Guide to LASIK in Singapore: Ready to say goodbye to myopia for good?

Guide to LASIK in Singapore: Ready to say goodbye to myopia for good?

Myopia is a visual disability that millions have all over the world. The World Health Organisation (WHO) has categorised myopia with other eye diseases such as cataract, macular degeneration, infectious diseases and Vitamin A deficiency amongst the leading causes of blindness worldwide. [1] A study by American Academy of Ophthalmology found that almost 10 million are severely short-sighted in the U.S. and at higher risk of a complication called myopic choroidal neovascularization that can potentially lead to vision loss. [2]

In Singapore, myopia is so common that most of us don’t give it a second thought. But the daily struggle with glasses and contact lenses is real; and only those who are short-sighted can understand.

Accidentally losing or destroying your glasses is like losing a lifeline – panic bubbles up and you just have to drop everything and head to the nearest optician to get a new pair done, ASAP. And you’ll have to survive blind in the meantime.

If you’ve finally had enough of all your glasses and contact lens woes, read on; this will prepare you for your laser vision correction journey in Singapore, towards what you’ve always wanted: perfect vision. 

“Okay I want to do laser vision correction in Singapore! Now what?!”

Generally, laser vision correction can correct eye refractive errors such as myopia, astigmatism, hyperopia and presbyopia in one sitting. Glasses and contact lenses be gone for good!

The good news? LASIK in Singapore is so advanced today that we now have different options to choose from. A quick google search of “LASIK Guide Singapore”, “LASIK Singapore” or  “laser vision correction Singapore” will bring up a myriad of medical procedure and technology names which can be confusing and overwhelming.

But in fact, in Singapore, there are four main methods you can go about correcting your vision – namely: LASIK, ReLEx SMILE, TransPRK (Advanced Surface Ablation) and Implantable Collamer Lens (ICL). The first three are corneal based procedures using a laser and the latter involves planting an intraocular lens into your eye, as the name suggests.

To choose, you will have to first understand more about each of the four procedures.

#1. LASIK

Main Steps of LASIK surgery, it starts with local numbing eye drops, and then creation of flap with either a blade or laser, reshaping of cornea curvature with excimer laser, and then putting the flap back to its original position
Main steps of LASIK surgery

LASIK (short for Laser-Assisted In Situ Keratomileusis) in Singapore is a popular method of laser vision correction which many Singaporeans and people living in Singapore are familiar with. It has been around since 1995, thus it is likely that you have family or friends who had undergone LASIK before.

In LASIK, the eye surgeon uses a Femtosecond laser to cut the surface of your cornea to create a flap. He then folds it open and uses an excimer laser to reshape the cornea curvature underneath the cut flap, thereby correcting refractive errors. The corneal flap is then folded back into place, adhering to your eyes with tissue pressure and forming your eyes’ natural bandage.

It’s a 15 – 20 mins day surgery per eye which only requires numbing eye drops. Your vision is usually clear within a day or two so you can go back to work in 2 to 3 days.

However, LASIK patients will have to refrain from rubbing the eyes and stay away from water sports for a month and contact sports for life. This is to prevent complications such as corneal flap dislodgement and flap wrinkles. [3] The other major risk of LASIK is permanent dry eyes.

#2. ReLEx SMILE

illustration showing the beginning step of relex smile where doctor create a 2-3 mm opening incision using femtosecond laser

illustration of steps of relex smile where surgeon remove the lenticule using a surgical device

In Singapore, ReLEx SMILE (Refractive Lenticule Extraction, Small Incision Lenticule Extraction) is the newest surgical method, out of all 4 procedures.

In SMILE, the eye surgeon uses the same Femtosecond laser which is used to cut an open corneal flap in LASIK, but this time, he uses it to cut an internal corneal flap (medically known as a lenticule) within the corneal bed. He then uses a blade to cut a small incision at the side and uses forceps to pull out this lenticule from the cut slit. After the lenticule is removed from the cornea, the topmost cornea tissue then collapses into the empty space vacated by the lenticule, changing the way light bends into the eye and thus correcting your vision.

This procedure will takes around 10 – 15 minutes per eye in general. However, the ReLEx SMILE procedure is more difficult to do as compared to LASIK and TransPRK, and is thus at higher risk of intra-operation complications. For example, complications such as incomplete lenticule extraction, lenticule tear, etc can occur during the SMILE surgery [3].

If the procedure is smooth and successful, vision is clear is two to three days so you can go back to work on the fourth day post-op. The risk of LASIK-induced dry eyes and open flap complications are less with ReLEx SMILE when compared to LASIK. However, do note that this method doesn’t work for hyperopia (long-sightedness), astigmatism and too low/too high conditions of myopia.

#3. TransPRK

TransPRK surgery process. Firstly, a local anaesthetic in a form of eyedrops is used. Secondly, the removal of epithelium layer using excimer laser. Thirdly, reshaping the cornea structure by using the same excimer laser. Fourthly, temporary placement of bandage contact lens to protect the eye while the epithelium cells are healing
The 4 main steps of TransPRK Procedure.

