Frequently asked questions about laser eye surgery

All visual defects can be corrected with laser surgery: myopia up to 12 diopters, hyperopia, and astigmatism up to 6 diopters. Laser correction of presbyopia is based on the principle of multifocality (especially in hyperopic patients) or monovision (the preferred technique in myopic patients).

It is essential to consult an ophthalmologist specialized in refractive surgery to obtain an accurate evaluation of your case.

Here are the preliminary steps to determine whether you are eligible for laser corrective surgery:

1. Prescription analysis: the doctor will first review your current glasses or contact lens prescription to identify your visual defects and determine whether they can be corrected by laser. You can already assess this yourself here (how to read your glasses or contact lens prescription). If you no longer have the prescription, the correction can simply be measured during the consultation.
2. Consultation and pre-operative assessment: during the consultation, the doctor will measure your visual defects and examine your eyes to assess their overall health. A corneal topography will also be performed (for more details, see the question “What does the pre-operative assessment involve?”).
3. Discussion of expectations and risks: the doctor will discuss with you the expected results of surgery, potential risks, and alternatives to treatment. It is essential to have realistic expectations regarding the outcomes of refractive surgery.
4. Eligibility confirmation: after reviewing all these factors, the doctor will tell you whether you are a good candidate for laser refractive surgery and which technique would be best suited to your specific case.

It is important to note that laser refractive surgery is not suitable for everyone, and each case is unique.

The pre-operative assessment for laser refractive surgery is a crucial step in the process, as it allows the surgeon to determine whether you are a suitable candidate for the procedure and which type of refractive surgery would be most appropriate for your case.

Here are the elements generally included in a pre-operative assessment for laser refractive surgery:

1. Refraction measurement: analysis of your glasses or contact lens prescription and measurement of visual defects to determine the required optical correction.
2. Comprehensive eye examination: examination of the anterior segment and dry eye testing, pupillometry, measurement of intraocular pressure, and fundus examination. Underlying conditions such as cataracts, glaucoma, or retinal disease could affect the success of the procedure. Dry eye can also be a limiting factor for refractive surgery.
3. Corneal topography: this is the key step of the pre-operative assessment. Corneal topography maps the shape of your cornea in order to detect any irregularities. It also allows precise measurement of corneal thickness. A cornea that is too thin may not be suitable for certain refractive surgery techniques.

The pre-operative assessment is essential to ensure the success of refractive surgery and to minimize risks. Be sure to discuss all steps of the process in detail with your surgeon, your expectations, and any concerns you may have before making an informed decision about laser refractive surgery.

Laser refractive surgery is very effective in correcting common refractive errors, but it is not suitable for everyone, and results may vary from one individual to another.

Even though results are excellent, they can never be guaranteed 100% (due to the healing process). However, a surgical enhancement can be performed after a few months (generally 6 months), and this enhancement is offered to you.

A re-intervention is possible even years after the procedure (in case of regression of the correction or the onset of presbyopia).

No, laser eye surgery techniques have benefited from advanced technological developments and improved safety systems that reduce the incidence and severity of ocular complications. This laser procedure only affects the surface of the cornea, and the eye is not opened. Potential complications affect the cornea, which is responsible for focusing the image, but they do not involve the retina or the optic nerve, which are the structures responsible for vision.

Presbyopia is defined by a reduction in accommodation with age (the eye’s ability to focus at near distances). There is no proven technique to restore lost accommodation. Laser correction makes it possible to compensate for presbyopia using two different techniques: either monovision, where one eye is corrected for distance vision and the other for near vision. This technique requires a period of adaptation, but it can be simulated before surgery by wearing contact lenses. Or multifocality, which allows both distance and near vision by finding a compromise between a slight reduction in distance vision and an improvement in near vision.

In most cases, both eyes are operated on during the same surgical procedure. This approach is intended to promote a faster recovery and to avoid any discomfort resulting from differences in correction between the two eyes if the surgeries were performed separately.

The precautions are the same for all techniques and are relatively simple :

• Do not wear contact lenses for at least 48 hours before the procedure.
• Do not wear makeup or perfume on the day of the procedure.

It is recommended to stop wearing soft contact lenses for at least 48 hours before undergoing a preoperative examination. Wearing contact lenses can alter the surface of the eye and affect test results. In the case of rigid contact lenses, it is preferable to stop wearing them ideally one month before the preoperative examination.

