Clinical Review

Laser refractive eye surgery

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d2345 (Published 20 April 2011) Cite this as: BMJ 2011;342:d2345
  1. Andrew Bastawrous, specialty registrar in ophthalmology1,
  2. Alexander Silvester, foundation year 2 doctor in ophthalmology2,
  3. Mark Batterbury, consultant ophthalmologist1
  1. 1St Paul’s Eye Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L7 8XP, UK
  2. 2Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L7 8XP
  1. Correspondence to: A Bastawrous andrew.bastawrous{at}gmail.com
  • Accepted 29 March 2011

Summary points

  • Refractive errors are common

  • Laser eye surgery is an effective alternative to refractive correction with spectacles or contact lenses

  • Glasses do not cause long term corneal problems, but contact lenses carry a small risk

  • Serious complications of laser eye surgery are rare and can be minimised through patient selection and advances in technology

  • Less serious complications are common and often under-reported as “side effects” or “symptoms”

  • Data on long term safety and stability are lacking largely because techniques are still evolving

Early attempts at refractive surgery used partial thickness corneal incisions to alter the curvature of the cornea, with the most popular technique being radial keratotomy. In 1990 the Prospective Evaluation of Radial Keratotomy study found that outcomes were unpredictable and unstable, and this led to the use of ablative laser refractive surgery instead.1

We review evidence for the efficacy of laser refractive surgery mainly from randomised controlled trials and discuss suitability, contraindications, and potential complications of the procedure to help generalists in answering patients’ queries.

Sources and selection criteria

We searched PubMed for articles in English on laser refractive surgery. We also consulted guidelines issued by the Royal College of Ophthalmologists, the American Academy of Ophthalmologists, and the National Institute for Health and Clinical Excellence. We identified systematic reviews and randomised controlled trials as well as informative and relevant level C research. Search terms were “laser assisted in situ keratomileusis”, “laser epithelial keratomileusis”, “photoreactive keratotomy”, “myopia”, “hyperopia”, “astigmatism”, and “laser surgery”.

Refractive error

Refractive error was recently reviewed in the BMJ.2 Refraction (measured in dioptres) is the process by which light is focused on the retina. The optical components of the eye are the lens, the length of the eyeball, and the cornea. The cornea provides three quarters of the overall refractive power of the eye.

If the eyeball is too long …

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