LASIK in Singapore – Everything You Need To Know About Suitability, Costs And Risks

Am I suitable for LASIK surgery?

Introduction

You are considering having LASIK done because you long for independence from your spectacles and contact lenses. For a long time, you have put up with the inconvenience of wearing and carrying them around, not to mention maintaining them and in the case of contaminated contact lenses, being afflicted with serious eye infections.

However, there is just too much information on the subject and everything is scattered all over various sites and blogs on the Internet. Well, worry no further because you’ve come to the right place – in this article, you will find everything you need to know about getting LASIK done in Singapore. It will shed light on the types of LASIK procedures available, the pros and cons of each, as well as their pricing.

Let our 3,000-word comprehensive guide be your go-to resource for all things LASIK. We believe that it will help you make the best decision based on the condition of your eyesight and your lifestyle needs.

eye refractive surgery

What is LASIK?

Since its introduction in the 1990s, LASIK has become the most common surgical procedure performed in Singapore to correct vision problems such as myopia (short-sightedness), hyperopia (long-sightedness) and astigmatism.

Its popularity has resulted in many people using the term LASIK interchangeably with Laser Vision Correction (LVC); in fact, LASIK is one of 3 main types of LVC procedures available in Singapore today:

  • Advanced Surface Ablation (PRK, Epi-LASIK, LASEK, TransPRK)
  • LASIK
  • ReLEx® SMILE
Advanced Surface Ablation (PRK, Epi-LASIK, LASEK, TransPRK)
LASIK
ReLEx® SMILE

What does LASIK correct?

 LASIK procedures are recommended for correcting:

  • Myopia (short-sightedness) in the range of 100 to 1,000 degrees
  • Hyperopia (long-sightedness) of up to 300 degrees
  • Astigmatism of up to 350 degrees

The ideal age for undergoing LASIK is when your eye prescription is stable – this should be when you are at least 18 years of age.

Is LASIK for everyone?

There is a popular assumption that LASIK is the solution for anyone craving independence from spectacles and contact lenses. The truth is that not everyone is suitable. Some of the main reasons why individuals have been turned away from undergoing the procedure are:

  • Below 18 years old as mentioned on the left (note that you need parental consent if you are below 21 years old)
  • Eye prescription that falls well out of the treatment ranges stated on the left
  • Eye prescription that is unstable during the past 12 months
  • Eye diseases such as cataracts and glaucoma
  • Suffering from poor health
  • Pregnant/breastfeeding women
  • Severe dry eye syndrome
  • Corneas that are too thin, irregularly shaped, or steep (keratoconus)

Pre-LASIK Evaluation

If you are keen to get LASIK done, sign up for a pre-LASIK evaluation. The evaluation process takes about 3 hours and consists of a comprehensive list of eye tests to determine your suitability.

You are required to stop using soft contact lenses at least 3 days before the evaluation, or at least 14 days if you are using hard contact lenses. Among the tests to be conducted include determining the corneal thickness and shape, intraocular pressure, manifest refraction and pupil dilation.

After pupil dilation, most people need to remove their glasses to see near; far vision remains unaffected. Some may also be sensitive to bright lights. This effect typically wears off in 4 to 6 hours. So, you may want to bring along your sunglasses on the day of your evaluation.

After the tests are done, your eye surgeon will share with you the results of the evaluation and discuss your surgical options based on your eye condition, occupation and lifestyle. Do take this opportunity to ask questions and clear your doubts.

What if I have dry eyes – can I still get LASIK done?

This is one of the most frequently asked questions – the good news is that for most individuals, their condition is mild enough for LASIK to be done. In our evaluation of patients with dry eye syndrome, we need to look at the severity as well as the reversibility of the dryness.

LASIK may temporarily cause increased dryness, but most patients will revert to their original state within 3 months of the procedure. For a small number of patients, they may have increased dryness up to 6 months, while a tiny proportion of patients (less than 1%) have increased dryness up to 12 months or more.

If you have dry eye syndrome, have it diagnosed and treated properly before getting LASIK done. After the procedure, keep up with your treatment faithfully to prevent the symptoms from reappearing. Use your prescribed eyedrops regularly, even if you do not feel that you need them – having the symptoms reappear before starting to treat them may be too late.

