You’ve thought long and hard about getting LASIK done in Singapore, but don’t know where to start. You're also too lazy to sift through all the information on the internet, or to go for one of those LASIK education seminars.
I don't blame you at all - the range of choices in terms of LASIK procedures, pricing and technologies offered by various eye centres here in Singapore can be bewildering.
Fortunately, you've have come to just the right place! With this comprehensive 3000 words LASIK guide I’ve put together, you now have a all-in-one resource to help you make the best possible decision, based on your eye condition and needs. After all, you only get one shot with your eyes!
First up, what does LASIK correct?
LASIK is able to correct the following conditions:
- Short-sightedness (myopia) from 100 to 1,000 degrees
- Long-sightedness (hyperopia) up to 300 degrees
- Astigmatism up to 300 degrees
I'm also often asked what the ideal age for LASIK is. The main consideration is that your "eye power" should be stabilised - this should be the case by the time you are 18 years old.
Are you suitable for LASIK?
Many patients assume that LASIK is the solution for anyone who wants to stop using spectacles and contact lenses – I admit that aggressive advertising in Singapore is to blame for this presumption.
It is certainly NOT for everyone, and I've had to reject patients for the following reasons:
- Age below 18 years old, because your eye is still changing into adulthood (parental consent is needed for those below 21 years)
- Unstable eye prescription in the past 12 months
- Poor health
- Presence of eye disease (including cataracts)
- Women who are pregnant/breastfeeding
- Severe dry eye syndrome
- Thin corneas
- Irregularly-shaped or steep corneas
How will you be assessed to determine if you are suitable for LASIK?
A pre-laser evaluation process of about 3 hours will be conducted to assess your suitability for LASIK.
You are required to stop using soft contact lenses at least 3 days before the evaluation, or at least 14 days for hard lenses.
The evaluation consists of various tests ranging from:
- Checking for cornea thickness and shape, to
- Intraocular pressure and visual acuity
Note that eyedrops to dilate your eyes will be applied. This will affect near vision for 4 to 6 hours and cause some sensitivity to bright lights, so bring along your sunglasses!
At the end of the evaluation, your eye surgeon will share with you the results and the options available. Take this opportunity to ask questions, and clear any doubts you may have.
Can you go for LASIK if you have dry eyes?
This is perhaps THE single most common question that patients ask me, so rest assured that you are not the only one with dry eyes who is considering LASIK.
LASIK does indeed make dry eye symptoms worse (albeit temporarily, for the most part). An assessment as to whether someone with dry eyes is suitable for LASIK needs to take into account:
- The severity of your dryness
- The reversibility (or not) of your dryness
Patients I see with dry eyes typically lie on a spectrum, ranging from mild to severe. The good news is that most people with dry eyes lie on the mild end of this spectrum.
My advice would be:
- Prior to LASIK, have your dry eyes assessed and treated properly.
- Immediately after your LASIK procedure, treat your dry eyes aggressively to prevent symptoms from appearing. Don’t wait for symptoms to appear before starting to treat them!
- Be conscientious about using your eyedrops. Use them frequently and regularly, even if you don’t feel you need them.
You may also want to try out some of these methods for treating dry eyes before and after LASIK.
What is the best LASIK option for dry eyes?
Most eye get drier after any kind of laser corneal refractive surgery, whether it is LASIK, PRK/Epi-LASIK , or SMILE.
The good news is that any increase in dryness after LASIK is usually temporary. Most patients go back to their original state within 3 months or so.
A small number may have increased dryness of up to 6 months, and an even smaller percentage of patients (<1%) have increased dryness of up to 12 months or more.
How much does LASIK cost in Singapore?
Whether you opt for a hospital or a private clinic in Singapore – there's not much difference in costs.
This is what you can expect to pay for the 3 Laser Vision Correction procedures (for both eyes):
- Advanced Surface Ablation (Epi-LASIK, LASEK, PRK, TransPRK): $3,800 to $4,000
- LASIK: $3,500 to $4,500
- ReLEx SMILE: $5,000 to $6,000
Why the disparity in pricing? Some packages include pre- and post-operative services such as:
- The initial eye evaluation
- Follow-up reviews and enhancements
To avoid potential landmines, I recommend you pay careful attention to what is being offered.
For more information on LASIK pricing in Singapore, read this article here.
Can I use Medisave or Insurance policies for LASIK in Singapore?
As LASIK is considered an optional/elective procedure – (yes, unfortunately it is) – you are unable to use your Medisave.
However, very few Singaporeans know that you can use your Medisave for LASIK if there's a difference of 300 degrees between your eyes.
Insurance policies generally do not cover LASIK in Singapore. Some policies with higher premiums do allow for it, while some companies include it under their corporate benefits. Do call up to check with your provider beforehand!
What are the different types of LASIK in Singapore?
Many people use the term LASIK, when what they mean is Laser Vision Correction. This is understandable, as LASIK is still the most widely performed Laser Vision Correction procedure in Singapore since its introduction in the early 1990s.
