Laser eye surgery is a refractive surgery procedure that is becoming increasingly popular. Keratomileusis – this is the name given to surgical techniques in refractive surgery that can change the refractive power of the eye by processing the cornea. Over the years, laser eye surgery methods have developed considerably. As a result, patients suffering from defective vision can now enjoy precise and customized treatment. You can find out more about the various laser eye procedures, their development and the advantages and disadvantages for you as a patient in this article.

PRK – laser eye surgery with a proven procedure

The laser eye procedure PRK (photorefractive keratectomy) is one of the oldest and most tried and tested methods. The PRK method offers several advantages: In contrast to other laser eye treatments, no corneal flap is created here, which means that no flap-related complications can occur. In addition, PRK surgery is possible for patients with a thin cornea.

The procedure can correct various visual defects: Short-sightedness (myopia), long-sightedness (hyperopia) and astigmatism. The procedure can be used both as an initial treatment and as a follow-up treatment if the result of a previous eye operation was not optimal (especially with LASIK). A short treatment time of 10 minutes per eye – after which patients can enjoy better vision. Both eyes can be corrected in one session.

Procedure for PRK laser eye treatment

A preliminary examination takes place before every laser eye treatment. The procedure itself is usually performed on an outpatient basis. The procedure is as follows:

1. Anesthetic eye drops are applied and ensure a pain-free procedure.
2. The corneal epithelium is removed.
3. An excimer laser is used to treat the underlying cornea, thereby changing the refractive power of the eye.
4. A protective lens is inserted and ensures that the healing process goes as smoothly as possible.

However, it should be noted that the healing process for PRK methods generally takes longer than for other laser eye surgery methods. In addition, patients who have been treated with PRK more frequently report postoperative pain.

Further development of the PRK method

LASEK – an advanced variant of PRK. Laser treatment with LASEK is characterized by the fact that the corneal epithelium is first treated with alcohol. The alcohol then allows the epithelium to be lifted with instruments and pushed aside. This is followed by treatment with the excimer laser – as with PRK. After the procedure, the epithelium is returned to its original position. However, treatment with alcohol often leads to irritation and complications, which is why this method is used less frequently nowadays.

Trans-PRK – a gentle no-touch procedure for laser eye surgery

Trans-PRK (Transepithal Photorefractive Keratectomy) is an alternative and more innovative procedure to PRK methods. Thanks to the no-touch procedure, Trans-PRK is considered a gentler method. Patients enjoy a shorter healing time and a lower risk of complications. Trans-PRK is suitable for people with a thin cornea. It can be used to correct visual defects with the following application limits:

• Myopia up to -6 diopters
• Farsightedness up to +3 diopters
• Corneal curvature up to 5 diopters

Trans-PRK: difference to simple PRK treatment

In contrast to PRK and LASEK, with Trans-PRK the eye to be operated on is not touched and treated mechanically, but only by a laser. Trans-PRK is therefore also referred to as a no-touch procedure.

After anesthetic eye drops have been applied, the epithelium is removed using an excimer laser. This is followed by the actual treatment of the cornea – also using the excimer laser. The therapeutic contact lenses that are then inserted provide the necessary protection after the laser operation. The epithelium regenerates within a few days.

Femto-LASIK – laser eye surgery using the latest methods

The Femto-LASIK method is one of the more modern laser eye surgery procedures. Here too, short-sightedness or long-sightedness and astigmatism can be corrected. The range of application of Femto-LASIK is relatively wide, which is why the method is suitable for around 95% of all patients with glasses or contact lenses if there are no other reasons for exclusion. The limit ranges are as follows:

• Myopia up to −8 diopters
• Farsightedness up to +3 diopters
• Corneal curvature up to 5 diopters

Femto-LASIK procedure

The operation itself only takes about 30 seconds per eye. Including the preparation and follow-up of the eye operation, the procedure is completed in just a few minutes.

In Femto-LASIK, the top layer of the cornea is opened and folded to the side – a so-called flap is created. A state-of-the-art femtosecond laser is used for this purpose. This enables particularly thin corneal flaps to be created. After the eye has been prepared, the actual correction of the visual defect is carried out using an excimer laser.

