Choosing a LASIK or SMILE surgeon: what the CertLRS is, what it tests, and what to ask

It is easy to choose laser eye surgery by price, by the offer of the month, or by a friend's recommendation. The surgeon's training is harder to see. One qualification you can ask about by name is the CertLRS, the Royal College of Ophthalmologists' Certificate in Laser and Refractive Surgery. I passed it in 2026. This article explains what it is, what it tests, what it does not prove, and the questions that matter alongside it.

What is the CertLRS?

The CertLRS is the Certificate in Laser and Refractive Surgery, awarded by the Royal College of Ophthalmologists in the United Kingdom after a two-part examination. Holders may use the letters CertLRS after their name. It is a postgraduate qualification for ophthalmologists, separate from the FRCOphth fellowship exams.

Refractive surgery is surgery that reduces your need for glasses or contact lenses by changing how the eye focuses light. It covers the lasers most people have heard of. In LASIK, a thin flap is made in the cornea, the clear front window of the eye, and the laser reshapes the tissue beneath it. In SMILE, a small disc of corneal tissue called a lenticule is cut inside the cornea and drawn out through a small opening. In surface treatments such as PRK, the laser works directly on the surface of the cornea. Refractive surgery also covers lens surgery: an implantable contact lens placed inside the eye, in front of your own lens, or refractive lens exchange, where your own lens is replaced, much as in cataract surgery.

The College's 2026 syllabus names every one of these. Older College pages still use the earlier name, the Certificate in Laser Refractive Surgery, so you may see both.

What does the CertLRS exam actually test?

It tests knowledge and judgement, not hands. The College describes it as an assessment of theoretical knowledge in commonly encountered refractive surgery scenarios, sat in two parts over two days: a written paper, then five structured vivas, oral examinations in which examiners question the candidate face to face.

The written paper has 100 multiple-choice questions, sat online and open book, over two and a half hours. Each viva lasts ten minutes, and together they cover good medical practice and audit, laser treatments, non-laser procedures, the assessment before surgery, and the assessment after surgery, including complications. Two examiners mark each viva independently. The College requires candidates to pass both parts, with a small allowance for a near miss in one, and it allows six attempts.

Look at where the weight falls. Two of the five vivas are about the patient rather than the machine: who is suitable before surgery, and what happens after it. The syllabus names ectasia screening, the scans that look for a cornea too weak to be safely thinned. It also names dry eye, blepharitis and meibomian gland dysfunction, problems of the lid margin and its oil glands that can decide how comfortable the eyes feel after a laser.

What it does not test is surgical skill. The College's own candidate information says the certificate should not be described as a legal licence to practise refractive surgery. A surgeon's hands are trained and judged elsewhere: in supervised operating, in their own audited results, and in how they handle the cases that do not go to plan.

Why does the surgeon's training matter so much in laser eye surgery?

Because many of the decisions that protect your eyes are made before the laser starts. Deciding who should not have surgery, which procedure suits which cornea, and what to do when something goes wrong are matters of judgement, and judgement is what the CertLRS examines.

Laser eye surgery is elective. You can see without it, with glasses or contact lenses, so the bar for saying yes should be high. Much of the surgeon's real work is choosing: reading the corneal scans, weighing the prescription against the thickness of the cornea, and noticing what makes a good result less likely, such as a prescription that is still changing, a hard rubbing habit or an unhealthy lid margin. The piece on eye rubbing, floppy eyelids and keratoconus before LASIK shows how much of that choosing happens around the cornea, not only on it.

The College sets its expectations out in its professional standards for refractive surgery. For a surgeon who began refractive surgery after 1 August 2018, the standards say they should be on the UK General Medical Council's specialist register in ophthalmology and hold the CertLRS. In the College's wording, "should" marks a duty that may not apply in every situation, rather than a legal requirement. Its checklist for patients puts it more simply: "We strongly advise that you choose a surgeon who is on the General Medical Council's specialist register in ophthalmology or has the Cert LRS qualification." These are UK standards, written for surgeons in the UK. What carries over to Malaysia is the question underneath them: how was this surgeon trained in refractive surgery?

