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ashleigh
from Singapore asked a question

Is it possible to have different LASIK procedures done on my left and right eye?

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Dr David Chan
Dr David Chan
(9 Reviews)
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Dr Claudine Pang
Dr Claudine Pang
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Eye & LASIK

I am 29 years old, with heavy astigmatism in one eye and relatively light myopia in the other (200+). Is there a possibility that I will receive a different LASIK procedure for each eye? Are there any incidences of people receiving different procedures in each eyes, and what are the cons of it?

DOCTOR’S ANSWER (4)
Dear Choohua,

It is not the usual thing to have different refractive  laser procedures done on each eye as logistically it is more convenient to perform the same technique on both eyes. Also, the recovery, possible risks, complications and side effects are different for the different procedures. However, in certain situations, different procedures may be chosen for the different eyes:

1) if there are selection criteria that excludes one eye from having a particular technique such as insufficient cornea thickness or irregular features on the cornea scans for Lasik/ Smile, or inadequate chamber depth for ICL  etc.

2) research purposes. Some centers offer trials to compare the results of different lasers / techniques. If you are offered this, make sure you understand thoroughly what you are signing up for. 

3) in the case of complication during original intended surgery, eg. flap creation issues during Lasik or suction loss during certain stages of Smile that make a repeat treatment using the same technique impossible. Possible remedies may then be with a different technique such as surface ablation or ICL 

The choice of laser refractive technique depends on many things like the person’s lifestyle, eye anatomy and measurements etc. Yet even in the same person, the two eyes may not be alike. Hence even though in general it is more natural to have the same procedure in the two eyes, when this is not possible, the next best thing may be having different procedures in the two eyes. 

And count that as luck too, coz there are actually people who don’t qualify for any refractive surgery whatsoever, not Lasik, Smile, surface ablation nor ICL, and will have to stick to glasses and / or contact lenses until such time when a lens extraction surgery is called for.

Best wishes and cheerio

Daphne Han

0 394 views 0 Doctors agree Thu May 17 2018 09:00:26 GMT+0000 (UTC)

Dear ashleigh

Laser vision correction (LVC) in all its forms helps patients correct their refractive errors by way of changing the curvature of the cornea. The various generations of LVC do so in slightly different ways that present unique sets of pros and cons in each of them. 

Advanced Surface Ablation (ASA), including PRK, TransPRK, Epi-LASIK and LASEK, is a great option in low degrees, thinner corneas and in patients who wish to avoid the risk of LASIK flap dislodgement due to their occupation or sport activities.

Femto-LASIK overtook ASA in terms of popularity primarily due to its speed of visual recovery and comfort. In addition, it has proven to be able to provide excellent results through a wider range of refractive errors compared to ASA. However, some eyes may not be eligible for LASIK due to insufficient corneal thickness or in patients wanting to avoid the risks of flap complications and dislodgement. 

ReLEx SMILE developed through lessons learnt from both ASA and Femto-LASIK, tries to combine the advantages of both previous generations of LVC by having the speed of recovery and comfort of LASIK and the avoidance of flap-related complications offered by ASA.

Now that I have walked you through a brief outline of the various advantages and limitations of the above types of LVC, you would appreciate that any serious laser centre should have the ability to offer the entire range of techniques to customise the treatment not just to the patient but to each eye as well.

I do agree with Dr Por Yong Ming that it is not often that we have to resort to applying to 2 different techniques in the same patient. 

An example of why this scenario might arise would be the need to maintain a healthy amount of corneal thickness in both eyes resulting, with ASA being applied to the eye with lesser available amount of cornea to laser as ASA causes less corneal thinning compared to both LASIK and ReLEx SMILE. However, do remember that ASA has a smaller range of correcting refractive errors than LASIK or ReLEx SMILE.

There are many other permutations of “combinations” treatments. Suffice to say, it is best you have your eyes properly assessed for LVC suitability and have your trusted surgeon discuss the treatment options that best suits your eyes.

Dr David Chan

0 315 views 0 Doctors agree Wed May 23 2018 14:01:57 GMT+0000 (UTC)

Yes, it is possible to have any combination of different refractive procedures done on each eye. Example: 

1. epiLASIK/PRK in one eye and LASIK in the other

2. epiLASIK/PRK in one eye and SMILE in the other

3. LASIK in one eye and SMILE in the other

4. ICL in one eye and LASIK in the other

5. ICL in one eye and epiLASIK/PRK in the other

and etc...

But it is very uncommon for a particular person to have a different procedure for each eye for various reasons, one of the most important being that there could be large differences in time taken for recovery between the different procedures.

If you are referring purely to LASIK, then the procedure is the same except that the spectacle power being treated could be different between the 2 eyes-eg mainly astigmatism in one eye and mainly myopia in the other.

All LASIK procedures operate on the same principle ie a femtosecond laser to create the corneal flap, followed by an excimer laser to reshape the cornea.

Excimer lasers nowadays treat astigmatism very well, up to around 400-500 degrees. Beyond that, ICL surgery is probably the better option.

However, if there is really such a large difference in astigmatism between the two eyes, it would be advisable to check for certain eye conditions that could be underlying this difference. As such, if you are thinking of refractive surgery, the best advice would be to go for a thorough eye check by a refractive surgeon, so that after looking at the results of all the tests, more definitive advice can be given in your particular case.

0 400 views 0 Doctors agree Thu May 17 2018 06:14:17 GMT+0000 (UTC)

Hi Choo Hua 

Yes - absolutely it is possible to have different laser-refractive procedures performed in each eye. This may occur if you have a strong desire to have a certain procedure to be performed (e.g. Smile / RELEX) but may not be suitable to have this done in one eye (for example due to high myopia).

One eye can have normal femto-assisted Lasik, whilst the other eye may have Smile / ReLEX procedure performed. The disadvantage is that you may have to be moved between machines between one eye and the next. 

This is not commonly done however, as most patients don't normally feel so strongly about having one procedure done over the other. 

Cheers

ESG

0 403 views 0 Doctors agree Thu May 17 2018 05:28:59 GMT+0000 (UTC)
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