Laser eye surgery - best and worst companies
Laser eye surgery companies compared
By Anna Studman
Article 1 of 2
Choosing where you're going to have laser eye surgery is extremely important. You can use the results of our laser eye surgery patient survey to help you make the right decision.
Undergoing surgery is stressful enough, without worrying whether the clinic is going to be absolutely upfront about the small but far-reaching risks to your eyes, rather than giving you sales hype. One in five (18%) of our survey respondents were given promises about their eyesight that they now know to be unrealistic.
We've surveyed nearly 1,000 people who have had laser eye surgery or lens replacement surgery and asked them about their experience with clinics, ranging from Optical Express to Moorfields. One in 10 of those we surveyed said their experience was worse than expected in terms of their vision.
You're making long-term decisions about your eyesight, so let us help you make the right choice for your needs.
Whether you're deciding whether laser eye surgery is right for you, or how to choose between big chains and independent clinics, our expert advice is here for you.
In this article:
- Best laser eye surgery companies (and worst)
- Laser eye surgery costs
- Who is a candidate for laser eye surgery?
- Types of eye surgery to correct eyesight
- Common laser eye surgery myths busted
- What are the risks of laser eye surgery?
Laser eye surgery is expensive and can cause complications. So who do you trust when you're choosing between high street companies, such as Optical Express, Optimax and Ultralase, and weighing up laser eye surgery costs?
We're independent and we've been meticulous in analysing the opinions of nearly 1,000 people who have had Lasik, Lasek, ReLEx Smile and lens replacement surgery. As well as the companies already mentioned, we have results on Advanced Vision Care, London Vision Clinic and Moorfields Eye Hospital.Logged-in Which? members can find out which laser eye clinics were rated the best. Not yet a member? Join Which? and get access to our results below and to unlock our analysis, plus all the reviews on our website including opticians stores compared and choosing varifocals.
|How customers rate laser eye surgery companies|
|Company||Explaining procedure||Enough time with surgeon||Sales practice||Pricing transparency||Customer service||Dealing with queries||After-care||Value for money||Customer score|
Based on a survey of 958 Which? members and members of the public who have had laser eye surgery in the last five years, conducted in June 2019. Individual sample sizes are as follows: Advanced Vision Care - 61, London Vision Clinic - 59, Moorfields Eye Hospital - 31, Optical Express - 304, Optimax - 166, Ultralase - 71.
Ultralase and Optimax have been jointly owned since 2012.
The biggest chain is Optical Express: it is said to do 6 out of 10 laser eye procedures in the UK, and has over 100 clinics.
Its prices vary, depending on your eyes and prescription (simple and lower prescriptions will be cheaper).
Hard to compare laser eye clinics? We have the information you need on laser eye surgery costs.
Ultralase and Optimax
These sister companies have 20 clinics between them (the Eye Hospitals Group Ltd), across the UK.
Smaller chains and independents
Moorfields Eye Hospital's private arm 'Moorfield Private' does its laser eye surgery at its City Road, London site.
Centre for Sight has three clinics, with Focus, Advanced Vision Care and London Vision Clinic having one apiece.
This chain has nine hospitals and clinics across England.
Optegra offers ReLex Smile (this makes up around 10% of laser eye treatments done in the UK) as well as more common laser eye surgery options of Lasik and Lasek, and lens replacement surgery.
Optegra is not included in our survey as we did not have enough respondents who had been Optegra customers in the past five years.
Smaller chains and independents
- Moorfields Eye Hospital's private arm 'Moorfield Private' has five private clinics.
- Centre for Sight has three clinics.
- Focus, Advanced Vision Care and London Vision Clinic have one apiece.
To be suitable for eye surgery, you have to be over 18 with a stable eye prescription (no change greater than 0.5 units or dioptres) in the past two years.
Eye clinics have different criteria, which may depend on the surgeon’s expertise and the laser being used. You might well find that clinics are more cautious if one of these applies to you:
- a significant (high) prescription (over +10.00D of myopia or short sight, over +4.00D of hyperopia or long sight, and over + or -6.00D of astigmatism)
- Type 1 (insulin-dependent) diabetes
- existing medical dry eyes
- you're over 50 or have early cataracts (lens replacement surgery - see below - could be a more suitable option).
Only the detailed eye scans carried out at a laser eye surgery clinic (more detailed than those you normally get at the optician) would reveal problematic issues that you wouldn't know about, such as having corneas that are too thin for surgery.