TransPRK stems from a category of laser vision correction called Advanced Surface Ablation (ASA) that has been around since 1989. In fact, if you study the history of laser vision correction, you will find that it first began with an ASA procedure called PRK. With surface procedures, the laser is applied right at surface of the cornea without cutting it.

In TransPRK, the eye surgeon applies the excimer laser to first ablate the surface epithelium cells (outermost skin cells of the cornea). The laser goes on to reshape the surface of the cornea, correcting your eye refractive errors. Immediately after, the doctor places a high-oxygen content contact lens onto the cornea and removes them when the epithelium cells have healed, typically 5 days later.

For this procedure, it requires a very specific brand of excimer laser called the Schwind Amaris laser as it is the only laser that has the capability to ablate corneal epithelium cells. In LASIK, epithelium cells are peeled back in the form of a corneal flap, thus any brand of excimer laser can be used to reshape the tissue within.

It takes only 20 to 40 seconds per eye for the treatment, making it the fastest laser vision correction procedure. However, there are slight fluctuations with visual acuity during the time when epithelium cells are healing, thus you can only go back to work in five days. The main benefits of this surface procedure overall is that you will have no risk of flap complications at all and the least risk of LASIK-induced dry eyes.

#4. Implantable Collamer Lenses (ICL)

illustration of the implantable collamer lens procedure where surgeon implants the artificial collamer lens on the eye

Lastly, the Implantable Collamer Lenses (ICL) procedure is the only procedure of the four that is not laser-based and not corneal-based. It involves implanting an artificial lens made of Collamer in your eye.

In ICL, numbing eye drops are applied to the eyes first. The surgeon then makes a tiny incision in the cornea and inserts a foldable, artificial lens into the eye, between the iris and your natural crystalline lens. The procedure takes about 20 to 30 minutes per eye.

Unlike the other procedures, ICL occurs deep within the eye and beyond the cornea, making it a more invasive procedure. It is a good option for those with severely high myopia (more than 1.2 dioptres per eye) which cannot be corrected with the other corneal-based laser procedures. However, you have to bear in mind that the ICL will rub against your own natural crystalline lens, causing an early cataract overtime. 

“So… which procedure should I opt for?”

Implantable Collamer Lenses (ICL)

In general, if you have extremely high myopia (more than 1.2 dioptres per eye), then ICL may be your only option to regain perfect vision. Implanting an artificial lens into your eyes is the most invasive out of all the procedures as it occurs within eye while the other procedures occur on the surface cornea of the eye. Thus, there are surgical risks that come with it. That being said, ICL is a widely performed eye surgery so a skilled eye surgeon should be able to mitigate these risks.

Price of ICL in Singapore: $12,000 to $15,000 for both eyes, inclusive of GST

As for the other 3 corneal-based procedures, there are pros and cons to each and every one of them. However, ReLEx SMILE has specific limitations so if you fall outside its treatment boundaries, you will not be suitable for SMILE. The other two procedures – LASIK and TransPRK – do not have so many procedural limitations and thus are suitable for most people.

ReLEx SMILE

Boundaries and limitations:

  • Only consider ReLEx SMILE if your myopia degree is between 200 to 600 degrees per eye. Due to the nature of the procedure, the internal lenticule flap cannot be cut too thin (low myopia) or too thick (high myopia) as it would be difficult to extract.
  • ReLEx SMILE cannot correct astigmatism and hyperopia, so if you have those refractive errors, these will not be corrected.
  • If a surgical complication were to occur (i.e. lenticule flap tear, incomplete lenticule extraction, etc), your surgeon may need to abort the whole ReLEx SMILE procedure and switch to a LASIK or TransPRK procedure to salvage. Thus, there is a possibility that even though you chose to opt for the SMILE procedure, you may not be able to do it.

In general, the main pro of ReLEx SMILE is that the recovery is fast and you can go back to work in 2 to 3 days. You can also avoid open LASIK complications post-op such as corneal flap problems (flap dislodgement, flap wrinkles etc) and dry eyes.

Price of ReLEx SMILE in Singapore: $6,000 to $8,000 for both eyes, inclusive of GST

LASIK

LASIK is the procedure that popularised it all and has been performed on millions of eyes worldwide, it is one of the more well known, if not most well known laser vision correction surgery in Singapore.

The main pro of LASIK is that it has the shortest recovery time and you can go back to work in 1 to 2 days. However, there are three major downsides of LASIK:

  • LASIK patients may experience flap complications such as flap wrinkles, flap inflammation, flap dislodgement, etc post-op. This can happen if you rub your eyes too hard after doing LASIK, or if you get poked/get hit in the eye. The most severe is flap dislodgement, where you will have to see your surgeon immediately to replace the dislodged corneal flap. Flap complications occur because the cut LASIK flap only adheres with tissue pressure and never fully heals.
  • LASIK can cause permanent dry eyes as the cornea is cut to create an open flap. This risk is estimated at 2 to 3%. If this happens, you will have to apply eye drops regularly for life.
  • It can cause cornea thinning problems such as keratectasia. Because a lot of cornea tissue is required during LASIK, it results in a thinning of the cornea and thus the cornea bulges forward.