• Sun exposure : after surgery, and especially after PRK, it is essential to protect your eyes from direct sun exposure by wearing sunglasses with high UV protection.
• Swimming : prohibited during the two weeks following surgery, so the procedure should be scheduled during a period when you have time to recover.
• Seasonal allergies : it may be advisable to avoid surgery during allergy season in order to reduce discomfort if allergies affect your eyes (however, an anti-allergy treatment may be proposed).
• Personal availability: the most important factor. Choose a period when you can allow yourself a few days of rest to recover after surgery.

Laser eye surgery during pregnancy is not recommended, as it may be less accurate due to temporary changes in vision and increased eye dryness. It is advised to wait at least 3 months after childbirth or after stopping breastfeeding before considering laser eye surgery, once hormone levels have returned to normal.

Refractive surgery is not suitable for everyone. Contraindications may vary depending on the technique (LASIK, PRK, SMILE), but here are some general contraindications that may apply:

• Instability of optical correction : if your glasses or contact lens prescription has changed significantly over the past year, you may not be a good candidate, as prescription stability is essential to achieve lasting results.
• Pregnancy and breastfeeding : women who are pregnant or breastfeeding are not eligible for refractive surgery, as hormonal changes can affect the shape of the cornea.
• Certain eye diseases : such as keratoconus or glaucoma (in the case of LASIK).
• Certain autoimmune or systemic diseases : such as lupus or scleroderma.
• Severe dry eye.
• Thin cornea : if your cornea is too thin, it may not be thick enough to allow laser correction.
• Previous corneal scars due to injuries, infections, or other conditions.

There is no specific age limit for laser refractive surgery, as eligibility for this procedure depends more on the stability of the vision prescription and overall eye health than on age itself. However, there are a few important considerations to keep in mind:

• Prescription stability : it is generally necessary to have a stable prescription for at least one year, or even longer.
• Minimum age : you must be at least 18 years old.
• Advanced age : there is no maximum age limit for refractive surgery, and many older patients successfully undergo this procedure. However, as you age, other eye conditions such as cataracts may develop, which could require separate surgical procedures.

If you wish to meet Dr. Bidgoli with a view to a possible procedure, you will need to schedule an initial appointment.

This first consultation will allow Dr. Bidgoli to determine whether you are eligible for refractive surgery. If so, he will explain in more detail the technique best suited to your visual defect. If not, he will propose alternatives to refractive surgery.

The cost of this consultation is €70.00 (50% reimbursed by the health insurance fund).

Any subsequent appointments, should you decide to schedule the procedure — namely the preoperative consultation and postoperative follow-up visits — are included in the total cost of the surgery.

The price ranges between €3,000 and €4,000 for both eyes, depending on the technique used. LASIK is more expensive than PRK due to the additional equipment required, including a femtosecond laser to create the corneal flap.

Health insurance does not cover laser refractive surgery, as it is considered an elective procedure and not medically necessary. Health insurance funds offer only minimal reimbursement.

For information purposes only :

• Partenamut €100/eye
• Solidaris €150/eye
• Mutualité Chrétienne €100/eye
• Mutualité Libérale €100/eye
• Mutualité Neutre €125/eye

In cases of contraindication to laser surgery, or for patients with high myopia or hyperopia, intraocular implants may be an option. There are two main types:

• Phakic lenses : implanted without removing the natural crystalline lens, they work in addition to it. For example, the ICL lens allows correction of myopia up to 20 diopters, hyperopia up to 10 diopters, and astigmatism up to 6 diopters.
• Pseudophakic lenses : mainly used in cataract surgery, where the natural crystalline lens is replaced with an artificial lens. Lens replacement, also known as clear lens extraction, is another option to correct refractive errors. This procedure is similar to cataract surgery, in which the eye’s natural lens is replaced with an artificial intraocular lens. Conventional pseudophakic lenses replace the refractive power of the crystalline lens without its accommodative ability. The eye can then no longer accommodate and becomes presbyopic.  There are multifocal lenses that compensate for this drawback by providing multifocal vision, but without true accommodation.

The possibility of seeing halos or glare, particularly with multifocal implants, is the main side effect of intraocular lenses.

As this is intraocular surgery, potential — though fortunately very rare — complications are serious and different from those encountered after laser correction: corneal decompensation, intraocular infection (endophthalmitis), inflammation, cataract (after phakic lens implantation), glaucoma, retinal detachment, etc.

For these reasons, laser correction should be preferred whenever possible. In case of contraindication, phakic lenses may be an alternative in young or middle-aged patients. At the age when cataracts develop, lens replacement is the best option.

Dr. Bidgoli is a specialist in laser eye surgery and does not perform this type of procedure, but can refer you to a colleague who specializes in intraocular implants.

