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Originally Posted On: https://bluefinvision.com/blog/laser-eye-surgery-checklist/
The Essential Checklist of Questions to Ask Before Your Laser Eye Surgery Consultation
Most laser eye surgery consultations begin with the wrong question: which laser should I have? LASIK, SMILE, PRK – patients have seen the names on websites, read forum threads, and perhaps watched a YouTube video filmed inside a laser theatre. The technology is presented as the product. The surgeon is often treated as its operator.
This framing inverts the clinical reality.
Laser eye surgery is a permanent, elective procedure performed on a healthy eye. Unlike cataract surgery, where the natural lens has failed and surgery is clinically indicated, refractive laser surgery intervenes on tissue that has no pathology. The margin for error is correspondingly narrow, and the standard to which every aspect of the pathway should be held is correspondingly high. ¹ ²
The Royal College of Ophthalmologists and the British Standards Institution have published guidance frameworks for refractive surgery providers. These frameworks set minimum standards for surgeon credentialing, equipment, consent processes and follow-up infrastructure. ³ ⁴
The checklist that follows is intended to help patients assess whether the clinical environment they are considering meets those standards – and to help them ask the questions that the best clinicians will welcome, and the rest will find uncomfortable.
How to Use This Checklist
This document is structured to help you prepare for your laser eye surgery consultation. The consultation should be a clinical evaluation, not a conversion appointment. A well-run pre-operative assessment will typically take between 90 minutes and two hours and will include corneal topography, wavefront analysis, anterior segment imaging, pupil assessment and a detailed refraction under both natural and cycloplegic conditions. Ectasia risk screening, using Pentacam tomography, Belin-Ambrosío display analysis, and corneal biomechanical assessment, is an essential component of any responsible pre-operative workup; patients with subclinical keratoconus or forme fruste ectasia should not undergo laser ablation. A responsible refractive surgery consultation frequently ends with the recommendation not to operate.
You may wish to:
- Print this checklist and bring it to your appointment
- Research specific questions using your surgeon’s website or the Royal College of Ophthalmologists’ register before attending
- Use the Plain English summaries if the clinical terminology feels unfamiliar
- Discuss any concerns openly with your surgical team before signing consent
1. Questions About Your Surgeon
The surgeon is the most important variable in your outcome. Technology is secondary to clinical judgement, and clinical judgement is secondary to experience, training, and the professional culture in which a surgeon operates.
Is your surgeon on the GMC Specialist Register?
The General Medical Council Specialist Register confirms completion of a recognised ophthalmology training programme and eligibility to practise as a consultant. This is the baseline credential. Entry-level laser eye surgery can be performed by non-specialist medical practitioners operating under regulatory permissions that do not require specialist registration. ⁵
Plain English: Check that your surgeon is a fully qualified eye specialist registered with the General Medical Council – not simply a licensed medical practitioner.
Does your surgeon hold the CertLRS qualification?
The Certificate in Laser Refractive Surgery (CertLRS), awarded by the Royal College of Ophthalmologists, is the nationally recognised postgraduate qualification specifically for laser refractive surgery practice. It requires completion of structured training, audit submission, and formal assessment. Its presence does not guarantee outcomes, but its absence is a meaningful gap in credentialing. ³
Plain English: Ask whether your surgeon holds the RCOphth laser refractive surgery certificate – a specific qualification beyond general ophthalmology training.
How many laser procedures does your surgeon perform each year?
Volume is a recognised proxy for consistency in surgical outcomes. High-frequency practice maintains the psychomotor precision that laser refractive surgery demands. A surgeon performing fewer than 200 refractive procedures per year may have reduced opportunity to consolidate technique and to encounter, and manage, the range of intraoperative variables that arise across a large case series. This figure is an approximate benchmark rather than a hard clinical threshold; current RCOphth guidance emphasises participation in outcome audit and transparent data reporting over any specific annual number. The more important question is whether your surgeon can show you their results. ¹ ⁶
Plain English: Ask how many laser procedures your surgeon personally performs each year, and compare this with national benchmarks.
2. Questions About the Clinic
The clinical environment within which surgery is delivered is as important as the individual surgeon. Platform quality, governance structures, and the capacity to manage complications all depend on institutional infrastructure rather than individual skill.
