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How Does LASIK Work? Step-by-Step Procedure Guide

Home / LASIK Eye Surgery Guide / LASIK Step-by-Step Procedure Guide

Tom Tooma, M.D., Founder/Medical Director

Medically Reviewed by Tom Tooma, M.D., Founder/Medical Director

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Last Updated

Laser-assisted in situ keratomileusis (LASIK) is a type of laser eye surgery that can be used to correct nearsightedness, farsightedness, and astigmatism. It is a very sophisticated surgical procedure requiring the skill of a very experienced surgeon. It is painless. Complications are rare in the hands of an experienced surgeon. It takes about 10 minutes for both eyes.

A comprehensive evaluation utilizing the most advanced diagnostic technology available is very important to determine if someone is a good candidate for surgery and to recommend the most appropriate procedure to give someone an excellent predictable outcome safely. A thorough evaluation of the health of the tear film and ocular surface is important to minimize or eliminate the chance of having any dry eye symptoms postoperatively. Diagnostic devices include a corneal topography, corneal thickness scanning, corneal epithelial thickness scanning, tear film stability, ocular aberrometry, among others.
Some people are not candidates for Lasik and it is important to recommend other procedures that can correct their vision. Alternatives to Lasik include PRK, SMILE, Dysfunctional Lens Replacement, as well as other procedures.
You will be asked not to wear daily wear soft contact lenses for one week, and astigmatism correcting contact lenses for two weeks prior to having this comprehensive evaluation. If you wear hard/gas permeable contact lenses, you’ll be asked to stop wearing the lenses, then have consecutive exams at least two weeks apart to determineIf your prescription is stable before having the comprehensive eye measurements. Your pupils will be dilated during that exam to determine the health of the retina and nerve in your eye.

lasik eye

The procedure itself takes less than 5 minutes per eye. It is painless since numbing eye drops are used. Relaxing medications are also given. The laser application itself typically takes less than 20 seconds.

Most are able to go back to work the day after surgery. Vision becomes stable usually by one month although for some it may take up to three months. You will be asked to use antibiotic and steroid drops for one week after surgery and frequent artificial tears for the first three months. There are some activities that you will be asked to avoid while your eyes are healing.

Basics of LASIK

Laser-assisted in situ keratomileusis (LASIK) is the single most commonly performed laser eye surgery to treat nearsightedness (myopia), farsightedness (hyperopia), and astigmatism.

A computer guided precise laser emitting a cold laser beam is used to reshape the cornea. The new shape is much like that of the shape of a soft contact lens that you wear to correct your vision. Instead of the images being focused in front of or behind the retina, the new shape makes it so that the images are focused precisely on the retina giving you clear Vision. More than 98% of people having Lasik, who have mild to moderate nearsightedness, farsightedness and astigmatism will get 20/20 vision. More than 2/3 of patients who have topography-guided Lasik will get better than 20/20 vision, which is considered perfect vision.

Prepping for Your Procedure

A few steps are necessary to prepare for your LASIK surgery.

Step 1: A thorough and comprehensive eye exam is crucial to determine whether you are a candidate for Lasik or if you are a candidate for another procedure. These measurements are important to give your surgeon the highest predictability of giving you perfect vision after surgery.

Your prescription will be checked with and without dilation. Dilating your pupil is also necessary to examine the back of your eye including the health of your retina and optic nerve.

An important part of this exam is assessing whether you have any signs of dry eyes. If you do, your surgeon will recommend a treatment regimen to optimize your tear film to hopefully minimize or eliminate the chance of you having any dry eye symptoms afterwards. If these symptoms occur, they’re usually temporary.

Step 2: Corneal topography and higher order aberrations mapping. These tests are extremely important to determine your corneal thickness and the corneal thickness distribution, as well as the shape of your cornea. These measurements will help your surgeon design a treatment to give you excellent vision safely, and to determine if you are a good candidate for surgery.

Step 3: Schedule your surgery. If all seems well, your surgery will be scheduled.

Step 4: Stop wearing contacts. If you wear contacts, you will have to stop wearing them prior to having your eye measurements.

Step 5: Take any prescribed medications as advised. An antibiotic and a steroid drop are typically used for 1 to 3 days before surgery. He will also be given relaxing medication’s 20 to 30 minutes before surgery to help you relax.

How Long Does it Take?

LASIK is one of the fastest vision correction procedures available. On average, it takes less than 5 minutes per eye.

