LASEK (Laser Epithelial Keratomileusis)

By Maurice E. John, MD

Published on July 20, 2006

If you are investigating the possibility of refractive surgery for yourself, one of the most important things you should do is undergo a very careful and comprehensive eye exam with the doctor you are considering for your procedure. A number of tests will be performed to ensure eye health and maximum success for the chosen refractive procedure.

While the measurements that are taken, the length of the visit, and the charge for this visit will differ among refractive practices, certain tests should be performed on every patient's eyes. One of these tests involves measuring the thickness of your cornea, the clear tissue that covers the front of your eye, is one of the most important tests in deciding the refractive procedure that is best suited for you. An experienced team of doctors and staff will have alternatives to offer an individual whose measurements lie outside the “normal” limits. Should your cornea be too thin or too flat, the most commonly performed refractive surgery, LASIK, will not be an option. Fortunately, there is now an exciting alternative available to skilled refractive surgeons for patients with thin or flat corneas -- a procedure called Laser Epithelial Keratomileusis or LASEK.

LASEK or “E-LASEK” is a hybrid of PRK (Photo-Refractive Keratectomy) and LASIK (Laser In Situ Keratomileusis). It offers the advantages of LASIK while reducing the disadvantages of PRK. E-LASEK is an excellent choice for individuals who are moderately to severely nearsighted and have thin or flat corneas. It is also an excellent choice for people who participate in contact sports such as martial arts or boxing. E-LASEK was developed by Italian doctor Massimo Camellin in the late 1990s and is now starting to be performed throughout the world.

For the small percentage of the population that has corneas that are too thin or flat for LASIK, and whose previous alternative was only glasses or contact lenses, E-LASEK is an exciting option. In addition to this group, individuals who participate in contact sports such as martial arts, kickboxing, or even basketball, may select to have E-LASEK over LASIK in order to avoid postoperative corneal flap complications as a result of impact to their eyes. While it is very rare to have a flap dislocated after the first month following LASIK surgery, your chances do increase if direct contact is made to the front of the eye. It should also be noted that while E-LASEK patients do experience some degree of postoperative discomfort, it is minimal compared to the discomfort patients undergoing PRK experience.

Since many people are familiar with or have researched LASIK, I thought it might be easier to understand E-LASEK if I did a comparison of the two procedures.

Differences Between LASIK and E-LASEK

• The microkeratome, or the instrument that is used during LASIK to create a thin corneal flap, is not used during E-LASEK. Instead, the epithelium, or the skin that protects the eye, is gently loosened with an alcohol solution and then rolled back before the laser treatment is applied. This eliminates the flap complications sometimes associated with the microkeratome.
• With E-LASEK, after the laser treatment, the epithelia is repositioned on the cornea and a soft contact lens is placed on the eye. This lens acts like a bandage and is worn to protect the eye for approximately four days. In contrast, with LASIK, the corneal flap acts as the bandage and therefore no contact lens is used.
• In addition to the antibiotic drop used with LASIK, a mild steroid drop is taken for up to two months following E-LASEK.
• Clearer vision may take 1-2 weeks.

Similarities Between LASIK and E-LASEK

• Both procedures utilize the accuracy of the Excimer Laser to reshape the cornea.
• The end result of both of these procedures is usually stable vision that permanently changes the shape of the cornea.
• Monovision (one eye set for near, one eye set for distance) is an option with either procedure.
• Some refractive surgeons require their patients are required to keep their eyes closed for 6 hours immediately following both procedures to enhance healing.
• LASIK and E-LASEK both involve a much smaller risk of developing postoperative haze than PRK.

Maurice John, M.D. is the founder and medical director of the John-Kenyon Eye Center. Dr. John has performed over 20,000 refractive procedures since 1980. If you are interested in additional information on E-LASEK or any of the refractive procedures performed at the John-Kenyon Eye Center please visit his website or contact Dr. Maurice John directly at mjohn@johnkenyon.net.

For more information on the author, please visit www.johnkenyon.com