LASEK
LASEK (laser epithelial keratomileusis) is a relatively new type of corrective laser eye surgery. It employs an alcohol solution to loosen the very outer layer (epithelium) of the cornea. Once the laser correction has been performed, this epithelial flap is replaced as a sort of natural bandage. LASEK is a good alternative for those patients who are not candidates for LASIK surgery due to thin corneas.
Reasons to consider LASEK:
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Wish to reduce or eliminate dependence on glasses or contacts for those with myopia, hyperopia or astigmatism.
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The epithelial layer is kept, reducing healing time and pain compared to PRK.
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An alternative for patients with thin corneas who are not candidates for LASIK.
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Reduces the chances of post-operative corneal haze, compared to PRK.
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Patients experience dry-eye less often after LASEK than compared to LASIK.
The Procedure
For the LASEK procedure, first the doctor creates an epithelial flap. Alcohol is used for about 30 seconds to loosen the epithelial cells. Then the epithelium is lifted, with the help of a trephine blade, and folded aside, to allow access to the inner layers of the cornea. At this point, the excimer laser ablates (burns off) the carefully mapped tissue, just as in LASIK and PRK. After the laser correction is complete, the doctor replaces the epithelial flap, and applies a bandage contact lens to aid in healing.
The Recovery
The epithelial layer fully heals in about a day, though usually the patient must wear the bandage contact lens for about four days. Patients may experience mild discomfort, irritation or pain for the first couple of days after the procedure. The doctor will schedule several check-up appointments to monitor the healing process, followed by periodic visits over the next several months. During the recovery process, the patient should rest and refrain from any strenuous activities for at least a week. Most patients can return to work in a few days, though it is best to take off whatever time needed to ensure a smooth recovery.
LASIK
LASIK (laser assisted in-situ keratomileusis) is the most commonly performed and well known vision correction surgery. Using an excimer laser, the doctor re-shapes the cornea (the stationary refractive element at the front of the eye) so that images are focused to the correct spot on the retina (the light receptor of the eye). The success rate with this procedure is excellent, with most patients achieving 20/20 vision or better upon completion.
The LASIK procedure itself involves little or no discomfort (or pain) both during the procedure and through the recovery process. Also, eyesight improvement is almost immediate, and maximum vision is typically achieved within a few days.
Reasons to consider LASIK:
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Nearsightedness (myopia).
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Farsightedness (hyperopia).
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Astigmatism (irregularly shaped cornea).
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Desire to decrease or eliminate dependence on glasses or contacts.
The Procedure
During the procedure, the doctor first administers a local anesthetic via eye drops, so the patient will feel no pain during the surgery. A speculum is then placed over the eye to prevent the patient from blinking. Next, the surgeon cuts an extremely thin flap from the outer layer of the cornea, using a microkeratome (a small blade specially designed for this purpose). The flap is folded to the side, and the excimer laser, programmed with the individual map of the patient’s eye, removes excess tissue with quick pulses of concentrated light. This process usually takes less than a minute. Once this is done, the doctor folds the flap back into place and surgery is complete.
The Recovery
The patient may go home shortly after the procedure; however, someone else must drive or alternate transportation must be arranged. Patients will be asked to get lots of rest, avoid any strenuous activities, and avoid rubbing the eye area for a period of time. There are follow up appointments with the doctor 24 to 48 hours after the procedure and periodically over the following weeks and months. Vision should dramatically improve in the first few days following surgery. The patient often may return to work in a day or two, though it is best to take a few days off to ensure a smooth recovery.
PRK
PRK (photorefractive keratectomy) was at one time the most common laser eye surgery. It uses the same excimer laser as the LASIK procedure to reshape the outer layer of the cornea to correct for nearsightedness, farsightedness, and astigmatism. These days LASIK is more common, but PRK is still an alternative for patients who cannot undergo LASIK Surgery.
Reasons to consider PRK:
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Nearsightedness (myopia).
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Farsightedness (hyperopia.
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Astigmatism (irregularly shaped cornea).
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Cornea too thin for LASIK.
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Pupil too large for LASIK.
The Procedure
In preparation for surgery, anesthetic eye drops are administered. Next, a speculum is placed in the eye to keep the eyelids open, which is normally not uncomfortable. While the patient fixes his or her gaze on a target, the laser reshapes the cornea by removing tissue (a process called ablation), which is controlled and closely monitored by the doctor. The laser is actually guided by a detailed map of the patient’s eye which has been programmed into a computer beforehand. The ablation usually takes around a minute for each eye, depending on how high the patient’s vision prescription is. Most patients feel no pain during the procedure. After the procedure is complete, a bandage contact lens is placed on the eye. The patient may go home shortly after the procedure; however, someone else must drive or alternate transportation must be arranged.
The Recovery
The doctor may prescribe pain medication for recovery; however, most patients don’t require it since only minor discomfort is experienced. The doctor will also schedule several check-up appointments to monitor the healing process, followed by periodic visits over the next several months. During the recovery process, the patient should rest, and refrain from any strenuous activities for at least a week. Most patients can return to work in a day or two, though it is best to take a few days off to ensure a smooth recovery.