How Laser Eye Surgery is Done: A Step-by-Step GuideConsidering laser eye surgery can feel both exciting and a little overwhelming. The idea of living without glasses or contact lenses is appealing, but the thought of having a laser near your eyes might make you feel uneasy. You’re not alone in feeling this way. Many people are curious about how the procedure actually works, what it feels like, and whether it’s as safe and effective as it sounds.If you or someone you care about is thinking about laser eye surgery, you probably have a lot of questions: What happens during the surgery? Will it hurt? How long does it take to recover? Understanding exactly how the procedure is done can help ease those concerns and give you confidence in your decision.In this article, we’ll walk you through the entire process - from the steps every laser eye surgery has in common to the details that make each type of procedure unique. By the end, you’ll have a clear picture of what to expect and feel more prepared to take the next step towards clearer vision, if that’s what you decide. Contact us at IVISION LASER if you’re looking for laser eye surgery in Adelaide. For more information about how these procedures improve vision, take a look at our article 'How does vision correction work?'What all laser eye surgeries have in commonWhile there are different types of laser eye surgery, every procedure shares a core process designed to ensure safety, precision, and the best possible results. Understanding these common steps can help you feel more empowered to consider your options.Pre-surgery eye assessments and mappingBefore any laser touches your eye, your surgeon will perform a series of detailed eye assessments. This involves checking your overall eye health, measuring the thickness of your cornea, and mapping the unique shape of your eye. Technology such as corneal topography and wavefront analysis, is used to create a 3D map of your eye. This information helps your surgeon plan a treatment that’s custom tailored to correct your specific vision issues, whether that’s short-sightedness, long-sightedness, or astigmatism.Numbing the eyes with anaesthetic dropsOne of the most common concerns patients have is whether laser eye surgery will hurt. The good news is that numbing eye drops are applied just before surgery begins. These anaesthetic drops completely numb the surface of your eye, so while you might feel some mild pressure at times, you won’t feel any pain. There’s no need for general anaesthesia, meaning you’ll be awake and fully aware, but comfortable throughout the procedure.Use of laser technology for corneal reshapingNo matter which type of laser eye surgery you choose—LASIK, PRK, or SMILE—the core goal is the same: to reshape your cornea so light focuses properly on your retina, giving you clearer vision. This is done using lasers that precisely remove microscopic amounts of corneal tissue. The type of laser and method used can vary depending on the procedure, but all are designed to optimise accuracy, safety, and results. We will explore each method in more detail below.Overview of the main types of laser eye surgery in AustraliaLaser eye surgery isn’t a one-size-fits-all procedure. In Australia, several types of laser eye surgery are available, each designed to suit different vision needs and eye conditions. Understanding these options can help you and your surgeon decide which treatment is best for achieving clearer, long-lasting vision.LASIK (Laser-Assisted In Situ Keratomileusis)LASIK is the most common type of laser eye surgery worldwide1 Kamiya et al. (2017) A Multicenter Retrospective Survey of Refractive Surgery in 78,248 Eyes. Journal of refractive surgery (Thorofare, N.J. : 1995). https://pubmed.ncbi.nlm.nih.gov/28880334/ . It’s popular because it offers quick results (patients usually notice improvements in vision within a few days2 https://www.healthline.com/health/eye-health/prk-vs-lasik#how-they-work ), minimal discomfort, and a relatively fast recovery time with most patients fully recovered within a few months3 https://www.healthline.com/health/eye-health/prk-vs-lasik#how-they-work . During LASIK, a thin flap is created on the surface of the cornea, which is then lifted so the underlying corneal tissue can be reshaped with a laser. The flap is then carefully repositioned, allowing the eye to heal naturally4 https://www.healthline.com/health/eye-health/prk-vs-lasik#how-they-work .PRK (Photorefractive Keratectomy)PRK was the first type of laser eye surgery developed and is still widely used today, especially among particular patient groups such as those with thinner corneas ineligible for LASIK5 https://www.healthline.com/health/eye-health/prk-vs-lasik#candidate . Instead of creating a corneal flap like in LASIK, PRK removes the thin outer layer of the cornea (the epithelium), allowing the laser to reshape the surface of the eye directly6 https://www.healthline.com/health/eye-health/prk-vs-lasik#candidate . The epithelium naturally grows back during the healing process.SMILE (Small Incision Lenticule Extraction)SMILE is the latest advancement in laser eye surgery. It’s a minimally invasive procedure where a small piece of corneal tissue (called a lenticule) is created and removed through a tiny incision7 https://www.tandfonline.com/doi/abs/10.1080/08820538.2020.1807028 . This reshapes the cornea without the need to create a flap.Why are there different types of laser eye surgery?No two eyes are exactly the same, and factors like corneal thickness, eye shape, vision problems, and even