Singapore is known as the myopia capital of the world and according to our Ministry of Health, ‘over 65% of Singapore children are myopic by Primary 6. In young Singapore adults, this figure stands at 83%”.
As such, it is no surprise that laser eye surgery like LASIK, LASEK and epi-LASIK are popular refractive surgery procedures in Singapore due to our high prevalence of myopia.
In this article, we will discuss more about the different types of laser eye surgery offered in Singapore:
Advanced surface ablation (ASA)
ASA is a type of laser eye surgery. Epi-LASIK, LASEK, PRK and TransPRK can all be broadly grouped under ASA. These laser eye surgeries have some common traits:
- Surface-based laser treatment.
- Flapless.
- Higher level of discomfort post-op surgery: May have more tearing and difficulty opening the eye the first 3 to 5 days.
- Slower vision recovery post-surgery: It can take about 1 week to regain about 75% to 90% of the vision.
At Lang Eye Centre, we may recommend LASEK or Epi-LASIK for those with thinner or irregularly shaped cornea. While there is more discomfort and vision recovery is slower post-surgery, LASEK and Epi-LASIK remove the least amount of corneal tissue from the eye, and this benefits those with thinner or irregularly shaped corneas. Your laser surgeon will always need to aim for a safe level of residual corneal thickness post-surgery for long-term stability.
LASIK surgery
LASIK surgery remains the most common and most popular type of laser eye surgery amongst those who want to eliminate or reduce the use of glasses and contact lenses. Features of LASIK surgery include:
- Fast vision recovery: Most can regain 75% to 90% of vision with some returning to work the next day.
- Low discomfort post-surgery: Will experience tearing the first few hours.
- The VISX Wavefront-guided treatment and iris registration provide a high level of predictability for high myopia and high astigmatism.
- Removes more corneal tissue than ASA but lesser than ReLEx SMILE/SMILE Pro.
- May experience more dry eye at first amongst all forms of laser eye surgery but it will usually go away with time and does not usually become chronic in the long term.
- LASIK enhancement may be performed multiple times by lifting up the pre-existing LASIK flap without the risk of scarring.
- Flap complications are rare with the IntraLase bladeless technology.
- Flap dislodgement is a concern that is usually brought up when it comes to LASIK surgery. The LASIK flap though remains stable and dislodgement is rare after one month; able to participate in contact sports.
- Large range of treatment: With sufficient corneal tissue, LASIK is able to correct up to 1,200 degrees of myopia, 500 degrees of hyperopia and 500 degrees of astigmatism. The treatment is performed beneath the Bowman’s membrane, hence, no scarring is associated with LASIK.
ReLEx SMILE/SMILE Pro
SMILE is the youngest member amongst all forms of laser eye surgery. It was granted US-FDA approval in 2017. SMILE has the following features:
- Corneal lenticule is manually dissected free and manually removed through an incision by the surgeon.
- Faster vision recovery than LASEK and Epi-LASIK but slower than LASIK.
- Lesser dry eye than LASIK.
- Unlike LASIK, LASEK and Epi-LASIK, SMILE has no option of a customised Wavefront-guided treatment, which aims to provide a better quality of vision and lower the incidence of night vision issues (haloes and starburst).
- Provides fairly high predictability though it is less accurate for low myopia. It is also less accurate for astigmatic correction and corrects lower levels of astigmatism compared to LASIK, Epi-LASIK and LASEK for example.
- Removes the most corneal tissue and therefore suitability criteria is more limited (eg not suitable for those with high eye prescription or thinner corneas).
- If there is a need to enhance the vision through a second laser eye surgery, ReLEx SMILE/SMILE Pro cannot be repeated. Enhancement has to be performed through other forms of laser eye surgery like Epi-LASIK or LASIK. Results can be unpredictable when different forms of laser eye surgery are performed on the same eye.
- Does not have the ability to correct hyperopia (long-sightedness).
Who is suitable for laser-assisted eye surgery?
You may consider laser-assisted eye surgery if you are at least 18 years old AND your eye prescription has been stable for at least the last 12 months.
You also need to be in general good health and free from eye diseases like cataract and glaucoma.
You also need to have sufficiently thick cornea and the cornea is not bulgy (a sign of keratoconus).
For ladies, you should not be pregnant as hormonal changes occur during pregnancy and can affect vision. You can consider laser-assisted eye surgery after you give birth.
Considerations before laser-assisted eye surgery – who to choose?
There are plenty of choices when it comes to laser-assisted eye surgery. Below is a list of factors for your consideration when choosing where and who to go to:
Surgeon experience – Read up on surgeons’ credentials and see what their area of speciality is. There are various subspecialties in the eye and it is prudent to choose a surgeon who is experienced in refractive surgery and with the cornea (the part of the eye where laser surgery is performed). You may also check with your surgeon the number of surgeries he/she has performed as you likely want to consider a surgeon who has performed a considerable number of surgeries. Consider seeking out a surgeon who can offer you a comprehensive list of refractive surgery options so he or he is able to recommend the best possible surgical option based on your eye condition.
Laser technology – There are many brands of laser machines in the market and while they serve the same objective which is to remove corneal tissue to reshape the cornea, they all differ in technology, surgical techniques and features. For example, some laser machines:
- Removes more corneal tissue for the same amount of eye prescription.
- Do not offer the option of customised treatments like the Wavefront-guided treatment which aims for a better quality of day and time vision.
- Are not able to offer a 2nd treatment (enhancement) when needed.
Enhancement rate – Check with the laser surgeon his/her enhancement rate ie how many patients needed a 2nd laser surgery to sharpen the vision.
Speak to friends and family (F&F) – It is always good to have F&F who have had the surgery to share their own experience
Read up and research: Seek out reviews on Google or other platforms to see public sentiments on the laser surgeon and eye centre.
Have a pre-laser evaluation: Nothing beats experiencing the process yourself by having a pre-laser evaluation with your chosen laser surgeon and eye centre:
- Did you have the right chemistry with the laser surgeon?
- Were you given the opportunity to ask all the questions you wanted to ask?
- Did you feel you could entrust your eyes to the laser surgeon?
- Had they been transparent and clear about their fee structure?
- Were the staff friendly, helpful and responsive?
Consult a laser eye surgery specialist
If you have enough of glasses and contact lenses and feel like it is time to evoke a change in your quality of life, please contact Lang Eye Centre at +65 6684 1000 or [email protected] for a comprehensive pre-laser evaluation to ascertain your suitability for laser eye surgery.
References:
https://www.channelnewsasia.com/advertorial/keeping-eye-myopia-singapore-2319171