You will be in the operating room for 15 minutes or less. From the time you check in to the center to the time you leave, it typically takes less than two hours. Most of the time is spent on repeating your measurements before surgery and going through some paperwork as well as to give you preoperative and postoperative instructions and to allow the relaxing medications to work. Most centers will have you watch a video tape that goes over what to expect during and after surgery, and your postoperative care.

The LASIK Procedure

Here’s what to expect during your LASIK surgery.

Preparation: Numbing drops are used to numb your eyes. A lid opener is used to keep your eyes open during the procedure. You will not feel it.

Lasik is highly sophisticated and requires the skill of an experienced surgeon to get excellent outcomes safely. It is a two step procedure – In the first step we use a computer-guided femtosecond laser to create the flap. It is like opening the cover of a book. If the cornea was a 500 page book the flap is at page 100. It is literally two human hairs thick. That step typically takes about 30 seconds. The second step utilizes an Excimer laser. This laser is also computer guided and has an eye tracker. You will be asked to look at a fixation light which will be very easy to see. The eye tracker tracks the eye more than 1000 times a second. If your eye moves while the laser is delivering the treatment, the laser follows your eye. If your eye moves too much the laser will stop. You literally cannot mess it up. The laser reshapes the cornea by removing microscopic amounts of tissue to correct your prescription. It typically takes less than 20 seconds to complete the laser ablation. The procedure is painless. Once the laser ablation is complete, the flap is restored to it’s original position.

The experience of the surgeon is what translates into the safety of the procedure. The technology used translates into the quality of vision. Experience plus technology gives you the highest chance of getting 20/20 safely.

Recovering After Your Surgery

You will be on your way home a few minutes after surgery. You will have an eye shield over your eye to protect your eye. Someone will need to drive you home since you will be under the influence of relaxing medications.

Most doctors will give you relaxing medications immediately after surgery so you can go to sleep for a few hours. It is important to keep your eyes closed for the first 4 to 6 hours to avoid having any significant discomfort, Otherwise you may have a burning sensation and a foreign body sensation. Once you wake up from your nap, you will be delighted to experience, for the first time, very good vision without any correction. You may have a mild scratchy sensation, and tearing. When you wake up the next morning, the vast majority of people will feel comfortable driving to their postoperative appointment. A mild foreign body sensation, light sensitivity and tearing are not uncommon. Using your prescribed medications as well as frequent artificial tears will minimize, or eliminate these symptoms.

If you were nearsighted or if you had astigmatism, your vision will most likely become stable by one month. If you were farsighted on the other hand, your vision will take 3 to 6 months to fully stabilize.

man using eyedrop

You may have some light sensitivity in the first week or two after surgery. Do wear sunglasses and use your artificial tears very frequently to minimize these symptoms.

Do not rub your eyes for three months after surgery. Actually, it is advisable that you never rub your eyes whether you have had surgery or not. Rubbing your eyes weakens your cornea and can result in increasing levels of nearsightedness and astigmatism.

Going Easy on Your Eyes

Some activities you may be told to avoid include:

  • Swimming. Hot tubs and whirlpools are to be avoided for the first two weeks. It is OK to shower as early as day one after surgery, however, try to avoid getting water in your eyes. Once you have finished showering, use antibiotic drops.
  • Avoid contact sports for three months. Always use an eye shield when playing contact sports. It is OK to go to the gym the day following your surgery. You can use the treadmill, stationary bike, and weights. Try to avoid getting sweat in your eyes. Do not bicycle or run outdoors for one week, since the drying effect of wind in your eyes will make your vision blurry and your eyes uncomfortable.

The Bottom Line

Millions of people around the world have Lasik every year. In the hands of a very experienced surgeon using the most advanced technology, Lasik is extremely safe and the results are excellent. 99% of people who have had Lasik, recommend Lasik to their family and friends. The risk of complications is extremely rare. Lasik is an investment in your vision for life. It is certainly a better investment than continuing to spend money on glasses and contact lenses for a lifetime.

Make sure to follow your doctor’s pre-op and post-op instructions closely to ensure the best outcome.

References

  1. The LASIK Procedure: A Brief Guide. (April 2019). All About Vision.
  2. LASIK Eye Surgery. (November 2019). Mayo Clinic.
  3. Do Dry Eye and LASIK Mix? (March 2004). Review of Optometry.
  4. What Should I Expect Before, During, and After Surgery? (July 2018). U.S. Food & Drug Administration.

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