Surgical procedures performed to achieve permanent, clear vision without the need for glasses or contact lenses are called refractive surgery. Excimer laser is one of the methods used in refractive surgery.
The excimer laser emits energy in the form of high-energy photons, which break the carbon-carbon and carbon-nitrogen bonds in the corneal tissue, causing it to vaporize without damaging the surrounding corneal tissue. This effect of the excimer laser is called photoablation. Using this method, the corneal tissue can be reshaped and thinned to correct refractive errors, depending on the type and degree of vision problem.
There are two main refractive surgery methods that use excimer lasers:
In the PRK method, the excimer laser is applied directly to the surface of the cornea. Since the outermost layer of the cornea, the epithelium, is also affected in PRK, patients may experience prolonged burning, stinging, and blurred vision. Complete recovery takes longer compared to LASIK. Additionally, there is a higher risk of corneal haze (cloudiness) due to tissue healing in PRK. For these reasons, LASIK, another excimer laser application method, was developed.
In LASIK, the excimer laser is not applied directly to the cornea. Instead, a thin flap of corneal tissue, about 100–140 microns thick, is lifted from the surface, and the laser is applied to the underlying corneal layer. The flap is then replaced. Compared to PRK, LASIK offers faster recovery, less burning or stinging after surgery, and a lower risk of corneal haze.
However, LASIK is not suitable for patients with thin corneas or high refractive errors, as a minimum corneal thickness (about 250 microns) must remain after the laser is applied, and the flap thickness must also be considered. In such cases, PRK remains a viable option.
The corneal flap in LASIK can be created using different techniques. Initially, microkeratomes—mechanical instruments capable of cutting corneal tissue at precise thicknesses—were used. Later, with advances in laser technology and the introduction of femtosecond lasers, flaps could be created more precisely and safely. Today, femtosecond lasers are most commonly used for this purpose.
The requirements for undergoing excimer laser surgery are:
Excimer laser surgery is usually recommended up to around age 35 (ideally 25),as presbyopia—the age-related difficulty in near vision—begins around age 40.
In addition, pregnant or breastfeeding women are not recommended to undergo excimer laser surgery due to potential changes in vision and prescription during this period.
Examinations and tests performed before excimer laser surgery include:
Excimer laser surgery is an outpatient procedure, and no hospital stay is required. Before the surgery, anesthetic eye drops are applied to numb the eye. The procedure usually takes 15–30 minutes. After surgery, a bandage contact lens is applied for a few days to reduce burning and stinging and to promote faster healing. Steroid and antibiotic eye drops, along with artificial tears, are used as part of postoperative treatment.
After excimer laser surgery, patients may experience burning, light sensitivity, and blurred vision for a short period. During this time, driving, working, and prolonged screen use may be inadvisable for a few days. Wearing sunglasses is recommended to protect against light sensitivity. Regular follow-up examinations are necessary for the first six months after the procedure.
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