lifestyle can influence which type of surgery is most suitable. While LASIK is the most common due to its fast recovery and excellent results, PRK and SMILE offer alternatives for those who may not be ideal candidates for LASIK.Your surgeon will carefully assess your eyes and personal needs to recommend the procedure that offers the safest and most effective path to clearer vision.How LASIK surgery is performedLASIK is carefully designed to reshape the cornea, improving how light is focused onto the retina for clearer vision. Here’s a step-by-step look at how LASIK surgery is performed.Creating a thin corneal flap with a femtosecond laserThe first step in LASIK surgery involves creating a thin, hinged flap on the surface of the cornea. This is done using a femtosecond laser, a highly precise laser that makes a clean and controlled cut without using blades. The surgeon gently lifts this flap to expose the underlying corneal tissue.Why this step matters:The flap allows the surgeon to access the cornea without fully removing surface tissue8 Pérez-Santonja et al. (undefined) Corneal wound healing after laser in situ keratomileusis in rabbits. Journal of refractive surgery (Thorofare, N.J. : 1995). https://pubmed.ncbi.nlm.nih.gov/9866098/ .It speeds up healing since the flap acts as a natural bandage after surgery9 https://www.michiganmedicine.org/health-lab/pros-and-cons-lasik-are-risks-worth-cost .Reshaping the cornea with an excimer laserOnce the corneal flap is lifted, an excimer laser is used to reshape the exposed corneal tissue. This laser emits cool ultraviolet light to precisely remove microscopic layers of tissue, correcting how light is bent (or refracted) into the eye.Depending on the patient’s vision problem:Short-sightedness (myopia): The cornea is flattened.Long-sightedness (hyperopia): The cornea is made steeper.Astigmatism: The cornea is smoothed into a more symmetrical shape.Why this step matters:The excimer laser is incredibly precise, targeting only specific areas of the cornea.This reshaping allows light to focus properly on the retina, leading to sharper vision.Repositioning the flap for natural healingAfter the cornea has been reshaped, the surgeon carefully lowers the corneal flap back into place. The flap naturally adheres without the need for stitches, acting as a protective layer during healing.Why this step matters:The flap protects the central part of the cornea and helps vision recover faster.Most patients notice clearer vision within 24 to 48 hours.Once the procedure is complete, patients are usually sent home to rest, with follow-up appointments scheduled to monitor healing.How PRK surgery is performedPhotorefractive Keratectomy (PRK) is one of the original forms of laser eye surgery and remains a trusted option, especially for patients with thinner corneas10 https://www.healthline.com/health/eye-health/prk-vs-lasik#cost . Unlike LASIK, PRK doesn’t involve creating a corneal flap. Instead, it focuses on reshaping the surface of the cornea to correct vision. Here’s how PRK surgery is performed step-by-step.Removing the corneal epitheliumThe first step in PRK surgery involves gently removing the epithelium, which is the thin outer layer of the cornea. This can be done using a special brush, a blunt surgical tool, or with the help of an alcohol solution that loosens the tissue. This exposes the underlying layer of the cornea for treatment.Why this step matters:Removing the epithelium allows direct access to the cornea for reshaping.It eliminates the need to create a flap, making it a viable alternative to LASIK for patients with thin or irregular corneas11 https://www.healthline.com/health/eye-health/prk-vs-lasik#cost .Laser reshaping of the corneal surfaceOnce the epithelium is removed, an excimer laser is used to reshape the corneal surface. This laser removes microscopic amounts of tissue to correct the way light enters the eye.Depending on your vision problem:Short-sightedness (myopia): The laser flattens the cornea.Long-sightedness (hyperopia): The laser steepens the cornea.Astigmatism: The laser smooths out irregularities in the corneal shape.Why this step matters:Directly reshaping the corneal surface leads to clearer, sharper vision.The excimer laser is highly precise, ensuring only targeted tissue is removed.Healing without a corneal flapAfter the laser reshaping is complete, the surgeon places a soft, protective contact lens over the eye to act as a bandage. The epithelium naturally regenerates over the next few days. Patients are given medicated eye drops to prevent infection and reduce inflammation during healing.Why this step matters:Without a corneal flap, there’s no risk of flap-related complications.Though recovery takes longer than LASIK, PRK is safer for patients with active lifestyles or jobs with a risk of eye trauma12 https://www.michiganmedicine.org/health-lab/pros-and-cons-lasik-are-risks-worth-cost .PRK may require a bit more patience during recovery, with vision gradually improving over several weeks, but it offers long-term, stable results for many patients13 https://www.healthline.com/health/eye-health/prk-vs-lasik#pros-and-cons .SMILESMILE (Small Incision Lenticule Extraction) is the most advanced form of laser eye surgery available today. It’s a minimally invasive procedure designed to correct short-sightedness (myopia) and mild astigmatism with fewer disruptions to the corneal surface. Unlike LASIK and PRK, SMILE doesn’t involve creating a corneal flap or removing the outer layer of the eye. Here’s how the SMILE procedure is performed.Creating