New York Lasek Surgery

LASEK...Latest 3rd Generation Procedure

History

As a clinical investigator for VISX, Dr. Robbins was one of the first surgeons in the country to perform PRK. VISX received FDA approval for the procedure to treat myopia in 1996 and astigmatism in 1997. That same year, Dr. Robbins introduced LASIK to the Rochester market. Since then, LASIK has been well-received by the public with a much more rapid visual recovery than any other prior refractive procedure.

LASIK involves the cutting of a corneal flap with a microkeratome. This mechanical device is attached to the eye with suction, and the flap must be perfect in order to proceed with surgery. Many of the potential complications of LASIK are related to the creation and healing of the corneal flap. Although serious flap complications are rare, they can be very serious and lead to permanent visual loss. In addition, the cornea must be sufficiently thick to allow for the creation of the corneal flap and tissue removal to effect the desired prescription change.

LASEK Introduced to Rochester

LASEK, not to be confused with LASIK, is the synthesis of PRK and LASIK. Rather than cutting a 160 micron flap with a microkeratome, the outer skin is partially fixated with dilute alcohol and manually peeled from the surface of the cornea. This epithelial-only flap is much thinner than the LASIK flap and much more superficial. Like LASIK, the energy is applied to the cornea tissue and the flap placed back over the eye.

LASEK is not PRK, but neither is it LASIK. Healing time and visual recovery is somewhere in the middle. In exchange for a slower visual recovery, is the greater margin of safety and elimination of the microkeratome. Most patients who undergo bilateral LASEK have functional vision the next day, but are decidedly blurry. By 3-4 weeks, acuities with LASEK are generally equal to those attained with LASIK and superior to the level found with PRK.

Since the flap is more superficial and not cut, many of the potential complications of conventional LASIK are avoided. For example, dislocation of the flap or folds in the flap can be easily treated in LASEK patients by removing the epithelial flap and converting the surgery to PRK. Relatively rare complications of LASIK such as Interstitial inflammation (DLK) and epithelial ingrowth cannot occur and any infection occurring post surgery would be more superficial and easier to treat following LASEK.

LASEK is particularly well suited for those eyes that are thinner than average or have large pupils. The additional room provided by LASEK allows for larger optical zones and lessen the risk of glare and halos.

LASEK is a new procedure and has not yet received FDA approval. As such, it is considered an Off-label use of the excimer laser. It is too early to say whether the visual outcomes are better or worse than LASIK, but they certainly appear to be comparable. However, results to date are better than PRK, a procedure which has already received FDA approval.

Which is Better?

The real question is which procedure best suits your visual needs and anatomy. After undergoing a thorough examination, your doctor will usually recommend one or the other. Certainly if your cornea is thinner than average, LASEK appears to be the safer procedure. For others, the rapid visual recover of LASIK outweighs any potential benefits of LASEK.