All Your Questions About Laser Eye Surgery

I can’t know without examining you. What decides is your assessment, not your prescription. I have operated on -10 diopter myopia in perfect corneas, and I have turned down -2 myopia in irregular corneas. You get the answer the same day, at the pre-operative consultation.

From 18. The ideal time is rather after 22 or 23, when the prescription has not changed for a while. Before that, it is possible if the request is justified, with the warning that some myopia may partly come back a few years later. If that happens, an enhancement is still possible.

Stability is not a figure measured to the decimal point. I compare your prescription on the day with that of your old glasses. A change of 0.25 or 0.50 diopter does not worry me, because fatigue and examination conditions make a measurement vary. At 24, with moderate myopia and a prescription identical to your glasses, it is stable.

No. No letter, no prescription, no referral. You book directly on Doctolib or by phone, and I see you.

Not necessarily. Eligibility for LASIK or TransPRK depends on several parameters, not only corneal thickness: average and maximum keratometry, posterior values, epithelial thickness. If all it took was looking at thickness, it would be a little too easy. Bring me your previous tests, I will compare them with new ones and give you a reasoned opinion. And if I think the refusal was justified, I will tell you that too.

It is a matter of personal motivation. When glasses or contact lenses become a burden, surgery is a very good solution. When you don’t feel the need, nothing is mandatory. I wear glasses myself and they have never bothered me. I operated on my wife, who wore contact lenses all the time and had had enough of them.

The goal is to see as you do with your glasses, but without glasses. Absolute zero is not a goal, and in fact it does not really exist. Some patients find they see better than with their glasses, others a little less well. What we aim for is your independence from glasses in everyday life, and everyone achieves that.

That depends on you. I operate every Friday morning at the Institut Laser Ophtalmologique Voltaire (Voltaire Laser Eye Institute). Some patients leave the consultation with a date for the following Friday, others think it over for six months. Both are fine with me.

It is charged at the standard rate set by French national health insurance, with no fee supplement at my practices in Paris 10th (10e arrondissement) and Paris 19th (19e arrondissement), and with direct billing: you pay nothing upfront. At the Institut Voltaire, in Paris 11th (11e arrondissement), you pay €50 upfront, including a €30 fee supplement, reimbursed at least €20 by your complementary health insurance and most often in full.

You go through the machines before seeing me: corneal topography, thickness measurement, aberrometry, pupillometry, tear film analysis, retinal examination. Then we sit down, I explain what I see, and we talk about your plans: your motivation, your needs, your lifestyle. Allow a good hour on site. At the end, you know whether you are a candidate, with which technique and at what price.

For the consultation, simply taking them out in the morning is enough. The measurements remain usable. It is before the procedure that the rule becomes strict: 48 hours without soft lenses, because a lens slightly changes the shape of the cornea and the laser works from measurements taken under its natural conditions. For rigid lenses, let me know: it is decided case by case, with a topographic check of corneal stability.

Yes, in the vast majority of cases. The fundus examination is done by retinal photography, without dilation, so you leave just as you came. On rare occasions I prescribe drops that relax accommodation to measure the true prescription. In that case, vision is blurry for several hours, and I tell you in advance so you can make arrangements.

Your current glasses, your old pairs if you still have them, and your Carte Vitale (French health insurance card). Old glasses prescriptions interest me a lot, because they show how your prescription has changed. If you already have topographies or reports done elsewhere, bring them.

Yes, and many patients do, especially those who come from far away or who have been turned down elsewhere. I will give you an honest first opinion. An opinion based on documents does not replace a full assessment on my machines, and I never schedule surgery without having examined you.

At three practices. At the Institut Laser Ophtalmologique Voltaire, 5 rue La Vacquerie in Paris 11th, on Wednesday afternoons. At 37 rue Archereau in Paris 19th, on Monday afternoons. At 12 rue du Faubourg Saint-Martin in Paris 10th, on Thursday afternoons. The assessment is done at all three practices. Only the procedure takes place at Voltaire, where the lasers are.

