LASEK Procedure: Who Should Consider Lasek Surgery?
- Asked 5 years ago
I am tired of wearing glasses and contacts, but my vision is very bad, and I don't know if lasek surgery will work for me. How do I know if I'm a good candidate for this procedure?
LASEK is ADVANCED surface ablation--it is NOT a "glorified PRK"
I performed my last PRK in 1995. In my opinion, PRK is an archaic procedure. In PRK, the epithelium is removed, but it is sandpapered off with an amoilis brush. The problem with this is, on a microscopic level, you're crushing the epithelial cells, which then release cytokines and other inflammatory mediators that are the body's signal of cellular injury. This causes the inflammation cascade that causes the pain and possible scarring that can occur with PRK, which is what prevented PRK from becoming popular in the 1990s.
LASIK was developed to address the pain and prolonged healing of PRK. It is not a safer procedure--in fact, there are dozens of additional complications that can happen in LASIK (flap striae, button-hole flap, incomplete flap, misaligned flap, debris under flap, dlk, dislocated flap, infection under flap, etc.).
LASIK is a good procedure; I was actually the 1st LASIK surgeon to get LASIK himself, way back in 1999, for high myopia. But now I have dry eyes and night glare for the rest of my life, like many LASIK patients. The etiology of this is simple: by cutting the corneal flap, you cut the corneal nerves, which causes the dry eyes by interfering with the normal blink rate and neurotrophic factors secreted by the nerves. And by putting the flap back, you wind up with a "sandwich" configuration that causes backscatter of light across the flap interface, which is the cause of glare post-LASIK.
Intra-lase was invented to cut thinner flaps with a laser, to save tissue and reduce flap complications. But many still remain, as obviously you still get the night glare and dry eyes as a flap is still being cut, and if you get hit in the eye the flap can and sometimes does still come up (impossible with LASEK). Every busy refractive surgeon has seen a guy playing basketball and has a flap come up by getting poked in the eye.
My symptoms, like most LASIK patients, are not debilitating, and overall, I am happy I had LASIK--but they are annoying, and I wish I didn't have them. Which is why I switched to the noncutting LASEK procedure.
LASEK was invented by 2 of the surgeons I worked with at Harvard when I was an ophthalmology resident there in the late 1990s, Jon Alamo, MD and Juan-Carlos Abad, MD. I actually published a paper with them in ophthalmology, which is the #1 eye journal in the world, so we are pretty close colleagues.
In LASEK, the epithelium of skin of the eye is removed en bloc, or in one clean sheet, without any cellular destruction, release of cytokines, or inflammation or scarring. Thus, the healing is much quicker than in PRK, and there is really no pain--only mild discomfort.
The advantage of LASEK is that, by not cutting a corneal flap, you have 100-150 microns or more of tissue (the thickness of the flap you didn't cut) you can use to treat the RX, which is enough to treat up to 10 diopters of correction. This means you can safely treat up to -19 or higher, whereas in LASIK the safe limit is -9. You can treat thin corneas, high RX's, irregular astigmatism, and even form frusta keratoconus in certain cases.
Epi-LASEK was invented last, and is, in my opinion, the most advanced procedure there is today. In epic-LASEK, a microkeratome pushes the skin of the eye aside, even cleanlier than in a manual LASEK. In Epi-LASEK, my patients report the comfort of a LASIK, and the safety of a PRK.
In summary, please do not say that LASEK is a "glorified PRK." one of my refractive fellows, dr. Almeida, had PRK a few years ago, because he's from Venezuela and down there, they are a bit behind the times and don't do LASEK. He, like all PRK patients, was in pain for 1-2 weeks. After being my fellow for a year, he had his entire family fly in here from Venezuela, and we did LASEK and Epi-LASEK on all of them, and none of them had any pain, and they all wound up better than 20/20. So we know that LASEK is not PRK, from first-hand and second-hand experience!
I hope this information has been helpful, and have a lot more to say about this topic, but didn't want to make this too technical for the lay people who will be reading this. Just trust me--as a LASIK patient and former LASIK surgeon, please understand that no cutting procedure can ever be as safe as a noncutting one. That is not really a matter of debate; in my opinion, and the opinion of other prominent eye surgeons (like marguerite McDonald)--it's a fact!
Why wait for Lasik?
LASIK surgery is the most common elective surgery performed and helps one reduce dependence on glasses or contact lenses. With visual results showing 98% of people achieving 20/20 or better vision after the procedure (for individuals with mild to moderate amounts of nearsightedness with or without astigmatism) this is a procedure which one should consider.
Why wait? The procedure has never been safer and more effective than it is now!
You are probably a good Lasik candidate
You are probably a good Lasik candidate if:
- You depend on glasses or contacts for good vision
- Your eyes are healthy
- Glasses or contacts are frustrating, inconvenient, uncomfortable, or impair your recreational and career interests.
Recent LASIK Reviews
A complete eye exam and consultation will confirm if LASIK is right for you.
I generally recommend LASIK (due to a shorter recovery time) but PRK (or a similar procedure, LASEK) may be more suitable for patients with thinner corneas, basement membrane dystrophies, corneal scars or other corneal concerns. A complete eye exam with a surgeon who offers these procedures is the best way to determine if you are a suitable candidate.
The only way to find out is to ask if you are a good LASEK candidate
Many patients believe that due to the severity or astigmatism, or other issues that they may not be a good candidate for LASIK. With modern technology, ultrathin flaps, and the newest laser technology, there are many patients who can be successfully treated that were not candidates previously. Some patients need other treatments such as PRK or in rare instances an ICL. LASEK is a version of PRK and for some patients with thin corneas or slightly irregular corneas a surface procedure can be recommended. The differences between LASIK is significant as opposed to LASEK vs PRK.
Usually we find other reasons that limit patients from being good LASIK candidates, but overall most patients can benefit from laser vision correction. It is important to have consideration of things like dry eyes, the size of your pupils, and the shape and stability of your eyes. In general we say that patients must have healthy bodies and healthy eyes to be good LASIK candidates, but this gets into the art and not completely the science of medicine. It is important to pick a doctor you trust, and if in doubt get a second opinion.
Almost all laser centers and doctors who perform this procedure offer as an incentive to visit them a free LASIK consultation, so what have you got to lose to see your doctor and find out if you might be a good candidate for this procedure.
LASEK versus LASIK
These terms can become alphabet soup if you are not careful. LASEK is, essentially, glorified PRK(photorefractive keratectomy), which involves the removal of the outer surface of the cornea(the epithelium) rather than lifting this outer layer up(LASIK). Both procedures are great and safe. Each has certain indciations that can make it a better choice, depending on the patients prescription and corneal thickness. In my opinion, one is not particularly safer or less safe than the other.....they are just different and you will need a surgeons opinion as to which is best for you.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.