The laser eye (refractive) surgery we're talking about is to correct vision such as short sight, rather than - for example - sealing the leaking blood vessels in the retina that can happen as a result of diabetic retinopathy, or making a small hole in your iris to allow fluid to flow freely around it (for people with acute glaucoma).
The main types of laser treatment are:
- Lasik and Lasek (PRK, the forerunner of Lasek, is rarely performed these days)
- and ReLex Smile.
Lasik (laser-assisted in-situ keratomileusis)
- The cornea is cut by a mechanical blade or infrared laser, creating and then lifting a precise flap of tissue.
- The surface underneath is sculpted using a different (excimer) laser.
- The flap then adheres without stitches.
It usually causes minimal pain and vision recovers quickly. 95% of people have Lasik, which can be less painful than Lasek, and heals more quickly (people often return to work the day after surgery).
Lasik is less suitable for those with thin corneas as - for example - it leaves less tissue if re-treatment is needed.
Wavefront is a laser technology that is customised to treat the individual shape of your eye. It's usually an add-on to Lasik or other treatments and costs more.
Older people are much more likely to have refractive lens surgery (see below). But Lasik may be possible for those over 65 with no signs of cataract and good eye surface health.
Lasek (laser epithelial keratomileusis)
- Lasek uses dilute alcohol to soften and roll back a thin flap of the cornea to do the excimer laser treatment.
It’s generally more uncomfortable and slow-healing after surgery (expect to be off work for a week), but better if you have thin corneas as it doesn't waste precious tissue.
The lack of a flap in the eye can be especially useful for sportspeople, who risk an injury such a finger nail snagging the edge of their Lasik flap. Lasek doesn't leave any flaps.
ReLex SMILE (Small Incision Lenticule Extraction)
- To re-shape the cornea, an infrared (femtosecond) laser creates a small disc [lenticule] of tissue inside the intact cornea of your numbed eye.
- The surgeon then removes the lenticule from inside the cornea through a small incision measuring a few millimetres, using a minimally invasive procedure.
The surgeon doesn't need to cut a flap (as with Lasik), and the surface corneal layer remains intact, but this is still surgery. . So you can probably return to sport more quickly than with Lasik (where a flap has been created in your eye).
As with a Lasik procedure, you should experience minimum discomfort and rapid restoration of vision after a SMILE procedure. It can be suitable for patients with a thinner cornea (something you'll find out after initial eye testing) who are not eligible for a LASIK procedure or with higher prescriptions.
However, recovery can be a little slower. Re-treatment - if needed - can be more tricky.
Intraocular lenses (refractive lens exchange or surgery)
This is an increasingly common alternative to laser eye surgery.
- You have your eye lens replaced by a synthetic one
- This is either monofocal (single vision) or multifocal.
Lens replacement is effectively the same as a cataract operation. It's an alternative where laser eye surgery isn’t possible. It's often suggested for older people or those with early cataracts - it wouldn't be worth having laser eye surgery if it was likely you'd need your eye's lens replaced in the near future.
Like cataract surgery, you're likely to have one eye treated at a time, with procedures a week apart.
But it's more expensive than laser eye surgery such as Lasik, as it’s a more complex and invasive procedure.
It's not the natural alternative for younger people where their own eye lenses are flexible.
Implantable (intraocular) contact lenses
- You can have an additional soft, very thin lens inserted in front of your eye's natural lens to change the eye’s power (prescription).
Implantable contact lenses can be an option for younger people whose prescription is too high for laser eye surgery and who can't tolerate contact lenses, but want to retain the natural flexibility in their own lenses.
It's also a potentially good option for people with medical dry eye or keratoconus.
Lens design is improving all the time, and these lenses don't have to be cleaned and you won't be able to feel them.
You'll either have monofocal lenses to reduce the need for glasses for distance, or multifocal lenses to correct your vision at multiple distances including near and distance.
The quotes are taken directly from laser eye clinics during our last mystery-shop:
Better vision guaranteed
- They say: 'You are definitely going to get a better vision than you get with your glasses or contact lenses...'
- Our experts say: A false promise: a very small proportion of people don't see as well as they did with glasses before surgery. In about 1 in 200 eyes, this can't be corrected with specs because the eye's optical quality has been reduced.
- They say: '...because with this laser 99.3% of patients achieve 20/20 [vision].'
- Our experts say: What you want to know is, is this true for your particular eyes? Ask for statistics to be for your individual prescription.
No need for glasses
- They say: 'The next day you'll have 20/20 vision and no need for glasses'.