Does the clinic offer both surface ablation (PRK/LASEK) and lenticule extraction (SMILE), as well as flap-based LASIK?
A well-equipped refractive surgery unit should be capable of offering the full range of corneal laser modalities. Clinics that offer only one technology may have a commercial incentive to direct patients toward that option regardless of clinical suitability. Patients should be in the position of a passenger who trusts the pilot to choose the safest route – not the position of a passenger who has already chosen the route before boarding. ² ⁷
Plain English: Check that the clinic can offer all major laser types – the choice between them should be driven by your clinical profile, not by which machines the clinic has invested in.
If PRK or LASEK is recommended, will mitomycin C be used to prevent corneal haze?
Surface ablation procedures (photorefractive keratectomy and laser epithelial keratomileusis) are associated with a risk of anterior stromal haze during the wound-healing phase, particularly at higher correction levels. Intraoperative application of mitomycin C (MMC), an antimitotic agent applied to the stromal surface following ablation, significantly reduces this risk. Its routine use in medium and high corrections is supported by published evidence. ⁸ ⁹
Plain English: If you are having surface laser, ask whether the surgeon routinely uses MMC to prevent scarring, particularly if your prescription is higher than -3.00 dioptres.
What is the post-operative drops regimen, and for how long are drops provided?
Post-operative medication following laser eye surgery typically includes a topical antibiotic, a topical steroid, and preservative-free lubricants. The duration of steroid therapy varies between modalities: surface ablation typically requires a longer steroid taper than LASIK. Patients should receive clear written instructions and a confirmed supply of drops at discharge.
Plain English: Ask what drops you will need after surgery, who will provide them, and for how long – and whether any additional medications that might be needed during recovery are included in the price.
Cost differences between clinics often reflect differences in the clinical pathway rather than the laser itself. A detailed breakdown of pricing and care pathways is discussed in our companion article: What Does Laser Eye Surgery Cost in the UK?
3. Questions About the Choice of Laser Technique
The question of which laser technique is most appropriate is a clinical decision – not a patient preference question. Informed patients may arrive with preferences, and those preferences should be heard. They should not, however, determine the surgical plan.
How does your surgeon decide between LASIK, PRK/LASEK, and SMILE?
Each laser modality has a distinct biomechanical effect on the cornea, a distinct wound-healing profile, and a distinct set of clinical indications and contraindications. LASIK involves creation of a stromal flap and excimer laser ablation beneath it. Surface ablation (PRK/LASEK) avoids flap creation and ablates the anterior stroma directly after epithelial removal. Lenticule extraction (SMILE) creates a refractive lenticule within the stroma using femtosecond laser and removes it through a small arc incision, without flap creation or excimer laser application. ² ⁷
Each approach carries specific advantages and risks across different corneal profiles. Patients with thin corneas may be better suited to surface ablation. Patients with dry eye may benefit from SMILE’s reduced nerve disruption. Patients with high myopia require particular care around the choice of modality, as described below.
Plain English: Ask your surgeon to explain, specifically, why a given technique is the right choice for your corneal measurements and lifestyle – not just that it is available.
Why is SMILE not always the best option for high myopia?
This is a question that is rarely asked – but should be.
Patients with higher myopic prescriptions are statistically more likely to require a refractive enhancement procedure in the years following their primary surgery. Enhancement after LASIK is straightforward: the original flap can be lifted and additional ablation performed beneath it, or surface ablation can be applied over the flap. ¹⁰
SMILE has genuine advantages in specific patient populations. Because no stromal flap is created, there is less disruption to anterior corneal nerves, which may reduce the severity of post-operative dry eye, a clinically meaningful benefit in patients with pre-existing dry eye disease or marginal ocular surface function. ⁶ The absence of a flap also eliminates flap-related complications and makes SMILE a reasonable first choice for contact-sport athletes or those in occupations with a risk of ocular trauma. ⁷ Contemporary published series report good refractive outcomes across a range of myopic corrections, and enhancement strategies, including LASIK conversion and surface ablation over the lenticule bed, are increasingly well-described when performed by surgeons with established protocols. ⁷ ¹⁰
The specific concern at higher myopic prescriptions is one of enhancement probability rather than primary outcome quality. Enhancement after SMILE is technically more complex, and subsequent treatment typically requires conversion to LASIK or surface ablation, a procedure that carries its own additional risks. A patient who undergoes SMILE for high myopia and subsequently requires enhancement has, in effect, undergone a more complex pathway than a patient who was offered LASIK from the outset. ¹⁰
At Blue Fin Vision®, SMILE is not routinely offered to patients with high myopia precisely for this reason. Where a patient has low-to-moderate myopia, a healthy ocular surface, or specific lifestyle risk factors that favour a flapless approach, SMILE is a well-supported option. Where the prescription is higher, and the likelihood of needing a future enhancement increases, LASIK preserves a more straightforward secondary treatment pathway. The analogy holds: a passenger does not tell the pilot which route to take – they trust the pilot to take the safest one. When the most likely future scenario involves a procedure that SMILE makes harder, starting with SMILE is not in the patient’s interest.
