LASEK and laser vision correction information.

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LASEK

What is LASEK?

LASEK stands for Laser-Assisted in Situ Epithelial Keratomileusis. A form of laser eye surgery, LASEK is similar in principle to both PRK and LASIK but uses a different method of exposing the cornea. The procedure is relatively new and not practiced by all ophthalmologists; as a result, statistics on its long-term effects have not been completely established. However, doctors who do employ LASEK tout its safety and effectiveness.

Who is a LASEK candidate?

LASEK is often the procedure of choice for patients who have thin corneas, which makes the cut made in LASIK more risky. Whereas LASIK involves cutting into the stromal layer of the cornea, LASEK makes a more superficial cut in the epithelial layer of the cornea.

A candidate for LASEK should, however, meet most of the criteria for LASIK. Familiarity and conciliation with the procedure are always important. The patient’s eyes should be mature and vision should be stable. Pregnancy and certain medications are problematic to the procedure. And, other than myopia or hyperopia, the patient should be reasonably free of problems with the eyes or immune system.

How is LASEK surgery performed?

In a patient’s initial evaluation for laser surgery, the ophthalmologist measures the patient’s eyes. One of the tests that is typically performed reveals thickness of the cornea. If the patient has particularly thin corneas, he or she may be unsuitable for LASIK but suitable for LASEK.

If the patient decides to undergo LASEK, the physician schedules a date for surgery and describes how the patient should prepare for it. Instructions usually include discontinuing eye makeup or creams and cleansing the eyelashes.

LASEK is typically performed on an outpatient basis. The LASEK surgeon begins by cleaning the eyes and administering anesthetic eye drops. The surgeon may also choose to administer a sedative at this time.

The flap that is created during LASEK is quite different from that of LASIK. The flap in LASEK is only made up of the epithelial layer, not the deeper tissue of the stroma. In addition, it is a free flap, meaning there is no hinge. The epithelial tissue that is carved out is completely removed from the eye, set aside, and later replaced. The surgeon uses either a laser or a tiny cookie-cutter device (called a trephine) to make the epithelial flap. Then, the eye is bathed in an alcohol solution that holds the cells of the flap together. The LASEK surgeon waits for about 30 seconds, sponges the alcohol from the eye, lifts the flap, and sets it aside.

The patient is then asked to stare at a light while an excimer laser reforms the cornea. It takes approximately 60 seconds to remove the preprogrammed amount of corneal tissue. Once this is completed, the epithelial flap is replaced with a small spatula. A plastic eye shield is put in place to protect the eye for the first few days.

What is recovery like?

Recovery from LASEK surgery is typically longer and more difficult than LASIK, but shorter and easier than PRK. Typical effects of LASEK surgery include:

Discomfort in the eye
Sensitivity to light
Hazy vision
Glare
Haloes around lights (especially at night)

There are risks involved with LASEK surgery. One possibility is that the patient’s vision can be corrected too much or too little. After a few months, if the patient’s vision has stabilized, the LASEK surgeon may recommend a second surgery. In rare instances, the laser ablation is off-center, inducing astigmatism. Patients can also have infections or reactions to anesthesia. When exploring LASEK, it is best to discuss these and other possible complications with a LASEK surgeon.

Despite the risks involved with LASEK, patients can look forward to a procedure that is particularly good in two respects. The first is that the cornea is subject to consistently better healing than other laser surgeries. There are few problems with the flap settling into place, such as the slippage, wrinkles, and deposits that can occur with the flap after LASIK. And the patient does not have to endure the pain that is associated with regrowing the epithelium after PRK.

Second, it is important to note that many doctors believe LASEK results in greater stability within the eye than LASIK. This is because the cutting instrument does not affect the deeper corneal tissue. The excimer laser removes tissue much closer to the surface of the eye, leaving a thicker corneal bed. LASEK specialists have long contended that this stability within the eye provides consistently better final results.

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