Is Laser Eye Surgery Safe in the UK?

When you ask friends and family or talk to colleagues around the office about Laser Eye Surgery, you’ll probably find a lot more people have had it than you first thought.

The fact is, Laser Eye Surgery has now been around 25 years. Today, it’s just another routine procedure carried out thousands of times a week in clinics and hospitals around the world.

Safety will always be a hugely important conversation that needs to be had. Today it’s no longer a question if Laser Eye Surgery is safe, but rather which procedures and clinics are you talking about and where can you get the best results.

Calculating the risks of eye surgery

When working out the risks of eye surgery, it’s important to first explain that surgery to improve your eyesight, also known as “refractive surgery” or “vision correction”, falls into two categories: Laser Eye Surgery and lens surgery.

Both types of surgery are designed to improve your vision and reduce dependency on glasses and contacts. However, which one suits you best depends on a variety of factors including your prescription, eye health, and age…

An expert eye surgeon will examine your eyes and help you determine whether lens surgery or Laser Eye Surgery is the right option for you. While nothing substitutes the advice of an expert,  you can get a long way by doing some of your own research.

The risks of lens surgery

Lens surgery improves vision by introducing an artificial lens into the eye.

There are two types of lens surgery: phakic intraocular lens (PIOL) surgery and refractive lens exchange (RLE).

PIOL surgery is a procedure based on implanting an artificial lens into the eye — either just in front of, or just behind the pupil — without removing the eye’s own natural lenses. In this way, it’s a bit like inserting a permanent contact lens inside your eye.

With such internal contact lenses, you get all the benefits of contacts without some of the drawbacks that come from covering the outer layer of your eye with a small plastic disk. This makes implantable lenses an option for people who have a high prescription but are bothered with their normal contact lenses. It can also be used in patients who, due to problems on the cornea, might not be a candidate for laser eye surgery.

The risks of intraocular lens surgery

Complications from PIOLs are considered rare. However, there are very few studies demonstrating their long term effects. That being said, infection rates of PIOL surgery are lower — approximately 1 in 6000 — than if you were to wear typical contact lenses.

Related risks and side effects of PIOLs include a temporary disturbance in your vision, specifically night vision, and the risk of developing early cataracts. It is important also for patients to have regular eye exams to monitor the health of the eye, in particular, the back of the cornea (the endothelium). Such risks vary from person to person and will be discussed with your surgeon before you decide on treatment.

The risks of refractive lens exchange (RLE)

Refractive lens exchange (RLE), also known as lens replacement surgery or clear lens extraction (CLE), is basically the same as cataract surgery but for general refractive errors.

Similar to PIOL, RLE introduces an artificial lens into the eye. However, rather than overlaying the eye’s natural lens with a new one it removes the natural one and replaces it with a new artificial lens.

For many people, RLE is considered to be a better option than PIOLs, particularly if you have the beginning of cataracts or if you’re unsuitable for Laser Eye Surgery due to a very high longsighted prescription. In this way, RLE is not often someone’s primary choice of treatment, but their only option if they want to gain clear vision.

One reason for this is that RLE is not tolerated by everyone and doesn’t always completely reduce a person’s dependency on glasses or contacts. There are two main types of artificial lenses used for RLE: monofocal and multifocal.

  • Monofocal lenses: Monofocal lenses provide focus only at one distance, for example, by improving your distance vision. In this way, you could get RLE monofocal lenses but still need to wear glasses for near work.
  • Multifocal lenses: On the other hand, multifocal lenses help improve your near, middle, and distance vision. The problem with them is that about 80% of patients notice some halo or rings around lights at night and one percent of people find them so intolerable that they decide to undergo a very risky surgery to change the lens for a monofocal instead.

Similar to PIOL, you can expect to experience some visual discomfort and side effects in the weeks or even months following refractive lens exchange surgery. However, serious complications are more common after RLE than after PIOL surgery.

According to the NHS, about 1 in 500 people have significant loss of vision after RLE. This is definitely something to discuss with your ophthalmologist when considering surgery and your treatment options.

The risks of Laser Eye Surgery

Today, Laser Eye Surgery can treat almost all prescriptions including astigmatism, presbyopia, or poor reading vision, and people with thin corneas, dry eyes, and conditions, which were traditionally deemed as unsuitable for treatment.

Laser Eye Surgery still has its limits, though. For instance, it is not suitable for those under the age of 18 as before having the treatment, you need to have a stable prescription for at least a few years. The same is true for those who have been diagnosed with cataracts that are affecting the vision, as cataract surgery is the only way to improve the vision.

There are three main types of Laser Eye Surgery: PRK/LASEK, LASIK, ReLEx SMILE:

  • PRK/LASEK: PRK and LASEK are known as surface treatments. They involve completely removing the clear layer on the outside of the cornea before the surgeon reshapes the underlying tissue with a laser. The outer layer then grows back naturally, but the recovery process can take a few weeks and involve some discomfort.
  • LASIK: The most popular Laser Eye Surgery treatment, LASIK, is performed using two lasers — one to create a thin flap on the surface of the cornea, and the other to reshape the tissue underneath. The recovery time is very fast and the procedure is more comfortable than PRK/LASEK.
  • ReLEx SMILE: In SMILE, the latest of the three techniques, the surgeon uses one laser for the entire procedure, reshaping the cornea through a small, self-sealing laser incision. The procedure and recovery time is thus even shorter than LASIK before you can return to normal activities. It also allows people with higher prescriptions to be treated.

All three types of Laser Eye Surgery have similar results and levels of safety. This is because the vast majority of complications from eye surgery relate back to the screening and assessment process.

As the industry is largely unregulated, the standard of screening can vary from clinic to clinic. This means safety is largely in the hands of patients — particularly in how well they can navigate the industry and recognise a high-quality clinic.

With that said, there are several common, albeit mild, side effects that most people can expect to experience after having Laser Eye Surgery:

  • Dry eyes and visual symptoms: Dry eyes and some visual disturbances can occur as part of the eye’s natural healing process. Artificial tears can help your eyes feel more comfortable until healing is complete. Most dry eye symptoms are gone with a few days to weeks.
  • Night vision disturbances: It’s not uncommon for people after Laser Eye Surgery to experience night vision disturbances such as glare like halos and starbursts from oncoming headlights when driving at night. These usually resolve by themselves shortly after treatment.

Unlike both PIOL and RLE, severe loss of vision as a result of Laser Eye Surgery is extremely rare. If you had to make an estimate, there is about the same chance of going blind from the treatment as there is of being hit by lightning, twice.

High-quality Laser Eye Surgery

As mentioned above, one of the best ways to lower the risk of Laser Eye Surgery is by choosing a high-quality clinic.

At 25 years young, Laser Eye Surgery is a proven treatment. With that being said, performance and safety standards have improved significantly, even over the last 5-10 years.

One indicator of a clinic’s quality is the surgeon’s expertise. At the very least, surgeons should have a certificate from the Royal College of Ophthalmologists and experience in your chosen treatment. But ideally, they’ll have additional formal refractive training, such as the Ulster University Postgraduate Diploma in Cataract and Refractive Surgery.

The reality is that refractive surgery today, whether RLE or Laser Eye Surgery, performed correctly and under the right circumstances, is incredibly safe with very few risks. The important thing is to undergo an assessment before jumping into any decision.

Find out more about choosing lens surgery or Laser Eye Surgery is right for you by leaving a comment or contacting a member of our friendly and expert team.