The ophthalmologists at the De Fré ophthalmology practice are not contracted. The price of a general consultation is €80. Please note that this amount may be higher if additional examinations are performed. In all cases, you will subsequently receive reimbursement from your health insurance fund depending on your status.

The total duration of laser refractive surgery is generally about 10 to 15 minutes per eye. It should be noted that the actual laser application times are quite short with modern equipment, taking less than 20 seconds to create the LASIK flap using a femtosecond laser, and about 2 seconds per diopter of correction when using the excimer laser. The remaining time is devoted to preparing the surgical field, performing checks, and aligning the eye with the laser, among other steps. The procedure itself is not painful, as it is performed under local anesthesia with the administration of eye drops before the surgery. Most patients describe a sensation of pressure under the femtosecond laser (LASIK), but no pain during excimer laser correction (PRK).

The procedure is performed using topical anesthesia (eye drops). A mild oral sedative may be administered to help the patient relax before the surgery.

Yes and no.

• Yes : Under the excimer laser (PRK and LASIK), the automated eye-tracking system (Eye tracker) ensures the precision of the correction. If the eye moves during the procedure, the excimer laser can adjust to follow these movements and keep the laser beam on target.
• No : Under the femtosecond laser (LASIK and SMILE), it is essential for the patient to keep the eye still to ensure precise cutting.

An eyelid speculum is placed in all cases to keep the eyelids open, making blinking impossible. In addition, you will receive clear instructions during the surgery to minimize eye movements. You will be asked to look at a fixed point or follow specific instructions to maintain eye stability throughout the procedure.

During laser refractive surgery, visual perception is generally limited and varies depending on the type of procedure.

• LASIK : during flap creation with the femtosecond laser, you may see flashing lights, blurry reflections, or experience temporary darkness. This phase is usually very brief.
• PRK and LASIK : during correction with the excimer laser, you may see colored lights or laser patterns.

On the day of surgery, it is recommended to follow the instructions for applying the prescribed eye drops. You can start using them at least one hour after the procedure. You may instill the different drops at 5-minute intervals or space them evenly throughout the day. If you experience irritation, it is advised to moisturize the eyes with artificial tears or rinse them with cold saline solution.

Postoperative treatment consists of instilling antibiotic and anti-inflammatory eye drops, autologous serum, and artificial tears. The drops must be stored in the refrigerator and used within a specific timeframe to ensure their effectiveness.

Autologous serum is an ophthalmic treatment derived from the patient’s own blood and used in the form of eye drops. It is prepared by drawing the patient’s blood, then centrifuging it to separate the serum, which is subsequently diluted and packaged as eye drops for ocular use. Autologous serum drops are generally applied several times a day. The treatment may last several weeks depending on the speed of healing and improvement of symptoms.

Autologous serum is particularly indicated after refractive surgery for the following reasons:

• Promotion of healing : the growth factors and proteins present in autologous serum promote regeneration of the corneal epithelial cells, thereby accelerating healing after PRK.
• Reduction of dry eye : dry eye is a common complication after refractive surgery. Autologous serum contains components similar to those of natural tears, which can help improve ocular lubrication and reduce dry eye symptoms.
• Prevention of infections and inflammation : the antibodies and other immune factors present in autologous serum can help reduce the risk of infections and inflammation after surgery.
• Improvement of ocular surface quality : by promoting an environment conducive to healing, autologous serum can help maintain a smooth and healthy ocular surface, which is essential for clear vision after refractive surgery.

You must be accompanied home or take a taxi. You should not attempt to drive after the procedure. Public transportation is also not recommended.

It is strictly forbidden to touch your eyes during the first week. You will be given protective glasses to wear at night. You may also choose to wear a sleep mask for added comfort if you wish.

From a general standpoint, even without surgery, rubbing the eyes is harmful because it deforms the cornea and is a cause of keratoconus. After surgery, regardless of the technique used, it is imperative not to rub the eyes, even in case of discomfort. In the immediate postoperative period, uncontrolled rubbing could displace the flap after LASIK or remove the bandage contact lens after PRK. At a later stage, repeated rubbing is responsible for post-LASIK ectasia. This is a feared complication of surgery caused by a weakening of the cornea’s biomechanical resistance, partly due to corneal thinning (laser ablation), flap creation, and above all repeated eye rubbing.

Keratoconus and its postoperative equivalent, known as ectasia, lead to a deterioration of vision due to myopia and astigmatism. As these refractive errors cannot always be corrected with glasses or soft contact lenses, rigid contact lenses or even surgical procedures (intracorneal rings or corneal transplantation) may then be required to restore acceptable vision.