Plain English: If you have a higher prescription, ask your surgeon what happens if you need a second treatment in the future, and whether the technique they are recommending makes that easier or harder.
4. Questions About Complications
Laser eye surgery is safe. That safety record is not an argument against asking about complications – it is precisely because outcomes are generally excellent that deviations from normal carry particular clinical significance.
What complications can occur with LASIK, and how are they managed?
LASIK-specific intraoperative complications include flap-related events such as buttonhole flap formation (where the flap is thinner than intended centrally), free flap separation, flap striae (wrinkling), and diffuse lamellar keratitis (DLK), an inflammatory response at the flap-stromal interface in the early post-operative period. Each of these complications has a defined management pathway. The surgeon should be able to describe their approach to each clearly and without hesitation. ¹ ²
Plain English: Ask your surgeon to explain flap-related complications and how their clinical pathway handles them, including out-of-hours access if a problem develops in the days following surgery.
What complications can occur with SMILE, and what happens if suction is lost during the procedure?
SMILE is performed using a femtosecond laser docked to the cornea under suction. Loss of suction during lenticule creation, before the lenticule is completed, is a recognised intraoperative event. Depending on the stage at which suction is lost, the surgeon may attempt to redock and complete the procedure, convert to LASIK, or abort the procedure and plan an alternative approach. Incomplete lenticule extraction, where the lenticule cannot be fully removed, is a further SMILE-specific complication that requires careful management. ⁷
Plain English: If you are considering SMILE, ask what the surgeon’s plan is if suction is lost mid-procedure, and whether the clinic has the equipment to convert to LASIK if needed.
Will I be asked to sign a detailed consent form?
Informed consent for elective surgery requires that patients are provided with information about the expected benefits, the material risks, the available alternatives, and the consequences of declining surgery, in a format and at a time that allows genuine deliberation. Montgomery v Lanarkshire Health Board UKSC 11 established that the legal standard of consent in the UK is patient-centred rather than clinician-centred: surgeons must disclose risks that a reasonable patient in the patient’s position would consider material. ⁴
Consent for laser eye surgery should not be a form presented on the day of the procedure. It should be a process completed during the pre-operative assessment, with time for questions, reflection, and if necessary, a second opinion.
Plain English: Your consent form should be given to you before the day of surgery, not handed to you in the treatment room. If it is presented at the last moment, that is a governance concern.
What is the clinic’s emergency access policy?
Complications following laser eye surgery, including raised intraocular pressure, corneal infection, and flap displacement, may require urgent clinical assessment outside routine consulting hours. Patients should understand in advance whether the clinic operates a genuine emergency contact pathway, and whether the operating surgeon is accessible if urgent review is required.
Corneal infection following laser eye surgery requires prompt microbiological investigation. If the clinical environment cannot perform a corneal scrape and has no established laboratory relationship for culture and sensitivity, the patient may be dependent on NHS emergency services for a complication arising from an elective private procedure.
Plain English: Ask whether your surgeon is personally contactable in an emergency, and whether the clinic can arrange an urgent corneal scrape if infection is suspected.
How is dry eye managed after laser eye surgery, and for how long?
Dry eye disease is both a contraindication to and a complication of laser eye surgery. LASIK transects corneal stromal nerves during flap creation, producing a temporary reduction in corneal sensitivity that impairs the neural arc of the tear reflex. This effect is generally self-limiting but can persist for several months. More severe or persistent dry eye may require escalation to prescription therapies including ciclosporin eye drops (Ikervis). ⁶ ⁹
Patients should establish in advance whether the quoted surgical price includes lubricant eye drops for the post-operative period, and at what point prescription dry eye therapies, which are not available over the counter, become a patient-funded expense.