Advantages and disadvantages of Femto-LASIK

Overall, it should be noted that a corneal flap is created during Femto-LASIK. This means that laser surgery is associated with flap-related risks. Flap-related complications include, for example

• Slipping of the flap
• Separation of the flap
• Flap folds

Femto-LASIK is generally considered to be a painless procedure. Some patients only feel a sensation of pressure during the treatment. The modern femtosecond laser ensures fast treatment. In addition, the corneal flap created acts like a natural plaster, allowing the eye to recover quickly. Accordingly, the healing time after femto LASIK treatment is short. Patients notice improved visual acuity within a few hours. The healing process is usually completed after around four weeks.

LASIK and Femto-LASIK: What is the difference?

Femto-LASIK is an innovation compared to the originally developed simple LASIK (laser in situ keratomileusis) treatment. LASIK is an older and more common method of laser eye surgery. A flap is created with both LASIK and Femto-LASIK – the procedures differ in how the flap is created.

With LASIK, a small incision is made in the cornea using a microkeratome. This is a precise electronically controlled microscalpel. The disadvantage of using a microkeratome is that the risk of infection is higher than with a laser procedure. In addition, a laser can work more precisely.

This is exactly where it’s worth asking for clarification. The term “LASIK” doesn’t actually indicate whether the flap was created using a microkeratome or a femtosecond laser. Both methods can be called LASIK, and some providers advertise using the term even though they use mechanical cutting. Therefore, before any treatment, be sure to ask specifically: Which device creates the flap? At our clinic, we use the SCHWIND ATOS femtosecond laser; the SCHWIND Amaris 1050 RS performs the correction. We do not use a microkeratome.

Procedures that we deliberately do not offer

There are more refractive surgery techniques than we use. This is a conscious choice, not a shortcoming: We focus on two methods that we perform daily, using a single platform of equipment that we have mastered completely. That’s why anyone who asks us will get an honest answer if another approach would make more sense.

Lenticule Extraction: ReLEx SMILE and SmartSight

In these procedures, no flap is created. Instead, a femtosecond laser cuts out a lens-shaped piece of tissue—the lenticule—from inside the cornea and removes it through a small incision. This protects the corneal nerves and is an advantage for patients with dry eyes.

We do not offer these procedures. For the types of vision problems we treat, Femto-LASIK and Trans-PRK achieve comparable results—at a price we could not maintain with lenticule extraction. If you are specifically looking for a lenticule procedure, we will be upfront with you about this during the initial consultation.

Lens Procedures: ICL, Lens Exchange, and Intraocular Lenses

If the refractive error is too severe or the cornea is too thin, the laser reaches its limits. In that case, the procedure focuses on the lens rather than the cornea: an implantable contact lens (ICL) is inserted in addition to the natural lens, while in lens exchange, the natural lens is replaced with an artificial lens.

These procedures are also not part of our services. They are more complex, more expensive, and involve different risk considerations than laser vision correction. If your measurements fall outside the range we can safely treat, we’ll let you know—and we won’t send you in for laser surgery with borderline results.

Presbyopia and Cataracts

Presbyopia occurs because the natural lens loses its elasticity starting around age 45. With cataracts, the lens becomes cloudy. Both are changes in the lens—and neither can be corrected by treating the cornea. We therefore do not treat either condition.

You can find detailed information about cataracts and their treatment at kataraktlaser.at.

Conclusion: Two Procedures, Two Prices, Clear Boundaries

For nearsightedness up to −8 diopters, farsightedness up to +3 diopters, and astigmatism up to 5 diopters, two well-established procedures are available: Femto-LASIK and Trans-PRK. Which one is right for you isn’t determined by price—both cost €950 per eye at our clinic—but rather by your corneal thickness, your diopter values, and your daily routine.

These results will not be available until after the preliminary examination. Our two-minute self-test will give you an initial indication of whether laser vision correction is generally an option for you. The criteria we use are clearly outlined in the KRC recommendations.