What are the differences between the 3 Laser Vision Correction procedures?

As mentioned previously, the 3 Laser Vision Correction procedures offered in Singapore today are:

  • Advanced Surface Ablation (PRK, Epi-LASIK, LASEK, TransPRK)
  • LASIK
  • ReLEx® SMILE

What Is Advanced Surface Ablation?

Advanced Surface Ablation (ASA) refers to a group of procedures that include PRK, Epi-LASIK, LASEK and TransPRK. It is a ‘no-flap, no incision, surface-based’ procedure that is suitable if you have:

  • An active lifestyle and are into rugged and contact sports (no cut or flap is made)
  • Thinner corneas
  • Concern over procedure-induced dry eye
  • Concern over flap-related issues from LASIK (i.e., dry eye, corneal ectasia, flap dislodgement)

ASA follows 3 main steps:

  1. Removal of a thin layer of cells on the surface of the cornea.
  2. Sculpting of the cornea tissue to correct the refractive errors by using a laser.
  3. Placing a protective contact lens over the eye to allow the regrowth of the surface cells over a few days.

Things to take note of:

  • You will face a relatively longer downtime of 5 to 7 days before your vision reaches a level that allows for normal activities.
  • Your vision will typically need a longer duration compared to LASIK and ReLEx SMILE to fully stabilise.
  • You will need to be on eye medication for several weeks to few months.

What is LASIK?

LASIK stands for Laser-Assisted In Situ Keratomileusis. It is the most widely accepted Laser Vision Correction procedure amongst refractive surgeons worldwide. It has excellent refractive correction, especially for higher levels of myopia, takes minutes to perform, and recovery is rapid and comfortable. It is currently the most widely performed Laser Vison Correction procedure in Singapore.

LASIK improves upon ASA in the areas of discomfort and recovery time. Although it involves creating a corneal flap during surgery, it is rare for complications to arise from it.

LASIK has 3 main steps:

  1. A 22mm circumferential side-cut flap is created on the surface of the cornea by a femtosecond laser. The flap is then folded back.
  2. The corneal tissue is then accurately sculpted by a second laser (excimer laser) to correct the refractive errors.
  3. Once completed, the flap is repositioned where it will stay in place until the cornea is fully healed.

Things to take note of:

  • Potential flap dislodgement due to trauma, though rare.
  • Rare occurrence of Corneal Ectasia (see section on Collagen Cross-Linking).

What is ReLEx SMILE?

ReLEx SMILE stands for Refractive Lenticule Extraction – SMall Incision Lenticule Extraction. It is flapless, minimally invasive and offers rapid recovery. Developed as a technique to combine the benefits of ASA (flapless) and LASIK (comfort and speed of recovery), ReLEx SMILE has gained increasing popularity over the last 10 years since its introduction.

ReLEx SMILE has 2 main steps:

  1. A lenticule (a disc-shaped piece of corneal tissue) is created by a laser just beneath the surface of the cornea.
  2. The lenticule is then removed from a small 4mm incision created by the same laser on the cornea. This results in a reshaped cornea that corrects your vision.

ReLEx SMILE may be a suitable procedure for you if you engage in sports or if your occupation entails some risk of head or eye trauma.

Things to take note of:

  • ReLEx SMILE cannot correct long-sightedness
  • Enhancement requires conversion to either LASIK or PRK

Comparative advantages of each procedure – a summary:

ASA

  • Flapless so there is no risk of flap complications
  • Lower occurrence of dry eye after surgery
  • Suitable if you are into contact sports
  • Recommended option if you have thinner corneas
  • Flexibility to treat most kinds of eye power

LASIK

  • Fastest visual recovery
  • Least discomfort after surgery
  • Relatively easier to do early enhancements
  • Flexibility to treat most kinds of eye power

ReLEx SMILE

  • Fast visual recovery
  • Flapless so there is no risk of flap complications
  • Less incidence of dry eye compared to LASIK
  • Suitable if you are into contact sports
  • Potentially lower risk of corneal ectasia
  • Smaller 4mm incision aimed at reducing infection

What are the risks of LASIK surgery?