One is enough in the vast majority of cases. You come, we do the assessment, we decide together, and you leave with a date if you wish. On rare occasions I ask for an additional test, a measurement of the prescription with accommodation relaxed for example, or repeat more detailed measurements at the Institut Voltaire if I saw you in the 10th or the 19th.

Four: LASIK, TransPRK, SMILE and PresbyLASIK. All are performed at the Institut Laser Ophtalmologique Voltaire, on the Schwind Amaris 750S excimer platform and the Visumax 800 femtosecond laser. I only do corneal laser surgery, and I spend my Friday mornings in the operating room doing nothing else, sometimes also Wednesday afternoons between two consultations.

The two of us. The assessment rules out what is not possible, then we decide together what suits you best. On a thin cornea or a borderline topography, it will be TransPRK. On a thick, regular cornea with a high prescription, my preference is LASIK.

Recovery. After LASIK, the discomfort lasts four to six hours and you already see well the same evening. After TransPRK, there are 48 to 72 unpleasant hours and vision returns over seven to ten days. In terms of final result, both techniques are excellent. TransPRK does not create a flap, so there is no risk of displacement and the risk of weakening is reduced to almost nothing.

With LASIK, up to -10 diopters of myopia, sometimes -12, +7 to +8 of hyperopia and -6 of astigmatism. With TransPRK, up to -10 of myopia, +6 of hyperopia and -4 of astigmatism. With SMILE, up to -10 of myopia and -3 of astigmatism. These are technical ceilings: a prescription within these limits on an inadequate cornea will still not be operable.

SMILE is available at the Institut Voltaire and I offer it when it is indicated. Everything is done with the femtosecond laser: a lenticule is cut inside the cornea and removed through a micro-incision, with about fourteen seconds of cutting per eye. That does not make it the universal technique: it does not correct hyperopia and it is limited for astigmatism. It is not better than LASIK. Its advantage is that it does without a corneal flap, with other drawbacks in exchange. Generally speaking, my preference is LASIK.

Yes. If LASIK scares you, we can switch to TransPRK, which does not create a flap and therefore avoids the risks associated with it. Recovery is slower, the result is just as good, and the only drawback is one extra week of visual discomfort. SMILE is another way to avoid the flap, with a fast recovery this time, but it does not suit every profile.

Yes, in many cases. Presbyopia appears around age 40-45 and progresses until 55 or 60. It cannot be cured, it is compensated for. The principle is to create multifocality, a new distribution of light rays between distance and near. You lose a little at distance to gain at near. The strategy depends on your starting refractive error: in nearsighted patients, we use blended vision (monovision), one eye for distance and the other keeping a little myopia for near. In emmetropic and farsighted patients, we sculpt a multifocal cornea with the PresbyMAX module. Sometimes treating only one eye is enough.

We talk about it honestly and I guide you. Depending on the case, it may be a phakic implant such as an ICL, lens surgery, or simple monitoring. I now perform corneal laser surgery exclusively, and I refer these cases to colleagues I trust. I remain available to discuss it before and after.

About ten minutes in the operating room, both eyes included. Plan on a good hour to an hour and a half at the clinic: paperwork, measurements on the day, preparation, the procedure, then the check before you leave.

No. You eat and drink as usual, there are no particular restrictions.

No soft contact lenses for the 48 hours beforehand. Stop by the pharmacy to pick up the post-operative treatment, so you can go straight home afterwards. And take the anti-anxiety tablet about an hour before your appointment time.

It relaxes you so that stress rises as little as possible during the procedure. It has no effect on your long-term health. You will simply arrive feeling a little woozy, which is not a bad thing. And if the medication worries you more than the surgery, we do without it: I operate on many patients without it.

Neither. Anesthesia is done only with drops, instilled a few minutes before the procedure. You are awake, you hear everything, you can talk to me, and you feel no pain.

You cannot blink: a small speculum holds the eyelids open during the procedure, and it is painless. As for moving, the laser tracks your eye using an iris recognition system. If you really move a lot, the laser stops on its own and we start again.

