Just for context and as this article only mentions LASIK and not other options such as (Trans-)PRK and SMILE, the majority of negative side effects one experiences post LASIK are not linked to the ablation/"carving" of the cornea, as they call it, but rather is a result of the need to sever the subbasal nerve plexus in the anterior stroma, which tends to be regenerate in a less comprehensive manner and significantly slower around the margins of the flap compared to other methods.
Flaps aren't inherently dangerous either (flap detachments are very rare, even more so with modern systems that create essentially a cavity where the flap can rest in), but the difference in healing post OP is a lead cause of heightened dry eye after LASIK. Both PRK and SMILE, due to the way they work, are less likely to suffer from this, but every procedure has trade-offs naturally.
With PRK, the epithelium in the area is removed and has to regrow, a process that takes a few days (to get the initial part done, full regrowth takes far longer but isn't noticeable in general). This regrowth can be both rather painful and also rob you of the "instantly perfect sight"-effect many people desire from their laser eye surgery. As the epithelium does regrow naturally however, it is less likely (both in theory and in medical literature) to lead to dry eye and other side effects in the short and long term, making it the preferred choice by many ophthalmologists when choosing such surgery for themselves.
SMILE, on paper, might be able to offer the best of both worlds, but is severely more expensive than either and there is not a sufficient degree of long term research to make a definitive statement that the side effect amount and severity is comparable to PRK, simply because it is rather new. What research is out there is promising though.
Overall, each option is very well tolerated, leads to major QOL improvements and we need to keep in mind that even the more common side effects one may face with LASIK may not affect everyone and still are comparably small considering other medical fields and their elective procedures.
In this context, I'm very excited to see whether this method might have even fewer short and long term side effects than PRK, but like with SMILE, it may take decades to have a conclusive answer.
Edit: Another thing I missed and which was not covered in the article, is the potential that this new method could be applicable to people who, because of a variety of factors, are not eligible for any ablative eye surgery. I myself was at the upper limit for Trans-PRK in regard to the severity of my Myopia and the thickness (or lack there off) of my Epithelium. In that regard, I see far more potential than just reducing already low side-effect risks further.
> [re: PRK] This regrowth can be ... rather painful
I'm here to tell everyone to listen to the doctor about pain medications and sleeping after PRK. I have a repeatedly-demonstrated very high tolerance for pain, and didn't bother to follow the directions.
As a result, I spent about an hour seriously considering whether it would hurt less if I physically scooped out my eyeballs by hand. That's not a metaphor -- I had to mentally restrain my hands.
And the punchline is that 12 years later I again need glasses for computer work, which is what I do all day.
Same here. Three days of absolute hell. Even a single blue led was too much to bear. And like you I now need reading glasses, but I don't really care: I can see well enough in the distance, I'm not visually crippled throughout the day without my glasses.
I used to have dry eyes afterwards for quite some time (years) as well, but that seems to have gone away at some point.
> As the epithelium does regrow naturally however, [PRK] is less likely (both in theory and in medical literature) to lead to dry eye
This is exactly opposite to how I understood and experienced healing after Trans-PRK. My eyes are still very dry 6 months post surgery. Being at the upper limit of Trans-PRK yourself, did you actually go through with the surgery? If yes, how was your healing process? I would be very interested in chatting about it, since I am not particularly happy with mine, and wondering what can be done (and whom to blame).
Sorry to hear that it did not go well for you. Yes, I did go through with it, was in April of 2024 (Trans-PRK via a Schwind AMARIS) and I did have a rather painful recovery, especially on day two and three after the surgery.
From there on, the pain and foreign object feeling quickly subsided alongside the remaining "haze" and by day five, I neither had any subjective pain, nor any major issues reading text (both typed and digital). Had multiple check-ins of course, both at the clinic which performed the surgery and with my decades long ophthalmologist, no issues were found there either. Subjectively, I do not experience a heightened severity in dry eye symptoms for what that is worth.
Also had a clinical rotation in Ophthalmology just this month (small world, though was why I felt the urge to comment) and the attendings did assess my epithelium as having regrown evenly too.
What could have gone wrong for you and how to go about this, I really can't say and I am sure you have already considered /pursued it, but I can only suggest getting a second opinion from another established ophthalmologist, including looking at the eye drop regiment prior to the surgery and during, as well as post recovery.
