Laser Eye Surgery for Astigmatism: Options, Limits and Results

Astigmatism is one of the most common refractive errors in the world (Hashemi et al., 2018), and one of the most common reasons people are told they “can’t have laser eye surgery”. That advice is usually out of date. Modern laser platforms correct astigmatism routinely, and where a laser is not the right tool there are lens-based procedures that are.

This guide brings together what the Focus Vision surgeons tell patients about astigmatism: what it is, which procedures correct it, who is suitable, what the published results show, and what recovery and cost look like in Brisbane.

Can laser eye surgery fix astigmatism?

Yes. LASIK, TransPRK and CLEAR lenticule extraction all correct regular astigmatism by reshaping the cornea so that light focuses evenly on the retina (AAO). The astigmatism is treated in the same procedure as any short-sightedness or long-sightedness, so one treatment addresses the whole prescription.

There are two situations where a laser is not the first choice. Very high astigmatism may be better corrected with a toric implantable contact lens or with lens replacement surgery, and the irregular astigmatism caused by keratoconus is a reason not to have standard laser surgery at all. Both are covered below.

What astigmatism is, and how you get it

Astigmatism occurs when the cornea (the clear front window of the eye) or the lens inside the eye is not evenly curved, so light is bent unevenly and does not come to a single focus on the retina (AAO). When the cornea is the cause it is called corneal astigmatism; when the lens is the cause it is lenticular astigmatism. It very often occurs together with short-sightedness (myopia) or long-sightedness (hyperopia).

Uncorrected astigmatism typically causes:

• Blurred or distorted vision at all distances
• Eye strain after reading or screen work
• Headaches linked to focusing effort
• Squinting, and difficulty seeing clearly in low light

Astigmatism is usually present from birth and often runs in families. It can also develop after an eye injury, eye surgery or disease, and conditions such as keratoconus, which progressively thins and steepens the cornea, cause an irregular form of astigmatism. A routine eye test diagnoses it, and glasses or toric contact lenses correct it well. Many people, though, want a permanent solution that does not depend on lenses, and that is where surgery comes in.

Your options for correcting astigmatism

Focus Vision offers every mainstream form of vision correction, so the recommendation is about your eyes rather than about the one machine a clinic happens to own.

LASIK, including ray-tracing LASIK

In LASIK a femtosecond laser creates a thin flap in the cornea, which is lifted so that an excimer laser can reshape the tissue beneath it (AAO). The laser removes tissue in a precise pattern that smooths out the uneven curvature causing the astigmatism. Visual recovery is the fastest of the laser procedures, and the trade-off is a small risk of flap-related complications.

Ray-tracing LASIK on the Alcon WaveLight Plus platform builds an individual virtual model of your eye from corneal tomography, biometry and aberrometry, and calculates the treatment by tracing rays of light through that model. The aim is to correct not just your glasses prescription but the eye’s own optical imperfections (higher-order aberrations). The technique has been tested in a randomised, double-blinded study in which 30 patients had ray-tracing-guided LASIK in one eye and standard wavefront-optimised LASIK in the other, with the ray-tracing treatment planned entirely from objective measurements taken on a single diagnostic device (Khoramnia et al., 2025). Topography-guided treatments, which map thousands of elevation points across the corneal surface, are particularly useful for uneven or irregular astigmatism and are associated with better contrast sensitivity and less induction of new higher-order aberrations (topography-guided ablation review).

TransPRK (surface laser)

TransPRK is the no-flap, no-touch version of PRK: the excimer laser removes the surface layer of the cornea and reshapes the tissue beneath in a single step, and the surface layer grows back over the following days. PRK corrects the same range of prescriptions as LASIK with equivalent long-term results, but visual recovery is slower (Shortt et al., 2013). It is the usual choice for thinner corneas and for people who want to avoid a flap altogether (AAO).

CLEAR lenticule extraction

CLEAR is Ziemer’s lenticule-extraction procedure, in the same family as SMILE. A femtosecond laser cuts a thin, lens-shaped disc of tissue inside the cornea, which the surgeon removes through a small incision, with no flap and no excimer laser (AAO). It corrects short-sightedness with or without astigmatism. In the first published one-year series its safety and visual outcomes were comparable with established lenticule extraction and femtosecond LASIK (J Refract Surg, 2024), and pooled trial data show that dry-eye symptoms occur less often after lenticule extraction than after femtosecond LASIK (PLoS One meta-analysis, 2016). You can read more on our laser eye surgery page.

Toric implantable contact lens (ICL)

For high prescriptions, high astigmatism, thin corneas or dry eyes, a toric implantable contact lens corrects the astigmatism from inside the eye. The lens sits behind the iris and in front of your natural lens, no corneal tissue is removed, and the procedure is reversible because the lens can be taken out or exchanged (AAO EyeWiki; Clin Ophthalmol review).

Lens replacement surgery with a toric lens

When the natural lens inside the eye is starting to change, or for very high prescriptions, refractive lens exchange or cataract surgery with a toric intraocular lens corrects astigmatism at the same time as it replaces the lens. Toric lens implantation is an established way to correct moderate to high corneal astigmatism during lens surgery (toric IOL study, PMC7840247).

