Choosing between Lasik and Lasek eye surgery

by Tim Harwood

Hundreds of thousands of people each year are taking the plunge and choosing to have the life changing procedure that is laser eye surgery.

It is currently the most popular elective surgery in the world and the number of people having it done is likely to increase as the procedure becomes safer and more accurate. If you yourself are considering having laser eye surgery, then you will almost certainly be confronted with the choice of whether to have Lasik or Lasek eye surgery (which is similar to PRK).

Both Lasek and Lasik are types of laser eye surgery and they account for about 99% of all procedures currently being carried out. Of the 2 types, Lasik is by far the most popular accounting for about 7 times more procedures than Lasek.

The main difference between these 2 types of laser eye surgery lies in the way in which the inner part of the cornea is accessed. The cornea (outer clear part of your eye) is the part of the eye that is to be lasered and your surgeon can not laser directly onto the surface of your eye. He/she needs to lift off a thin layer of your cornea before the laser can be applied.

During Lasik, a flap is created which effectively means a thin layer of your cornea is cut and then lifted to one side. The surgeon then applies the laser which eliminates your prescription and then the flap is replaced back in exactly the same place as it was before.

During the Lasek procedure however there is no flap created. The surgeon simply loosens the very outer layer of your cornea (epithelium) and moves it to one side. This is loosened using an alcohol solution rather than a surgical blade. The laser is then applied (the same as it is for Lasik) and the epithelium is then smoothed back over and left to heal.

The following lists some of the other differences between the procedures:

* Resulting vision: Lasik and Lasek produce very similar visual results and they are equally likely to produce 20/20 vision.

* Recovery: The recovery period for Lasik is far quicker and more comfortable than the Lasek recovery. Following Lasik, most people experience only very mild discomfort (e.g. dryness, irritable, stinging) and most people can return to work and drive 24-48 hours following surgery. People can however experience quite moderate pain following Lasek surgery and it is normally advisable to have 5-7 days off work.

* Complications: There are more risks with Lasik than Lasek as the vast majority of complications are associated with the creation and healing of the flap. There is of course no flap created during Lasek. Both procedures however are extremely safe and most complications are easily treatable by your surgeon.

* Price: Most clinics charge the same price for the 2 procedures.

* Corneal thickness: If you have thin corneas you may be advised to have Lasek eye surgery by your surgeon. Lasek can be carried out on people with thinner corneas when compared with Lasik.

* Contact sports: If you are involved with contact sports you will probably be advised to have Lasek as the strength of your cornea will be in no way compromised following the procedure.

In summary most people choose to have Lasik surgery as they can return to work and normal activities sooner following surgery. It is generally only those who have been specifically advised to have Lasek who end up having that treatment. Both procedures are equally likely to give you 20/20 vision. The only real way you will ever know which treatment is the most suitable for you is by going to see a qualified surgeon for a laser eye surgery consultation.

Timothy Harwood is an optometrist and founder and managing director of Treatmentsaver.com.

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Comments

Vox Rusticus
One might rhetorically ask: what exactly is the value of re-applying a de-vitalized layer of corneal epithelium to the freshly-lasered face of corneal stroma that is left after the excimer laser has done the planned ablation? (Is it just a autologous bandage?) Or better yet, is there more value in preserving the Bowman’s layer as is done in either traditional microkeratome LASIK and in femtosecond YAG flap construction followed by LASIK versus “epilasik,” “LASEK” and traditional PRK?
A fairer discussion should say from the start that the decision to choose a non-flap refractive laser procedure may be driven by the amount of planned ablation needed to achieve the desired refractive result and the preoperative central corneal thickness of the treated eye. Generally-speaking, the more correction, the deeper the ablation depth needed and the greater the possibility that a thin-flap or no-flap procedure will be necessary (setting aside crossed-cylinder ablation strategies and other matters beyond this discussion).
The choice of one over the other will depend on the needs of the particular patient, the experience and comfort of the patient, and the technology available to both the surgeon and the patient.

Vox Rusticus
I meant “experience and comfort of the surgeon . . .”

Peter Lombard MD
I feel obliged to point out inaccuracies in this article for the benefit of the reader. The author states, “…you will almost certainly be confronted with the choice of whether to have Lasik (also called PRK) or Lasek eye surgery.”
LASIK is NOT also called PRK, and should not be confused with it. LASIK is indeed the most common refractive procedure, followed by PRK. To my knowledge, LASEK is less common than both LASIK and PRK. I looked at the author’s website treatmentsaver.com and the same inaccuracies are there.
LASIK = flap. PRK = no flap. In PRK the outer layer of the cornea (the epithelium, or skin) is completely removed with a brush or with alcohol, which is why the healing time takes so much longer with PRK, and is why there is more postoperative discomfort. After PRK most patients have a bandage contact lens placed to allow the epithelium to heal. PRK is in fact much more similar to LASEK, a procedure which the author did correctly describe.
Because of the difference in technique, the potential complications also differ, and this is perhaps the most crucial aspect for patients to fully understand.
Briefly, complications unique to LASIK include flap dislocations, flap striae, and epithelial ingrowth under the flap, among others. While flap creation technology has improved tremendously with the femtosecond laser, some patients just don’t like the thought of a flap that might be dislodged with trauma later in life, and thus choose PRK. The complication more associated with PRK is postoperative corneal haze, which is mitigated by the use of medicine during and after surgery.
It is true that the application of the excimer laser to the cornea stroma is essentially the same for all three procedures, and that the outcomes and efficacy of the procedures are essentially the same.
I encourage patients considering PRK, LASIK, or LASEK to be very clear on the differences between the procedure and their unique potential complications. A further discussion to have with your ophthalmologist would be the benefits of “custom” also known as “wavefront guided” treatment, versus “conventional” treatment with the excimer laser.
A very nice website that accurately describes the procedure may be found at http://www.dohenylaser.com/index.php?id=procedures. The University of Southern California Doheny Eye Clinic is a very well respected academic teaching institution in the field of ophthalmology.
Respectfully,
Peter Lombard, MD
http://www.treatmentsaver.com Tim Harwood
Thanks to both Peter Lombard and Vox Rusticus for their helpful comments about my article.
I have requested a change to be made where I wrote that Lasik was also called PRK which as they pointed out is no true.
The aim of the article was to keep things simple and not over complicate things. As an optometrist I constantly get told by my patients that information given out to them by Opthalmolgists is overly complicated and confusing. This piece is not an academic paper but something written to explain things to the Lay person.
Best regards
http://www.diabetesdaily.com/blogs/fadingtogray Christine
Dr. Lombard- thank you for the clarification. I was confused as when I had my corrective surgery I was offered LASIK or PRK. It was only upon doing my own research that I heard of LASEK. I ended up opting for wavefront custom LASIK and have been extremely pleased with the results. I was amazed at my quick and uneventful healing.
http://www.kevinmd.com Kevin
This post has been corrected, as mentioned above.
Kevin

Choosing between Lasik and Lasek eye surgery

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