It is likely that everything that you have heard up until now has been about LASIK. This literature is to inform you about a different procedure, called LASEK. It is unfortunate that the names selected for these two procedures are so similar as it leads to confusion.

LASIK is the procedure of choice for most people that are suitable – it is almost pain-free, offers a very fast visual recovery and both eyes can be treated at one sitting. These features just described explain why LASIK has become such a popular and commonly performed procedure.

During a LASIK procedure, a flap is made with the use of a machine called a "microkeratome".

The laser ablation is then applied underneath this flap. Once the laser has been completed, the flap is replaced.

In the event that your cornea is too thin, then it becomes impossible to make a flap and do the laser ablation, as it would leave too little residual corneal thickness. This is where LASEK is primarily indicated, as it is a procedure that saves corneal thickness.

It works in the following way:

No mechanical flap is fashioned. Instead, a flap of epithelium (the very thin layer of cells that covers the surface of the cornea) is gently lifted by the surgeon and rolled to one side to facilitate laser treatment. The level of laser treatment is now at 50 microns beneath the surface as opposed to 160 microns beneath the surface that is usually the case with LASIK.

This difference in the level at which the laser ablation is applied, has saved 110 microns of tissue and this can be crucial in certain individual cases. It needs to be remembered that the higher your refraction, the more tissue that needs to be removed. There are therefore cases where LASIK would simply not be possible due to the existing corneal thickness and the amount of tissue that needs to be removed. In these specific cases, LASEK allows the procedure to go ahead as it saves 110 microns of tissue.

How does it differ from the patient's perspective?

The procedure itself is very similar except that with a LASEK there is no pressure feeling during the procedure. It also lasts for approximately 10 minutes per eye.

A Bandage Contact Lens is routinely placed on the eye for 4 or 5 days following the procedure. This implies that you will have the contact lens in permanently for these 4 or 5 days, including sleeping with the lens in at night.

There is some discomfort for the first day after surgery and this improves quite steadily to the point that on the 2nd post-operative day, the eye is already quite comfortable.

It takes longer before the vision is fully recovered. With LASIK, the vision is normally very good by the very next day. With LASEK, the vision takes longer to recover. Once the contact lens is removed on the 5th day, the vision is normally around 80% of what it is going to be eventually. The final visual acuity is achieved at approximately 1 month after the procedure although the quality of vision continues to improve for up to 6 months afterwards.

Typical questions and answers concerning LASEK

Is it safe?

The procedure is very safe as there is no flap. Very few complications occur with LASIK, but when they do, they are almost invariably flap related. There is no flap with LASEK.

How does it differ from PRK?

(PRK was the procedure of choice some 5 to 10 years ago) With PRK the surface cells were removed and discarded. The cells then regenerated over the next 4 to 5 days. This explained why the procedure hurt more than the newer procedures and why the vision took longer to recover. With LASEK, the cell layer is placed back into position and held in position with the use of the bandage contact lens. This has resulted in more comfort and a quicker visual recovery. LASEK can almost be described as a marriage between PRK and LASIK.

Why is LASEK not the procedure of choice considering the fact that there can be no flap-related complications?

This is a very good question that has no simple answer. It is an excellent procedure and theoretically, it is safer than LASIK. On the other hand, LASIK performed by experienced surgeons very rarely has any complications at all.

The biggest reason that almost everyone still chooses LASIK, is the fact that the procedure has such a small “inconvenience factor” – it is almost pain-free, both eyes can be treated together and the visual recovery is very fast. These features mean that the average person is out from work for just a couple of days and after these initial days, is functioning as well as they were before the procedure with the only difference now that they are without their glasses.

With LASEK, there is more discomfort (although much less than with PRK), there is a period of anything up to a number of months before the 2nd eye is treated where a contact lens needs to be used to achieve a balance between the 2 eyes. Another option is to change the one lens in the glasses to accommodate the treated eye’s new prescription.

In the past number of years, the number of patients electing to do LASEK to both eyes on the same day has increased dramatically and at present, 95% of patients treat both eyes on the same day. This is most likely due to the fact that with the new modern bandage contact lenses that are worn for 5 days after LASEK, the visual recovery is faster and the discomfort less than before.

So basically, it comes down to convenience on behalf of the patient.

Can enhancements be done?
Enhancements (fine-tuning or adjustments) can be done but unlike LASIK, where they are relatively simple, here they are an exact replica of the initial procedure again. So where LASIK patients generally do not mind having enhancements done as they know the recovery is very quick, LASEK patients are less inclined to have enhancements done as they know that their vision is going to be blurred for longer, the recovery is slower and the discomfort factor higher. An interesting fact however is that LASEK patients need enhancements less regularly than LASIK patients (5% vs. 10% on average)

In what other situations may LASEK be indicated rather than LASIK?
a) In any situation where access to the eye with the microkeratome may be difficult (e.g. very deep-set eyes)
b) LASEK tends to induce less dry eye than LASIK, so is sometimes used when tear production is inadequate and cannot be improved sufficiently to allow LASIK
c) When the patient requests it – remember that refractive surgery is always elective. This means that you always have the final say concerning whether you want to do any procedure at all and to choose which procedure you prefer.

LASEK CONSENT FORM (PDF Download)

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