge you after 3 months. However, we are committed to providing a comprehensive life long after care with no additional cost for any treatment related to your surgery if required
- As a general rule below table shows when you need to be seen after your surgery
|First visit||1 day||3-7 days||3-7 days|
|Second visit||1 month||1 month||1 month|
|Third visit||3 months||3 months||3 months|
- Avoid any rigorous activity for about one month
- Below table gives some recommendations on resuming different activities but your consultant surgeon may give you personalised advice depending on your individual circumstances
|Jogging, aerobic excursive, Yoga and pilates||1 week||1 week||1 month|
|Weight lifting||2 weeks||2 weeks||1 month|
|Swimming, sauna, steam room and football||1 month||1 month||1 month|
|Skiing, snowboarding, tennis, squash and cricket||6 weeks||6 weeks||6 weeks|
|Rugby and Martial Arts||3 months||6 weeks||6 weeks|
|Deep scuba diving||3 months||3 months||3 months|
- It is important recognise that the healing process can vary from person to person and from eye to eye. Therefore, below table only give a guidance of expected average recovery time and time off work.
- Returning to work depends on your occupation. Our consultant surgeon will be able to give you more personalised advice during the consultation as required
- You will be advised when it is safe for you to drive but as a general rule, it is safe to drive one day after LASIK and 3-5 days after PRK as long as you can see the number plate from 20.5 meter and your level of vision is 6/12 or better.
|LASIK||PRK/TransPRKLens surgery||Lens surgery|
|Expected visual recovery||1 day||3-5 days||1 day|
|Recommended time off work||1 day||3-5 days||1 day|
Normal vision (emmetropia)
In order to see clearly, all the light rays entering the eye must come into focus on a single point onto the retina. In patients with normal vision (emmetropia: no refractive error), all the rays of light entering the eye focus onto the retina without glasses.
Hyperopia or long-sightedness
Hyperopia (long-sightedness) occurs when the eyeball is small. As a result parallel rays of light come into focus behind the retina when the eye is in an unaccommodated state. In younger people with long-sightedness, the lens is still flexible and is able to change its shape to accommodate and focus the rays of light on to the retina, providing clear vision without glasses. This however, exposes the eye to stress due to the need for constant use of the eye muscle (accommodation), sometimes leading to eye fatigue and headaches. As the natural lens stiffens with age, patients with long-sightedness are no longer able to accommodate and become more dependent on glasses or contact lenses.
Myopia or near-sightedness
Myopia occurs when eyeball is too big. As a result, parallel rays of light come into focus in front of the retina. People with myopia are able to see objects that are closer to them more clearly, but distant objects are blurred. They may, for example, have difficulty seeing detail on the TV screen and will not be able to drive without wearing their glasses.
This is caused by an irregularly shaped cornea or lens. Normally, the cornea is symmetrically round shape and curved equally in all directions (like a football). In a person with astigmatism, the cornea is shaped more like a rugby ball, which is more curved one direction (vertically) than the other direction (horizontally). As a consequence, in an eye with astigmatism, light does not come into focus at a single point, instead, there is more than one focal point. For example, in simple (regular) astigmatism, some light rays are brought into focus in front of the retina and some are behind it.
This is a normal, age-related condition which typically starts to occur after 40 years of age. It’s the reason most people need reading glasses after this age, even if they have never needed glasses before. This is because the natural lens of the eye becomes stiffer and loses its flexibility to change its focusing power. In younger patients, the lens is able to increase focusing power (accommodate), to see near objects clearly, and these patients only need glasses for distance. However, presbyopic individuals require bifocals/varifocal glasses or two separate glasses to see near and distance clearly. Patients who have RLE surgery may have, or will eventually, develop presbyopia even without having surgery. Once you have RLE, it is not possible to accommodate, but there are different options available to achieve good distance and near vision after Lens Replacement Surgery:
- A multifocal/trifocal IOL implant:These IOLs provide distance vision and restore some, or all of the focusing (accommodating) ability of the eye. These lenses are “multifocal/Trifocal,” meaning they correct both distance vision and other ranges, such as near and/or intermediate. These lenses are associated with a higher degree of symptoms such as glare, haloes or starbursts, particularly at night.
- Monovision: The ophthalmologist could implant IOLs with two different powers, one eye for near vision, and the other eye for distance vision. This combination of a distance eye and a reading eye is called monovision. It means the brain using one eye for near sight and the other eye for distance enables you to read without glasses. It has been used successfully in many contact lens and refractive surgery patients. You will need a trial of contact lens to simulate the surgery results to see if you can tolerate monovision.
- Eyhance IOL: If you are not suitable for multifocal or monovision, you may still get relatively good distance and intermediate vision with the new models of monofocal IOL.
- Glasses: You can choose to have a monofocal (single focus) IOL implanted for distance vision and wear separate reading glasses, or have an IOL implanted for near vision and wear separate glasses for distance.
- Multifocal laser vision correction or laser blended vision: The advanced laser machine can reshape the cornea to make it multifocal, or treat one eye for distance vision and the other eye for near vision
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