When laser is not the answer: keratoconus

Irregular astigmatism caused by keratoconus is a reason not to have standard laser eye surgery: the FDA lists conditions that thin the cornea, such as keratoconus, among those that can lead to serious problems during and after LASIK (FDA). Both Focus Vision surgeons specialise in keratoconus and treat it with corneal cross-linking, CAIRS (corneal allogenic intrastromal ring segments) and, where needed, corneal transplant. If your optometrist has mentioned keratoconus or an unusual corneal shape, say so when you book, so the assessment is planned accordingly.

Who is a suitable candidate?

For LASIK, TransPRK and CLEAR, the criteria are the same as for any laser vision correction:

• At least 18 years old, with a prescription that has been stable for at least a year (FDA)
• A cornea that is thick enough, with a regular shape and no sign of keratoconus
• Healthy eyes, without cataract, glaucoma or severe dry eye
• Not pregnant or breastfeeding, because hormonal changes make the prescription unstable (FDA)
• Good general health, since autoimmune disease and uncontrolled diabetes can affect healing

If your astigmatism is very high, your cornea is thin, or your natural lens is beginning to change, the assessment may point to a toric ICL or lens surgery instead. That is not a rejection; it is the assessment doing its job.

The pros and cons, honestly

The case for surgery

• Clear unaided vision for most people: in a review of 97 studies covering more than 67,000 eyes, 99.5% of eyes saw 20/40 or better without glasses after LASIK and 90.8% saw 20/20 (Sandoval et al., 2016)
• A permanent change to the cornea, with ten-year follow-up showing stable results for most eyes (Alió et al., 2008)
• Astigmatism, short-sightedness and long-sightedness corrected in the same procedure
• Fast recovery, particularly after LASIK
• Freedom from glasses and contact lenses for sport, travel and everyday life

The case for caution

• It is surgery, and surgery carries risk. Serious infection is rare: 26 cases in 564,165 LASIK eyes and 11 in 81,792 PRK eyes in one large series (Schallhorn et al., 2017)
• Dry eyes, glare and halos are common early on and usually settle, but the FDA’s PROWL studies found that some patients develop new visual symptoms after LASIK (FDA PROWL)
• Not everyone is suitable, and the final result can take months to settle (healthdirect)
• The upfront cost is higher than a pair of glasses, although it is a one-off

Results you can expect

The figures above are for LASIK across all prescriptions. In the same review, 0.61% of eyes lost two or more lines of best-corrected vision (Sandoval et al., 2016), and a separate review of the world literature found 95.4% of patients were satisfied with their outcome (Solomon et al., 2009). How completely your own astigmatism is corrected depends on how much you have, how regular it is, and how well the treatment is centred on your eye, which is exactly what ray-tracing and topography-guided planning are designed to improve.

Recovery and aftercare

• LASIK: most people see well within 24 to 48 hours, although it can take up to six months for vision to fully stabilise (healthdirect).
• TransPRK: the surface layer regrows over the first few days (AAO EyeWiki), you will usually need at least a week off, and vision sharpens over the following weeks (healthdirect).
• CLEAR: most patients notice improvement within days, with no flap to protect.
• Side effects: dry eyes, light sensitivity and mild discomfort are common. The discomfort settles within days; dryness and glare can take several weeks or months (AAO).
• Restrictions: no swimming or water in the eye for at least two weeks (AAO) and no contact sports for at least four weeks (FDA).

Follow-up appointments for the first year are included in the procedure price, and they matter: they are how we confirm the astigmatism correction has landed where it was planned.

What it costs in Brisbane

Focus Vision’s all-inclusive surgical prices are TransPRK from $3,500 per eye, LASIK and ray-tracing LASIK from $4,250 per eye, CLEAR lenticule extraction from $4,250 per eye, ICL surgery from $7,000 per eye including the anaesthetist, and refractive lens exchange from $6,000 per eye including the anaesthetist. Prices include the pre-operative assessments, the procedure and a year of follow-up appointments; prescribed medications and eye drops are extra, and we do not charge more for higher prescriptions. Interest-free plans over 24 months start from $34 a week. Medicare does not cover laser vision correction (healthdirect). The live price list and a comparison with other Brisbane clinics are on our costs page. The paid specialist surgeon consultation fee is deducted from the surgery price for every procedure if you proceed. Prescribed medications are purchased separately so eligible patients can use PBS subsidies for eligible prescriptions; see our pricing details.

Choosing a surgeon

Whoever you see, check three things. First, that they are a registered ophthalmologist on the AHPRA register, ideally with fellowship training in corneal and refractive surgery. Second, that the clinic offers more than one procedure, so the advice is not shaped by the equipment. Third, that they are willing to tell you no. At Focus Vision your assessment and surgery are with fellowship-trained corneal specialists, and if laser is not right for your astigmatism they will say so and explain the alternative.

Get in touch

If you would like to know whether your astigmatism can be corrected, book a free optometrist assessment. Call us on (07) 3239 5005, email hello@focusvision.com.au or contact us online.

