Read this all in one laser eye surgery guide for Canadians. Topics include: Procedures, treatment options, results and recovery, and cost.

1. Olympia HSA Medical Series
Laser
Eye Surgery
A COMPLETE GUIDE FOR CANADIANS
1

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3. INTRO
Imagine vision improvements that could translate into
driving without glasses or playing sports without contact
lenses. That’s become a reality for many of the millions
of people worldwide who have elected to have laser eye
surgery. This popular surgery is seen as a safe and effective
way to correct vision problems and enhance lifestyles.
Basically, it all comes down to the shape of the eye.
Any variations in shape, including length, can result in vision
problems. By using a laser to change the shape of the cornea,
surgeons can correct refractive errors and improve the eye’s
ability to focus on objects.
Laser eye surgery can correct vision problems such
as near-sightedness, far-sightedness and astigmatism,
providing candidacy requirements are met. And cuttingedge advancements in laser technology means a wider
range of candidates can be treated.
While the idea of improved vision is a compelling one,
the wide range of procedures, associated costs and laser eye
surgery providers can seem overwhelming. The purpose of
this guide is to provide an overview of laser eye surgery
and to shed some light on the options available.
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4. TABLE OF CONTENTS
Intro 3
Geting started 5
LASIK 7
PRK 9
Keratoconus Treatment 11
Laser Epithelial Keratomileusis 14
Epi LASIK 15
Cataract Surgery 16
Artificial Lens Procedures 18
Monovision, Laser Blended Vision Correction
and Corneal Inlay for Presbyopia 21
Laser Eye Surgery Results and Recovery 23
Laser Eye Surgery Cost 27
Conclusion and Additional Resources 29
4

5. Getting
started
The first step in the process is an assessment
that will help the surgery provider determine whether
or not a patient is a candidate for laser eye surgery. It is
also geared towards helping potential patients decide
whether laser eye surgery is right for them.
The preoperative assessment, which is normally
complimentary, differs amongst providers. During this
initial appointment, which can last between two and
three hours, surgeons and clinic staff will gather patient
information, including medical history, as well as answer
questions and provide information through patient
counseling.
Eye testing is also a key component of the
process. The eye specialists could be examining criteria
such as current vision prescription, corneal thickness,
pupil diameter, as well as both general and eye health.
If a patient is deemed eligible for laser eye surgery,
the provider will recommend and outline a surgical
procedure and review pricing. Laser eye surgery is
considered an elective surgery and is not covered by
provincial health care plans. However, it is an eligible
5

6. expense under a health spending account.
Clinics normally have a contact lens policy in place
which means that contact lenses must be removed for a
certain amount of time before appointments. This allows
the cornea to return to its natural shape and ensures
accurate test results.
There are a few factors that will exclude a patient from
having laser eye surgery:
•
•
•
•
Certain medical diseases
Certain eye injuries and diseases or disorders
Candidates should be a minimum age of 18
Have a vision prescription that has been stable for at
least a year and that falls within an admissible range
• Pregnant or nursing women are not eligible for
surgery
Recent advancements in laser technology have opened
doors so that a wider range of candidates can turn to laser
eye surgery as a vision correction option.
6

7. Types
of Laser
Eye Surgery
LASIK
Laser-Assisted In Situ
Keratomileusis
LASIK can be used to correct nearsightedness
(myopia) farsightedness (hyperopia) and astigmatism.
Myopia and hyperopia are refractive errors that are caused
by variations in the shape of the eyeball. Astigmatism
is a result of an irregular-shaped cornea, which is the
transparent outer portion of the eye surface.
Surgeons can use the two-step LASIK procedure
in different ways, specialized for each patient, to correct
refractive errors. Generally, the process involves
reshaping the cornea to improve the way that light
rays focus on the retina (the light-sensitive, back portion
of the eye).
First, surgeons use either a bladed instrument
called a microkeratome or a laser to create a precise flap
of the cornea. This hinged flap, which is still attached to
the cornea, is raised.
Next, surgeons will use an excimer laser to reshape
the cornea by accurately removing corneal tissue. The
preoperative eye exam determines how much tissue
should be removed for each patient.
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8. An advanced technology, custom wavefront
LASIK, is available that allows surgeons to further refine
the standard LASIK procedure and enable more precise
vision corrections.
LASIK, which is an outpatient surgical procedure,
takes place under local anesthetic. The surgery itself is
considered painless and takes only a matter of minutes
per eye. After surgery, the natural healing processes of
the eye take over to help seal the flap of the cornea.
Although LASIK surgery is considered safe, there are
risks involved:
•
•
•
•
•
Poor night vision due to halos
Bright light sensitivity
Dry eyes
Double vision and regression
Rarely - infection or weakening of the cornea
8

