For people with moderate to high myopia or thin corneas which cannot be treated with LASIK or PRK, the phakic intraocular lens is an alternative.

"[10] A detailed pre-operative screening will assess corneal thickness, shape, and refractive error, ensuring the patient is a suitable candidate.

During the surgery, a surgeon uses a femtosecond laser or a microkeratome blade to create a thin corneal flap, which is then carefully folded back to expose the underlying tissue.

An excimer laser precisely reshapes the stromal layer of the cornea, removing microscopic amounts of tissue to correct refractive errors.

The entire procedure typically takes 10–15 minutes per eye and offers minimal discomfort and rapid recovery, allowing most patients to return to normal activities within a day or two.

Before the surgery, the patient's corneas are examined with a pachymeter to determine their thickness, and with a topographer, or corneal topography machine,[3] to measure their surface contour.

The procedure is contraindicated if the topographer finds difficulties such as keratoconus[3] The preparatory process also detects astigmatism and other irregularities in the shape of the cornea.

The patient is prescribed and self-administers an antibiotic beforehand to minimize the risk of infection after the procedure and is sometimes offered a short acting oral sedative medication as a pre-medication.

Factors that may rule out LASIK for some patients include large pupils, thin corneas and extremely dry eyes.

[2] Performing the laser ablation in the deeper corneal stroma provides for more rapid visual recovery and less pain than the earlier technique, photorefractive keratectomy (PRK).

The goal is to achieve a more optically perfect eye, though the result still depends on the physician's success at predicting changes that occur during healing and other factors that may have to do with the regularity/irregularity of the cornea and the axis of any residual astigmatism.

[28] In 1980, Rangaswamy Srinivasan, Samuel E. Blum, and James J. Wynne at the IBM Research laboratory, discovered that an ultraviolet excimer laser could etch living tissue, with precision and with no thermal damage to the surrounding area.

[29][30] Five years later, in 1985, Steven Trokel at the Edward S. Harkness Eye Institute, Columbia University in New York City, published his work using the excimer laser in radial keratotomy.

In 1998, the "Kremer Excimer Laser", serial number KEA 940202, received FDA approval for its singular use for performing LASIK.

[35] Subsequently, Summit Technology was the first company to receive FDA approval to mass manufacture and distribute excimer lasers.

[36] The procedure seems to be a declining option for many in the United States, dropping more than 50 percent, from about 1.5 million surgeries in 2007 to 604,000 in 2015, according to the eye-care data source Market Scope.

[38] This decrease in interest can be attributed to several factors: the emergence of refractive cataract surgery, the economic recession in 2008, and unfavorable media coverage from the FDA's 2008 press release on LASIK.

[9] In 2006, the British National Health Service's National Institute for Health and Clinical Excellence (NICE) considered evidence of the effectiveness and the potential risks of the laser surgery, stating "current evidence suggests that photorefractive (laser) surgery for the correction of refractive errors is safe and effective for use in appropriately selected patients.

Clinicians undertaking photorefractive (laser) surgery for the correction of refractive errors should ensure that patients understand the benefits and potential risks of the procedure.

Risks include failure to achieve the expected improvement in unaided vision, development of new visual disturbances, corneal infection and flap complications.

[40][41][42] In March 2008, the American Society of Cataract and Refractive Surgery published a patient satisfaction meta-analysis of over 3,000 peer-reviewed articles from international clinical journals.

[44] Some people with poor outcomes from LASIK surgical procedures report a significantly reduced quality of life because of vision problems or pain associated with the surgery.

Punctal occlusion is accomplished by placing a collagen or silicone plug in the tear duct, which normally drains fluid from the eye.

[73] Also in 2014, FDA published an article highlighting the risks and a list of factors and conditions individuals should consider when choosing a doctor for their refractive surgery.

[74] People with large pupils (e.g. due to taking medications or in the younger age group) may be particularly prone to symptoms such as glare, halos, starbursts, and ghost images (double vision) in dim light after surgery.

[11] Since 1991, there have been further developments such as faster lasers; larger spot areas; bladeless flap incisions; intraoperative corneal pachymetry; and "wavefront-optimized" and "wavefront-guided" techniques which were introduced by the University of Michigan's Center for Ultrafast Optical Science.

The goal of replacing standard LASIK in refractive surgery is to avoid permanently weakening the cornea with incisions and to deliver less energy to the surrounding tissues.