A sensation of touch on the face, pressure on the eye, water running, lights and shadows floating in the field of vision. There is music in the room, and I sometimes sing. An operating room assistant is next to you, gives you instructions and can hold your hand. I talk to you the whole time.

You keep your clothes on. We add a gown, a surgical cap and shoe covers. No bun or braid: the cap has to stay in place and your head must be able to lie flat. Your belongings are placed in a locked cloakroom. The person accompanying you can come as far as the entrance to the preparation room.

Yes, but not behind the wheel. You go home by taxi, by ride-hailing car, with someone accompanying you, or on foot if you live nearby. Public transportation is not forbidden, but a car remains more comfortable when possible.

You rest for a few minutes, we go over the instructions for the first hours and the first weekend with you, and I check your eyes to make sure everything is fine. Then you go home.

During the procedure, no. After LASIK, SMILE or PresbyLASIK, the eyes sting and water for four to six hours, then it settles down. After TransPRK, the first 24 to 48 hours can be painful: you take the prescribed painkillers, you rest, and once the weekend is over, things are already better. I say this clearly to all my TransPRK patients before operating on them.

About six hours after the procedure, when you wake up from your nap. If you got the time wrong, it makes no difference to the result. And if you really can’t open your eyes that evening, drops were already instilled in the operating room, so it can wait until the next morning.

After LASIK, yes, for three nights, secured with Micropore tape that you pick up at the pharmacy. The eye shields are given to you on surgery day. After TransPRK, no: the bandage contact lens protects the eye. After SMILE, no eye shields either.

Between the third and fifth day. I remove it at the check-up. When it comes out, the discomfort may seem to increase suddenly, because the lens was acting as a bandage. That does not mean something is wrong.

After LASIK or SMILE, vision is already usable the same evening, through a haze. It sharpens over the following days and stabilizes over one to three months. After TransPRK, expect 20 to 30% of your visual acuity at three days, about 70% between the seventh and tenth day, 90% at one month, and all of it at around two to three months.

Yes, completely. A normal recovery is not linear: it goes up, comes down a little, goes back up. One eye does better than the other for ten days, then it reverses. This is especially marked in the first month and with high prescriptions. Treatment of significant astigmatism takes a good three months to settle.

No. The redness comes from the pressure applied to the eye during the procedure. It can take the form of a well-defined bright red patch, very alarming in the mirror, and perfectly harmless. It disappears on its own in one to two weeks, like a bruise. With the Visumax 800 at the Institut Voltaire, which applies pressure on the cornea rather than on the conjunctiva and sclera as older lasers did, this redness is less marked, but it remains common and harmless.

It is one of the most common sensations after refractive surgery, along with stinging and burning. Sometimes there is none at all, sometimes it lasts a few days, sometimes a few weeks. Moisturizing artificial tears are your best tool: use them as soon as you feel discomfort, there is no limit.

On the Monday afternoon after the Friday surgery. Depending on the case, it may be on the Wednesday or Thursday instead, or later if all is well. After that we see each other at one month, at three months, then whenever you need. Follow-up is unlimited and included.

Two situations, written on your prescription: a sudden drop in vision, and severe eye pain outside the first day after TransPRK, especially if it is increasing rather than decreasing. Phone and WhatsApp: 01 84 80 28 04. Outside opening hours, the ophthalmology emergency department at Cochin Hospital is open around the clock, 27 rue du Faubourg Saint-Jacques, 01 58 42 23 00.

After LASIK or SMILE, most of my patients get back to their normal lives the next day. Operating on Friday morning leaves the weekend to rest. After TransPRK, allow just under a week. A sick note is possible; we discuss it case by case.

Not on the day of the procedure. After that, there is a good chance you can drive the day after LASIK, and by three days it is generally no longer an issue. You will be slightly bothered and not yet perfect, but vision is sufficient. After TransPRK, we wait for vision to return, more like a week.

Yes, immediately. Screens are tiring, but they do not damage anything and have no effect on healing. After LASIK or SMILE, the first week back can be tiring: increase the font size, move your chair back, take a twenty-second break looking into the distance every twenty minutes. After TransPRK, it is the vision itself that is bothersome for the first three days. End-of-day headaches are mild and go away on their own in ten to fifteen days. If the discomfort persists, I can prescribe a small pair of computer glasses for screen use.