Comparative disadvantages of each procedure – a summary:

ASA

  • Slowest visual recovery
  • Higher levels of discomfort

LASIK

  • Possible occurrence of rare flap-related complications and post-procedure dry eye

ReLEx SMILE

  • Unsuitable for very low myopia cases
  • Cannot treat hyperopia (long-sightedness)

Which is the best LASIK option for me?

If you have been evaluated as being suitable for Laser Vision Correction, the best procedure for you will depend on your:

  • Corneal thickness and shape – if it is quite thin, then ASA may be preferred
  • Degree of short-sightedness – if it is low, then ASA is recommended
  • Degree of astigmatism – ASA is not advisable if you have high astigmatism
  • Lifestyle and occupation – Avoid LASIK if you are into contact sports

Together with your eye surgeon, you will be able to determine which procedure is most suitable for you after a thorough consultation and eye evaluation.

Atlas Eye - 02

What are the side effects of LASIK?

You may experience some temporary side effects over the following days/weeks after the procedure:

  • Haloes
  • Glares
  • Dry eye
  • Mild fluctuation of vision
  • Corneal flap complications and infections – very rare with today’s laser technology

There is a small probability of over or under-correction of eyesight power occurring (less than 2 to 5% of cases). If your resulting prescription is +/-0.75 or more, you may undergo enhancement surgery 3 months after your procedure or when your refractive error has stabilised.

How much does LASIK surgery cost in Singapore?

It can be challenging to make direct comparisons between what various clinics and hospitals charge for LASIK surgery as there are many variables involved. However, there is actually not much difference between a hospital and a private clinic in Singapore in terms of costs. The following are the estimated rates for what you can expect to pay for the different LASIK procedures (for 2 eyes):

  • Advanced Surface Ablation (PRK, Epi-LASIK, LASEK, TransPRK): $3,600 to $4,000
  • LASIK: $3,500 to $4,500
  • ReLEx SMILE: $5,300 to $6,000

The differences in the packages can be attributed to pre- and post-operative services that the individual hospital or clinic provides, such as:

  • Pre: Eye evaluations
  • Post: Reviews and enhancement

Do pay careful attention to what is being offered to avoid being faced with hidden costs or paying for unnecessary add-ons. If you prefer, you can approach several hospitals/clinics to get a better estimate of the cost of the procedure you have chosen.

Can I use my Medisave or Insurance Policy?

LASIK is considered an optional/elective procedure, so you are unable to use your Medisave. The only exception to this is when there is a difference of at least 300 degrees between your eyes AND if you are intolerant to glasses and contact lenses.

Insurance policies on the other hand, generally do not cover LASIK procedures. However, some policies with higher premiums allow for it, while some companies include it under their corporate benefits. Do check with your provider beforehand.

Frequently Asked Questions

When LASIK was first introduced, patients had to undergo surgery 1 eye at a time. This was because of:

  1. The risk of infection to both eyes – by having 1 eye treated at a time, the risk would only be limited to 1 eye.
  2. The accuracy of lasers being not as precise as what they are today – having the procedure done for the second eye at a later time, would allow for the second procedure to take into account any inaccuracies in the first eye and make the adjustments accordingly.

As these are no longer concerns today, the majority of LASIK procedures are done on both eyes in the same sitting, minimising your downtime after surgery.

However, if you prefer to stagger the procedures, surgeons are usually happy to oblige your request.

Collagen Cross-Linking (CXL) is a top-up procedure in addition to LASIK procedures, done at the same session, that aims to strengthen the cornea to:

  • Reduce the risk of Corneal Ectasia, a rare complication where the cornea loses its ability to keep its shape, thus degrading vision.
  • Extend the longevity of the laser results.
  • Minimise the possibility of an enhancement after the first procedure.

The process consists of applying drops of Vitamin B12 to your eye during the laser treatment. UV light is then shone on your eye for about 1 minute which activates the collagen fibres in your eye to cross-link, thereby strengthening your cornea. The whole process adds merely another 5 minutes to the procedure time.

The need to have CXL done can’t be directly answered, as it is difficult to predict if your eyes are prone to having poor vision returning. However, studies have indicated that generally, people with high power have a greater tendency to suffer a regression in eye power. If you have CXL done, it can reduce the chance of this happening, as well as reduce the risk of Corneal Ectasia which may occur over time; many years after LASIK surgery.

