Other Surgical Options

PRK (Photo-Refractive Keratectomy) is also a surgical procedure to correct visual anomalies such as nearsightedness, farsightedness, and astigmatism.  PRK differs from LASIK in that no flap is created before applying the laser. The top skin of the cornea, the epithelium, is brushed away manually before the laser reshapes the cornea. A "band-aid" contact lens is placed on the eye to protect it as the epithelial top layer grows back. There is more discomfort with PRK due to the longer healing time. The vision will be blurry for several weeks before it begins to clear up. Because of this, sometimes one eye is done at a time to allow good vision to return in the one eye before doing the other.  There is also a more significant risk for corneal haze or scarring in the visual axis than with IntraLASIK.  As a result, PRK is only performed infrequently today.

LASEK (Laser Assisted Epithelial Keratomileusis) is somewhat like a hybrid of LASIK and PRK.  LASEK is a refractive surgical procedure that is performed currently on an investigational basis to correct nearsightedness, farsightedness and astigmatism.  LASEK is much like traditional LASIK in that a flap is created with a metal blade before reshaping the underlying corneal tissue.  With LASEK, the flap that is created consists only of the epithelial layer, which is the top layer of cells on the cornea.  As a result, the flap made is far thinner than the stromal (deeper layer) flap that is created in LASIK. 

There are some advantages of LASEK over traditional microkeratome LASIK.  One is that there is no possibility of epithelial ingrowth (a condition in which the top layer cells known as epithelial cells can grow underneath the flap).  The other is that there is no risk of flap complications like a partial flap or buttonhole flap because no stromal flap has been created.  However, these latter complications are extraordinarily rare when the Intralase is used to perform LASIK.  As a result, LASEK has few if any advantages over IntraLASIK. 

A significant disadvantage of LASEK is that the alcohol solution that is placed on the eye to create the epithelial flap is very harsh and can disrupt the tissue to the point where it cannot be laid down smoothly.  As a result, with LASEK there is frequently much more discomfort and and very increased healing time when compared to IntraLASIK.  This change in the healing pattern also has the effect of decreasing the predictability of attaining the right visual correction.  There is also a greater chance of permanent corneal haze with LASEK.  This is a condition in which there is a trace amount of scarring of the cornea.  Because of the delayed healing, it takes several weeks longer for the vision to improve as compared with IntraLASIK.  

The majority of surgeons currently believe that the few advantages that LASEK offers do not outweigh its disadvantages at this time.  As a result, IntraLASIK remains the safest and most predictable vision correction procedure available anywhere.