Laser Eye Surgery
Laser vision correction: SMILE Pro · No Touch · Femto-LASIK · Q-LASIK · Prof. Dr. Fırat Helvacıoğlu, FEBOS-CR · Veni Vidi Eye Clinic, Caddebostan – Kadıköy, Istanbul
Laser eye surgery corrects myopia, hyperopia and astigmatism by reshaping the cornea with a laser. We perform it under topical (eye-drop) anaesthesia. It usually takes 15–20 minutes for both eyes, and patients go home the same day. We choose the most suitable method (SMILE Pro, No Touch, Femto-LASIK or Q-LASIK) according to your corneal thickness, prescription and lifestyle.
What is laser eye surgery?
Laser eye surgery corrects myopia (short-sightedness), hyperopia (long-sightedness) and astigmatism by reshaping the cornea — the clear front surface of the eye — with a laser. You may also hear it called laser vision correction or refractive surgery. The aim is to eliminate or minimise the need for glasses or contact lenses.
Today, surgeons use three main approaches: SMILE Pro, performed without creating a corneal flap; No Touch (TransPRK), a surface treatment in which no instrument touches the eye; and LASIK procedures (Q-LASIK and Femto-LASIK), which involve creating a thin corneal flap. Comparative meta-analyses have shown that the visual outcomes of these methods are broadly similar, so the structure of your eye determines the choice of method.
Which laser method suits whom?
| Method | Technique | Recovery | Particularly suitable for |
|---|---|---|---|
| SMILE Pro | The laser creates a thin disc of tissue (lenticule) within the cornea, and the surgeon removes it through a 2–4 mm incision; there is no flap | Return to daily life usually the next day; vision clears within a few days | Myopia and astigmatism; people prone to dry eye; active lifestyles |
| No Touch (TransPRK) | The excimer laser removes the surface layer and applies the correction in a single step; no instrument touches the eye | The surface layer usually heals in 2–4 days; burning and grittiness may occur during the first days | Thin corneas, contact sports, occupations with a risk of eye trauma |
| Q-LASIK | The Med-Logics ML7 LASIK system creates the flap in about 7 seconds with low suction; minimal oedema and a temporal hinge allow rapid recovery, after which the excimer laser reshapes the tissue | Vision clears within 5–6 hours (quick visual recovery); little pain | Myopia, hyperopia and astigmatism; eyes with regular topography and adequate corneal thickness |
| Femto-LASIK | A femtosecond laser creates the flap, and the excimer laser reshapes the underlying tissue | Rapid visual recovery; little pain | A wide range of myopia, hyperopia and astigmatism; adequate corneal thickness |
| Topography / wavefront-guided | Personalised ablation based on the corneal map or the optical aberrations of the eye | Depends on the method used | Irregular corneas; enhancements after previous surgery |
Am I suitable for laser eye surgery?
- Age: At least 18; the most suitable period is usually between 18 and 40.
- Stable prescription: Your prescription should not have changed significantly (by more than 0.5 dioptres) in the past year.
- Healthy cornea: Corneal mapping (topography/tomography) and thickness measurements must be normal, and the tests must rule out keratoconus.
- General health: We do not perform surgery during pregnancy or breastfeeding, and we carefully assess uncontrolled diabetes and certain rheumatic and immune disorders.
- Eye health: We treat significant dry eye, blepharitis or intraocular disease first.
For high prescriptions unsuitable for laser, an implantable lens (ICL) — and for people over 45 or with early cataract, a smart lens — may be the better option.
What does the pre-operative assessment involve?
The pre-laser assessment takes about 1.5–2 hours. It includes corneal topography and tomography, corneal thickness, pupil measurement, dry eye tests and refraction with and without dilating (cycloplegic) drops, as well as a retinal examination. Soft contact lens wearers need to stop wearing their lenses for a period before the assessment, as lenses can temporarily alter the corneal map.
Safe planning
Prof. Dr. Fırat Helvacıoğlu is a member of the Medical Advisory Board of RLES AI, a clinical decision support platform. He has also contributed to its modules for laser planning, keratoconus screening, detection of contact lens–induced corneal changes and dry eye analysis. However, the surgical decision always rests with the surgeon; decision support systems help ensure a complete check of hundreds of measurements.
Is laser eye surgery safe?
The most important safety consideration in laser treatment is the risk of ectasia — weakening and forward bulging of the cornea. The percent tissue altered (PTA) reflects how much of the cornea the treatment changes, and it is one of the strongest risk indicators for ectasia. In one case-control study, researchers examined 30 eyes that developed ectasia after LASIK despite normal topography. In 97% of these eyes, the PTA was 40% or more (Santhiago et al., Am J Ophthalmol 2014). For this reason, we calculate corneal thickness, topography and PTA together for every plan, and we choose a safer method instead of a risky plan.
Dry eye and halos around lights at night are common, mostly temporary, symptoms in the first months after surgery. In the FDA-supported PROWL studies in the United States, overall dry eye symptoms decreased after surgery. The same studies reported that 1–2% of patients were dissatisfied with their surgery (Eydelman et al., JAMA Ophthalmol 2017).
Cost of laser eye surgery and information for international patients
We determine the cost after the examination, according to the chosen method, whether we treat one or both eyes and the need for personalised planning. Laser eye surgery is an elective procedure, and health insurance generally does not cover it.
Frequently asked questions
The laser application itself lasts only seconds; the whole procedure for both eyes usually takes 15–20 minutes. Then, after a brief check, patients go home the same day.
Thanks to anaesthetic drops, you feel no pain during surgery. A few hours of burning may occur after SMILE Pro and Femto-LASIK; after surface treatments such as No Touch, grittiness and watering are more pronounced for the first 2–3 days.
In patients with a stable prescription, the result is largely permanent. However, a small number of patients may develop a minor prescription over time; if the cornea is suitable, we can perform an enhancement.
You must be at least 18, and your prescription must also have been stable for the past year. After 40, as near vision declines, we may also consider a smart lens instead of laser.
We can complete the pre-operative assessment and surgery within a few days. After SMILE Pro and Femto-LASIK, we recommend staying about 3–4 days for the post-operative checks; after No Touch, about 5–7 days until the surface layer has healed. Most patients can also return to desk work within 1–2 days after SMILE Pro and Femto-LASIK.
No single method is best for everyone. Visual outcomes are broadly similar, so your corneal thickness, prescription, occupation and dry eye status determine the most suitable method.
References
- Wen D et al. Postoperative efficacy, predictability, safety, and visual quality of laser corneal refractive surgery: a network meta-analysis. Am J Ophthalmol. 2017;178:65–78. doi:10.1016/j.ajo.2017.03.013
- Shortt AJ, Allan BD, Evans JR. Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia. Cochrane Database Syst Rev. 2013;(1):CD005135. doi:10.1002/14651858.CD005135.pub3
- Santhiago MR et al. Association between the percent tissue altered and post-laser in situ keratomileusis ectasia in eyes with normal preoperative topography. Am J Ophthalmol. 2014;158(1):87–95. doi:10.1016/j.ajo.2014.04.002
- Eydelman M et al. Symptoms and satisfaction of patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) studies. JAMA Ophthalmol. 2017;135(1):13–22. doi:10.1001/jamaophthalmol.2016.4587
- Shen Z et al. Small incision lenticule extraction (SMILE) versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia: a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158176. doi:10.1371/journal.pone.0158176
This page is intended for patient information and does not replace an examination or medical assessment. The treatment that is right for you is determined after an eye examination and measurements.
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Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Caddesi No: 257, Caddebostan – Kadıköy, Istanbul, Türkiye