This is why I decided to go with PRK. Recovery time is rough, but after a week I was able to go back to work as a programmer. Well worth it to avoid the complications of severing the nerves in my cornea.
This is the first I've heard of this. In my area it seems comparable in price, within 1.5x the cost of LASIK. Considering how relatively cheap it is (a couple months' rent, or a fraction of the price of a car, to correct your vision for decades) I've never seen cost mentioned as reason to choose one over the other.
I can only speak for Austria, but the difference, if SMILE had been an option, would have been at the lower end € 3400,- compared to the PRK I got and roughly € 3200,- compared with LASIK, for what that’s worth, more than double the cost. Yes, that falls under multiple months rent, but to me that is more reason why one would consider the cost as well.
Maybe “severely more expensive” wasn’t the best wait to phrase it, but the difference is still quite steep and this can be a decision maker for many people. Especially as currently it appears that medium term/6-month outcome between PRK and SMILE are very comparable, or even slightly better in PRK [0].
I'm not candidate for LASIK or any other eye surgery due to the thinness of my cornea :( I would love to see this new approach. Maybe I'll be a candidate for it.
I had PRK 15 years ago. I also woke up multiple times last night because my eyes felt like they had a bad sunburn (eyes so dry they stick to your eyelids + REM sleep.)
Some unsolicited advice: wait for widespread adoption, and review data on long term side effects from sources without a conflict of interest before you have a procedure like this. I went from 20/150 to 20/15 for a few years (which was pretty cool) but they're 20/40 now so I wear glasses/contacts when I leave the house anyway. Glasses and/or contacts aren't that bad.
My wife wasn't a candidate for LASIK due to her eyes being so bad they would have had to burn off the entire cornea to fix it. But she got ICL surgery, which is when a new lens is inserted into the middle of an eye, similar to the surgery for cataracts. $9k out of pocket, but she has 20/20 vision now.
I am wondering whether EMR could help people with keratoconus (degenerative cornea condition). Due to cornea thickness laser correction surgery is not performed in such case.
There are also intrastromal corneal rings to correct myopia (but not astigmatism) -- in the US (Intacs) for -1 to -3 diopter, while in the EU they go up to -6. They're inserted though a small hole to surround the cornea, and they can be removed. So overall less effective than lasers, but also more safe (though much less common, so harder to find a high-traffic expert surgeon).
I have keratoconus, which is where a lack of strength in my corneas has resulted in their losing their proper shapes.
I have several focal points in each eye, randomly clustered together. And unfortunately, there is no correlation (or reason for a correlation) between my eyes.
Imagine not being cross-eyed with two focal points, but with well over a baker's dozen. Even if I could line up one pair of points between my eyes, any improvement would be indiscernible in the mess I see.
Because the focal points are clustered close together, their impact is less at a distance (it just feels hard/impossible to properly focus, like looking through very slightly warped glass), but it is devastating up close. For reading.
Without help, I see so many copies of all the letters, randomly and tightly stamped all over each other, I could stare at a short line of text all day and never figure out what it said.
And this after having better than 20-20 vision at all distances, for most of my life.
(Fun fact: if I am in a dark room, and look at one of those tiny power-on LED lights on some media equipment with enough distance that it is basically a point, I can clearly see all my focal points - and also a dimmer curvy, spaghetti crossover mess of focal Beziers between and around them. My corneas are neither convex or concave. They are chaotic. Evil.)
Fortunately, I have hard gas-permeable "scleral" contact lenses. They form a near perfect cornea for me, so when I wear them, my awesome vision and glyphs live once again. "Scleral" refers to the fact that they are wide enough to rest on the whites (sclera) of the eyes, to completely cover and fill out my lame natural corneas.
So I am in pretty good if inconvenient shape.
But I would absolutely love it if this new method allowed my corneas to be reshaped. Any improvement would be a big deal.
(There is surgery where corneas are soaked with a binder, which is fixed with a laser, that strengthens them and stops/slows Keratoconus from getting worse. But it cannot recover what has already been lost.)
I've heard good things about sclerals and am planning to get them. Small triple images in the left eye and triple in the right eye with a major image further away, like 3 lines on my computer screen away. It doesn't sound nearly as bad as the many images but good to hear sclerals work with worse cases!
