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Correction Procedures: LASIK
LASER SURGERY THAT DOES NOT CUT YOUR CORNEA
This is really a play on the word “cut” used by some other practices as an advertising gimmick. Every laser vision correction procedure requires removal of epithelium (the superficial layer of skin) from the corneal surface prior to the actual vision correction. This may be done using a laser, a dull instrument, or an oscillating blade. By definition, only the oscillating blade makes a “cut”. Again, ALL procedures must remove the epithelium prior to laser vision correction.
HOW IS THIS IMPORTANT?
There are actually two very important factors to this issue.
- Flap versus No Flap
The first is whether you are simply folding the epithelium out of the way and then replacing it (flap), or completely removing a part of the epithelium (No flap). - Blade versus Laser
If a flap is made, it can be done using an oscillating blade (microkeratome) or a laser (INTRALASE).
FLAP versus NO FLAP
The original laser vision correction procedures, called PRK, required removal of the epithelium prior to laser vision correction. A number of physicians still use a variant of this technique today (LASEK, PRK, SUPERLASE). The results with these techniques were and still are excellent. There are three drawbacks to this technique.
- It takes many days for the epithelium to grow back. This can result in many days of blurred vision and discomfort.
- Some patients tend to get a haze on their cornea after this type of surgery.
- If a touch-up is necessary, the patient must undergo the entire procedure again.
To maximize recovery time and minimize discomfort, physicians started creating a flap which allowed the surgeon to replace the epithelium after the laser vision correction so that it did not have to grow back. Only the epithelium at the edge of the flap needs to regrow. This often takes only a few hours.
A flap is a thin slice of the superficial corneal layer (stroma) with the epithelium attached that is simply flipped out of the way for the laser vision correction procedure. After the laser vision correction, this flap can be flipped back into its original position. This flap becomes firmly attached back to the underlying corneal surface within seconds. (Like wet plastic sticks on a window.)
The drawbacks to this procedure are:
- If a blade is used to create the flap, complications can occur that may require a delay of 3 months before the vision correction can be retried.
- Creating a flap can make thin corneas unstable after the laser vision correction.
BLADE versus LASER
Creating a flap was deemed by most ophthalmologists to be a significant advantage over the PRK surgery. However, when we started making flaps, the creation of the flap itself became the riskiest part of laser vision correction. (Complications from creating a flap were still very unusual. However, as complications from the laser itself were very, very, very unusual, creating the flap was still riskier than the laser vision correction itself.). This was because the flaps were made with a mechanical device called a microkeratome, which used a sharp oscillating blade. Rarely, the microkeratome would create a flap that was too thin; a flap with a hole in it; a partial flap; or a decentered flap. As advances in laser vision correction occurred, lasers were developed that could create the flap (INTRALASE). Complications from creation of the flap were significantly reduced when we started making the flap with the laser.
SO WHICH PROCEDURE IS BEST FOR YOU?
At AAPECS Eye Care we customize each procedure for each patient. HOWEVER:
- We do NOT recommend the use of the oscillating blade (microkeratome) for most patients.
- If a flap is to be made, we strongly suggest the use of the INTRALASE laser for almost every patient.
MORE INFORMATION
MORE INFORMATION