Here you find answer to the most common questions that you may have.
Before your treatment FAQs
- Contact lenses can change the shape of the cornea and therefore can affect some measurements we take. Therefore it is a good idea to stop wearing them before you come for your baseline evaluation so get very accurate measurements of your eye. The length of time depends on the type of contact lens you are 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
When you come to see Dr. Arbabi, he will perform a full and comprehensive assessment to take into account your eye health, general health as well as your lifestyle and hobbies before recommending a personalised tailored treatment that best suits your eyes and your lifestyle. ‘‘Click on Am I suitable? 1-minute assessment or on What treatment suits me best? To take my quick suitability quiz for an IMMEDIATE and interactive answer.
Dr. Arbabi is one of a few surgeons in the UK who has access to 4 of the most advanced laser technologies in the world (The Zeiss Mel 90 Excimer with Ziess Visumax femtosecond as well as access to Schwind Amaris 1050RS excimer and Ziemer Z8 femtosecond). Therefore he is able to safely treat glasses 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. I also offer other refractive surgery options such as ICL implant and refractive lens exchange which can treat almost any glasses prescription
You must be at least 18 years old before vision correction by laser 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 develop naturally occurring cataracts and therefore may be more suitable for refractive lens exchange. This procedure in older patients hits two birds with one stone, so we deal with any cataract you may have or were going to probably have in the future. At the same time the advanced multifocal lens implant have the potential to give you natural clear vision for both distance and near without glasses.
Yes. If you are very anxious about being awake during surgery, we can give you Valium (diazepam) to help you calm down and relax. It is very rare we need to do this as I continually listen to you, in case you need to say something and keep talking throughout the procedure, giving you constant reassurances. If in the extremely unlikely circumstance you could not relax or proceed with surgery on the day we can cancel the operation and you will get a full refund.
Results from 67, 000 treated eyes*
- Very high success rates with over 99% of patients having better vision than driving standard without glasses
- The glasses prescription after laser surgery was 1D or less in 99%
- 99% of patients were satisfied with the laser eye surgery
- In only 0.6% of patients the vision was worse by 2 or more lines on the visual charts
PROWL 1 and PROWL 2 studies**
were two of largest studies looking at patient reported outcome from LASIK surgery. This was a collaboration between military and non-military ophthalmologists in in USA in conjunction with the FDA (Food and Drug Administration). This study found below results:
- Over 96% of patients had 20/20 or better vision without glasses
- More than 95% of participants were satisfied with their vision following LASIK surgery.
- 28% of patients developed mild dry eyes after LASIK but in 65% of patients who had dry eyes before surgery had no dry eyes after LASIK.
*Sandoval HP, Donnenfeld ED, Kohnen T, et al. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42(8):1224-1234.
**Summary of study can be found on the EyeWorld (American Society of Cataract and Refractive Surgery) website: https://www.eyeworld.org/article-ascrs-responds-to-fda-prowl-studies
- Dry eyes is the most common side effect. About 30 to 40% of patients can experience some degree of dry eye symptoms. The reassuring part is these symptoms tend to be mild and resolve in overwhelming majority of patients. If you were going to get dry eyes it tends to be worse in the first 3 months and then resolve over next 6 to 12 months. Although, persistent and severe dry eye symptoms are rare, especially if you did not have pre-existing dry eyes before laser surgery, they may still occur in about 2% of people. So, there is a very small risk that you may have to live with dry eye symptoms or require permanent eye drops. In a very small subset of patients, dry eye symptoms may be debilitating and may affects all day-to-day activities.
- The second most common symptom is experiencing some sort of visual disturbances such as glare, halos around light, star bursts and decreased quality of vision. This can be particularly troublesome in low light conditions and may affect night time driving. This complication used to be to be more common with the early laser technologies. However, with modern flying spot laser technology and new algorithms this is far less common now. These symptoms occur in about 20% but tend to resolve spontaneously in most people. Rarely, they may need additional treatment or repeat laser surgery to resolve. In a very small number of cases, these symptoms may not resolve or be treatable and may cause permanent symptoms. In PROWL study***** 1% of patients had visual symptoms that significantly affected their day to day activities.