Plain English: Ask how long lubricant drops are included in your care package, and what the arrangement is if you need prescription-strength treatment for dry eye after surgery.
5. Questions About Enhancement Procedures
An enhancement, a second laser procedure to refine or improve the result of the first, is not a complication. It is a planned part of the refractive surgery pathway, particularly for patients with higher prescriptions or those whose refraction has not fully stabilised.
What is the enhancement threshold, and when is enhancement typically offered?
Enhancement thresholds vary between clinics and surgeons. A residual refraction of -0.50 dioptres or more, or a patient-reported functional complaint attributable to residual ametropia, is a reasonable basis for enhancement consideration. Enhancement is typically not offered until refraction has been stable for a minimum of three months following primary surgery. ¹⁰
Plain English: Ask your surgeon at what prescription level they would recommend a second procedure, and how long you would need to wait for your vision to stabilise before it could be performed.
Who performs the enhancement, and is it included in the price?
Enhancement policy varies widely between providers. Some clinics offer lifetime enhancement guarantees; others impose time limits or exclude certain patient categories. Patients should understand the specific terms of any enhancement commitment before signing consent for primary surgery, including whether enhancement is performed by the same operating surgeon and whether any additional investigations or consultations are charged separately.
Plain English: Get the enhancement terms in writing – including the time limit, who does it, and whether there are any conditions that would exclude you from the guarantee.
What happens if epithelial ingrowth or haze develops?
Epithelial ingrowth, migration of epithelial cells beneath the LASIK flap, is an uncommon but recognised late complication that may require flap lifting and mechanical debridement. Anterior stromal haze following surface ablation, if progressive, may require further intervention with topical steroids or, in severe cases, phototherapeutic keratectomy. ⁸
Patients should establish how many post-operative clinic visits are included in their care package, what the arrangement is for extended follow-up if complications arise, and whether prescription medications required during treatment of complications are funded by the clinic or the patient.
Plain English: Ask how many follow-up appointments are included and what happens, clinically and financially, if a complication requires extended management.
What provision is made for patients who develop anxiety on the day of surgery?
Laser eye surgery is performed on an awake patient under topical anaesthesia. Anxiety on the day of surgery is common and clinically relevant: patient movement during ablation can affect refractive accuracy and, in extreme cases, require abortion of the procedure.
Oral anxiolytic medication, typically low-dose diazepam, can be prescribed for patients who are likely to benefit from it. Laser refractive surgery clinics are not typically licensed to hold controlled drugs, and this medication would need to be prescribed in advance, usually by the patient’s GP. A well-organised clinic will discuss this during pre-operative assessment rather than leaving it to the day of surgery.
Plain English: If you are anxious about surgery, ask whether oral sedation is available and what the advance arrangements are – this is not something that can be organised on the day.
6. Questions for Patients Travelling to Surgery
An increasing number of patients travel, whether domestically or internationally, for laser eye surgery, attracted by price differentials or specific surgeon reputations. Travel for refractive surgery is clinically possible but requires careful planning.
What is the minimum stay required near the surgical centre?
The post-operative pathway for LASIK includes a day-one flap check and a one-week review. For surface ablation, the epithelial healing phase extends over the first four to five days and requires monitoring. Patients travelling to surgery should plan to remain within reasonable travel distance of the treating centre for a minimum of one week.
At Blue Fin Vision®, the standard pathway for travelling patients includes a video consultation prior to attendance, scans and consultation on the day of surgery, the procedure itself, a day-one check (for LASIK), a one-week in-person review, and then transition to a named local ophthalmologist who has been identified before surgery and copied into all clinical correspondence from the outset.
Plain English: If you are travelling for surgery, plan to stay nearby for at least a week – and confirm in advance that the clinic has a structured arrangement for your ongoing follow-up with a local eye specialist.
Who will manage post-operative care in my home region?
Continuity of care following refractive surgery requires that the local clinician managing follow-up has full access to the operative record, pre-operative measurements, and the identity and specification of any procedure performed. A well-organised centre will formally introduce the patient to the local provider before surgery – not after a complication has arisen.
