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Is LASIK Right for You? Understanding the Procedure and Choosing the Ideal Candidates

by | May 1, 2025 | Manuscripts | 0 comments

Dipanwita Karmakar, B.Optom.

NSHM Knowledge Campus, Durgapur, India

 

Laser-assisted in situ keratomileusis (LASIK) is a refractive surgical procedure that corrects vision by reshaping the cornea with an excimer laser. This procedure was patented in 1989 by Dr. Gholam Peyman. (1)

Earlier, there used to be refractive keratoplasty (RK) done. However, with the future innovations, better procedures of LASIK have come up which take the help of an excimer laser beam and ablate the amount of corneal tissue to reshape the cornea (ablates 14microns for every 1 dioptres) and reduce the number. Some are:

  1. Photorefractive Keratectomy (PRK): The beam of excimer laser directly ablates the corneal epithelial tissues and helps to reduce the number, and no flap is being created. That is why the major drawback of this procedure is to get some amount of your number back due to the regrowth of corneal epithelium.
  2. Microkeratome LASIK: As there is a high chance of getting your number back in PRK procedure due to the corneal epithelial cell regrowth, in this procedure an irregular flap almost 120microns is created with the help of the blade of the microkeratome machine and then ablates the required corneal tissues from the stromal layer (bed of the cornea), and then again puts the flap back.
  3. Femto-LASIK: To avoid the creation of an irregular flap in microkeratome procedure, further innovations around 1990’s revealed that femtolaser beam can be used to make even a better regular flap of 90microns and then firing the excimer laser on the corneal stroma and putting the flap back by securing it with a bandage contact lens.
  4. Contoura: This is a customised additional procedure offered to be done during the Femto-LASIK procedure where the professional takes the help of detailed map of the cornea by dividing it into 22,000 points and finding the smallest amounts of number at each and to be corrected precisely during the procedure, to provide a crystal-clear vision without any residual numbers.
  5. SMILE and SILK: Here the energy level is 500KHz in SMILE procedures. The difference between them is the shape of the lenticule, which becomes a plano-convex one in SMILE and that of a biconvex one in SILK. Both are minimally invasive and need minimum precautions.
  6. SMILE PRO: This is the latest advancement in the LASIK procedures, where no such flaps are required, and the process is minimally invasive with the fastest recovery and lesser chances of dry eye post effects. It has an energy level of 2MHz and has Artificial Intelligence, which directly ablates the stromal tissues without creating a flap. The ablated tissues are then removed through a 2mm lenticule created (smallest possible incision) by the femtosecond laser and this whole procedure is done within 9-10 seconds per eye.

Who is the suitable candidate?

Age: Patient should be above 18 years old to get LASIK done so that the stable number can be estimated and the chances of getting back the number gets reduced, thus improving the success rate.

Corneal thickness: The patient should have a healthier and thicker cornea and no pathological conditions. Corneal topography is done to assess the thickness of the patient’s cornea, and upon this and the number, it is decided which procedure is suitable for the patient to undergo. To be in safer hands, the patient after surgery must have 400 microns of thickness all total, including the flap and 280 microns of thickness before putting back the flap, according to the FDA, US rules.

Other pathological conditions: Like severe dry eye, giant papillary conjunctivitis (GPC), keratoconus, glaucoma, cataract, or any retinal pathologies, patients in such cases would not get expected results, and some of them act as a contradiction.

Pregnancy: Also, women who are pregnant or continuing breastfeeding must consult their gynaecologist and the ophthalmologist before undergoing LASIK procedure to avoid any further side effects. (2)

 

References:

  1. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555970/
  2. American Academy of Ophthalmology. LASIK [Internet]. San Francisco (CA): AAO; [cited 2025 Apr 22]. Available from: https://www.aao.org/eye-health/treatments/lasik
  3. S. Food and Drug Administration. LASIK [Internet]. Silver Spring (MD): U.S. Food and Drug Administration; [updated 2022 Oct 24; cited 2025 Apr 22]. Available from: https://www.fda.gov/medical-devices/surgery-devices/lasik

 

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