Bandage contact lenses are worn for approximately 4 to 5 days after PRK. This duration allows the epithelium to heal and cover the entire surface of the cornea to which it adheres. The bandage contact lens must not be removed and reinserted by the patient.

Dry eye can be a complication after LASIK. If a patient already has dry eye before surgery, it is recommended to intensify moisturizing treatment after the procedure or, in some cases, to opt for PRK. Indeed, dry eye after PRK is generally less severe and of shorter duration. In certain situations, the placement of punctal plugs may be considered to reduce the need for artificial tears before and/or after surgery. The use of autologous serum eye drops (made from your own blood) is indicated to help counter dry eye.

No. The eyes look exactly the same. Corneal refractive surgery does not cause any change in eye color, which is determined by the iris and not by the cornea.

In the case of myopia correction, the ability to see up close without glasses depends on the patient’s age. Patients under 45 years old can generally expect clear vision at all distances, whereas patients over 45 may need glasses to see nearby objects clearly, especially if both eyes have been operated on.

In the case of hyperopia correction, near vision is improved in any case. Depending on the patient’s age and the degree of hyperopia, this correction may or may not be sufficient to do without glasses for near vision.

Most night vision problems can be avoided by treating an area larger than the dilated pupil during surgery. After the procedure, it is possible to perceive halos around light sources in low-light or dark conditions. In general, these phenomena do not interfere with driving or nighttime activities and are usually temporary, lasting only a few weeks at most.

For LASIK, the operated patient must be examined the day after surgery, then at one week and one month postoperatively.

For PRK, the operated patient must be examined 4–5 days after the procedure, as well as after one month and three months.

Please note that these three postoperative follow-up visits (as well as the preoperative consultation) are all included in the total cost of the procedure. You will therefore not have to pay anything extra for these visits.

Thereafter, it is important to continue regular ophthalmological follow-up with your treating ophthalmologist to monitor intraocular pressure, the condition of the retina, etc., depending on age.

The ability to return to work after refractive surgery depends on the type of professional activity and the technique used. In general, work can be resumed 48 hours after LASIK, provided that vision is clear enough to carry out professional tasks. For PRK, it is recommended to wait until visual discomfort has resolved, which may take 4–5 days.

In all cases, you will be given a medical certificate of incapacity for work lasting one week after PRK and three days after LASIK.

You may resume driving as soon as your vision is sufficiently clear (the second day after LASIK and 4–5 days after PRK).

After PRK, it is perfectly possible to spend time in sunny environments, provided that sunglasses are worn for one month. After LASIK, wearing sunglasses is mainly recommended for comfort.

You can swim or go bathing approximately 10 to 15 days after the procedure.

You can wash your hair as early as the day after or the day following the procedure: simply keep your eyes closed, and rinse them with saline solution after showering or if any droplets get into your eyes.

Resuming physical activity is allowed after one week.

You can start wearing eye makeup again from the 10th day after the procedure.

It is recommended to avoid spending too much time in front of a computer or mobile phone screen during the first few days following the procedure. Take regular breaks to rest your eyes.

There is no contraindication to air travel after laser eye surgery, but it is nevertheless recommended to wait until your first postoperative check-up (4–5 days after PRK and 24 hours after LASIK).

The overall complication rate is very low (below 1%), but it varies depending on the technique used and individual factors.

Here are some factors that influence the complication rate :

• Careful selection of patients who are candidates for surgery
• Surgeon’s experience: experienced and specialized surgeons tend to have lower complication rates.
• Eye health: people with thin corneas, dry eyes, or other pre-existing ocular conditions may have a higher risk of complications.
• Postoperative follow-up: adequate follow-up after surgery is crucial to detect and treat any potential complications promptly.

In practice, complications can be managed in a way that minimizes their impact on vision and provides 100% vision to the vast majority of patients.

The outcome of refractive surgery depends on the correct choice of indication, flawless execution of the procedure, and strict adherence to postoperative treatment.

The majority of studies show that patient satisfaction rates after refractive surgery are close to 95%.

This very high satisfaction rate also applies to many healthcare professionals (doctors and nurses) who wish to get rid of glasses, such as Dr. Bidgoli, who underwent surgery in 2015 for myopia and astigmatism !

Radial keratotomy is an older technique used to correct myopia by making radial incisions in the cornea. It has been abandoned in favor of laser techniques. Many patients who were operated on in the 1980s or 1990s are now hyperopic (more rarely myopic). To correct residual or secondary refractive errors after radial keratotomy, PRK can be performed. The results are less precise than on a cornea that has never undergone surgery, but they do lead to an improvement in vision.