- Our experts say: A vital fact is missing: even if your eyes are fully corrected for distance vision, most people need reading glasses when they reach 45-50 years old.
- In fact, one in five of our survey respondents told us they needed to wear reading glasses when they weren't expecting to after laser surgery.
- They say: 'it's more like a procedure, it's not ...erm...that much surgical involved... [it's] something like a Botox injection...'
- Our experts say: Unrealistic. Sales staff may avoid using words such as 'surgery', 'cut' or 'blade', but, unlike Botox, Lasik and Lasek are operations, and you should consider complications and risks as well as benefits.
- They say: 'My husband had treatment about two years ago now and he had like a highest prescription [sic] that the surgeon had ever treated...'
- Our experts say: On our past mystery-shop visits, we heard staff refer to a surprising number of relatives, and in our survey one in five (20%) had been told about the staff member's friends or relatives getting great results. While it may be comforting to hear this and true, don't let it influence your decision.
Laser eye surgery and replacement surgery are generally very safe and the majority of people will do well, with problems likely to be short-term.
However, some people do experience longer-term and more serious problems and it's important that the risks are explained to you, especially for your prescription as risks are likely to be higher if you have more complex eyes or a very high prescription.
Read on to find out what side-effects do occur, and the likelihood of experiencing them:
Dry eye after laser eye surgery
This is common after surgery (a third of those we surveyed experienced it) and usually clears up, but it can persist in the longer term and be very debilitating. It's more common in certain people - including those with a history of dry eye - who should be specifically warned of the increased risks for them.
Infection after laser eye surgery
Infection is rare and usually due to bacteria under the flap caused by the laser (the risk of developing an infection after surgery is around 1 in 4,000). It's usually picked up quickly and treated successfully with anti-biotics.
However, some cases can't be easily controlled by medication - which could cause some reduction in vision or, in extreme cases, loss of some sight.
Scarring after an infection, abnormal healing or an unstable corneal shape (corneal ectasia) can - in the worst case scenario - lead to a damaged block of tissue in the cornea meaning that corneal transplantation is needed. This is significant surgery.
More commonly, these problems can be corrected without transplant surgery, with less than 1 in 5,000 people needing a corneal transplant.
Even when transplantation is needed, good vision can normally be restored, although glasses or contact lenses may be required.
Some people experience permanent corneal nerve damage (corneal neuralgia).
This is a very rare but distressing condition, whereby the patient experiences chronic eye pain and eye sensitivity like a neuralgia (nerve pain) elsewhere in the body, after LASIK. This is usually treated by a neurologist.
Loss or reduced quality of vision
A small proportion of people don't see as well without glasses or contact lenses following surgery as they did with their spectacles or contact lenses before surgery.
In up to 5% of cases, the person can be left with a prescription (ie still having some long or short sight) and will need glasses or further surgery.
For a smaller group of patients, this can't be corrected with spectacles and relates to a reduction in the optical quality of the eye.
One in seven people we surveyed told us they weren't well informed that their vision could be worse after surgery.
Some patients (a quarter of those we surveyed) experience glare or halo effects around lights when driving at night, or increased flare from oncoming car headlights.
This is more likely for those whose vision needed greater correction, and possibly those who also have larger pupils.
These problems are usually mild and last for a few months, but very occasionally, problems are permanent and can affect activity such as driving.
Under-correction or over-correction
It's difficult to know exactly how an individual's eyes will heal, so around 5% of people (depending on the clinic and the patient) require another treatment - 10% of our respondents who had laser eye surgery did.
People with very complex prescriptions are more likely to need this (for people with prescriptions over -10D, around 10-15% are likely to need re-treatment). Ask clinics about their specific results for your prescription.
Re-treatment is similar to the first treatment in terms of the procedure and recovery.
Red blotches on the white of the eye may be seen, especially after Lasik, but are usually temporary (up to six weeks) although they can persist.
Future cataract surgery
Successful cataract surgery is possible after laser eye surgery. But if you have had Lasik, you should request and keep a copy of all eye measurements taken before and after their surgery.
You can also contact your original clinic and ask for your notes.
This makes it easier - but is not essential - for your cataract surgeon to identify the correct power (prescription) of the lens to be implanted during your cataract surgery.
Yes, this is a surgical procedure and there are always risks involved. This includes the rare risk of infection and inflammation that can lead to some reduced vision, a detached retina, or night vision problems.
Talk to your surgeon about the risks for you, as they vary for each individual.
Want to find out more? What you get from every company is very different so we've put together what you need to know about laser eye surgery costs.