Laser eye surgery types and procedures

Here we present the most popular and best eye laser procedures from EyeLaser Vienna and Linz:

  • Femto-LASIK 7D
  • Trans-PRK 7D
  • SmartSight
  • PresbyMAX for presbyopia
  • Lens surgery
    • Lens replacement
    • Lens implantation

You will learn how the different types and procedures of laser eye surgery work, which requirements must be met, and what advantages, risks and side effects you can expect!

A wide range of laser eye procedures for every visual defect:

Modern ophthalmology has made considerable progress in recent decades, particularly in the field of refractive surgery. Today, a variety of laser eye procedures are available that can effectively correct almost any visual defect. Whether short-sightedness, long-sightedness, astigmatism or presbyopia – there is a tailor-made solution for every visual defect.

Procedures such as Femto-LASIK 7D, Trans-PRK 7D and SmartSight (ReLEx SMILE) offer precise and reliable corrections, while lens surgery with ICL Phake lenses and cataract surgery provide additional options for patients with more complex visual defects or cataracts. There are also specialized treatments such as crosslinking, which was developed especially for patients with keratoconus . This variety of procedures enables ophthalmologists to respond to the individual needs of each patient and achieve the best possible vision.

Development of the technology:

1980s: Photorefractive keratectomy (PRK)

  • First laser eye treatment in which the epithelium is removed and the cornea is shaped.

1990s: Introduction of LASIK

  • Incision of a corneal flap that is folded to the side to shape the underlying tissue.

2000s: Femto-LASIK

  • Use of a femtosecond laser for precise creation of the corneal flap – increased safety and accuracy.

2000s: Trans-PRK

  • Further development of PRK, in which the epithelium is ablated directly with the laser, which reduces the risk of complications.

2010s: Introduction of SMILE technology

  • Minimally invasive method in which a piece of lens (lenticule) is prepared inside the cornea and removed through a small incision.

Femto-LASIK 7D:

How does Femto-LASIK work?

Femto-LASIK 7D is an advanced method of laser eye surgery that offers maximum precision and safety. It combines the advantages of Femto-LASIK technology with a 7-dimensional (7D) tracking system to follow and compensate for the patient’s eye movements in real time during the procedure. Here is a detailed description of how it works:

Steps of Femto-LASIK 7D:

1. preparation and anesthesia: The eye is anesthetized with anesthetic drops to avoid pain. The patient is asked to focus on a target light to stabilize the eye.

2. creation of the corneal flap:

  • A femtosecond laser, which emits extremely short pulses of light, is used to create a thin, precise corneal flap. The laser works in a high-frequency range, which enables a very fine and clean incision to be made.
  • The 7D tracker monitors and compensates for any eye movements in real time to ensure that the laser works exactly where it is supposed to.

3. shaping of the corneal tissue:

  • Once the flap has been created, it is carefully folded to the side to expose the underlying corneal tissue.
  • An excimer laser then reshapes the cornea to correct the defective vision. The laser beam is controlled with millimeter precision to achieve the desired correction of the refractive power of the cornea.

4. reclosure of the corneal flap:

  • After reshaping, the corneal flap is folded back again and smoothed out. It adheres without sutures due to the natural adhesive properties of the cornea.

Eligibility criteria for LASIK

  • At least 18 years old
  • Stable visual defect – no change in the last 12 months
  • Short-sightedness: up to -10 diopters
  • Farsightedness: up to +4 diopters
  • Astigmatism: up to 5 diopters
  • Sufficient corneal thickness

Femto-LASIK 7D advantages

1. highest precision

  • Femtosecond laser: The use of a femtosecond laser enables extremely precise incisions and the exact creation of the corneal flap, which increases the accuracy of the procedure.
  • 7D tracking: The 7-dimensional tracking system monitors and compensates in real time for any patient eye movements during the procedure, which further increases precision and minimizes the risk of errors.

2. increased security

  • Minimal tissue damage: The femtosecond laser works with ultra-short light pulses that damage less tissue and accelerate healing.
  • Reduced risk of complications: High precision and real-time monitoring reduces complications such as irregular flaps or corneal inflammation.

3. fast healing

  • Shorter recovery time: The minimally invasive nature of the procedure allows for faster healing and a quick return to normal activities, often as early as the next day.
  • Less postoperative discomfort: Patients report less pain and discomfort after the procedure compared to other methods.

4. excellent visual results

  • Better vision: The precise correction of the cornea leads to excellent visual results, often immediately after the procedure.
  • Stable results: Corrections are stable over the long term, meaning patients can enjoy improved vision for many years to come.