I wouldn't trust it, myself. I was laying out a new circuit board design for a client when my eyesight went all wonky. It turns out I had a detached retina. Yhe first repair procedure failed. The second procedure went well. Then I got a cataract in that eye. My retina specialist sent me to a cataract specialist. The cataract specialist told me "I was allergic to laser beams" and didn't recommend cataract surgery. And also to get used to audiobooks. Like I could write program code and design GUI's by listening to audiobooks. For "fun" I read. Sometimes I write books. I put up with a 'weird' double vision and gave up driving a car. Audiobooks indeed.
It was as if a dark gray curtain fell slowly and I couldn't see through it. This was the retina coming off from the top edge and folding down over the bottom half.
Originally there was a mention of developing a less invasive method of correcting a deviated septum, but I guess they went with the harder problem first.
In any case I'm up for both, because while my vision is not terrible, it's slowly, but consistently getting worse, so max-twice-a-lifetime interventions like laser eye surgery won't cut it for me.
Agreed, going from 20/10 vision to "I've given up trying to read small text 50m away" as I age over 40 doesn't affect my quality of life, but it doesn't help my self-esteem.
I'm between +3 and +4 now depending on how tired I am. I used to be able to read the print on the smallest SMT packages :(
And it does affect my quality of life: forget glasses? Good there goes your day until you've found a replacement. The best improvement so far has not been the glasses but a simple string to make sure I don't put them down but they stay around my neck. That has made a massive difference and it also helps when looking down (so the glasses won't fall off) and it has cut the rate at which I was losing them to zero from about one pair per month (which really was not sustainable).
I remember being able to read the timer on the other end of the subway station(120m) in my city, so in low light conditions at that. The numbers were maybe 20cm in height.
In my case it's not even the defect itself, but the associated astigmatism. For a long time I was unaware of the issue because it started in one eye, so the other compensated until it couldn't.
Now I get around two weeks of perfect vision upon getting a new glasses prescription and it's back to "normal".
Interesting article. For myopida, there is also this Ortho-K and a specialized version of it from a Canadian optometrist, where one get a K test and then they make a set of customized lens based on the test, and there are these daily exercise that one needs to do while wearing them the lens. Many testimonies claim that they corrected their vision after 6 months.
Would anyone know could they use this to fix the glares and halos from lights at night in person's vision, I understand cannot be fixed with any technology now? Including risk of making worse by laser surgery.
I only have wore glasses, i dont care about trying contacts. Its the glare with or without thats pretty bad driving at night in US
Halos and glare at night are usually a sign that something in the eye is scattering light. Sometimes it’s just uncorrected prescription, but it can also come from things like dry eye, early cataracts, or the way the cornea focuses light. Glasses can’t always fix that because they only correct the main focusing errors, not the little imperfections that cause glare.
Contacts (especially the rigid or scleral kind) can sometimes smooth out those imperfections, but if you’re not interested in them, the next step is usually an eye exam to look for things like lens changes or surface dryness. Cataracts, even very early ones, are a common culprit for glare driving at night in the U.S.
Laser surgery can sometimes make halos worse, especially if someone already has them, so you’re right to be cautious. But it’s not the only option. Treating dry eye, using anti-reflective coatings on your glasses, or addressing cataracts (if present) can all help a lot.
In short: it’s not hopeless, but the “fix” depends on what’s causing the scatter in the first place. A detailed eye exam is the best way to pin that down.
Sounds like astigmatism, which I also have. I don't know if this procedure, unlike LASIK, can correct astigmatism. I know you said you weren't interested, but for me personally, wearing contacts (not glasses) completely fixes my astigmatism and makes it much easier to drive at night.
Source: Had LASIK in 1999. Severe myopia and astigmatism, corrected to 20/10 and 20/15 (right and left eye).
My night vision was definitely worse after the surgery, but improved over a year or two. I still get blurry when my eyes are dry and tired, but otherwise remain glasses-free at 50+.
As in, you have this without any eye surgery? My dad had LASIK and that gave him 20/20 vision but also what he described as horrible halos around all lights at night, to a point where he really found it difficult to drive in the dark. He had it done about 15 years ago so I wonder if the state of the art has improved in that area.
When I looked into it last year, it´s still an under-acknowledged issue. The impression I formed was that it was a bit of a crapshoot - along with some bad practitioners, there didn´t seem to be much information on when and why it would or would not occur.
There’s a current product that does simple mechanical remodeling: sleep with this chunky contact lens in and the next morning you see better. But it wears off in ten hours or less.
