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How does laser eye surgery work?

Laser eye surgery has progressed by leaps and bounds since the very first procedures in the late 1980s. LASIK, LASEK, PRK, SMILE: these acronyms describe different techniques for laser eye surgery.

Read on to find out more.

LASIK (laser-assisted in-situ keratomileusis)

LASIK is performed using a suction ring applied to the eye to secure it for the creation of a thin corneal flap on the top of the cornea with a femtosecond laser. The excimer laser is then applied under the flap to re-shape the cornea following which the flap is re-positioned.

Visual recovery after LASIK is quick, with minimal discomfort.

PRK (photorefractive keratectomy)

PRK avoids the need to create a flap. Instead, the surface skin layer (epithelium) is first scraped off the eye, before the excimer laser is used to reshape the cornea. An anti-scarring solution (mitomycin-C) is then appliedfor a few seconds to the surface of the corneabefore a soft (bandage) contact lens is placed on the eye for the first few days while the epithelium grows back.


A variation of PRK is called LASEK (laser sub-epithelial keratomileusis) – in this technique, the epithelium is peeled back before the laser is applied, after which the epithelium is placed back over the cornea.

TransPRK (transepithelial PRK)

With the Schwind Amaris 1050RS laser used by Daniel Gore at Moorfields Eye Hospital, the laser can remove the epithelium and reshape the underlying cornea in one step. This technique is called TransPRK. It is sometimes referred to a ‘no touch’ laser surgery – with no scraping, cutting or peeling of the cornea, the only thing to touch your cornea is the laser light.

Visual recovery after TransPRK is slower compared with LASIK, and the first 24 hours can be painful.

SMILE (small incision lenticule extraction)

This is a more recent development in laser vision correction (2009) in which a femtosecond laser cuts a sliver (lenticule) of tissue within the cornea. This lenticule is then removed through a small key-hole incision. Visual recover is quick, with minimal discomfort