There are in fact, 3 Laser Vision Correction procedures offered in Singapore today:
- Advanced Surface Ablation (Epi-LASIK, LASEK, PRK, TransPRK)
- ReLEx SMILE
This is what you need to know about the 3 types of procedures in more detail:
What Is Advanced Surface Ablation?
Procedures that fall under Advanced Surface Ablation include: Epi-LASIK, LASEK, PRK and TransPRK.
ASA is a “ no-flap, no incision, surface-based" procedure. ASA is most suitable if:
- You wish to avoid flap-related issues from LASIK (ie dry eyes, cornea ectasia, flap dislodgment )
- You are into active rugged or contact sports (as no cut or flap is made)
- You are concerned about procedure-induced dry eyes
- You have thin corneas
ASA has 3 main steps:
- The thin layer of cells on the surface of the cornea needs to be removed first.
- A laser accurately sculpts the cornea tissue to correct the refractive errors.
- A protective contact lens is placed over the eye until the surface cells grow back within a few days.
The main drawback of ASA is its relatively longer downtime of 3 to 5 days before vision reaches a level allowing for normal activities.
It also typically requires a longer duration compared to LASIK and SMILE for your vision to fully stabilise.
What is LASIK?
Laser-Assisted In Situ Keratomileusis (LASIK) improves upon ASA in the areas of discomfort and recovery time.
Although a flap is created during surgery, it's rare for patients to experience complications arising from it.
LASIK has 3 main steps:
- A femtosecond laser creates a flap with a 22mm circumferential side-cut on the surface of the cornea, which can be folded back.
- A second laser, called an excimer laser, accurately sculpts the corneal tissue to correct the refractive errors.
- The flap is repositioned, and will stay in place until it is fully healed.
LASIK is currently the most widely performed laser vison correction in Singapore. It has gained widespread acceptance amongst refractive surgeons worldwide mainly for its excellent refractive correction, especially at higher levels of myopia, its swiftness and comfortable recovery.
However, its main drawbacks include traumatic flap dislodgement and the rare complication of corneal ectasia.
What is ReLEx SMILE?
SMall Incision Lenticule Extraction (ReLEx SMILE) is a minimally invasive procedure that is flapless and offers fast recovery.
The procedure has 2 main steps:
- A laser creates a disc-shaped piece of corneal tissue (lenticule) just beneath the surface of the cornea.
- The same laser then creates a small incision of 4mm on the cornea, from which the lenticule is removed, resulting in a reshaped cornea that corrects your vision.
If you have an active lifestyle or if your job or sport entails some risk of trauma to the head or eyes, then ReLEx SMILE may be a suitable procedure for you.
The main drawback of SMILE is that it cannot correct for long-sightedness, and that enhancement after SMILE requires conversion to either LASIK or PRK/Epi-LASIK.
What's the TLDR summary of the pros/cons of each type of LASIK procedure?
Here's a summary of the main advantages of each LASIK procedure:
- ASA - No risk of flap complications as there's no flap. Lower incidence of post-procedure dry eyes. Suitable for those in contact sports. Best option for those with thin corneas. Flexibility to treat all kinds of eye power.
- SMILE - Fast visual recovery, and less worry about flap complications and dry eyes as compared to LASIK. Suitable for those in contact sports.
- LASIK - Fastest visual recovery, and least post-op discomfort. Relative ease of early enhancements. Flexibility to treat all kinds of eye power.
Here's a summary of the main disadvantages of each LASIK procedure:
- ASA - Slowest post op visual recovery.
- SMILE - Not suitable for high astigmatism or very low myopia cases. Cannot treat farsightedness.
- LASIK - Possibility of rare flap-related complications and post-procedure dry eyes.
Which is the best LASIK option for you?
If you are suitable for LASIK, the best LASIK procedure for you will depend on:
- Cornea thickness and shape – if slightly thinner, then ASA (advanced surface ablation) may be preferred
- Degree of short-sightedness – if low, ASA is recommended
- Degree of astigmatism - SMILE is not advisable for high astigmatism
- Your lifestyle, hobbies, and occupation
You and your chosen LASIK doctor will be able to determine which LASIK procedure suits you best, after a thorough consultation and eye assessment.
What are the side effects of LASIK?
Over the first few days/weeks after LASIK, you may experience some temporary side effects such as:
- Dry eye
- Mild fluctuation of vision
Severe side effects like corneal flap complications and infections are very rare with today’s modern laser platforms.
Over or under-correction of eyesight power occurs in less than 2 to 5% of cases. If your resulting prescription is+/-0.75 or more, enhancement surgery can be performed 3 months after your initial treatment.
Should you do LASIK on one eye at a time, or on both eyes together?
When doctors first started doing LASIK in Singapore, all patients were operated on one eye at a time. The reasons for this were as follows:
1. Risk of infections. We were worried that if an infection occured, it would only affect one eye.
2. Accuracy of lasers. We were unsure about the accuracy of lasers back then, and if one eye had residual spectacle power, then treating the other eye at a different time would allow the second treatment to be adjusted as necessary to take into account any inaccuracies in the first eye.
