Epi Lasek or Intralase Lasik (Both with Wavefront)

Question

I am led to believe that these are currently the most advanced laser eye surgery techniques to date. I am leaning towards lasek because it seems it is just as effective these days with less complications (eg less likely to get long term dry eyes) but a slower recovery time? I could be convinced otherwise if one had better long term results but they are both relatively new.

Michael K. Tracy, MD · Answer

Given your goals, I think you have come to the right conclusion. Epi-LASIK is really PRK. Other new names for PRK include Advanced Surface Ablation and LASEK. But they are all PRK and have the same outcomes as PRK. Numerous studies have proven this. Which is a good thing! The long term outcomes of PRK and LASIK are identical and PRK does have fewer complications, although both procedures are very safe. Custom PRK provides better outcomes than traditional PRK. If what you want is the best outcome with the fewest possible complications and you don't mind a slightly longer recovery time, I think that this is a great option for you.

Christopher Coad, MD · Answer

IntraLase Lasik (or iLASIK) certainly has much faster recovery, usually 1-2 days. Epi Lasik can take 2-4 weeks or more for visual recovery. The first week can be quite painful. I have not found much difference in dry eye issues, especially if dry eyes were not a problem before the laser vision treatment.

Mark Golden, MD · Answer

When you ask about the most advanced form of laser eye surgery, the only difference is in the laser used. Custom WaveFront gives better vision than the others. Then the decision is whether you want the slower healing with Surface Ablation or the speedy recovery of LASIK. No definitive studies have shown significant differences over the long term. Most of my patients find the much faster recovery from LASIK to be a big advantage. The final decision is whether your LASIK flap is made with a femtolaser like the Intralase or with a microkeratome. This decision probably makes no difference in the hands of an experienced surgeon. If your surgeon only uses the Intralase, that is fine. If your surgeon has done 10,000+ microkeratome procedures and thinks that you are a good candidate that will be just as good. Don't believe the hype with the Intralase. It works very well, but it has significant complications not seen with a microkeratome.

Emil William Chynn, MD, FACS, MBA · Answer

first of all, you and all the readers need to be clear that epiLASEK is noncutting, and IntraLase is cutting. many offices market IntraLase as "bladeless" which i suspect is a semi-intentional way to "confuse the public" and think that IntraLase is non-cutting, which is not true

	all IntraLase is is cutting your cornea in half with a laser, instead of a metal blade. it is slightly safer than cutting with a metal blade, as you can make the flap both thinner (which decreases how deep into the eye you go) and more accurate. however, if you get punched in the eye, the flap can still come up, as your eye doesn't exactly "remember" what tool was used to make the cut--only that you were cut, and the flap never really heals (which is why you can enhance LASIK and IntraLase flaps for years afterwards, just by poking the flap with a little metal instrument and "popping the flap back up")

	epiLASEK, which is the term i'm trying to get MDs and the public to use, because it sounds more like LASEK, and is really much more like LASEK than LASIK, does not involve making any cut into your eye at all. for this reason it is safer, because you obviously can't have a flap complication, either during or after your procedure, since you aren't having your eye cut in the first place.

	what the other MD said is true, that the recovery is longer after epiLASEK (3-4 days) than after IntraLase. if i were a patient, i would think a couple of days slower recovery is worth a stronger, safer eye for the rest of your life, but the consumer has to make that choice

	regarding quality of vision, when i switched from performing incisional procedures (LASIK and IntraLase) to nonincisional ones (LASEK and epiLASEK) back in 2005, the night vision of my patients improved dramatically. this is because after a cutting process, your cornea is forever in 2 pieces, with an interface between those 2 pieces of your cornea. so when light comes in (esp at night) there is some reflection, refraction, and back-scatter of this light across the flap interface, which causes some night glare

	this is probably why i have some night glare after my own LASIK, and why i switched to the noncutting ASA (Advanced Surface Ablations) 5 years ago

	so, in summary, my advice to you is to get an epiLASEK over an IntraLase, for the above reasons

	there are other reasons why your vision is better after epiLASEK than IntraLase also having to do with the flap that is cut messing up your WaveFront treatment, so your CustomVue map is distorted, but i can't get into this further here as i actually have to run and see/treat some live patients now!:) hope this helps!

Jay Bansal, MD · Answer

We offer both Epi-LASEK and Intralase in our clinic and have many patients in both categories. There is some data that suggests that Epi-LASEK might provide slighter better long term vision performance results over Intralase but the choice of one over the other is not always clear and certainly varies from patient to patient. Other studies suggest that Intralase might have a shorter recovery time and better safety profile. There are many factors to consider and a trained refractive surgeon should certainly be involved when trying to decide which treatment to undergo since your eyes are unique to you. Some surgeons might feel more comfortable with one type of technology as well. Both Epi-LASEK and Intralase provide excellent results so in most cases it wouldn't matter which one a patient receives. Most likely, they would be very happy with either.

Epi Lasek or Intralase Lasik (Both with Wavefront)

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