Dr. Dello Russo responds.
Most doctors would advise PRK.
Although I always favor LASIK, if the thickness is exact I would recommend PRK.
I personally would not advise a Visian ICL, as much as I admire dr. Wachler.
In most cases with a prescription and thinner cornea I prefer the VIsian ICL. The quality of vision is excellent with the VIsian ICL and this avoids possible risk of you developing ectasia. Ectasia is a condition that develops after PRK or LASIK and weakens the cornea. Usually presents in patients who had thinner corneas prior to PRK or LASIK. Ectasia can cause a progressive steepening of the cornea, which can leads to decreased quality of vision and a return to needing contacts, usually RGP. In patients with your prescription if they prefer to opt for PRK, then I would recommend a cornea collagen crosslinking treatment performed in combination. Cornea Collagen Crosslinking, also know as Holcomb C3-R or CXL, helps to strengthen the cornea and avoid weakening of the cornea structure after LASIK or PRK. In my office, I call this procedure Fortified PRK or Fortified LASIK. Basically helps to lock in the treatment of PRK or LASIK and reduce the risk of developing ectasia.
There has been a lot of talk about not doing LASIK or PRK in relatively thin corneas. None of this is based on evidence. We have hundreds of patients who started out with corneas thinner than 500 microns and had successful LASIK for over ten years. Additionally with your corneas of about 480 microns, we would create a flap of 90 microns brining the bed to 390, and then you would need an additional 96 microns removed for your treatment (with a 6.5 mm treatment diameter) leaving you with 294 microns. Acceptable is to 250 microns.