After LASIK, from the next day for anything with no risk of a blow to the eye: running, cycling, weight training, the gym. After TransPRK, it is visual recovery that sets the pace. Combat sports and ball sports require a three-week wait, swimming two weeks.

Two weeks. It is written on the prescription. Showering and bathing are another matter: you can wash from the next day, avoiding getting water full in the face for the first three days. A gentle swim, with your head out of the water, is possible after three days. Avoid opening your eyes underwater for two weeks.

From two weeks, with a suitable mask. Diving masks are wide, rest on the bones of the face and put no direct pressure on the eyeball. Swimming goggles, which are smaller, press on the eye socket: wait one month. Your eyes may be a little more sensitive to seawater in the first weeks.

No. There is a myth that boxing is dangerous after LASIK, because a bad punch would displace the flap. That is false. You box with gloves, and a glove is larger than the eye socket: the blow stops on the bone. A cat’s claw in the wrong place is more dangerous than a straight right. Bare-handed martial arts call for a little more caution.

Face makeup, from the next day. Eyelid and eyelash makeup, after one week. Also remember to avoid mascara and eyeliner the day before the procedure: a little always remains at the time of surgery.

Wait two weeks. After two weeks, you can enjoy a spa, even a very humid one. Simply take breaks if you feel discomfort.

Yes. I have operated on patients who flew the next day; cabin pressurization poses no problem for an operated cornea. The only drawback is the dry cabin air: carry your moisturizing artificial tears in your hand luggage.

Yes, it can be done, but it is tiring. Light is bothersome, so bring sunglasses. If you can postpone by a day or leave at the end of the day, it is easier.

Alcohol poses no particular problem, within reason: a drink or two, three at most, should be enough. As for cigarettes, avoid them in the first post-operative hours; smoke irritates a surface that is already sensitive. A disposable vape is the lesser evil for the first day.

Yes. The tissue removed by the laser does not grow back, and the new curvature of your cornea is permanent. What continues to change is your eye itself, and that is a different matter.

We don’t speak of recurrence but of regression. The epithelium, the surface layer of the cornea, can thicken again over the years and compensate for part of the ablation done underneath. This is very limited and does not significantly reduce vision. For example, on astigmatism of -2 diopters, the maximum that can come back in five to ten years is around -0.50, which generally does not bring vision below 20/20 (10/10).

It is rare, but it is planned for. An enhancement is included in the first post-operative year if needed, then offered at a preferential rate for up to five years. I never perform an enhancement before the end of the first six months: healing keeps working, and things most often improve on their own.

Yes. Surgery corrects your current prescription; it does not stop the aging of the lens. Presbyopia appears around age 40-45 in everyone, whether they have had surgery or not. If you have surgery at 30, you will probably need reading glasses around 45, just like someone who was never nearsighted. Laser correction of presbyopia can then be considered.

For distance vision, the goal is that you no longer need them, and that is what happens in the vast majority of cases. Two caveats: you may still use a small pair of computer glasses for screens at the end of the day, and if you are presbyopic and only distance vision was corrected, you will need glasses for reading.

One to three months depending on the technique and the prescription. LASIK for moderate myopia settles within a few weeks. TransPRK for high astigmatism takes a good three months. Until it has stabilized, I prescribe glasses only on a temporary basis and I do not discuss an enhancement.

They first increase, peaking at around two months, which unsettles many patients, then they gradually fade. With high prescriptions, the decrease can take four to six months. They can persist to a minimal degree with very high prescriptions combined with a large pupil, and that is something I identify during the assessment with pupillometry.

Yes, once the adjustment period is over. In the first weeks, headlights spread out and driving at night is less comfortable than before. This is a normal stage of recovery. If the discomfort persists beyond a few months, we talk about it again; solutions exist.