9. Types
of Laser
Eye Surgery
PRK
Photorefractive
Keratectomy
In photorefractive keratectomy (PRK), surgeons
remove the thin surface layer of the cornea (called the
epithelium). Like LASIK, PRK can be used to correct
nearsightedness, farsightedness or astigmatism. PRK
differs from LASIK in that it doesn’t involve cutting a flap
in the cornea.
After the epithelium is removed, PRK surgeons
will then use an excimer laser to reshape the cornea
by removing a predetermined amount of tissue. Either
standard PRK or custom wavefront PRK can be used at
this stage of the process. Custom wavefront PRK is an
enhanced version of standard PRK that allows surgeons
to further customize the procedure for patients and can
improve the outcome of laser vision correction.
The actual treatment time, including preparing
the eye and the laser process, is roughly 30 minutes.
During that time, the laser is used for only a few minutes
per eye.
Healing time is longer with PRK than with LASIK
since it takes about three to five days for the epithelium
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10. to grow back. During this time, patients are fitted with
contact lens ‘bandages’ to protect the cornea and help it
heal.
The surgical process itself is considered painless.
However, patients can expect some pain during the
healing process.
PRK can be used on patients with high vision
prescriptions or whose cornea is too thin or too
soft to withstand the creation of a flap. It can also be
recommended for people who participate in activities,
such as boxing or martial arts, which put them at risk of
getting hit in the eye.
Although PRK surgery is considered safe, there are
risks involved:
•
•
•
•
•
Poor night vision due to halos
Increased bright light sensitivity
Double vision and regression
Hazy vision (normally clears up after healing)
Rarely - infection or weakening of the cornea
10

11. Types
of Laser
Eye Surgery
Keratoconus
Treatment
In recent years, laser eye surgery has been
combined with a process called corneal collagen crosslinking or CXL, to treat a progressive eye disease known
as keratoconus. This disease, which often emerges when
people are in their late teens or early 20s, causes the
normally dome-shaped cornea to bulge into a more conelike shape.
The irregular shape results in blurred vision that, as
the disease progresses, becomes increasingly difficult to
correct with glasses or contact lenses.
Traditionally, some people with keratoconus would
have had to consider a corneal transplant to curb the effects.
But recent advancements in keratoconus treatment are
offering new hope for diagnosis and treatment of the
disease.
Using a technique called corneal collagen crosslinking, or CXL, surgeons are able to strengthen the
cornea, helping it to retain its natural shape and resist
bulging.
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12. The CXL Process
•
•
•
•
•
Anesthetic drops applied to numb the eye
Surface skin of the cornea is polished
Riboflavin drops are applied to the eye
10 and 30 minutes of UV-A light
Bandage contact lens worn for several days
Riboflavin drops, combined with the UV-A light, act
on the cornea to strengthen it. Recent advancements in
corneal collagen cross-linking are reducing the riboflavin
soak time as well as the UV-A light exposure time.
CXL can be combined with laser eye surgery to
improve vision quality with glasses or contact lenses for
people with keratoconus. Before the CXL process, surgeons
can use a standard laser vision correction process to reshape
the cornea and help improve overall vision by reducing
myopia, hyperopia or astigmatism.
A more advanced laser eye surgery option, CXL
combined with T-PRK, has also recently become available.
12

13. Using state-of-the-art imaging technology, surgeons are
able map out and improve corneal irregularities in people
with keratoconus prior to CXL treatment.
Treatments for keratoconus, including laser eye surgery
combined with CXL, will not normally eliminate the need
for glasses or contacts in people with the disease. The goal
of these procedures is to improve vision quality and to
slow or prevent the progression of the disease.
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14. Types
of Laser
Eye Surgery
Laser Epithelial
Keratomileusis
Photorefractive
Keratectomy (LASEK)
LASEK is a newer procedure in which the surface
layer of the cornea (epithelium) is cut with a fine blade
and loosened with alcohol drops. This thin, hinged layer
is raised and pushed to the side, allowing surgeons to
use a laser to reshape the cornea. Once the procedure
is complete, the epithelium is replaced and a bandage
contact lens is inserted to help with healing.
Risks of this surgery can include:
•
•
•
•
•
•
•
•
Initial vision clouding or haze
Night vision issues
Bright light sensitivity
Double vision
Regression
Overcorrection or undercorrection
Rarely - infection, sores on the cornea
Rarely - Glaucoma or pressure inside the eye
14