- Third most common symptoms side effect is under or over correction so your glasses prescription is not quite close to zero. About 5% of patients may require enhancement, which means repeat laser treatment to smooth out any remaining near-sightedness, far-sightedness or to correct any irregularity of the corneal surface. The chance of requiring the repeat laser is higher in certain patients such as those with higher glasses prescription. The repeat laser is usually suitable and highly effective in majority of patients to correct the residual glasses prescription. However, a very small percentage of patients may not be suitable for enhancement and hence may still need glasses or contact lenses after surgery or have to have other types of surgery. Therefore, it is important to understand that it is not always guaranteed to be glasses free.
- It is important to have realistic expectations. Laser refractive surgery is highly effective in reducing or eliminating the need for glasses in most people. However, there is no always guarantee that you will be completely glasses-free. At the very least, you should expect to play sports and socialise comfortably without glasses but some patients may still require glasses for certain activities such as reading small print or driving at night.
- Another important point to realise is that it is normal to require reading glasses from around the age of 45 with good uncorrected distance vision. This normal aging process of the eye is called presbyopia. This process explains why people who have never required glasses in the past, start to wear glasses for reading and near work once they get in their 4th decade of life and beyond. This process is not altered by the laser eye surgery. If you have laser eye surgery before this age, you are very likely to require glasses for reading once you in 4th decade of life and beyond. There are, however, effective treatments available to reduce spectacle dependence for older patients such as PRESBYOND Laser Blended Vision, Refractive Lens Exchange or monovision.
- The results of laser eye surgery are intended to be lifelong, but a small percentage of patients may experience a partial return to the vision that they had before surgery (Regression). They may once again become longsighted, short-sighted or have astigmatism.
- One of most serious complications is corneal Ectasia. In this condition, the inner corneal layer becomes weaker causing corneal thinning and irregularity of eye surface which leads to poor vision. This condition is similar or may be identical to another condition called keratoconus which occurs 1 in 2000 of general population who never had laser eye surgery. The risk corneal ectasia after laser eye surgery is generally lower than in general population due to diagnostic pre-treatment test which highlights those patients who are at a higher risk. This condition used to be more common with early LASIK technique when a microkeratome was used than it is now with advanced femtosecond LASIK which is blade-less. A study by NICE estimated the risk of ectasia was 0.2% but highlighted that most of the affected eyes may have been selected inappropriately for LASIK treatment. Which means they should not have had laser as they were at high risk and this should have been picked up by the treating surgeon before surgery. This used to be the most dreaded complication which usually required a corneal transplant. However, over past decade, there is a treatment called collagen cross linking which is very effective if the condition is diagnosed and treated early.
- Another serious complication is corneal infection. This is estimated to occurs in about 1 in 4000 cases. Again, if this is diagnosed and treated early can usually lead to good visual outcome but it has potential to causes significant corneal scaring and may require corneal transplant. If you are a contact lens wearer, your risk of getting a serious corneal infection is higher than it is with laser eye surgery. With laser eye surgery, the risk of infection if it occurs tend to happen in the first a few days to weeks or rarely months post-surgery. However, with CL the risk of infection is always there for as long as you wear CL.
- With LASIK there is a small added risk of complication because of the LASIK flap. However, with the use of modern bladeless femtosecond lasers, flap related complications are significantly lower compared to the first-generation LASIK which used a microkeratome blade to create the flap. Potential complications with flap surgery include flap misalignment, epithelial ingrowth, inflammation (abnormal healing) or infection. These may require another procedure or intensive treatment with drops. In rare cases, flap surgery can lead to a permanent decrease in vision and may require a corneal transplant.
- Another rare but extremely serious condition is called corneal neuralgia where the corneal nerves become hypersensitive. It can cause burning, stinging, and light sensitivity. However, in some patients it can causes excruciating and debilitating pain which may be difficult or impossible to treat and may require strong painkiller tablets as well as many drops.
- Corneal infection or inflammation may lead to corneal haze or corneal scaring which can be minimal and not troublesome or could causes significant visual loss. About 1 in 5000 (0.02%) of patients may need corneal transplant as a result of these complications or if they develop other complications such as corneal ectasia. Corneal transplant is a major surgery, but, if required, a good level of vision can normally be restored in most people although glasses or contact lenses are likely to be required after surgery.
