LASEK: What You Need to Know

Pros

• Some people, including those with thin corneas or who are very nearsighted, may be better candidates for LASEK (or PRK) than LASIK.
• Because LASEK cuts only the very top layer of the cornea, the risk of certain side effects—including dry eye—associated with LASIK may be reduced, according to the Federal Trade Commission. The LASEK technique also lessens the likelihood of ectasia (which can compromise the structural integrity of the eye).
• Outcomes for LASIK and LASEK patients are similar: most people achieve 20/20 vision after any type of laser eye surgery, and nearly all achieve 20/40 visual acuity or better.

Cons

• The healing time with LASEK is longer and usually more uncomfortable than with LASIK. Often, the stronger your prescription, the longer healing takes. 
• Though it’s unwise to choose any medical procedure on price alone, LASEK may be more expensive than LASIK, according to RealSelf members.
• It’s possible that you won’t see as well after surgery—even with glasses or contacts—as you did before the surgery. “This is true for any vision correction procedure, though the overall risk of this happening is very low,” says Dr. Kligman.

• Average Cost:
• $5,000

Your cost will really depend on who’s performing your procedure and their practice location. 

Most insurance plans don’t cover refractive procedures like LASEK, LASIK, and PRK because they’re considered elective (not medically necessary) surgeries. 

As tempting as $299 laser eye surgery may be, doctors on RealSelf advise avoiding offers for discount refractive surgery. For starters, these clinics often use outdated techniques and equipment—not what you’d want used on your eyes, says Dr. Andrew Caster, an ophthalmologist in Beverly Hills, California. 

There’s also the possibility that the discount provider is cutting corners by skimping on laser maintenance and hardware or software upgrades. 

Low costs are often come-ons, to get people into the office. Once you’re there, you’re likely to find that the cost applies only to people who have such a mild prescription (+1 or -1 and no astigmatism) as to barely need the procedure. “It’s like the car dealership that has only one car at the low, low price,” says Dr. Caster. With additional charges for post-op visits, medications, and needed enhancements, you’re likely to end up paying as much as $1,500 per eye.

The main difference is in how the eye is prepared for treatment. Both LASEK and LASIK can be done with the same excimer laser, which emits a cool beam of ultraviolet light to remove microscopic amounts of tissue from the cornea with a high degree of accuracy, without damaging the surrounding tissue. 

During LASIK eye surgery, the surgeon uses the laser or a microkeratome blade to cut a circular corneal flap on the eye’s surface. They lift the flap and laser the underlying corneal tissue, to change the curvature of the cornea. The flap is then returned to its original position, where it acts as a natural bandage, keeping the eye comfortable during the healing process.

With LASEK eye surgery, your surgeon separates just the ultra-thin outer layer of the cornea (the epithelium) from the underlying layer, with a quick application of an alcohol solution. This epithelial flap can then be slid to the side while remaining attached to the eye at one edge. This exposes the underlying corneal tissue for remodeling by the laser.

After the corneal laser sculpting is finished, your surgeon repositions the epithelial flap on the surface of the eye. A special contact lens that acts as a bandage is placed on the eye, to keep the epithelium in place as it heals. 

During PRK, the epithelium is completely removed, the underlying tissue is reshaped, and a new epithelial layer grows back after about five days. “Studies comparing PRK and LASEK have not shown significant differences in healing time, discomfort or postoperative vision”, explains Dr. Brad Kligman, an ophthalmologist and refractive surgery specialist from Long Island, NY.  “Some surgeons may market LASEK as a superior procedure to PRK but the data shows equivalent results,” adds Dr. Kligman.

There is no universally accepted “best” method for correcting refractive errors, but some providers and patients prefer LASIK because it typically has a shorter healing time with less discomfort. A complete eye exam with a surgeon who offers all these procedures is the best way to determine the right option for you.

LASEK is an in-office procedure that takes about 15 minutes to complete for both eyes. You’ll be awake for the procedure, lying on your back in a reclining chair.

Prior to the procedure, anesthetic drops will numb your eyes and reduce your urge to blink. If you’re especially anxious, you may be given an oral sedative to help you relax. LASEK is painless, but you may feel some slight pressure. 

Here’s what happens during the procedure. 

• A special instrument called a lid speculum holds your eyelids open. You’ll be asked to look straight ahead and focus on a target light. 
• A circular cut is made in the corneal epithelium, using a fine blade called a trephine. The trephine leaves a small arc-shaped area of the circle uncut, so the “flap” that’s created remains attached to the eye. 
• The epithelium is soaked with a dilute solution of alcohol for about 30 seconds in order to detach it from the underlying tissue. 
• The epithelium is then gently lifted or rolled back as a single sheet, so the corneal tissue beneath it can be accessed with the laser. 
• The lasering takes just a few seconds, and it may smell like burning hair. With each pulse of the laser, a tiny amount of corneal tissue is removed. Decreasing the curve of your cornea corrects nearsightedness, and increasing it corrects farsightedness. 
• Once the cornea is reshaped, the epithelium is repositioned and smoothed with a small spatula. 
• A protective clear contact lens is placed on your eye as a bandage for four to six days while the epithelium heals. 

You’ll rest for a while after the procedure before a friend or family member takes you home. It’s best to refrain from using your eyes as much as possible during the first 24 hours after your procedure, so plan to stay home from work and limit your activity.

Immediately after surgery, your vision will probably be hazy or blurry. It’s common to feel some discomfort, once the numbing drops start to wear off. It’s also normal to be light-sensitive and for your eyes to burn, itch, water, and feel like there’s something (like an eyelash) in them. Thankfully, this usually only lasts for a few days following surgery. Pain medication, lubricating eye drops, and light ice packs can help keep you comfortable. 

In addition to protecting your eyes during healing, the bandage contact lens also helps reduce pain, so keep it in place for as long as your doctor suggests (usually four to five days). You’ll also use a topical steroid and antibiotic drops for several weeks to reduce inflammation and your risk of infection.

Full LASEK recovery takes between three and six months, but initial visual recovery can take up to a week (as opposed to 24 hours or less with LASIK). Everyone's healing process is different, so your individual recovery time may be shorter or longer. Patients can usually drive and return to work three to six days after LASEK surgery.

While you’re waiting for your vision to stabilize, you may experience halos, difficulty driving at night, and other visual symptoms. 

LASEK produces long-term results, lasting for years or decades for most people. If you’re unsatisfied with your outcome (for instance, if your vision was undercorrected), you could have a retreatment or touch-up, often referred to as an enhancement. However, the U.S. Food and Drug Administration (FDA) says that if further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits, at least three months apart, before reoperation.