Freedom from glasses with LASIK, Contoura Vision, SMILE or a phakic ICL — offered only after topography, pachymetry and a dry-eye assessment confirm your cornea can safely take it. Roughly one in six people who ask for LASIK should not have it, and we will tell you if you are one of them.
If you wear glasses, light entering your eye is not landing precisely on the retina. In myopia it focuses in front of it, in hypermetropia behind it, and in astigmatism it focuses at two different points because the cornea is shaped more like a rugby ball than a football. Spectacles and contact lenses compensate for this from outside the eye. Refractive surgery changes the focusing power of the eye itself, so no compensation is needed.
In laser procedures — LASIK, Contoura Vision and SMILE — an excimer or femtosecond laser removes a precisely calculated few microns of corneal tissue to reshape its curvature. The reshaping is permanent and the tissue does not grow back. In lens-based procedures such as the phakic ICL, no corneal tissue is removed at all; instead an ultra-thin collamer lens is placed inside the eye behind the iris, leaving the natural lens untouched.
The decision between them is not a matter of preference or marketing. It is determined by your spectacle power, your corneal thickness, the shape of your corneal surface on topography, your pupil size, your tear film quality and your age. A thin cornea with high myopia points firmly toward an ICL. A subtle irregularity on topography, suggesting early keratoconus, rules out laser altogether — and performing LASIK on such an eye can cause progressive corneal ectasia years later.
This is why the workup matters more than the laser. Every good refractive outcome starts with correctly identifying the people who should not be operated on.
Refractive surgery is elective, so the reasons people come are practical rather than medical:
The blade-free standard. A femtosecond laser creates a thin corneal flap, an excimer laser reshapes the bed beneath, and the flap is repositioned without stitches. Visual recovery is fast — most patients see well within a day. Suitable for a wide range of myopia, hypermetropia and astigmatism given adequate corneal thickness.
Uses a detailed map of thousands of points on your corneal surface to treat not just your spectacle number but your individual corneal irregularities. Often gives crisper quality of vision and better night-time performance than conventional LASIK, particularly in eyes with higher-order aberrations.
A flapless technique. The femtosecond laser carves a lens-shaped disc of tissue within the cornea, which is removed through a two to four millimetre incision. Because no flap is created, corneal biomechanical strength is better preserved and dry eye tends to be less pronounced — attractive for contact sports and for patients with borderline tear films.
For very high myopia, thin corneas or eyes unsuitable for laser. A soft biocompatible lens is placed inside the eye without removing any corneal tissue. It is removable if ever required and gives excellent optical quality at high powers where laser correction would be unsafe.
Where corneal thickness is marginal or the profession carries a high risk of eye trauma. The surface epithelium is removed and the cornea reshaped directly. Recovery is slower and more uncomfortable for the first three to four days, but the final result is comparable and no flap is ever created.
For patients past forty-five with early lens changes, replacing the natural lens with a multifocal or EDOF intraocular lens addresses both the spectacle number and the developing presbyopia in one procedure.
The examination is longer than the surgery. Expect to spend about two hours on the assessment visit, and around fifteen minutes in the laser suite on the day itself.
Soft lenses must be out for at least seven days and rigid gas-permeable lenses for three to four weeks before the workup. Lenses temporarily distort the corneal surface, and testing on a distorted cornea produces a measurement you cannot trust.
Your spectacle number is measured both normally and after cycloplegic drops that relax the eye's focusing muscle, revealing the true underlying power. Your prescription must have been stable for at least twelve months.
A detailed map of both corneal surfaces and its thickness across the whole cornea. This is the single most important test — it screens for keratoconus and forme fruste changes that absolutely contraindicate laser treatment.
Corneal thickness is measured and the tissue that will remain after treatment is calculated. If the residual stromal bed would be too thin, laser is not offered, whatever your expectations.
Schirmer's test and tear break-up time. Untreated dry eye is the leading cause of dissatisfaction after LASIK, so it is treated first and the surgery is deferred until the tear film is healthy.
High myopes have thinner peripheral retinas and a higher lifetime risk of retinal tears. Dr. Mithal's retinal training means the periphery is examined properly before refractive surgery, and any tear is lasered first.
On the day, anaesthetic drops are instilled and you lie under the laser. The laser itself runs for well under a minute per eye; the entire session, both eyes, takes ten to fifteen minutes. You walk out afterwards, though vision is hazy for several hours.
Next day, one week, one month and three months. Lubricating drops continue for several weeks to months, since tear film recovery is the slowest part of healing.
After LASIK or Contoura, most patients see functionally by the next morning, with watering, light sensitivity and a foreign-body sensation for the first four to six hours. SMILE recovery is similar. PRK is slower — expect three to five uncomfortable days with a bandage contact lens before vision starts clearing.
Some fluctuation of vision through the day, mild glare and starbursts around lights at night, and dryness are all normal in the early weeks and settle progressively over one to three months.
Refractive surgery is elective and is not covered by health insurance. Cost depends on the technology used rather than your spectacle power. Indicative ranges for both eyes in Delhi NCR:
Indicative ranges for Delhi NCR as a guide only. Your written estimate is given after examination and depends on the technology, lens or drug used, hospital tariff and insurance cover. Most procedures are supported by cashless insurance at Max hospitals.
Retina, cataract, glaucoma and LASIK evaluations at Max Smart Saket, Max Panchsheel Park and Synergy Eye Care.