Readit News
Flaps aren't inherently dangerous either (flap detachments are very rare, even more so with modern systems that create essentially a cavity where the flap can rest in), but the difference in healing post OP is a lead cause of heightened dry eye after LASIK. Both PRK and SMILE, due to the way they work, are less likely to suffer from this, but every procedure has trade-offs naturally.
With PRK, the epithelium in the area is removed and has to regrow, a process that takes a few days (to get the initial part done, full regrowth takes far longer but isn't noticeable in general). This regrowth can be both rather painful and also rob you of the "instantly perfect sight"-effect many people desire from their laser eye surgery. As the epithelium does regrow naturally however, it is less likely (both in theory and in medical literature) to lead to dry eye and other side effects in the short and long term, making it the preferred choice by many ophthalmologists when choosing such surgery for themselves.
SMILE, on paper, might be able to offer the best of both worlds, but is severely more expensive than either and there is not a sufficient degree of long term research to make a definitive statement that the side effect amount and severity is comparable to PRK, simply because it is rather new. What research is out there is promising though.
Overall, each option is very well tolerated, leads to major QOL improvements and we need to keep in mind that even the more common side effects one may face with LASIK may not affect everyone and still are comparably small considering other medical fields and their elective procedures.
In this context, I'm very excited to see whether this method might have even fewer short and long term side effects than PRK, but like with SMILE, it may take decades to have a conclusive answer.
Edit: Another thing I missed and which was not covered in the article, is the potential that this new method could be applicable to people who, because of a variety of factors, are not eligible for any ablative eye surgery. I myself was at the upper limit for Trans-PRK in regard to the severity of my Myopia and the thickness (or lack there off) of my Epithelium. In that regard, I see far more potential than just reducing already low side-effect risks further.
I'm here to tell everyone to listen to the doctor about pain medications and sleeping after PRK. I have a repeatedly-demonstrated very high tolerance for pain, and didn't bother to follow the directions.
As a result, I spent about an hour seriously considering whether it would hurt less if I physically scooped out my eyeballs by hand. That's not a metaphor -- I had to mentally restrain my hands.
And the punchline is that 12 years later I again need glasses for computer work, which is what I do all day.
First 30 hours after the surgery weren't the most pleasant but to me it wasn't painful—at least not as painful as a migraine.
I thought I generally had dry eyes but after the surgery I didn't notice any dryness at all.
My right eye is not fully healed yet so I don't see perfectly. But still very happy and overall a good QOL improvement.
I used to have dry eyes afterwards for quite some time (years) as well, but that seems to have gone away at some point.
This is exactly opposite to how I understood and experienced healing after Trans-PRK. My eyes are still very dry 6 months post surgery. Being at the upper limit of Trans-PRK yourself, did you actually go through with the surgery? If yes, how was your healing process? I would be very interested in chatting about it, since I am not particularly happy with mine, and wondering what can be done (and whom to blame).
From there on, the pain and foreign object feeling quickly subsided alongside the remaining "haze" and by day five, I neither had any subjective pain, nor any major issues reading text (both typed and digital). Had multiple check-ins of course, both at the clinic which performed the surgery and with my decades long ophthalmologist, no issues were found there either. Subjectively, I do not experience a heightened severity in dry eye symptoms for what that is worth.
Also had a clinical rotation in Ophthalmology just this month (small world, though was why I felt the urge to comment) and the attendings did assess my epithelium as having regrown evenly too.
What could have gone wrong for you and how to go about this, I really can't say and I am sure you have already considered /pursued it, but I can only suggest getting a second opinion from another established ophthalmologist, including looking at the eye drop regiment prior to the surgery and during, as well as post recovery.
This is the first I've heard of this. In my area it seems comparable in price, within 1.5x the cost of LASIK. Considering how relatively cheap it is (a couple months' rent, or a fraction of the price of a car, to correct your vision for decades) I've never seen cost mentioned as reason to choose one over the other.
Maybe “severely more expensive” wasn’t the best wait to phrase it, but the difference is still quite steep and this can be a decision maker for many people. Especially as currently it appears that medium term/6-month outcome between PRK and SMILE are very comparable, or even slightly better in PRK [0].
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC9009506/
It is an unpleasant procedure and the recovery is quite painful. There is a reason why it is almost never done today.
https://moskowitz-eye.com/blog/most-popular-laser-eye-surger...
I had it done about fifteen years ago. My vision was perfect for a decade, but now I'm back in glasses.
