No-Flap LASEK / Epithelial LASIK / Advance Surface Ablation

Laser vision correction without preparation of a LASIK flap goes by a number of names - LASEK (laser epithelial keratomileusis), surface LASIK, epithelial LASIK, epi-LASIK, or Advanced Surface Ablation). Although LASEK and LASIK sound the same, unlike traditional LASIK, LASEK does not require the preparation of a corneal flap. This has three potential advantages:

1. Risks of making the corneal flap in LASIK are avoided. This may be important in some patients in whom there is an additional risk in making the flap, such as patients with corneal scars or irregularities, or in patients who prefer a no-flap treatment. This technique may also be required for some occupations.
2. Since laser treatment is done on the surface, LASEK/PRK preserves more corneal tissue. In particular, patients who have thinner corneas may be more safely treated with a no flap technique rather than LASIK
3. LASEK/PRK may be an option for patients who are not good candidates for LASIK

At the beginning of the LASEK / PRK eye surgery procedure, topical numbing drops are applied. A lid speculum holds your lids open to avoid blinking during the procedure. The surface cells of the cornea are first loosened and moved to the side. The laser treatment then is applied, taking between 20 and 60 seconds depending on the desired correction. Medications are given and, at the end of the procedure, a contact lens bandage is applied. You will use topical drops to avoid infection and control wound healing for approximately 3 weeks.

Vision after LASEK/PRK does take a little while longer to completely improve and stabilize than after LASIK. Substantial improvement usually is noticed the day after the procedure and fluctuates over the next 2 weeks. The contact lens is removed in 5 days in most patients. Most people return to work 2-5 days after the procedure.  Driving vision in the days after the procedure can be variable and take up to 2 weeks in some patients.

As with traditional LASIK, there are two basic types of possible side effects with LASEK / PRK eye surgery. Because patients may respond and heal differently, it is possible that the entire refractive error may not be corrected or that there might be some over-correction. In this case, vision will be clearer without glasses, but less powerful glasses may still be necessary to fine tune to your best vision. Patients who are under-corrected or over-corrected often can undergo a re-treatment procedure to further improve their vision. In addition, like LASIK, other optical side effects include halos around lights and glare, especially at night. Other possible complications include scarring or corneal haze. We will discuss these possibilities in detail.

Frequently Asked Questions:

1. Are results different from LASIK? No. Extensive clinical trials which we have published show no difference in outcomes. The only difference is extended time for vision stabilization in surface laser procedures.
2. Is the laser different from LASIK? No. The same Wavelight laser and technique is used.
3. Aren't surface procedures more uncomfortable than LASIK? Advances in surgical technique and postoperative care have made the recovery period after LASEK/PRK quite comfortable as compared with the original PRK procedure years ago.

Other in depth articles and studies related to LASEK/PRK:

Introduction to the Excimer Laser
Results of Phase III Excimer Laser Photorefractive Keratectomy for Myopia
Characteristics Influencing Outcomes of Excimer Laser Photorefractive Keratectomy

At Issue: preferred regimen for curing haze after PRK - June 15, 2000