5. broad suitability

  • Versatility: The method is suitable for a wide range of visual defects, including high myopia, hyperopia and astigmatism. Even patients with thinner corneas can often benefit from Femto-LASIK 7D.
  • Individualized treatment: The system can be individually adapted to the eye structure of each patient, which enables customized treatment.

6. improved comfort

  • Painless treatment: The procedure is virtually painless, both during the operation and in the recovery phase.
  • Lower risk of dry eyes: Due to the more precise incision and less tissue ablation, there is a lower risk of dry eyes after the procedure.
More about Femto-LASIK 7D

Risks and side effects

Although Femto-LASIK 7D is considered one of the safest and most effective methods of vision correction, there are still some risks, side effects and disadvantages that should be considered:

Risks

  • Infections: As with any surgical procedure, there is a small risk of infection. Careful post-operative care is important to minimize this risk.
  • Flap complications: Problems with the corneal flap, such as irregular incisions or displacement, can occur but are rare thanks to the precision of the femtosecond laser.
  • Under- or overcorrection: In some cases, vision correction may not be completely successful, resulting in under- or overcorrection. Further surgery may be necessary to achieve the desired vision.

Side effects

  • Dry eyes: Many patients experience temporary dry eyes after the procedure. This can last for several weeks to months, but can usually be treated with eye drops.
  • Halos and glare: Some patients report halos or glare around light sources, especially at night. These symptoms are usually temporary, but in rare cases can last longer.
  • Temporary visual disturbances: Slight visual disturbances such as blurred vision or double vision may occur in the first few days after the procedure, which usually improve quickly.
Doctors carry out laser treatment on the eye.

Trans-PRK 7D:

How does the Trans-PRK work?

Trans-PRK (Transepithelial Photorefractive Keratectomy) is an advanced form of PRK (Photorefractive Keratectomy) that provides a surface treatment of the cornea to correct visual defects. Here is a detailed description of how it works:

Steps of the Trans-PRK:

1. preparation:

  • The patient’s eyes are anesthetized with anesthetic drops to avoid pain during the procedure.
  • A special excimer laser device is prepared to perform the procedure.

2. removal of the epithelium:

  • In contrast to conventional PRK, in which the epithelium is removed manually, in trans-PRK the epithelium is removed directly using the excimer laser. This step only takes a few seconds and is very precise, exposing the underlying corneal tissue.

3. remodeling of the cornea:

  • After the epithelium has been removed, the excimer laser is used to change the shape of the cornea. The laser removes microscopic layers of corneal tissue to correct the curvature of the cornea. This is done in accordance with the patient’s specific visual defects, be it short-sightedness, long-sightedness or astigmatism.

4. healing and regeneration:

  • After laser treatment, the cornea begins to heal immediately. The epithelium regenerates within a few days, allowing the protective layer of the cornea to be restored quickly.
  • The patient is given protective contact lenses that act as a bandage and support the healing process. These contact lenses are removed after a few days.

Suitability criteria at a glance

  • At least 18 years old
  • Stable visual defect – no change in the last 12 months
  • Short-sightedness: up to -8 diopters
  • Farsightedness: up to +3 diopters
  • Astigmatism: up to 3 diopters
  • Sufficient corneal thickness

Trans-PRK 7D Advantages

1. no mechanical removal of the epithelium

  • Gentle procedure: The epithelium is removed directly with the laser, avoiding mechanical damage.
  • Reduced risk of complications: The uniform removal of the epithelium with the laser reduces the risk of complications that could occur with manual removal of the epithelium.

2. precision and safety

  • 7D tracking system: The 7-dimensional tracking system monitors and compensates for eye movements in real time, which increases the precision of the procedure and minimizes the risk of errors.
  • High precision: The use of the latest laser technology enables extremely precise correction of the cornea, which leads to better visual results.

3. fast healing process

  • Less pain: Patients report less pain and discomfort after the procedure compared to traditional methods.
  • Rapid recovery: The epithelium regenerates within a few days, speeding up the healing process and allowing patients to return to their normal activities more quickly.

4. broad suitability

  • Suitable for thin corneas: Trans-PRK is particularly suitable for patients who have a thin cornea and are therefore not suitable for other laser treatments such as LASIK.
  • Versatility: The method can correct a variety of visual defects such as short-sightedness, long-sightedness and astigmatism.

5. long-term stability

  • Lasting results: Studies show that vision correction through Trans-PRK is stable over the long term, ensuring a lasting improvement in vision quality.

6. fewer side effects

  • No risk of flap complications: Since no corneal flap is created during Trans-PRK, there is no risk of flap complications that can occur with other procedures such as LASIK.
  • Less chance of dry eyes: Patients often have fewer problems with dry eyes after the procedure as the nerves in the cornea are less affected.
More about Trans-PRK 7D

Risks and side effects

Although Trans-PRK 7D is considered safe and effective, there are potential risks and side effects, as with any surgical procedure.