PRK recovery was certainly uncomfortable, but I'd gladly do it again for another decade without glasses.
Some unsolicited advice: wait for widespread adoption, and review data on long term side effects from sources without a conflict of interest before you have a procedure like this. I went from 20/150 to 20/15 for a few years (which was pretty cool) but they're 20/40 now so I wear glasses/contacts when I leave the house anyway. Glasses and/or contacts aren't that bad.
She said a Collamer lens was inserted into her eye and the procedure was reversible. I assume this is also available in the US?
My bet is on SMILE evolving but we'll see where it goes
I have several focal points in each eye, randomly clustered together. And unfortunately, there is no correlation (or reason for a correlation) between my eyes.
Imagine not being cross-eyed with two focal points, but with well over a baker's dozen. Even if I could line up one pair of points between my eyes, any improvement would be indiscernible in the mess I see.
Because the focal points are clustered close together, their impact is less at a distance (it just feels hard/impossible to properly focus, like looking through very slightly warped glass), but it is devastating up close. For reading.
Without help, I see so many copies of all the letters, randomly and tightly stamped all over each other, I could stare at a short line of text all day and never figure out what it said.
And this after having better than 20-20 vision at all distances, for most of my life.
(Fun fact: if I am in a dark room, and look at one of those tiny power-on LED lights on some media equipment with enough distance that it is basically a point, I can clearly see all my focal points - and also a dimmer curvy, spaghetti crossover mess of focal Beziers between and around them. My corneas are neither convex or concave. They are chaotic. Evil.)
Fortunately, I have hard gas-permeable "scleral" contact lenses. They form a near perfect cornea for me, so when I wear them, my awesome vision and glyphs live once again. "Scleral" refers to the fact that they are wide enough to rest on the whites (sclera) of the eyes, to completely cover and fill out my lame natural corneas.
So I am in pretty good if inconvenient shape.
But I would absolutely love it if this new method allowed my corneas to be reshaped. Any improvement would be a big deal.
(There is surgery where corneas are soaked with a binder, which is fixed with a laser, that strengthens them and stops/slows Keratoconus from getting worse. But it cannot recover what has already been lost.)
Every morning I put them in, look out my window at the high leaves of a garden tree. Then rotate them until the leaves are sharp,
I am still using my first pair, which are nine years old now. No irritation unless I wear them overnight sleeping.
I highly recommend giving them a try!
https://www.youtube.com/live/Dw9D7C8CpM0?si=e-KJ8J2u_oVy4RvM
Originally there was a mention of developing a less invasive method of correcting a deviated septum, but I guess they went with the harder problem first.
In any case I'm up for both, because while my vision is not terrible, it's slowly, but consistently getting worse, so max-twice-a-lifetime interventions like laser eye surgery won't cut it for me.
And it does affect my quality of life: forget glasses? Good there goes your day until you've found a replacement. The best improvement so far has not been the glasses but a simple string to make sure I don't put them down but they stay around my neck. That has made a massive difference and it also helps when looking down (so the glasses won't fall off) and it has cut the rate at which I was losing them to zero from about one pair per month (which really was not sustainable).
In my case it's not even the defect itself, but the associated astigmatism. For a long time I was unaware of the issue because it started in one eye, so the other compensated until it couldn't.
Now I get around two weeks of perfect vision upon getting a new glasses prescription and it's back to "normal".
I only have wore glasses, i dont care about trying contacts. Its the glare with or without thats pretty bad driving at night in US
Contacts (especially the rigid or scleral kind) can sometimes smooth out those imperfections, but if you’re not interested in them, the next step is usually an eye exam to look for things like lens changes or surface dryness. Cataracts, even very early ones, are a common culprit for glare driving at night in the U.S.
Laser surgery can sometimes make halos worse, especially if someone already has them, so you’re right to be cautious. But it’s not the only option. Treating dry eye, using anti-reflective coatings on your glasses, or addressing cataracts (if present) can all help a lot.
In short: it’s not hopeless, but the “fix” depends on what’s causing the scatter in the first place. A detailed eye exam is the best way to pin that down.
Source: Had LASIK in 1999. Severe myopia and astigmatism, corrected to 20/10 and 20/15 (right and left eye).
My night vision was definitely worse after the surgery, but improved over a year or two. I still get blurry when my eyes are dry and tired, but otherwise remain glasses-free at 50+.
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