a lenticule within the corneaThe first step of SMILE surgery involves using a femtosecond laser to create a thin, disc-shaped piece of tissue called a lenticule within the deeper layers of the cornea. The laser is incredibly precise, shaping the lenticule according to the patient’s exact vision correction needs.Why this step matters:The lenticule’s shape is tailored to correct the specific refractive error.The femtosecond laser allows for a clean and precise cut within the cornea, minimising damage to surrounding tissue.Removing the lenticule through a small incisionOnce the lenticule is created, the surgeon makes a tiny incision—typically just 2–4 millimetres—on the surface of the cornea. Through this small opening, the surgeon carefully removes the lenticule. Once it’s extracted, the cornea naturally reshapes itself, correcting the way light enters the eye.Why this step matters:The small incision eliminates the need for a larger corneal flap.Less disruption to the cornea reduces the risk of complications and promotes quicker healing.Minimising surface disruption for faster recoveryBecause SMILE doesn’t involve creating a flap or removing the outer layer of the cornea, the eye’s surface remains largely intact. Although this promotes a faster, more comfortable recovery than PRK14 Denoyer et al. (2015) Dry eye disease after refractive surgery: comparative outcomes of small incision lenticule extraction versus LASIK. Ophthalmology. https://pubmed.ncbi.nlm.nih.gov/25458707/ , its important to remember that this procedure does involve an incision, albeit a tiny one. Most patients notice improved vision within a few days.Why this step matters:Reduced risk of dry eyes and other surface-related issues15 Denoyer et al. (2015) Dry eye disease after refractive surgery: comparative outcomes of small incision lenticule extraction versus LASIK. Ophthalmology. https://pubmed.ncbi.nlm.nih.gov/25458707/ .Suitable for patients with active lifestyles or those in physically demanding jobs.SMILE surgery offers a cutting-edge, gentle alternative to traditional laser eye surgeries, providing similar long-term vision correction outcomes to LASIK16 https://www.tandfonline.com/doi/full/10.1080/08820538.2020.1807028 .Advanced laser technology in eye surgeryLaser eye surgery has come a long way, thanks to cutting-edge technology that makes procedures safer, more precise, and more effective. Two key types of lasers are used in modern eye surgery: the excimer laser and the femtosecond laser. Each plays a vital role in reshaping the cornea and improving vision with minimal risk.Excimer vs. Femtosecond lasers: How they workExcimer laser:The excimer laser is an ultraviolet laser used to precisely remove tiny amounts of corneal tissue. It works by breaking the molecular bonds in the tissue without generating heat, allowing for extreme accuracy without damaging surrounding areas. This laser is primarily used in LASIK and PRK surgeries to reshape the cornea and correct refractive errors like short-sightedness, long-sightedness, and astigmatism.How it’s used:In LASIK, it reshapes the corneal tissue after the flap is lifted.In PRK, it directly reshapes the exposed corneal surface.Femtosecond laser:The femtosecond laser uses ultra-fast pulses of infrared light to cut precise layers within the cornea. It’s most commonly used to create the corneal flap in LASIK and to form the lenticule in SMILE surgery. This bladeless method offers greater control and reduces the risk of complications compared to traditional surgical tools.How it’s used:In LASIK, it creates a thin, precise corneal flap.In SMILE, it sculpts and isolates the lenticule inside the cornea.Safety and precision in modern laser systemsModern laser systems are designed with advanced safety features to protect patients and ensure optimal outcomes. These include:Eye-tracking technology: Lasers are equipped with high-speed eye trackers that monitor and adjust for even the slightest eye movements, ensuring the laser targets exactly the right area.Customised treatment plans: Wavefront-guided and topography-guided lasers create personalised treatment plans tailored to the patient’s unique eye shape and vision needs.Temperature control: The excimer laser operates at cool temperatures, preventing heat damage to surrounding tissue.Automated safety checks: Built-in safety systems continuously check the laser's alignment and function during the procedure.These technological advancements make laser eye surgery safer and more precise than ever, providing patients with better results and faster recovery times.Post-procedure care and immediate recoveryOnce the laser work is done, your eyes begin the healing process. Regardless of the procedure type, you’ll be given protective eyewear to prevent rubbing or accidental contact and may be prescribed antibiotic and anti-inflammatory eye drops to prevent infection and reduce discomfort. Most patients experience clearer vision within a few days, although it can take longer for some depending on the type of surgery. Your surgeon will schedule follow-up appointments to monitor your healing and ensure your eyes are recovering as expected.Knowing these shared steps can help ease your mind and give you a better understanding of what to expect, no matter which type of laser eye surgery you’re considering.FAQsAre you awake during laser eye surgery?Yes, you are awake during laser eye surgery—but there’s no need to worry. Many patients feel anxious about being awake, but the procedure is designed to be safe, comfortable, and stress-free. Discuss