PRK or LASIK? I'm a Minus 8 with Dry Eye.

Question

I went to 3 different places for consultation. First suggested LASIK... second (Bascom Palmer) said I was a candidate for either LASIK or PRK... third Rand Eye suggested LASEK, but I believe that is all they do now. When I went to the 2nd consult I didn't understand that their was a difference between PRK and LASEK. Why as a surgeon would you prefer one over the other (not taking LASIK into account). Thanks.

Michael K. Tracy, MD · Answer

LASEK vs. PRK is very controversial because the two procedures are so similar.  However, LASIK vs. PRK or LASEK is different and just like any other specialty, each surgeon is going to have a different opinion.

	 

	Some surgeons are convinced that LASEK gives faster healing than PRK, but the research is still unclear.  Other surgeons have had exactly the opposite experience.  Both procedures produce excellent results and any differences in healing time are obviously modest if it has taken this many studies to find any difference at all.  My strongest recommendation is to always have your surgeon use the procedure he is most comfortable with, as this is strongly correlated with better outcomes.

	 

	The major difference here is the recommendation of LASIK vs LASEK/PRK, you may be on the boarderline and as a result you are getting different opinions. Very likely your corneas are a bit thin in relation to your prescription. Historically, PRK/LASEK are safer than LASIK because no flap is created. Keep in mind the long-term results of the procedures are the same. The difference is in the first month or so after during the healing process.

	 

	I would recommend you have the surgeons explain WHY they are recommending each procedure and then see who you feel most comfortable with and what procedure.

Arkady Kagan, MD · Answer

We don’t recommend that you have LASIK done but rather consider PRK with mitomycin C.

	Here are the concepts which you need to keep in mind:

	
		By having having LASIK at your prescription level requires a lot of corneal tissue removal which  increases your chances of possible corneal ectasia problems in the future.    
	
		Also LASIK will increase your chances of having dry eye problems in the future although most of the dry eye symptoms are temporary there are some cases where the dry eye may last for years.   
	
		LASEK and PRK are very similar procedures and many studies do not show a big advantage of one versus the other.      
	
		We prefer PRK in our institute for patients like yourself because of its safety profile  and low risk of dry eye.    
	
		We like to use Mitomycin C with our PRK patients to reduce and eliminate the risk of haze in the cornea after the PRK procedure.  
	
		The only trade off you will have is that you need to have a little bit of patience with PRK because it takes a little bit longer to get the sharp clear vision that you would otherwise have with LASIK.


	But in our opinion patience is a virtue, and is well worth it because you only have 2 eyes. Good luck!

Andrew E. Holzman, MD · Answer

to read some of the answers to your question by physicians, it makes my blood boil. LASEK is very similar to PRK and it is very controversial at best which procedure gives better outcomes and better patient experiences. In fact, you can find many, likely hundreds, of studies comparing them, and most of them will show almost no difference, although the majority will likely show better comfort and recovery with PRK. In fact, many doctors used to do LASEK and then finally realized that if they do a small surface defect with PRK and manage the patient properly, the PRK patient heals faster with better comfort also. To say that PRK is "old and not advanced" shows what can be wrong with a forum such as this. Doctor's give opinions that are geared towards their own bias and not based on fact or scientific data. Go to the doctor you liked and trusted the most. LASIK also works quite well for your myopia and in fact, more patients undergo LASIK with this prescription than PRK or LASEK combined.

Emil William Chynn, MD, FACS, MBA · Answer

once your Rx is -8 or higher, the laser would have to take off a lot of tissue to correct that Rx, it takes off a certain amt of tissue to correct each diopter of Rx, so then your cornea would be too thin and not that strong

	so for high Rxs like yours, a surface ablation is preferred, as by not cutting a flap in LASIK, you save 100 microns of tissue, which is the least amount of tissue you can waste by cutting a flap, even with a laser, which is called IntraLase

	since a surface ablation doesn't use a flap, it's safer for people like you with high Rxs

	the old form of surface ablation was PRK, which i performed 15 years ago, then stopped in 1999, when i switched 100% to LASIK

	in 2007, i switched 100% to LASEK and in 2009, to epiLASEK, which are called ASAs, or advanced surface ablations, to distinguish them from the old, non-advanced PRK

	so you really should do LASEK or epiLASEK in your case, i feel very strongly that this is the best and safest Rx for high Rxs like yours

PRK or LASIK? I'm a Minus 8 with Dry Eye.

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