I would say no: you cannot go blind from refractive surgery performed under normal conditions and with a favorable pre-operative assessment. The laser works only on the cornea and touches neither the lens, nor the retina, nor the optic nerve. Serious complications exist; they are extremely rare and they can be treated, and it would take a completely crazy combination of circumstances to lose your sight.

It is extremely rare. Thank God, I have never had one in any of my patients. I worked for five years at Cochin Hospital, including three as head of the cornea department, and I never saw an infection there following refractive surgery. The keratitis cases I treated came from contact lenses, injuries and vulnerable patients.

It is the risk I monitor most closely, and the reason I turn down some cases. It is called post-operative ectasia: a cornea that has been weakened too much gradually becomes deformed. My safeguard is simple: I check that the residual thickness under the flap, the residual stromal bed, stays above 300 microns, when standard recommendations go as low as 250 or 280. And when I don’t like a cornea, I offer TransPRK, which does not create a flap.

Yes, and you are not alone. Many of my patients were very motivated and held back by fear for months. What I suggest is that we talk about it: we call each other and go over what worries you, point by point. And sometimes the solution is technical: switching to TransPRK, which removes the flap issue.

Yes. The most important thing with this kind of surgery is to feel ready, however long that takes. There is no urgency to operate. If the timing isn’t right, change the timing; my door remains open.

That refractive surgery has existed for more than thirty years, that it is one of the most commonly performed procedures in the world, and that the stories going around often date back to the techniques of the 1990s. What matters is that you feel ready, without letting yourself be influenced by outside advice that is sometimes poorly informed, in one direction or the other.

Yes, and regularly. A cornea that is too thin, an irregular topography, keratoconus even at an early stage, severe dry eye, a retinal or optic nerve condition that changes the picture, an ongoing pregnancy. I also refuse when expectations are not realistic.

Yes, it is the riskiest habit for a cornea, whether operated on or not. Chronic rubbing is the main factor in the development of keratoconus. Track down even the most discreet gestures, and check your sleeping position: sleeping on your stomach with your face in the pillow, or with your hand or elbow under your eye, puts continuous pressure on it all night.

That is what the eye shields are for. They simply need to be well secured with the Micropore tape. They protect just as well if you sleep on your side.

The fees are fixed, the same for everyone, and they are posted. These fees include the procedure, unlimited post-operative follow-up and any enhancement in the first year.

The operating room, my fees, consumables, the treatment instilled during the procedure, the eye shields and protective glasses, all post-operative check-ups with no time limit, and the enhancement if it proves necessary within the year. Not included: the eye drops and tablets bought at the pharmacy, which are reimbursed, and the initial consultation.

No. Refractive surgery is not covered by French national health insurance (Assurance maladie), because it is considered elective surgery. This is the case with every surgeon in France. The consultation, however, is reimbursed, since it is charged at the standard rate.

Many complementary health insurers contribute, with amounts ranging from a few hundred euros to several thousand. Some reimburse per eye, others per procedure, others under a multi-year allowance. I prepare a detailed quote for you to send them before the surgery. Check in their reply whether they are counting one eye or both; the mistake is common.

Ask me for it, at the consultation or by message, and I will send it to you. It is a personalized document that states the technique, the fee and the codes your complementary health insurer needs.

Yes, in four installments, by check or by direct debit. You can also pay in one go by bank card, bank transfer or check. Checks are kept in a safe, in an envelope with your name on it, with each cashing date noted.

On the day of the procedure, at the front desk, before going into the operating room. You are given the invoice at that point. If you have set up a payment plan, everything is agreed in advance and you hand over the checks or sign the direct debit mandate that day.

Not in the first year: if an enhancement is needed within twelve months, it is included in the fee you paid. After that, up to five years after the procedure, I offer it at a preferential rate.

No. Post-operative follow-up is unlimited and included. Whether you come three times or fifteen times, at six months or at four years, there is nothing to pay.

The simplest thing is to group everything together. You come for the assessment on a Wednesday afternoon, or on the morning of the procedure itself if your case allows, we operate on Friday morning, and we do the check-up before you leave. If you can stay until Monday for the check-up, it is more comfortable. Otherwise, we review things by phone and you come back when you can.