Likewise, with how you would prepare yourself for a pre-LASIK evaluation, stop using soft contact lenses at least 3 days before the surgery, and at least 14 days for hard lenses.

If you want to have Collagen Cross-Linking on top of your procedure, do not consume large amounts Vitamin C 1 week before the surgery. Having small pieces of fruits and vegetables containing Vitamin C is fine.

You can expect to spend a total of about 2 hours in the hospital/clinic, with the procedure itself taking about 30 minutes for 2 eyes.

You will experience blurry vision during the first 6 hours, so it will be nice to have someone accompany you home after the procedure. Otherwise, you are still able to make your own way home in a cab.

Do follow all medical instructions strictly. You will also be provided with eye shields to be used while sleeping during the first week to prevent the accidental rubbing of your eyes.

You will be required to return for reviews after the surgery. The general timeline is as follows:

LASIK/ReLEx SMILE: 1 day, 1 week and 1 month post-surgery. Depending on your recovery, your eye surgeon may want to review you again 3 months, 6 months and 1 year post-surgery.

ASA: 1 day, 3 days, 1 week and 1 month post-surgery. Depending on your recovery, your eye surgeon may want to review you again 3 months, 6 months and 1 year post-surgery.

Of the 3 procedures, LASIK and ReLEx SMILE has the fastest recovery time, followed by ASA.

The majority of LASIK and ReLEx SMILE patients can resume work/school after resting for 3 days though some do return to work to work/school the next day. For ASA patients, this usually takes 5 to 7 days.

Do follow these precautions after the surgery to ensure the best outcomes:

  • 12 hours: Avoid prolonged reading, computer work or watching TV
  • 24 hours: Do not drive vehicles or operate heavy machinery
  • 1 week: Do not use eye makeup
  • 1 week: Avoid smoky and dusty places
  • 1 week: Avoid getting water into your eyes when washing your face/bathing
  • 1 month: Avoid swimming, jacuzzi, sauna, hot tubs and hot yoga
  • 1 month: Avoid contact sports, and prevent sweat from entering your eyes by using a headband

Studies have shown that more than 95% of patients continue to enjoy good vision many years after having their procedure done. However, some patients (up to 6%) may require an enhancement procedure for short-sightedness, long-sightedness or astigmatism within 10 years of having the surgery.

If you develop Cataracts, Glaucoma and Macular Degeneration (eye diseases that typically occur due to ageing), you can still go for surgery to correct them.

If you like putting on cosmetic and coloured contact lenses for aesthetic reasons, you may do so, but only 1 to 3 months after your surgery. However, due to the altered shape of your cornea post-procedure, your contact lenses may not fit as well as before, and they may also tend to fall out, especially if you have dry eye.

To prevent this from occurring, you should have an optometrist prescribe contact lenses that are shaped for a better fit with your cornea.

When deciding who you should go to for your surgery, keep in mind the following considerations:

  • The ability of the surgeon to listen to your needs and provide an unbiased consultation
  • Transparency in the pricing with neither hidden costs nor hard-selling/upselling
  • The credentials and experience of the eye surgeon and eye centre
  • The percentage of patients who require an enhancement after surgery
  • The laser technology adopted by the eye centre
  • The availability of the full spectrum of treatment choices to enable a customised approach
  • The level of service provided by the eye centre

Ultimately, you should choose the eye surgeon/centre you feel the most comfortable with.

Your sight is precious, and you should do all you can to ensure a positive outcome for your health and well-being.

DR DAVID CHAN
Senior Consultant Eye Surgeon
Medical Director
MB ChB (UK), M Med, FAMS,
MRCS (Edin), FRCS (Edin)

Dr David Chan is the Medical Director and Senior Consultant Eye Surgeon at Atlas Eye Specialist Centre. He specialises in complex cataract surgery, anterior segment surgery and refractive surgery. His treatments include high-risk cataract surgery, lens replacement or exchange, lens capsular bag support, iris repair, laser vision correction (ReLEx SMILE/LASIK), collagen cross-linking, implantable contact lens and refractive lens exchange.