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LASER EYE SURGERY: Lasik, ASLA, ICL or Lens exchange?

Laser Eye Surgery is synonymous with throwing away your glasses […]

By Published On: 6 April 20184.5 min read

Laser Eye Surgery is synonymous with throwing away your glasses and contact lenses but…

Throwing away glasses and contact lenses can sometimes be achieved with other eye procedures, which most people have not heard about.  In this post we will go through a number of procedures; some that use the Laser, and some that don’t. Ultimately these eye procedures are designed to minimise the use of glasses and contact lenses.

PRK – the first laser eye surgery

The first Laser Eye Surgery Procedure was performed in Australia in 1991. It was called Photo Refractive Keratectomy – or PRK. Our principal  optometrist Dr Jim Kokkinakis consulted at the largest laser Eye Surgery Centre in Australia between 1996 to 2002.  During this time he saw thousands of patients seeking independence from glasses or contact lenses.  These days, a day does not go by that he is not explaining, referring or seeing patients that have had these procedures done.

Which is the best procedure?

This will depend on a number of variables, but before we go into those let us discuss the available procedures that can be performed on the eyes to eliminate dependence on glasses and contact lenses.  They are:

1. LASIK: This is an acronym for Laser Assisted In Situ Keratomileusis. Despite some exciting newcomers, LASIK is still the most popular Laser Eye Surgery and Vision Correction Surgery done at this point in time, due to its wide availability.

2. SMILE:  This is an acronym for Small Incision Lenticule Extraction. It involves separating a disc of tissue from within your cornea and surgically removing it via a small keyhole incision.

This is the newest laser vision correction procedure and has gained popularity over the past 5 years, becoming the go-to procedure of choice for many surgeons. This is due to it’s minimal effect on the corneal nerve supply (compared to LASIK) and it’s uncanny accuracy, even at high levels of myopia.

SMILE is less likely to cause dry eyes and appears to provide a more accurate correction for very short-sighted people (-5 or more).


This is an acronym for Photo Refractive Keratectomy. It is also known as ASLA, or Advanced Surface Laser. This procedure is usually reserved for eyes that have thin corneas, where LASIK or SMILE surgery are not safe options.  Its main disadvantage is that the healing time is weeks instead of days. 

When comparing visual results after 3 months of healing to LASIK and SMILE, the results are very similar.  It is imperative that if your corneas are borderline thin that your Laser surgeon chooses to do ASLA for you. 

By having Dr Jim Kokkinakis of The Eye Practice do your assessment, he will independently calculate your suitability and recommend a surgeon that will do the correct procedure for you.

What if I’m not suitable for laser eye surgery?

What most people do not realise is that Laser Eye Surgery is not the only way to eliminate glasses and contact lenses.  There are a number of slightly more invasive procedures that can also achieve a great visual result.

These procedures are not as common as LASIK or ASLA but certainly are reasonable options for people that are very motivated to correct their vision.

Lens Replacement

If you’re over 50, chances are your reading vision is quite different from your distance vision. This is due to the ageing of the natural crystalline lens within your eye – or presbyopia.  Your lens no longer focuses from distance to near.

It is possible to replace your natural lens with an intraocular lens in a procedure similar to cataract surgery – even if your lens is perfectly clear with no cataract. This procedure goes by many names including Clear Lens Replacement, Clear lens exchange, Lensectomy, and Refractive lens exchange.

The procedure is identical to modern cataract microsurgery: the contents of your lens are removed and replaced with an artificial lens which corrects your shortsightedness, longsightedness or astigmatism. There are even multifocal lenses available which allow distance and near focus with both eyes.

The best lens for you depends on a number of factors and is best decided by an experienced eye surgeon.

Phakic IOL (ICL)

Some people are too short-sighted for LASIK or SMILE. If your prescription is above about -9 dioptres of short-sightedness and you cannot successfully wear glasses, you may be suitable for a special kind of artificial lens called a phakic intraocular lens (IOL) or Implantable Contact Lens (ICL). This device sits behind your iris (coloured part of your eye) but in front of your crystalline lens.

The advantage s that there are no limitation in how much short-sightedness they can treat.  If you have a phakic IOL you will need to see your surgeon or optometrist for follow up every 6 to 12 months for the rest of your life to monitor for any signs of side effects from these devices.

There is an increased risk of certain eye diseases such as cataract and glaucoma, but with the right surgeon and the right eye, this procedure can be life-changing.

What do I do next?

Laser eye surgery is a procedure that requires careful consideration of the risks and benefits that apply to YOUR particular eyes. At The Eye Practice, we recommend these procedures when we deem it a good fit for their eye sight, their visual needs and their personality.  If you are interested in Laser Eye Surgery, do not hesitate to call 9290 1899 or Book an Eye Test appointment ONLINE now.


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