LASIK Vs LASEK
LASIK Or LASEK?
Laser eye surgery has changed a lot since it was first introduced in the early 1990’s. Since then, many improvements have been made in the field which have led to new techniques and equipment which have subsequently led to improved success rates, faster healing times and a reduction in discomfort and pain.
While there are far newer and improved techniques such as Intralase and Wavefront available today, LASIK and LASEK are two techniques that are still widely used in laser eye surgery. In order to understand the differences one must first understand how each technique works.
LASEK stands for Laser-Assisted Sub-Epithelial Keratectomy. It is one of the newer variations of PRK, in which the laser energy is applied directly to shape the outer surface of the eye in order to correct one’s vision. In the LASEK procedure, the epithelial layer is preserved. It is cut using a blade called a trephine, which is a thinner blade than what is used in LASIK. It is lifted prior to the application of the laser energy. When the reshaping is complete, the epithelium is repositioned on to the surface of the eye.
LASIK is an acronym of LASer assisted In situ Keratomilieusis. LASIK laser eye surgery is a procedure in which a thin flap of tissue is cut, and then peeled back from the very front of the cornea, which is the transparent covering over your pupil. The laser literally vapourises away some of your corneal tissue beneath the flap to make your cornea a slightly different shape which will correct your refractive error. Then the flap is placed back over the front of your eye. As the flap is not completed removed there is a dramatic reduction in recovery time.
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LASIK Vs. LASEK
Watch Mr Romesh Angunawela, Consultant Eye Surgeon at Moorfields Eye Hospital, compare the differences between LASIK and LASEK:
"Broadly laser surgery can be divided into two groups. One is a procedure called LASIK which involves making a small flap in the cornea then doing the laser surgery under the flap and then replacing the flap on top. The advantage of that technique is that the visual recovery is fairly rapid, there is very little discomfort afterwards, and the results are excellent.
LASEK, PRK, TransPRK, these are all techniques where there is no flap, the treatment is done on the surface of the cornea, and so it takes a little while longer for the healing to occur, there can be a little bit of discomfort in the first day or two, but if you look at results at three to six months they are absolutely identical between the two techniques.
Very briefly one involves making a flap in the cornea and that is called LASIK, and LASEK is a technique where the treatment is applied directly to the surface of the cornea."
Mr Romesh Angunawela, Consultant Eye Surgeon at Moorfields Eye Hospital
What's The Difference Between LASIK And LASEK Laser Eye Surgery?
The primary difference between the LASIK and LASEK methods is that the LASIK method uses a microkeratome cutting tool or a special laser while in the LASEK method, a cutting tool called a trephine is used. LASEK is generally considered to be more painful than the LASIK procedure. LASEK is perfect for people who have an overly thin or steep cornea. The LASEK procedure reduces the amount of risk that is associated with the flaps in LASIK. The thickness of the flap is also a prime difference between the two procedures. The flap which is cut during LASIK is about three times the thickness of the flaps cut through LASEK. This is why the healing period for LASIK is typically much shorter.
Both LASEK and LASIK are used for refractive error correction for nearsightedness, farsightedness, astigmatism and presbyopia. They both have roughly the same success rates, however, they are generally intended for people with differing characteristics. For example, if someone’s cornea is too thin for LASIK then the LASEK procedure would be advantageous. However as the healing process is faster for the LASIK procedure, patients should expect superior results in much less time. LASIK laser eye surgery is considered to be slightly more expensive than LASEK due to the sophistication of the equipment which is used.
One cannot offer an overall general assessment of which is better as LASEK laser eye surgery will be preferential for some patients while LASIK would be beneficial for others. It is all down to each individual person as each procedure has its own advantages and disadvantages depending on the severity of the eye disorder.
Before And After LASIK Surgery
In the lead up to your LASIK surgery, you will need to follow preoperative instructions as outlined by your eye doctor.
If you wear contact lenses, you will likely be asked to refrain from wearing them ahead of your initial evaluation. This is because contacts can change the shape of your cornea, and you will need to allow time for your cornea to return to its natural shape to ensure the success of the surgery. Failing to do this could result in inaccurate measurements being taken, which in turn could lead to poor surgical planning and therefore ineffective results. If you wear soft contact lenses, you will be asked to stop wearing these for two weeks before your initial consultation. If you wear toric or RGP lenses, you will need to stop wearing these three weeks in advance, while hard lenses should be stopped four weeks ahead of your consultation. Your doctor will also examine your medical history, confirm whether you are a good candidate, explain the advantages, risks and alternatives to the surgery, along with steps to follow in the lead up to and weeks following the surgery.
Immediately following the procedure, it is normal to experience a burning and/or itching sensation, along with “foreign body” syndrome. Mild pain can be alleviated with some over-the-counter medication, and you may find your vision is blurry or hazy right away. Do not touch or rub your eyes, but leave well alone to allow them time to heal. If you experience severe or prolonged pain, or your vision fails to get better, contact your surgeon straight away.
Before And After LASEK Surgery
Before you undergo the procedure, your surgeon will conduct a general health exam along with eye tests to ensure you are in fact a suitable candidate for LASEK eye surgery.
You will be asked to refrain from wearing contact lenses ahead of your consultation, and the amount of time will depend on the type you use. This is to allow the cornea to retake it’s natural shape (which is altered by the use of contact lenses), and it will enable the doctor to take accurate measurements that will be used in the laser eye surgery. Leading up to the surgery, you should make arrangements to take time off work to allow your vision time to adjust. Patients should typically schedule a week off for recovery. You will not be able to drive home from the surgery, so you will need to make arrangements to have someone take you home.
It is normal for most patients to report mild to moderate discomfort in the initial days following their LASEK treatment. You will be given a "bandage" contact lens once your surgery is complete to keep out dirt and dust that can cause infection, and you will need to wear this for approximately four days while the surface epithelial cells regenerate. Your doctor may also prescribe steroids and a course of antibiotics that could last up to three weeks – these can help with healing and lower the risk of infection.
Benefits And Drawbacks Of Both LASIK And LASEK Surgery
LASIK can be beneficial for those patients who have thicker corneal tissue. It can typically result in 20/20 vision being achieved, with patients experiencing less discomfort than LASIK and a virtually pain-free recovery. Vision normalizes very quickly, with complications such as corneal haze occurring infrequently. If a need for a follow-up enhancement surgery arises, it is easier for these procedures to take place. There are some potential drawbacks; patients with thinner corneas may suffer less effective results, and it is possible for the corneal flap to dislodge with trauma. However, complications are rare, as post-operational treatment is required to treat approximately just 5 per cent of patients.
Candidates ideally suited to LASEK include those who have thinner corneal tissue, and therefore would not be suited to undergo LASIK. There are many benefits to this kind of treatment, including lower chances of hazy vision following the procedure, fewer complications associated with a corneal flap, and less risk of dry eye during the recovery period. However, patients may experience higher levels of discomfort than they would with LASIK, and experience a longer recovery period. A number of conditions, medications and diseases are contraindications, and there is a risk of the flap being dislodged in the event of a trauma.