Price of LASIK in Singapore: $2,600 to $5,000 for both eyes, inclusive of GST

TransPRK

TransPRK is a surface-based procedure that requires the shortest amount of time. It belongs to a category of Advanced Surface Ablation (ASA) methods, of which the oldest – PRK – was how laser vision correction all began.

The main downside of TransPRK is that it has the longest recovery time of all the procedures and you can only go back to work in 4 to 5 days. There may also some discomfort experienced during recovery. This is because of the epithelium (outermost cornea surface cells) healing process. On our cornea, there is an outerlayer of tough epithelium skin cells.

In TransPRK, the laser removes the epithelium cells before reshaping the cornea body. Epithelium cells grow back in five days, similar to how our skin’s epithelial cells grow back whenever we fall down and scrape it. In the other procedures like LASIK, the surgeon cuts through the epithelium; and in ReLEx SMILE, the laser bypasses the epithelium internally to cut a lenticule below it.

Aside from the two major cons above, the pros of TransPRK are multi-fold:

  • TransPRK is least invasive and protects the structural integrity of your cornea in the long-term, making you less susceptible to problems like keratectasia.
  • There is zero risk of corneal flap complications since no corneal flap is cut whether internally (SMILE) or externally (LASIK)
  • TransPRK has the lowest risk of dry eyes since no cutting is done at all, so corneal nerves are not damaged.
  • It is especially suitable for active sportspeople and military personnel; since you may be at high risk of corneal flap problems if you are in either of these categories. You will be able to go about your sporting activities with no fear about dislodging the cut corneal flap.

Price of TransPRK in Singapore: $4,000 to $6,000 for both eyes, inclusive of GST

“Going for your LASIK eye evaluation”

Infographic showing information about pre-LASIK eye evaluation and things to take not of such as stopping the use of contact lens, and the eye assessment a patient has to take to determine his or her suitability.
Not everyone is suitable for a Laser Vision Correction surgery! You will first have to go for an eye evaluation to determine your suitability.

Armed with more knowledge about the different laser vision correction procedures, you may now book your LASIK eye evaluation to check if you are a suitable candidate for these procedures.

Your pupils will be dilated and you will undergo a series of eye tests, determining your eye degree and measuring key metrics such as corneal thickness and corneal irregularities. The whole evaluation takes about 2 to 3 hours in general, including a personal consultation with your eye surgeon.

An eye evaluation in Singapore ranges from $10 to $300 inclusive of GST (Find the latest list of LASIK surgery prices in Singapore here!).

“Going for your LASIK Surgery”

some of the things you will have to take note prior your lasik surgery day. To stop wearing contact lens for certain number of days. To not wear any perfumes, deodorant, colognes or after shave on your surgery day. To not drive to the clinic. TO not wear any makeup or face lotions on the surgery days.
Important things to take note prior to the surgery day! Do check with your LASIK clinic if there are more things you should take note of.

Prior to your LASIK surgery in Singapore, there are a few things you will have to take note of! Most likely, you will be told by your LASIK clinic to:

  • Stop wearing your contact lens prior to the evaluation.
  • Not wear perfume, deodorant, colognes, aftershave on your surgery day.
  • Not wear any make up or face lotions on your surgery day.
  • Not drive to the clinic.

When you wear contact lens, especially for a long period of time, the pressure created from the lens might temporarily change the shape and thickness of your cornea, Therefore, by stopping contact lens wear for a few days prior to the surgery, it will give your eyes time to rest, to be back to its normal state. Having your eyes in a normal state prior to your LASIK surgery is important, to ensure you get an accurate LASIK result, While for makeups and perfumes, you are not allowed to wear them on your surgery day as the fine particles emitted from them might affect the laser that is used to reshape your eyes.

If you would like to book an LASIK eye evaluation to determine your suitability for laser vision correction procedures, contact us here to connect with a few LASIK centres in Singapore.

Resources

[1] Fredrick, D. R. (2002). Myopia. BMJ (Clinical research ed.), 324(7347), 1195-1199. https://www.bmj.com/content/324/7347/1195

[2] Willis, J.R. et al. (2016) The Prevalence of Myopic Choroidal Neovascularization in the United States, Ophthalmology, Volume 123, Issue 8, 1771- 1782. Retrieved https://www.aaojournal.org/article/S0161-6420(16)30140-3/fulltext

[3] Alastair K. O. Denniston, Philip I. Murray (2018), Oxford Handbook of Ophthalmology, Oxford University Press, pg 958-960

Jolene

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Jolene lives for avo toasts, yoga and is a little more OCD than she cares to admit. She never fails to start her day with her morning coffee and is very partial to flat whites. She also has gone a little too far down the rabbit hole with interior design and dabbles in styling her own home at @februarynest.

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