Laser Assisted Epithelial Keratomileusis or LASEK

Laser Assisted Epithelial Keratomileusis or LASEK gained some popularity several years ago but most of that enthusiasm has waned. LASEK is essentially a PRK procedure with a twist designed to reduce healing time and postoperative pain. Unfortunately, as larger data sets were accumulated, it was recognized that LASEK did neither.

Like Lasik and PRK, LASEK is a refractive surgical procedure that is performed correct nearsightedness, farsightedness and astigmatism. If a wavefront guided system is used such as the AMO-VISX Star S4 IR, then the procedure can correct higher order aberrations as well. The fundamental difference between PRK and LASEK is that in PRK the epithelial cell layer is discarded during the procedure while in LASEK an attempt is made to retain the epithelial layer as intact as possible and then to carefully spread this layer of cells back over the exposed cornea. Because the epithelial layer is just a layer of cells with little if any structural integrity, actually accomplishing the goal of retaining an intact cell layer is often more theoretical than practical.

The principle advantages of LASEK are identical to PRK. Specifically, it is a good alternative if the patient’s cornea is too thin to safely perform Lasik or there is a lifestyle need to not have the worry of a Lasik flap being displaced by repeated eye trauma such as in a boxer or martial arts expert.

The primary reason why LASEK has fallen from favor is that the notion of maintaining a healthy epithelial layer is a myth more than a scientific fact. Once the epithelium is excised from the corneal surface it simply does not reattach. Over time the old layer of cells simply dies away. New cells grow in from the periphery to cover the exposed corneal tissue in precisely the same manner that occurs in PRK. In addition, the belief that the procedure would have less pain than traditional PRK was not able to be substantiated in controlled clinical trials likely because the dying epithelial cells created more inflammatory mediators and subsequently more pain than in PRK.

As a result, use of the LASEK procedure by surgeons today is a true anomaly. Because it renders essentially no advantages to standard PRK technique, LASEK is most frequently it is used as a marketing gimmick to simply confuse patients into thinking that they are having “Lasik” rather than PRK.

At Will Vision and Laser Centers, rather than LASEK, we typically select PRK as an option when a patient’s cornea is not considered to be thick enough to undergo Lasik surgery. However, because we use the iFS Advanced Femtosecond laser we are able to create exquisitely thin Lasik flaps so we can often perform Lasik in patients that have been told that that they need PRK or LASEK by surgeons who either don’t have access to advanced technology or have inadequate experience with how to safely create thin flaps. In other cases, if a patient is involved in a profession or hobby such as boxing that places the eye at risk for direct trauma, PRK is considered a better option.

If you have been told that you need to have LASEK, we are happy to perform our advanced PRK technique using our state-of-the-art wavefront guided technology. In fact, the wavefront guided PRK technology used at Will Vision and Laser Centers is identical to that used by the US military for soldiers in the warfighter program. Dr. Will also has extensive experience with PRK having performed PRK procedures since 1991. However, if you are considering having Lasik surgery as your preferred surgical option but have been told that you only qualify for LASEK or PRK you might consider giving us a call to see if our thin flap technology can provide you with the option of pursuing Lasik.

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