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What Is Vision Correction Surgery?

If you need glasses, you've probably heard about surgery for sharper vision. The most common types are laser surgeries like LASIK and PRK. Another option is a lens implant, which might work better if you’re very nearsighted. These surgeries can bring back 20/20 vision -- and reduce or end the need for glasses or contacts. But vision surgery can have unwelcome side effects. Your health and your eyesight affect whether it might help you.

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Good Candidates for Vision Surgery

Laser surgery helps people who are nearsighted, farsighted, or have an oddly shaped cornea, called astigmatism. But it's not for everyone. It might work for you if:

  • You are 21-60 years old.
  • Your prescription hasn't changed for at least one year.
  • Your eyes and overall health are good.
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Cautions for Vision Surgery

Illnesses that affect healing may make vision surgery a poor choice. If you have diabetes, HIV, lupus, or rheumatoid arthritis, talk with an ophthalmologist about your best options. Other conditions that need careful evaluation and could make you a poor candidate for surgery include:

  • Dry eye
  • Large pupils
  • Thin corneas

Laser surgery is not a good idea for people with keratoconus, a cornea disorder.

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You May Still Need Glasses

There's no guarantee that you can toss your glasses or contacts after successful surgery. You may still need glasses to drive at night or read. If you have a strong prescription, there's a chance you'll still need glasses most of the time after laser surgery. Lens implants might be better. Standard laser vision surgeries also don’t treat presbyopia, the blurry close-up vision that starts after 40. "Blended" or monovision procedures are an option for that.

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How LASIK Works

LASIK reshapes the cornea, the clear, rounded surface of the eye, so it better focuses light that enters the eye. The eyeball is held in place by a suction ring, and the cornea is lifted and flattened. The surgeon creates a small, hinged flap in the cornea and folds it back. Then an excimer laser -- an ultraviolet light beam -- reshapes the cornea based on an eye exam you had before surgery. The corneal flap is folded back in place.

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PRK

Surgeons operate directly on the surface of the cornea in these laser surgeries, rather than working under a flap. They correct the same vision problems as LASIK, but these procedures may be a better choice for people with thin corneas or dry eyes. Recovery time is longer and less comfortable than for LASIK. Patients usually wear a contact lens "bandage" for 5-7 days after the procedure.

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Strong Rx: Implantable Lenses

If you can't get laser surgery because of a strong prescription, artificial lenses -- called phakic intraocular lenses (PIOLs) -- may be an option. They're FDA-approved for treating nearsightedness. The lenses are made of silicone or plastic and are surgically placed in front of or behind your eye's natural lens. Possible risks include loss of vision, night vision problems, and more surgery to adjust, remove, or replace lenses.

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Risks of Laser Eye Surgery

No surgery is risk-free. Many side effects, such as dry eye or other discomforts, clear up in days or months. But some can require more surgery or can cause permanent damage. Some risks of LASIK and PRK are:

  • Permanent dry eye
  • Halos, glare, or double vision, making it hard to drive at night
  • Over- or under-correction of vision, meaning you still need glasses or contacts
  • Worse vision or, very rarely, loss of vision
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How to Choose an Eye Surgeon

  • Ask friends who've had successful surgery.
  • Look for a doctor with at least 200 surgeries and who tracks patients carefully afterward.
  • Price is important, but your eyes are more so. Avoid offers that sound too good to be true.
  • How many patients are turned away? A doctor who's careful about screening out poor candidates will turn away more than 10%.
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Laser Eye Surgery: What to Expect

Laser eye surgery usually takes less than 30 minutes. Your eyeball will be numbed, but you'll remain awake. You may feel pressure, but should not be in pain. Your vision will dim during the procedure, and you may notice a burning smell as the laser works on your cornea. Afterward, you'll wear a shield or bandage at night to protect your eyes, which may itch or burn. You'll use eye drops for a few days or weeks. 

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Preparing for Surgery

Your doctor will give you a thorough eye exam to make sure you're a good candidate for vision surgery. You may also follow these steps:

  • 3-5 days before the exam: Stop wearing soft contacts.
  • One day before surgery: No creams, lotions, makeup, or perfume.
  • The day of your operation: Scrub your eyelids to remove debris.
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Early Recovery From Surgery

You'll see your doctor 1-2 days after laser surgery, and most people will be able to drive to the clinic. It is important not to rub your eyes during recovery. You should skip vigorous activities for 3-7 days, depending on the type of surgery. Avoid makeup and lotions around the eyes for about 2 weeks. For a few days after surgery, you may have:

  • Discomfort or mild pain
  • Watery eyes
  • Changes in your vision
  • Hazy or blurry eyesight
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Full Recovery Timeline

Your vision may take as long as 6 months to stop changing after laser surgery. You may notice glare, starbursts, or halos, or you may be sensitive to light. Here's a general timeline:

  • Days 1-3: Itching, burning, mild pain and discomfort, tearing
  • First week: Hazy, blurred vision and sensitivity to light
  • Weeks 1-4: Dry eyes, glare, trouble with night driving
  • First 6 months: Changes in vision. You’ll need regular checkups.  
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How Effective Is LASIK?

LASIK has a high success rate, especially for nearsightedness (myopia). Follow-up studies suggest:

  • 94%-100% of nearsighted people get 20/40 vision or better.
  • 3%-10% of people who get LASIK need another surgery.
  • 1 in 5 people report having dry eye after the surgery.
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PRK Success Rates

Follow-up studies suggest:

  • By 1 year after the surgery, about 90% of people who get PRK achieve 20/20 vision.
  • 95% of people get 20/40 vision or better.
  • These surgeries work better for low to moderate farsightedness than high.

 

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Lens Implant Success Rates

One study that compared PIOL implant surgery with laser surgery found:

  • People who got either type of surgery had about the same chance of getting 20/20 vision without glasses or contacts.
  • After a year, those who had PIOL surgery were less likely to lose sharpness in the best level of vision they can get using glasses or contacts.
  • People who got PIOL were better able to see contrasts than those who had laser surgery.
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Higher Order Aberrations (HOAs)

These vision problems are much less common than being nearsighted or farsighted, but they're harder to correct. Laser eye surgery can sometimes worsen mild HOAs, including halos, glare, and ghosting. These can make it hard to drive at night. Lens implants are less likely to make HOAs worse.

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Sizing Up Vision Correction Surgery

Most people who have LASIK, PRK, or lens implants are satisfied -- even delighted -- with the results. Second surgeries may give you sharper vision, but they rarely correct HOAs from the first surgery. The FDA is still studying options to treat HOAs. These procedures may not be advisable for some people.

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