References

1. Hashemi H, Fotouhi A, Yekta A, Pakzad R, Ostadimoghaddam H, Khabazkhoob M. Global and regional estimates of prevalence of refractive errors: Systematic review and meta-analysis. J Curr Ophthalmol. 2018. pubmed.ncbi.nlm.nih.gov/29564404
2. American Academy of Ophthalmology. What Is Astigmatism? Symptoms, Causes, Diagnosis, Treatment. EyeSmart. aao.org/eye-health/diseases/what-is-astigmatism
3. American Academy of Ophthalmology. LASIK — Laser Eye Surgery. EyeSmart. aao.org/eye-health/treatments/lasik
4. Khoramnia R, Naujokaitis T, Blöck L, Fabian K, Kessler LJ, Łabuz G, Auffarth GU. Prospective intraindividual comparison of automated customized ray-tracing-guided versus wavefront-optimized LASIK. Ophthalmology. 2025;132:1169-1179. pubmed.ncbi.nlm.nih.gov/40482723
5. Topography-guided excimer laser ablation in refractive surgery. PMC11182089. pmc.ncbi.nlm.nih.gov/articles/PMC11182089
6. Alcon. WaveLight Plus: Personalized Refractive Surgery Solutions. myalcon.com/professional/refractive/wavelight-plus
7. Shortt AJ, Allan BD, Evans JR. Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia. Cochrane Database Syst Rev. 2013;(1):CD005135. pmc.ncbi.nlm.nih.gov/articles/PMC11848121
8. American Academy of Ophthalmology. What Is Photorefractive Keratectomy (PRK)? EyeSmart. aao.org/eye-health/treatments/photorefractive-keratectomy-prk
9. American Academy of Ophthalmology. Photorefractive Keratectomy. EyeWiki. eyewiki.aao.org/Photorefractive_Keratectomy
10. American Academy of Ophthalmology. What Is Small Incision Lenticule Extraction? EyeSmart. aao.org/eye-health/treatments/what-is-small-incision-lenticule-extraction
11. Keratorefractive Lenticule Extraction Using the Ziemer FEMTO LDV Z8 Platform (CLEAR): One-Year Results. J Refract Surg. 2024. journals.healio.com/doi/full/10.3928/1081597X-20241016-01
12. Small incision lenticule extraction (SMILE) versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia: a systematic review and meta-analysis. PLoS One. 2016. ncbi.nlm.nih.gov/pmc/articles/PMC4930219
13. American Academy of Ophthalmology. Phakic Intraocular Lenses. EyeWiki. eyewiki.org/Phakic_Intraocular_Lenses
14. Intraocular Implantable Collamer Lens with a Central Hole Implantation: Safety, Efficacy, and Patient Outcomes. Clin Ophthalmol. pmc.ncbi.nlm.nih.gov/articles/PMC10046236
15. Toric Intraocular Lens Implantation in the Correction of Moderate-To-High Corneal Astigmatism in Cataract Patients: Clinical Efficacy and Safety. PMC7840247. ncbi.nlm.nih.gov/pmc/articles/PMC7840247
16. U.S. Food and Drug Administration. When is LASIK not for me? fda.gov/medical-devices/lasik/when-lasik-not-me
17. U.S. Food and Drug Administration. LASIK: What should I expect before, during, and after surgery? fda.gov
18. U.S. Food and Drug Administration. LASIK Quality of Life Collaboration Project (PROWL studies). fda.gov
19. Sandoval HP, Donnenfeld ED, Kohnen T, et al. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42(8):1224-1234. pubmed.ncbi.nlm.nih.gov/27531300
20. Solomon KD, Fernández de Castro LE, Sandoval HP, et al. LASIK world literature review: quality of life and patient satisfaction. Ophthalmology. 2009;116(4):691-701. pubmed.ncbi.nlm.nih.gov/19344821
21. Alió JL, et al. Ten-year follow-up of laser in situ keratomileusis for myopia of up to −10 diopters. Am J Ophthalmol. 2008;145(1):46-54. pubmed.ncbi.nlm.nih.gov/18154754
22. Schallhorn et al. Infectious keratitis after laser vision correction: Incidence and risk factors. J Cataract Refract Surg. 2017. sciencedirect.com/science/article/abs/pii/S0886335017301694
23. American Academy of Ophthalmology. Laser Surgery Recovery. EyeSmart. aao.org/eye-health/treatments/laser-surgery-recovery
24. American Academy of Ophthalmology. When to Resume Exercise After an Eye Surgery or Injury. EyeSmart. aao.org
25. healthdirect Australia. Laser eye surgery. healthdirect.gov.au/laser-eye-surgery
26. Australian Health Practitioner Regulation Agency. Registers of Practitioners. ahpra.gov.au

Start with a free optometrist assessment to explore your suitability. Every patient proceeding to surgery then has a paid consultation with a specialist surgeon to confirm suitability, discuss their procedure and plan surgery. The consultation fee is deducted from the surgery price for every procedure. See consultation and pricing details.