with your dentist the possibility of anti-anxiety medication if you are particularly concerned about being awake for this procedure.One common concern is how blinking or moving your eyes might affect the surgery. Before the procedure begins, numbing eye drops are applied to prevent discomfort and reduce the urge to blink. Additionally, a small device called a lid speculum gently holds your eyelids open, so you don’t have to worry about blinking.Advanced laser systems also include eye-tracking technology that follows even the smallest eye movements in real-time. If your eye moves, the laser automatically adjusts or pauses to ensure precision and safety.Why general anaesthesia isn’t necessaryGeneral anaesthesia isn’t used because it’s not needed. Laser eye surgery is quick, painless, and minimally invasive. Staying awake allows you to follow simple instructions from your surgeon, like focusing on a target light, which helps guide the laser. Using only local anaesthetic drops keeps the procedure safer and speeds up recovery.How long does laser eye surgery take?Laser eye surgery is surprisingly quick. Most procedures are completed in less than 30 minutes for both eyes. The actual laser reshaping part of the surgery often takes just a few minutes per eye.Comparing procedure times for LASIK, PRK, and SMILELASIK: Typically 10–15 minutes per eye. The laser reshaping takes only seconds, with most of the time spent on preparation.PRK: Around 15 minutes per eye due to the additional step of removing the epithelium.SMILE: 15–20 minutes per eye, slightly longer due to the creation and removal of the lenticule.Factors that can affect surgery durationEye shape and prescription: Higher prescriptions or irregular corneas may take longer.Technology used: Advanced laser systems can shorten procedure times.Patient movement: Although eye trackers manage movement, extra time may be needed if you feel nervous or move unexpectedly.What happens immediately after surgery?Once your laser eye surgery is complete, your recovery begins right away. Your surgeon will provide instructions to help your eyes heal safely and comfortably.Post-surgical monitoring and initial healingYou’ll rest in a recovery area for a short time while your surgeon checks your eyes. It’s normal for your vision to be blurry immediately after surgery. You’ll be given protective eyewear to prevent accidental touching or rubbing and eye drops to prevent infection and reduce inflammation.For LASIK and SMILE, many people notice clearer vision within 24–48 hours. For PRK, recovery is slower, and vision can take around a month to stabilise17 https://www.healthline.com/health/eye-health/prk-vs-lasik#pros-and-cons .Expected sensations and aftercare instructionsIn the hours following surgery, you might feel:Mild discomfort or grittiness in the eyesSensitivity to lightWatery or dry eyesYour surgeon will give you specific aftercare instructions, which may include:Using prescribed eye drops to aid healing and prevent infectionWearing protective glasses or shields while sleepingAvoiding strenuous activities and swimming for a few weeksFollow-up appointments will be scheduled to monitor your healing and ensure your vision is improving as expected. Most patients can return to normal activities within a few days, with ongoing improvements in vision over the following weeks.Choosing the right procedure for youWith several types of laser eye surgery available, it’s natural to wonder which procedure will deliver the best results for your vision. While it’s helpful to understand how LASIK, PRK, and SMILE work, the final decision should always be made with guidance from your eye surgeon.Which laser eye surgery best suits your vision needs?Each laser eye surgery procedure is designed to address specific vision issues and personal circumstances:LASIK is often suitable for patients with stable prescriptions and healthy corneas, offering fast recovery and quick visual improvement.PRK may be better suited for those with thinner corneas, dry eyes, or individuals involved in contact sports where a corneal flap could pose a risk.SMILE can be a great choice for patients with short-sightedness (myopia) or mild astigmatism, offering a minimally invasive approach with a quicker recovery.However, factors such as corneal thickness, eye health, lifestyle, and the degree of refractive error all play a role in determining the most suitable procedure.Consultation and next stepsThe best way to know which surgery is right for you is to book a consultation. During your consultation, your eyes will be thoroughly examined using advanced diagnostic tools to assess your corneal shape, thickness, and overall eye health.Your surgeon will explain the options in detail, discussing the risks and benefits of each procedure based on your unique vision needs. They will recommend the safest and most effective treatment to help you achieve clear, long-lasting vision.Ready to take the first step? Book your consultation.ConclusionLaser eye surgery has helped millions of people worldwide achieve clearer vision and greater freedom from glasses and contact lenses. Whether it’s the quick recovery of LASIK, the flap-free precision of PRK, or the minimally invasive approach of SMILE, each procedure is designed to safely and effectively correct vision problems.Understanding how these surgeries are performed can help ease any worries and give you confidence in taking the next step. However, the most important decision—choosing the right procedure—should always be made with the guidance of a qualified surgeon.