15. Types
of Laser
Eye Surgery
Epi-LASIK
In this procedure, the surface layer of the cornea is
lifted with an epithelial separator or epi-keratome, which
is a special machine with a blunt blade. Surgeons reshape
the cornea and then replace the surface tissue. A bandage
contact lens is worn to assist with healing.
Depending on the results of the preoperative
consultation, Epi-LASIK may be recommended for
patients who are not suitable candidates for LASIK due
to a higher risk of an eye injury due to certain careers or
sports activities, or whose corneas are too thin for the
creation of a LASIK flap. Custom wavefront techniques
can be used with Epi-LASIK to customize the procedure.
Risks of this surgery can include:
•
•
•
•
•
•
•
•
Initial vision clouding or haze
Night vision or bright light sensitivity
Double vision
Regression
Overcorrection or undercorrection
Rarely - infection and sores on the cornea
Rarely - Glaucoma
Rarely - Increased pressure inside the eye
15

16. Types
of Laser
Eye Surgery
Cataract
Surgery
Cataracts can affect vision quality by causing cloudiness
in the lens of one or both eyes. Although cataracts are
often linked to aging and are most common in adults over
40, children can also be affected.
Cataracts are painless and usually progress slowly.
Glasses or contact lenses can often help with mild forms
of cataracts, but they cannot correct vision when cataracts
become more advanced. There is no cure for cataracts
and surgical removal is the only option to help restore
vision.
Laser surgery is beginning to be offered as an
alternative to traditional cataract surgery with lasers
replacing some of the steps that are normally completed
with a diamond blade. Advanced imaging technology,
called optical coherence tomography (OCT,) is used
to provide surgeons with a detailed ‘map’ of the eye.
The resulting images and measurements are used in
conjunction with laser surgery to customize the surgical
procedure to each patient’s unique eye characteristics.
16

17. Based on results from the imaging part of the
process, a femtosecond laser is used to make precise
incisions, to reduce or control astigmatism, and to breakup the cataract. Then, ultrasound technology is used to
further break down and remove the cataract.
Finally, a clear, artificial lens, called an intraocular lens,
is inserted into a tiny, laser-created pocket. The surgical
procedure takes only a few minutes, with minimal or
no patient discomfort. Antibiotic eye drops are given and
recovery can take from about 48 hours up to a week.
17

18. Alternatives to
Laser Eye Surgery
Artificial
Lens
Procedures
Artificial lens procedures were initially designed
to replace natural lenses that had become clouded
by cataracts. Since then, the technology has evolved to
be used to correct refractive errors as well, offering an
alternative vision correction solution for those who are
not suitable candidates for laser eye surgery.
• Refractive Lens Exchange (RLE) - This surgery is
similar to traditional cataract surgery in that a natural
lens is replaced with an artificial lens implant. The
primary difference is that while cataract surgery is
done for medical reasons, RLE is an elective surgery
to correct refractive errors and improve vision. The
procedure can be performed on patients whose
extreme nearsightedness or farsightedness would
affect the outcome of laser eye surgery. In the
RLE process, the natural, crystalline lens is removed
using either a laser or special ultrasound tool, called
a phacoemulsifier. The artificial lens, which is chosen
based on the amount of correction required, is
inserted through a tiny incision in or near the cornea.
Depending on a preoperative assessment, the
surgeon may choose a foldable lens, which unfolds
18

19. once placed in the eye, or a more rigid lens. Anesthetic
drops are used to numb the eye and minimize
discomfort during the procedure, which takes
about 15 minutes per eye. Stitches are not normally
needed since the incision is designed to self-seal.
• Phakic Intraocular Lenses - This procedure is
similar to the RLE process, except the natural lens
is not removed. The implantable lens is inserted
into an incision and placed over the natural lens
of the eye. The procedure takes roughly 20
minutes per eye and usually requires no stitches.
Phakic Intraocular lenses can be used to correct
extreme
nearsightedness,
farsightedness
and can also be used to treat astigmatism.
• Presbyopic Lens Exchange - Commonly referred
to as PRELEXR, presbyopic lens exchange is used to
correct presbyopia, which affects the eyes’ ability
to focus on near objects. The natural lens of the
eye is replaced with an artificial lens that will allow
the eye to focus on objects that are both near and
in the distance. The procedure is aimed at reducing
19