Risks

  • Infections: As with any laser eye surgery, there is a small risk of infection. Careful post-operative care and the use of antibiotic eye drops help to minimize this risk.
  • Scarring: In rare cases, scarring may occur on the cornea, which can impair vision.
  • Under- or overcorrection: In some cases, the desired vision correction cannot be fully achieved, resulting in under- or overcorrection. Further surgery may be required to achieve optimal vision.

Side effects

  • Dry eyes: Many patients experience temporary dry eyes after the procedure. This can last for several weeks to months, but can usually be treated with moisturizing eye drops.
  • Halos and glare: Some patients report halos or glare around light sources, especially at night. These symptoms are usually temporary, but can persist for longer in rare cases.
  • Temporary visual disturbances: Slight visual disturbances such as blurred vision or double vision may occur in the first few days after the procedure, which usually improve quickly.
  • Pain and discomfort: During the healing phase, pain, a foreign body sensation in the eye and sensitivity to light may occur. These symptoms usually subside within a few days.

Disadvantages

  • Longer healing time compared to LASIK: The healing time with Trans-PRK is longer than with LASIK, as the epithelium has to grow again.
  • More post-operative care required: Patients must carefully follow post-operative care and medication instructions to ensure optimal healing.

Lenticular extraction: SmartSight / ReLEx SMILE

How SmartSight works

SmartSight, also known as ReLEx SMILE (Small Incision Lenticule Extraction), is a modern and minimally invasive method for correcting visual defects such as myopia and astigmatism. The technology uses a femtosecond laser to make precise incisions in the cornea and remove a small piece of tissue (lenticule) to change the curvature of the cornea. Here is a detailed description of how it works:

Steps of the SmartSight (ReLEx SMILE):

1. preparation and anesthesia:

  • The patient’s eye is anesthetized with anesthetic drops to avoid pain during the procedure.
  • The patient is asked to focus on a fixation light to stabilize the eye.

2. creation of the lenticel:

  • A femtosecond laser is used to prepare a thin, disc-shaped piece of tissue (lenticule) inside the cornea. This step is performed with the utmost precision and only takes a few seconds.
  • At the same time, a small access incision of about 2-4 mm is made in the cornea.

3. removal of the lenticel:

  • The prepared lenticule is carefully removed through the small incision. This step changes the curvature of the cornea, which corrects the visual defects.

4. healing and regeneration:

  • Once the lenticule has been removed, the cornea begins to heal immediately. As the procedure is minimally invasive and only a small incision is required, the recovery time is usually short.
  • The small incision heals by itself without stitches, and the patient can often notice a significant improvement in vision the very next day.

Who is SmartSight suitable for?

  • At least 18 years old
  • Stable visual defect – no change in the last 12 months
  • Short-sightedness: up to -10 diopters
  • Farsightedness: correction not possible
  • Astigmatism: up to 5 diopters
  • Sufficient corneal thickness

Advantages of modern lenticel extraction

1. minimally invasive

  • Small access incision: The procedure is performed through a very small incision of only about 2-4 mm, which causes less tissue trauma and accelerates healing.
  • No flap creation: Unlike LASIK, where a corneal flap is created, the corneal structure remains intact, eliminating the risk of flap complications.

2. rapid healing and recovery

  • Less post-operative discomfort: Patients report less pain and a faster healing process compared to other procedures.
  • Rapid return to normal activities: Most patients can resume normal activities the very next day.

3. excellent visual results

  • Precise correction: The femtosecond laser enables high-precision correction of the cornea, which leads to excellent visual results.
  • Stable results: The changes to the cornea are permanent and lead to long-term stable visual results.

4. lower risk of side effects

  • Less dry eyes: As there is no flap creation, fewer nerves in the cornea are damaged, which reduces the risk of dry eyes.
  • Reduced risk of infection: The smaller incision and minimally invasive nature of the procedure reduce the risk of post-operative infections.

5. broad suitability

  • Suitable for many patients: SmartSight is suitable for a wide range of patients with myopia up to -10 diopters and astigmatism up to 5 diopters.
  • Also for thin corneas: Patients with thinner corneas, who may not be suitable for LASIK, can often benefit from SmartSight.

6. comfort and safety

  • Gentle procedure: The entire procedure is virtually painless and is performed under local anesthesia.
  • High safety standards: The use of state-of-the-art femtosecond lasers ensures maximum precision and safety.