Yes, I am used to it. Patients come to France for three or four days, long enough for the assessment, the surgery and the check-up. I continue to follow them remotely afterwards, by email or WhatsApp, for as long as necessary, and they come back to see me during a future stay in France if needed.

No, I do not operate during pregnancy; it is a precaution I impose on myself. After delivery, we look at it together. Breastfeeding poses no problem, either for the surgery or for the eye drops: the treatments are local and the amount that passes into the bloodstream is tiny.

Yes. Breastfeeding poses no problem, either for the surgery or for the eye drops: the treatments are local and the amount that passes into the bloodstream is tiny. Only pregnancy requires waiting.

Rarely, but tell me about it. Most systemic medications make no difference to corneal surgery. Those that warrant discussion are the ones that dry out the surface of the eye, certain acne treatments, certain hormonal treatments and immunosuppressants. Bring the list to the consultation; we will go over it in two minutes.

These are two different problems. Glaucoma is treated by controlling intraocular pressure and monitoring the optic nerve. Refractive surgery is only about glasses and has no influence on glaucoma. Treated ocular hypertension is not an obstacle. One thing to know: pressure measurement after corneal laser surgery is slightly underestimated, and your ophthalmologist will take this into account based on your corneal thickness.

Not necessarily. Severe dry eye, yes: I do not operate. Moderate dry eye is treated first and we operate afterwards. I measure the quantity and quality of your tear film during the assessment, and this test helps me predict how you will tolerate the recovery. If your tear film is good, there is no reason for dryness to be greater than average.

A chalazion poses no problem for corneal healing and creates no risk of infection. It may simply contribute to somewhat more pronounced dryness in the first weeks. Active conjunctivitis, on the other hand, is treated first: we postpone by a few days.

Not necessarily. There is no contraindication and no risk in having surgery with the flu or a cold; it is a question of comfort and fatigue. Write to me, and we will decide together. If your condition gets worse, we postpone and I reschedule you for a later Friday.

Technically yes, but it offers no advantage. You expose yourself to two separate recovery periods, so potentially two phases of discomfort, and in between you live with one corrected eye and one uncorrected eye, which is uncomfortable when the prescription is high. There are a few exceptions, such as presbyopia correction, where operating on only one eye is sometimes enough.

Yes, in the same session, one after the other. This is standard practice in laser refractive surgery.

A predisposition to corneal deformation can be hereditary, but keratoconus does not develop without eye rubbing. If your child does not rub their eyes chronically, there is no reason to worry. Watch for gestures, even the most discreet ones, and their sleeping position. A baseline topography provides a clear starting point, and I am happy to look at any test results you send me. When keratoconus is confirmed before age 25, cross-linking may be considered: it is a much-debated technique, whose indication seems to me most solid in this age group.

Send me your test results and the treatment report; I need precise measurements to tell you something useful. Depending on the case, the solution may be a glasses correction while things stabilize, treatment of the ocular surface, which often relieves a large part of the discomfort, a trial of rigid or scleral lenses, or a topography-guided surface enhancement. I will tell you things with complete transparency.

I now devote myself entirely to laser refractive surgery, an activity that requires being in the operating room and on the machines constantly. I have performed cataract surgery and implants, and I continue to follow these cases when my patients ask me to. For a procedure, I refer to colleagues whose work I know.

Phone and WhatsApp: 01 84 80 28 04. I answer it myself. By email: nahaisi@laservisionparis.com, or through Doctolib messaging.

Yes. Messages come to my phone and I answer them like a WhatsApp message, in the evening, between two consultations, sometimes on weekends. It sometimes takes me 24 hours. If I forget something, a prescription or a sick note, remind me; it never bothers me.

On Doctolib, at https://www.doctolib.fr/ophtalmologue/paris/steven-nahaisi, or by phone at 01 84 80 28 04. All my consultation availability is listed there, for all three practices. No referral letter is needed. By email: nahaisi@laservisionparis.com, or through Doctolib messaging.

On my Google profile, which has more than 450 reviews. These are texts I do not control, written by my patients after their surgery.