- On rare occasions, one of the devices used in surgery may malfunction. In this case, surgery will be postponed or stopped altogether. In most cases the treatment can still be restarted and completed but in some instances the surgery may need to be changed, for example from a LASIK to LASEK or from SMILE to a LASIK or LASEK. If the type of treatment needs to be changed, Dr. Arbabi will discuss it with you before proceeding.
- The risk of blindness is exceedingly rare and the risk is lower than wearing contact lenses. The risk of blindness is estimated to be 1 in 5 million. If through an extremely unfortunate and unlikely series of events, a laser eye procedure was to cause blindness, it’s highly unlikely that you would lose vision entirely. So, even in that 1-in-5-million scenario, it’s improbable that you would lose your sight entirely. To put that in perspective, the chance of someone in the UK dying by falling out of bed is 1 in 2 million*** and the chance of getting struck by lightening in the UK per year is 1 in 1.2 million****. This means an individual is four times more likely to get hit by lightning every year in the UK than losing sight in one eye because of laser eye surgery.
* https://www.rcophth.ac.uk/wp-content/uploads/2018/07/Patient-Info-LVC-May-2018.pdf **Sandoval HP, Donnenfeld ED, Kohnen T, et al. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42(8):1224-1234. ***https://www.mirror.co.uk/news/weird-news/scientists-calculate-odd-ways-die-282884 ****https://www.researchgate.net/publication/223811436_Deaths_and_injuries_caused_by_lightning_in_the_United_Kingdom_Analyses_of_two_databases *****Summary of study can be found on the EyeWorld (American Society of Cataract and Refractive Surgery) website: https://www.eyeworld.org/article-ascrs-responds-to-fda-prowl-studies
No, Please do not wear any makeup, nail vanish and perfume or after shave for at least 24h before the procedure. Make sure to thoroughly wash any old makeup.
On the day of surgery FAQs
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. We first put an anaesthetic eye drop in your eye and make sure your eye is numb and comfortable throughout the procedure. You may feel some mild pressure but it should not be painful. This will last only for a few seconds.
Usually nothing as the laser will stop automatically and we will then restart the treatment. We will ask you to stay still only when the femtosecond laser delivers the treatment. This part usually lasts 40 seconds or less but it is very important you are still for this part otherwise we many not be able to deliver the treatment.
Most LASIK and SMILE patients do not experience any discomfort after surgery although, it is common for the eye to be light sensitive and the vision to be slightly blurry. This is normal and should quickly resolve within the next 24h. However, after LASEK the eye can take a few days to heal and will be uncomfortable for the first 2-3 days following your vision correction surgery. You will be given pain relief medication after LASEK to keep your eye as comfortable as possible during this period.
- Eye makeup: Avoid eye makeup for 2 weeks post surgery. After this you can put on eye makeup but take care not to allow any makeup or makeup removal products go inside your eyes for up to one month.
- Facial makeup: Try to avoid facial makeup for 1 week post-surgery surgery. You can resume wearing skin products such as foundations, concealers, lipsticks and blusher on your face after one week.
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 aftercare with no additional cost for any treatment related to your surgery if required for up to 12 months.
As a general rule, the following table shows when you need to be seen after your surgery:
|3-7 days||3-7 days|
The following table gives some generalised recommendations on resuming different activities but we will give you personalised advice depending on your individual circumstances and your recovery.
|Jogging, aerobic exercise, Yoga and pilates||1 week||1 week||1 week||1 month|
|Weight lifting||1 week||2 weeks||2 weeks||1 month|
|Swimming, sauna, steam room||2 weeks||1 month||1 month||1 month|
|Football, mountain biking||2 weeks||2 weeks`||2 weeks||1 month|
|Skiing, snowboarding, tennis, squash and cricket||2 weeks with appropriate eye-wear|
|Rugby, Martial Arts, water skiing||4 weeks||3 months||4 weeks||4 weeks|
|Deep scuba diving more than 30ft||4 weeks||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, the following table only gives guidance for the expected average recovery time and time off work.
Returning to work depends on your occupation. Dr. Arbabi 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 meters and your level of vision is 6/12 or better. We will advise you regarding this when you come for your day one review.
|Expected visual recovery|
|Recommended time off office based work|