These worries proved completely unfounded, and the vast majority of cases of LASIK procedures nowadays are done with both eyes at the same sitting. This minimises your downtime after surgery.
Having said that, if you are uncomfortable with same day surgery for both eyes, surgeons are usually happy to do each eye for you on different days.
What is Collagen Cross-Linking, and do you need it?
In recent years, many eye surgeons in Singapore offer Collagen Cross-Linking (CXL) to patients as an add-on procedure on top of Laser Vision Correction.
This extra step aims to:
- Reduce the risk of spectacle power returning after LASIK
- Reduce the risk of corneal ectasia. Corneal ectasia is a rare complication where the cornea loses its ability to maintain its shape, thus affecting vision.
During CXL, drops of Vitamin B12 are applied to your eye during the laser treatment. Your eye is then shone under UV light for about 1 minute. This process activates the collagen fibres on your eye to cross-link, thereby strengthening your cornea after LASIK.
Whether you "need" to have CXL is not something that can be directly answered, as no one can predict if you may be prone to having your spectacle power return.
However, what we do know from studies is that in general, people with high powers have a higher tendency to have spectacle power return, and CXL aims to reduce the chances of that. CXL is also intended to reduce the risk of corneal ectasia, a rare complication in which the cornea loses its ability to maintain its shape many years after laser vision correction.
How do you prepare for your LASIK surgery?
As with the preparation for your first LASIK evaluation, stop using soft contact lenses at least 3 days before the evaluation, and at least 14 days for hard lenses.
If you are including Collagen Cross-Linking on top of your LASIK, do not consume Vitamin C a week before the surgery.
You can expect to spend about 2 hours in total at the eye centre during your operation, with the procedure itself taking 20 to 30 minutes for both eyes.
What happens after your LASIK procedure?
After your LASIK procedure, you'll experience blurry vision for the first 6 hours, so please have someone fetch you home after.
Use the eye shields provided while sleeping for the first week to prevent accidental rubbing of your eyes, and follow all medical instructions strictly.
Your doctor will also arrange for reviews after the surgery. The timeline for this is as follows:
- LASIK/SMILE: Reviews on the day after surgery, 1 week after surgery, 1 month after surgery, and 3 months after surgery
- ASA: Reviews on the day after surgery, 3 days after surgery, 1 week after surgery, 1 month after surgery, and 3 months after surgery. Additional reviews at 6 months for patients with high myopia.
What should you NOT do after LASIK to ensure the best recovery and outcomes?
LASIK has the fastest recovery time, followed by SMILE and then ASA.
Most LASIK and SMILE patients can go back to normal activities after 3 days of rest. For ASA patients, usually 4 - 5 days is required.
To ensure the best outcomes, do follow these precautions:
- 12 hours: Avoid heavy reading, computer work or watching TV
- 24 hours: Do not drive or operate heavy machinery
- 1 week: Do not apply eye makeup – sorry ladies…!
- 1 week: Avoid getting water into your eyes when bathing
- 1 month: No swimming, hot tubs, hot yoga, jacuzzi and sauna
- 1 month: Avoid contact sports, and use a headband when exercising to prevent sweat from entering your eyes
Do LASIK results last forever? What are the chances of regression?
More than 95% of patients enjoy good vision many years after LASIK. However, up to 6% of patients may require an enhancement procedure for short-sightedness, long-sightedness or astigmatism within 10 years of the original surgery.
If required, you can still safely undergo surgery for Cataracts, Glaucoma and Macular Degeneration (eye diseases typically seen in older folks) as necessary.
Can you still wear contact lenses after LASIK?
My patients often ask this question. Commonly, post-LASIK patients still love wearing cosmetic and coloured contact lenses to give them that large-eyed “manga-doll” like look.
The answer is yes; wearing contact lenses is still possible 1 - 3 months after your LASIK surgery.
However, due to the altered shape of your cornea post-LASIK, your contact lenses may not fit as well. They may also have a tendency to fall out, especially if your eye is dry.
To prevent this, you should have an optometrist adjust the shape of the contact lens, which allows for a better fit between the contact lens and your cornea.
Which LASIK doctor should I choose?
In choosing the best LASIK doctor for yourself, you should take into consideration the following:
- The ability of the eye surgeon to listen and to provide an unbiased consultation
- Transparency in pricing with no hard-sell or upselling
- Credentials of the eye surgeon and eye centre
- The number of patients at the centre who require enhancement after LASIK surgery
Ultimately, I always believe you should choose the eye surgeon and/or eye centre you feel the most comfortable with, so you should definitely consider getting a few opinions by sending in a free enquiry to various LASIK centres in Singapore here.
After all, your sight is precious, and you should do all you can to ensure a successful outcome.
Dr David Chan is the Medical Director at Atlas Eye Specialist Centre. He has been in ophthalmology practice since 1999. Dr David was previously a Surgical Instructor at the Singapore National Eye Centre and University of Calgary, Canada. In his free time, he enjoys digital photography.