20. or eliminating the need for reading glasses. Also,
since the natural lens, which can be prone to the
development of cataracts, is removed and replaced
by an artificial lens, the risk of cataracts is eliminated.
• Cataract extraction - Cataracts can cause symptoms
such as cloudy vision, reduced appearance of colours,
reduced night vision or double vision in the affected
eye. In this procedure, surgeons replace a natural
lens that has been clouded by cataracts with a clear
artificial lens. An ultrasound tool is commonly used to
break up the natural lens, which is then removed. The
artificial lens, which is normally a soft, foldable lens,
is inserted into a small incision, replacing the natural
lens. Once placed in the eye, the lens unfolds and the
incision begins to heal naturally. Often patients can
resume normal activities about 24 hours after the
surgery.
20

21. Types
of Laser
Eye Surgery
Monovision,
Laser Blended
Vision Correction
and
Corneal Inlay
for Presbyopia
• Monovision - Using LASIK or PRK laser eye surgery,
one eye is corrected for distance vision.The other is undercorrected, leaving it slightly near-sighted, allowing for
improved focus on near objects. Monovision can improve
presbyopia and reduce the need for reading glasses. One
of the challenges for people who undergo monovision is
to become accustomed to relying on one eye for distance
vision and the other for near vision. Monovision can also
result in reductions in depth perception, distance vision
clarity and quality of night vision. While reading glasses
would still be required for activities such as reading for
an extended time, monovision can help with scans of
smaller print on things like price tags, restaurant menus or
documents.
•
Laser Blended Vision Correction - With a special
excimer laser, using a LASIK procedure, surgeons correct
a dominant eye for distance vision, while near vision
is improved in a non-dominant eye. The depth of field
in both eyes is also increased. The brain is able to blend
the two images together creating improved vision at
near, intermediate and far distances without the need for
glasses. The image appears to be in focus for both eyes,
and, although there will be a variation in vision between
21

22. both eyes, patients are less likely to notice it with laser blended
vision correction. This is different from monovision surgery,
in which patients must adjust to relying on one eye to see
near and the other to see distance. Laser blended vision
correction also appears to have a higher acceptance rate
among patients, compared to monovision, with a shorter
adaptation time.
•
Corneal Inlay - Commonly called the KAMRATM Inlay,
this process involves inserting a microscopic ring into only
one eye. The black ring, which is much smaller than a contact
lens, has a diameter of 3.8 mm with a tiny opening in the
middle. If LASIK is done, the inlay is inserted into a LASIK flap,
or it can also be inserted into a laser-created pocket if LASIK is
not done. The outer ring part of the inlay prevents unfocused
light from reaching the retina, while the tiny opening in the
ring allows only focused light through. This procedure can
improve presbyopia by bringing near objects into focus.
The inlay is etched with thousands of microscopic openings to
help the cornea stay healthy. The procedure is reversible and
takes about 20 minutes. There are no stitches required and
eye drops are given to help with the healing process. Recovery
time varies from a few days up to months, depending on
individual healing times. Most patients are able to return to
work and resume normal activities within 24 hours.
22

23. Laser Eye Surgery
Results
and
Recovery
When it comes to laser eye surgery, it’s important to
focus on realistic expectations. Before undergoing any
procedure, a thorough consultation with a surgeon can help
clarify expected results for patients.
Follow-up care can include:
•
•
•
•
Taking a number of days off work
Taking prescribed medication
Attending post-operative appointments
Temporary break from sports activities
Results and recovery time will vary from patient-topatient. Here’s a snapshot of possible results and recovery
time after laser eye surgery.
LASIK Recovery
• Little or no pain after
• Vision improvements often noticeable within a few days
• Return to work within 24 hours (depdending on the
level of eye trauma risk associated with a certain job)
• Protective sunglasses during the initial healing process
• Administration of eye drops
• Follow-up visits to check on recovery and healing
23

24. A temporary condition called dry eyes can occur.
Symptoms can include:
• Temporary blurry vision
• Excessive tearing
• Burning, itchiness or redness of the eyes
Dry eyes can be treated with artificial tear drops or comfort
plugs.
PRK Recovery
PRK surgery takes slightly longer than recovery
from LASIK. That’s because PRK surgery involves the
removal of the epithelium (top layer) of the corneal, instead
of the creation of a LASIK flap. It can take between three
and five days for the body to regrow the epithelial layer
that was removed during surgery. Patients will be fitted
with a contact lens ‘bandage’ the will help the protect the
cornea and help it heal. Patients who undergo PRK surgery
can expect some level of pain for a few days following
the procedure.
24

