In the beginning, there were spectacles. Until then, if your eye-sight failed you, your best bet was to squint. Then came contact lenses which are a god-send compared to clunky glasses, but still a hassle. Now, you can go under the knife or, to be specific, laser and get your eye-sight corrected with the Lasik procedure. How much would this actually cost though? We deep dive into the options you have at private clinics as well as the public health route with the Singapore National Eye Centre.
It should shock no one that Singapore is the myopia capital of the world. 80% of 18-year-olds here are short-sighted and a study estimates that five million Singaporeans will suffer the same fate by 2050. So, odds are pretty high that you (like me) are short-sighted and may be considering Lasik as an option.
What is LASIK?
LASIK is short for Laser-Assisted In situ Keratomileusis. It’s a mouthful, so we appreciate the acronym. LASIK is a type of eye surgery where a laser is used to sculpt the cornea to improve short-sightedness (myopia), far-sightedness (hyperopia) and astigmatism.
The cornea is the transparent front part of the eye that lets light into the eyeball and retina so you can see. Think of it like the camera’s lens. When your cornea goes out of shape, the image on the retina becomes fuzzy.
LASIK helps to correct the misshapen cornea by using a laser to cut the surface of the cornea and create a thin flap. Another laser (an excimer laser) is then used to shape the middle section of the cornea. Once the cornea has been re-shaped, the flap is put back in place to cover the cornea. It then naturally adheres to the cornea, forming your eye’s own bandage.
It’s a 10- to 15-minute day surgery that requires only topical anaesthetic eyedrops. Improvements are usually immediate and within a day or two (a week at most), you can go back to life as normal (though you have to stay off water and contact sport for a month).
There is a premium LASIK treatment called iLASIK. It involves creating a 3D map of the eye using Wavefront technology. This allows for a more intricate representation of your vision needs. Then, a bladeless laser technique that promises greater precision and safety is used to create the flap in the cornea. Of course, greater accuracy also demands greater cost.
Apart from LASIK, there are other types of laser eye surgeries:
Advanced Surface Ablation (Epi-LASIK, LASEK, PRK, TransPRK)
A no-flap, no-incision, surfaced-based procedure, ASA involves the removal of a thin layer of cells on the surface of the cornea so the laser can shape the cornea. A protective contact lens is then placed over the eye till the cells grow back in a few days.
This is the best option for those with thin corneas but it requires a longer treatment and recovery time (three to five days).
ReLEx SMILE (Refractive Lenticule Extraction, Small Incision Lenticule Extraction)
Like ASA, it’s a flapless procedure but it’s recovery time is faster. A laser creates a disc-shaped piece of corneal tissue (lenticule) just beneath the surface of the cornea. The same laser then makes a small cut on the cornea to remove the lenticule. It’s the removal of the lenticule that changes the way light bends into the eye, clearing the vision.
This method doesn’t work for long-sightedness and isn’t as effective for high astigmatism or low myopia.
So, LASIK remains the most common and popular form of laser eye surgery in Singapore and around the world. Some estimates put the number between 28 and 40 million worldwide who have undergone LASIK.
Collagen Cross-Linking (CXL)
You might be offered CXL in addition to your laser eye surgery. This extra procedure aims at reducing both the risk of your degree returning and that of your cornea losing its shape which is known as corneal ectasia (though this is rare).
CXL is done during your laser surgery. Vitamin B12 drops are applied to the eye before UV light is shone on it for a minute. This activates the collagen fibres on your eye to cross-link and strengthen your cornea after LASIK.
Are there any side effects with LASIK?
The short answer is: Yes. The long answer is: Yes, but they are minimal, bearable and often temporary.
This is caused by the creation of the corneal flap and the effect of the laser on the cornea which cuts the corneal nerves responsible for normal tear production. It should resolve itself in a few months.
Night vision issues
Seeing halos, glares and starbursts at night is especially common with people with high myopia or high astigmatism. This goes away gradually within nine months to a year.
Discomfort and itchiness
The discomfort is part of the healing and will go away a few hours after the procedure. Closing your eyes or sleeping should alleviate the sensation. The itch should disappear in a few days. Using preservative-free artificial tears eye drops will help.
Risks associated with LASIK
This is rare (globally only 0.04% to 0.06%) but it does happen. The cornea becomes irregular and unstable in a condition known as post-LASIK ectasia.
Problems with cataract surgery in the future
During cataract surgery, the lens in your eye is replaced with an artificial one to clear your vision. Because LASIK permanently changes your cornea, the lens calculations become more difficult since it requires a normal cornea for correct reading. So, you might end up having to wear glasses after your cataract surgery, which you would not have otherwise had to do.
Inaccurate eye pressure readings
Glaucoma is a condition where there’s increased pressure on the eyeball. This causes damage to the optic nerve that can lead to poor eyesight or even blindness. LASIK makes reading your eye pressure more of a challenge, leading to a lower reading.
Your old degree could return, especially if your myopia is very high. But odds are, the improvements are permanent and require only minor adjustments because the shape of your cornea can still continue to alter LASIK.
Who can (or can’t) benefit from LASIK?
Like any procedure, there are ideal candidates and less than ideal ones for LASIK.
You can go for LASIK if:
- You are at least 18 years old (some say 21 years old)
- Any younger, and your eye-sight may not have stablised yet. If you are in your 40s, you may need reading glasses as you age even with LASIK.
Your degrees have stablisied for at least a year
- You are in good health
- LASIK isn’t advisable if you:
- Have very high refractive error, for example myopia of more than 1000 degrees, hyperopia of more than 400 degrees, and astigmatism of more than 400 degrees. Results tend to be less predictable and satisfactory for patients with these conditions.
Suffer from severe dry eye syndrome
- Have thin corneas relative to the degree of improvement you want
- Have irregularly-shaped or steep corneas
- Are pregnant or nursing
- Hormonal changes in this season of life can cause vision to fluctuate. You may need to wait six months after pregnancy and nursing before undergoing LASIK.
Have existing eye injuries or diseases such as cataract, glaucoma, diabetic eyes or retina problems
- Are hoping to correct presbyopia (long-sightedness due to age)
Where can I get LASIK procedures done? – Private versus public clinics
As with all medical procedures, you have your choice of public institutions and private clinics for your LASIK procedure. Public institutions are generally, though not always, the cheaper options.
There are a few of these that you can go to for LASIK:
- Singapore National Eye Centre
- National University Hospital
- Tan Tock Seng Hospital
See attached pdf for estimate costing.