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LASIK and Refractive Eye Surgery
Laser eye surgery is one of the most-studied elective procedures there is, and it works: satisfaction runs about 95% Solomon et al. 2009, with roughly 90% of eyes reaching 20/20 or better Sandoval et al. 2016. So people shop for the laser brand and the ads. Wrong thing to shop for. What separates a life without glasses from a rare disaster is the workup: the corneal scan that decides whether you should have it. Screened properly, the odds run strongly your way.
Decide Β· Once Evidence Strong Chapter Vision

There is no single "LASIK." There are five procedures, and the right one falls out of your cornea, prescription, and age. Laser methods reshape the cornea; lens methods leave it alone.

  • LASIK. A flap is lifted, the cornea reshaped underneath, the flap laid back. The default for moderate prescriptions in healthy eyes. Functional vision within a day.
  • SMILE. No flap; less nerve disruption means less dry eye 1. Best for moderate nearsightedness.
  • PRK. No flap to dislodge, so it suits boxers, soldiers, anyone hit in the face for a living. Slower, rougher first week.
  • ICL. A lens implanted inside the eye, cornea untouched. For prescriptions too strong or corneas too thin to laser; β‰₯20/20 in 80–90% 2. Removable.
  • RLE. The natural lens swapped out, same as cataract surgery. The route from about age 50, when reading vision is already going.

The result holds. A ten-year audit of nearly 38,000 eyes kept β‰₯20/40 vision in 94% at the decade mark 3; high prescriptions drift back by about half a diopter over ten years, a small return of blur, not a collapse 4. Followed side by side over three years, laser patients stayed more satisfied than contact-lens wearers, and the gap widened 5.

The workup is the procedure. Demand this before you agree to anything:

The morning after, the clock across the room is just sharp β€” no reaching for anything. Within a week the whole apparatus is gone: no fogged glasses, no contact ritual, no blurred swimming. By a year most people have stopped thinking about it, and 94–98% say they would do it again 6. The result still holds at ten years 4.

The fine print β€” when to skip it, and what people get wrong

Do not have laser surgery if: you have keratoconus or any corneal thinning, even "suspect" on topography; an unstable prescription, active infection, or severe dry eye; you're pregnant or breastfeeding (wait six months). A too-thin cornea routes you to ICL or PRK instead.

The honest tail: dry eye hits a fifth to two-fifths at six months, mostly fading by a year; 5–10% keep it longer 1. Night halos bother 1–4% "very much" 7. Ectasia, the rare catastrophe, stays well under 1% with Scheimpflug screening 8.

It won't save you from reading glasses. Around 45 your lens stiffens regardless; a 28-year-old treated today still needs readers at 45. And 20/20 isn't "perfect" β€” it misses night and low-contrast vision, so some feel worse than their old contacts 9.

References
  1. 1Kobashi H, Kamiya K, Shimizu K (2017). Dry eye after small incision lenticule extraction and femtosecond laser-assisted LASIK: meta-analysis. Cornea. link
  2. 2Packer M (2018). The Implantable Collamer Lens with a central port: review of the literature. Clinical Ophthalmology. link
  3. 3Yuen LH, Chan WK, Koh J, Mehta JS, Tan DT (2010). A 10-year prospective audit of LASIK outcomes for myopia in 37,932 eyes at a single institution in Asia. Ophthalmology. link
  4. 4Alio JL, Muftuoglu O, Ortiz D, et al. (2008). Ten-year follow-up of laser in situ keratomileusis for myopia of up to -10 diopters. American Journal of Ophthalmology. link
  5. 5Price MO, Price DA, Bucci FA Jr, Durrie DS, Bond WI, Price FW Jr (2016). Three-year longitudinal survey comparing visual satisfaction with LASIK and contact lenses. Ophthalmology. link
  6. 6Sandoval HP, Donnenfeld ED, Kohnen T, Lindstrom RL, Potvin R, Tremblay DM, Solomon KD (2016). Modern laser in situ keratomileusis outcomes. Journal of Cataract & Refractive Surgery. link
  7. 7Eydelman M, Hilmantel G, Tarver ME, et al. (2017). Symptoms and satisfaction of patients in the patient-reported outcomes with laser in situ keratomileusis (PROWL) studies. JAMA Ophthalmology. link
  8. 8Randleman JB, Woodward M, Lynn MJ, Stulting RD (2008). Risk assessment for ectasia after corneal refractive surgery. Ophthalmology. link
  9. 9American Academy of Ophthalmology (2022). American Academy of Ophthalmology statement on FDA draft guidance on LASIK. link
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