25. After PRK, vision can temporarily be reduced or can
remain blurry for some time and it can also take longer
for vision to stabilize. A schedule for follow-up surgery
will be provided and surgeons will provide prescriptions
for eyedrops and, if necessary, pain medication. The visual
correction outcomes of PRK and LASIK are comparable.
LASEK Recovery
Recovery times for LASEK, a newer procedure, are
normally longer compared to recovery from LASIK or
PRK surgery. Bandage contact lenses or eye shields are
applied and worn for a few days after surgery. They help
protect the cornea so that the epithelial layer, which is
loosened during this process, can reattach and heal. Vision
can be temporarily reduced while the epithelial layer heals
following LASEK surgery and there can be pain associated
with the healing process. Prescription eye drops are used
for up to several months after the surgery and follow-up
visits are scheduled to monitor recovery.
25

26. Epi-LASIK Recovery
Vision correction results from Epi-LASIK can be
comparable to LASIK and PRK. After surgery, bandage
contact lenses are inserted to help keep the epithelial flap
in place and to protect it as it heals. There can be pain
associated with the Epi-LASIK healing process. After EpiLASIK surgery, vision stabilization can take anywhere
from a few days up to several months. An eye drop
prescription and application schedule will be given and
follow-up visits will be scheduled to monitor healing and
recovery.
Artificial Lens Implant Recovery
Normally, incisions used in this process are selfsealing and do not require stitches. Although patients
can notice vision improvements immediately following
surgery, best results are often not realized until a day or
two following the surgery. Recovery time and followup procedures can vary depending on the type of lens
inserted.
26

27. Laser Eye
Surgery Cost
While the idea of improved vision is appealing, cost
is a primary question for many people considering laser
eye surgery.
There is a wide range of pricing for the procedures,
from a starting point of about $500 up to thousands of
dollars per eye, but the average price falls around $2,000
per eye. Costs of refractive lens exchange tend to run
higher than those of laser eye surgery.
Vision prescription strength, surgeon experience,
laser technology used and the surgical procedure itself
can all have an influence on cost. And, since pricing
packages vary amongst service providers, it’s important
for prospective patients to ask questions about what’s
included in order to avoid surprises. Pre-operative and
post-operative consultations, including all eye testing, are
commonly included.
Other costs to consider:
•
•
•
•
Post-surgery prescription medication
Bandage contact lenses
Protective glasses
Possible laser vision enhancement surgeries in the
future
27

28. Some clinics have options for surgery financing.
Since laser eye surgery is considered an elective procedure,
it is not normally covered under insurance policies.
The procedure is an eligible expense under a
Health Spending Account.That means, the entire cost of
laser eye surgery can be deducted as a pretax expense.
28

29. Conclusion
and
Additional
Resources
29

30. CONCLUSION
Laser eye surgery can be a life-changing experience
that opens doors to a world of vision improvements without
the hassle of glasses or contact lenses. It is also a big decision
that can be daunting.
Anyone considering laser eye surgery can benefit from
carefully researching and choosing their service provider
to find the best fit. It is also a good idea to prepare a list of
questions and concerns to review at the first appointment.
Millions of people world wide have already benefited
from having their vision improved with laser eye surgery.
It’s considered safe and effective. Overall, the surgical
procedures have had high success rates with minimal
downtime. Plus, laser technology used for vision correction is
constantly evolving, bringing new options to more patients
who wish to enjoy the freedom of better vision without
glasses or contact lenses.
Since most health insurance plans don’t include laser eye
surgery, it’s important to review costs in detail. Also, keep in
mind that laser eye surgery is an eligible expense under
a Health Spending Account, making this type of plan an
effective tool to reduce costs.
30

31. Laser
Eye Su
rgery
Discover the Savings
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32. Terms and Conditions
All content provided in the guide is for informational
purposes only. The owner of this guide makes no
representations as to the accuracy or completeness of any
information in the guide or found by following any link.
The owner will not be liable for any errors or omissions in
this information nor for the availability of this information.
The owner will not be liable for any losses, injuries, or
damages from the display or use of this information.
This policy is subject to change at any time.
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