Does a LASIK surgeon in Malaysia need the CertLRS?

The Malaysian Medical Council's published documents on ophthalmology training and specialist registration set no such requirement; they do not mention the CertLRS. The council's list of specialties gives ophthalmology a single field of practice, ophthalmology itself, with no separate field for refractive surgery.

That last point matters more than it sounds. The Malaysian registers can tell you that a doctor is registered and recognised as an eye specialist. They cannot tell you which eye specialists have trained in laser vision correction, because refractive surgery is not a field the register records. The steps for checking those registers are in how to check that an eye surgeon is registered in Malaysia.

So in Malaysia the certificate is something a surgeon chooses to sit. That makes it a fair thing to ask about. It also means its absence is not a verdict. The College's own standards accept another route for surgeons already in refractive practice before August 2018: specialist registration plus evidence of an established refractive practice. Experienced surgeons have trained by many routes, and a certificate is one sign of training among several.

The College's pass lists give a sense of scale. They are published by candidate number, never by name, and they show 41 passes in 2024, 34 in 2025 and 30 in 2026. That is a few dozen a year. Because the lists carry no names or countries, no one can count from them how many surgeons in Malaysia hold it.

What should you ask a LASIK or SMILE surgeon before you book?

Ask who will operate, what training in refractive surgery they have, why they advise this procedure for your eyes, what complications they have seen in their own patients, and who looks after you afterwards. Then give yourself time before you decide.

• Who will operate on me, and can I meet them first? The College advises meeting the surgeon who will perform the procedure, and says only the operating surgeon should advise you on the choice of procedure and take your consent.
• What is your training in refractive surgery? Ask about the CertLRS by name, and about any fellowship or supervised training in laser and lens surgery.
• Why this procedure for my eyes? LASIK, SMILE, surface treatment and lens surgery suit different eyes. Ask what your scans showed, and what would have made you unsuitable.
• What complications have you seen, how often, and what did you do? This is the College's own suggested question, and a surgeon who audits their results can answer it.
• Who looks after me afterwards, and how do I reach them? Leave with the name and contact details of the doctor who will deal with any problem after surgery.

Watch for pressure, too. The College's checklist warns against being rushed into consent by limited-time offers, discounts or two-for-one deals, and suggests taking at least a week after the consultation to think it through.

From my side of the eye, add one more question: has anyone examined my eyelids? Dry eye is common after laser surgery, and lid margins crowded with blocked oil glands make it worse. What an oculoplastic surgeon checks before LASIK, SMILE or lens surgery covers the lid examination, and dry eye and the meibomian glands before laser eye surgery explains why the oil glands matter. If you want the lasers themselves compared side by side, my colleague Dr Chan Li Yen, a consultant ophthalmologist who performs LASIK, SMILE and Presbyond, sets out what LASIK, SMILE and PRK each do on Little Eyes 101, and what Presbyond can and cannot do for reading glasses after 40.

How do you check a surgeon's registration and certificates?

Check registration yourself on the Malaysian Medical Council's public registers, and ask to see certificates. The College publishes its pass lists by candidate number rather than by name, so a surgeon who holds the CertLRS can show you the certificate itself; the registers cannot.

Asking is not rude. These are ordinary questions, and the College's checklist says you can change your mind at any point and ask for a second opinion from another surgeon. If you would like a second view before any eye or eyelid operation, a second opinion is a normal part of deciding.

The CertLRS will not tell you everything about a surgeon. It tells you they have been examined, by two examiners at a time, on the judgement that refractive surgery depends on. Ask about it, then ask the other questions too. The wider set of pieces sits under refractive surgery and your eyelids, and the general question of why eyes feel and look tired is in what makes eyes look tired.