7. short treatment duration

  • Quick procedure: The entire procedure only takes a few minutes per eye, which increases patient comfort and minimizes stress.
More about SmartSight

Risks and side effects

Risks

  • Infections: Despite the minimally invasive nature of the procedure, there is a small risk of postoperative infection. This risk can be minimized by careful post-operative care and the use of antibiotic eye drops.
  • Under- or overcorrection: In some cases, the desired vision correction cannot be fully achieved, resulting in under- or overcorrection. In such cases, follow-up treatment may be necessary.
  • Loss of visual acuity: In rare cases, loss of visual acuity may occur, especially if complications arise during the healing process.

Side effects

  • Dry eyes: Many patients experience temporary dry eyes after the procedure. This can last for several weeks to months, but can usually be treated with moisturizing eye drops.
  • Halos and glare: Some patients report halos or glare around light sources, especially at night. These symptoms are usually temporary, but can persist for longer in rare cases.
  • Temporary visual disturbances: Slight visual disturbances such as blurred vision or double vision may occur in the first few days after the procedure, which usually improve quickly.
  • Pain and discomfort: During the healing phase, pain, a foreign body sensation in the eye and sensitivity to light may occur. These symptoms usually subside within a few days.
  • Regression: In some cases, a regression of the correction can occur, in which the vision partially diminishes again.

Low risk of serious complications

  • No flap complications: Because SmartSight does not create a corneal flap, there is no risk of flap-related complications that can occur with LASIK.
  • Stable corneal structure: The minimally invasive nature of the procedure helps to maintain the structural integrity of the cornea, increasing long-term safety and stability.

PresbyMAX for presbyopia:

PresbyMAX is a specialized laser treatment for the correction of presbyopia, which offers an innovative and precise method for improving vision in people aged 40 and over.

How it works:

PresbyMAX uses an excimer laser to reshape the cornea and create multifocal zones. These zones allow the eye to see objects in focus at different distances by optimizing both central and peripheral vision.

Suitability:

The method is ideal for patients who suffer from presbyopia and no longer wish to wear glasses or contact lenses. It is suitable for people aged 40 and over with stable vision and no serious eye diseases such as cataracts or glaucoma.

Advantages:

  • Improved near and far vision: Patients can see both near and distant objects clearly after treatment.
  • Minimally invasive: The procedure is gentle and only takes a few minutes per eye.
  • Rapid recovery: Most patients can return to their normal activities the very next day.

Side effects:

  • Dry eyes: Temporary dryness and irritation of the eyes are possible, but can usually be treated well with eye drops.
  • Halos and glare: Some patients report halos or glare around light sources, especially at night. These symptoms usually subside after a few weeks.
More about PresbyMAX
Patient during laser eye diagnostics

Lens surgery instead of laser eye surgery: The alternative

In addition to laser vision correction, lens surgery offers an excellent alternative for treating visual defects. Two particularly effective procedures are the implantation of ICL Phake lenses and lens replacement with multifocal lenses, also known as cataract surgery.

ICL Phake lenses (lens implantation):

ICL (Implantable Collamer Lens) Phakic lenses are specially developed lenses that are implanted in addition to the eye’s natural lens. This procedure is particularly suitable for patients with high diopter values for whom laser procedures are not an option. The procedure is minimally invasive and reversible, meaning that the lens can be removed again if necessary. Benefits include excellent quality of vision and a quick recovery time. Possible side effects include the risk of infection and inflammation.

More about lens implantation

Lens exchange with multifocal lenses (cataract surgery):

Lens replacement, often performed as part of cataract surgery, replaces the natural, cloudy lens with a clear artificial lens. When multifocal lenses are used, both near and distance vision can be corrected, which is particularly beneficial for patients with presbyopia. This procedure offers a permanent solution and significantly improves quality of life. Risks and side effects can include post-operative infections and glare, but these are rare.

More about lens replacement

How to find the right laser eye surgery

Choosing the right laser eye surgery procedure is an important decision for your vision and quality of life. At EyeLaser, we offer a variety of modern and proven procedures to ensure that we can offer the best solution for your individual needs.

Your next step:

Arrange a free, no-obligation suitability test at EyeLaser to find out which procedure is best for you. Our experienced ophthalmologists will give you comprehensive advice and carry out a detailed examination of your eyes. Take this opportunity to ask your questions and find the best treatment options for you.

Make an appointment
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Author:

Dr. Victor Derhartunian

Nachdem er sein Handwerk von den beiden Pionieren der Laserchirurgie gelernt hat, gehört Dr. Victor Derhartunian zu den führenden Augenlaser-Chirurgen. Er leitet die Praxis in Wien und kann seine Patienten in fünf Sprachen beraten.