Second opinions, if required, should be discussed and arranged through the treating centre. Patients should not be in the position of self-referring to a third party for interpretation of their own post-operative course.
Plain English: Before travelling for surgery, confirm that the clinic will identify and contact a local eye specialist on your behalf – and get that in writing.
Conclusion
Laser eye surgery performed within a well-governed, well-equipped clinical pathway is one of the most consistently successful elective procedures in modern medicine. The questions in this checklist are not intended to create anxiety – they are intended to help patients identify the environments in which that standard of care is actually being met.
The best clinicians welcome detailed pre-operative questions. They regard thorough informed consent as a clinical responsibility rather than a regulatory formality. They will discuss complications openly, explain their enhancement policy clearly, and have systems in place for every scenario described in this document before the patient arrives.
If a clinic finds detailed questions inconvenient, that is important information.
Blue Fin Vision® Laser Eye Surgery Checklist
Questions to Ask Before Laser Eye Surgery
Questions About Your Surgeon
- Is your surgeon on the GMC Specialist Register?
- Does your surgeon hold the CertLRS qualification?
- How many laser procedures does your surgeon perform each year?
Questions About the Clinic
- Does the clinic offer PRK/LASEK, SMILE and LASIK?
- If PRK or LASEK is recommended, will mitomycin C be used to prevent corneal haze?
- What is the post-operative drops regimen, and for how long are drops provided?
Questions About the Choice of Laser Technique
- How does your surgeon decide between LASIK, PRK/LASEK and SMILE?
- Why is SMILE not always the best option for high myopia?
Questions About Complications
- What complications can occur with LASIK, and how are they managed?
- What complications can occur with SMILE, and what happens if suction is lost during the procedure?
- Will I be asked to sign a detailed consent form?
- What is the clinic’s emergency access policy? How is dry eye managed after laser eye surgery, and for how long?
Questions About Enhancement Procedures
- What is the enhancement threshold, and when is enhancement typically offered?
- Who performs the enhancement, and is it included in the price?
- What happens if epithelial ingrowth or haze develops?
Questions About Anxiety and Comfort
- What provision is made for patients who develop anxiety on the day of surgery?
Questions for Patients Travelling to Surgery
- What is the minimum stay required near the surgical centre?
- Who will manage post-operative care in my home region?
References
- Grzybowski A, Kanclerz P, Huerva V, Ascaso FJ, Tuuminen R. A review on the safety and efficacy of laser in situ keratomileusis. Medical Science Monitor. 2019;25:4828-4842.
- Shortt AJ, Bunce C, Allan BD. Evidence for superior efficacy and safety of LASIK over photorefractive keratectomy for correction of myopia. Ophthalmology. 2006;113(11):1897-1908.
- Royal College of Ophthalmologists. Certificate in Laser Refractive Surgery (CertLRS): Requirements and Curriculum. London: RCOphth; 2020.
- Montgomery v Lanarkshire Health Board UKSC 11. United Kingdom Supreme Court.
- General Medical Council. The Specialist Register. London: GMC; 2024. Available from: https://www.gmc-uk.org/registration-and-licensing/the-medical-register
- Toda I. LASIK and dry eye. Cornea. 2008;27(Suppl 1):S70-S76.
- Shah R, Shah S, Sengupta S. Results of small incision lenticule extraction: all-in-one femtosecond laser refractive surgery. Journal of Cataract and Refractive Surgery. 2011;37(1):127-137.
- Raviv T, Majmudar PA, Dennis RF, Epstein RJ. Mitomycin-C for post-PRK corneal haze. Journal of Cataract and Refractive Surgery. 2000;26(8):1105-1106.
- Ambrósio R Jr, Wilson SE. LASIK vs LASEK vs PRK: advantages and indications. Seminars in Ophthalmology. 2003;18(1):2-10.
- Hardten DR, Fahd DC. LASIK enhancement: a review of current techniques. Current Opinion in Ophthalmology. 2007;18(4):297-303.
Schedule Your Consultation Today
If you are considering laser eye surgery, Blue Fin Vision® offers a complimentary consultation with a consultant ophthalmic surgeon. With centres across London, Hertfordshire, and Essex, book your consultation to discuss your laser eye surgery options with Mr Hove and his team.
