Epi Lasik: The Best Of Both Worlds

Written by Johh Taylor

For folks who may not be a candidate for LASIK because of an inability to sustain a corneal flap, Epi-LASIK is an exciting new option that may allow them to have a laser-assisted refractive surgery that has all the benefits of LASIK and fewer drawbacks than other options such as LASEK or PRK.

Traditional LASIK surgery involves the use of a surgical instrument to create a flap in the outermost layer of the cornea, and then the use of an excimer laser to resculpt the tissue beneath to allow it to better refract light. The improvement in refraction leads to an increase in the patient's vision. This treatment can be used to improve vision affected by myopia, hyperopia and astigmatism.

Not everyone has enough corneal tissue for surgeons to create a flap, and as a result, these folks are not good candidates for LASIK surgery and must resort to other treatments such as PRK and LASEK. In LASEK, the very top layer of the cornea, the epithelium is removed by weakening it with chemicals and then using a specialized tool to lift it. Once that's done an excimer laser ablates the tisue beneath, and then the epithelium is replaced. In PRK, the oldest form of laser-assisted refractive surgery, the excimer laser is applied directly to the cornea without the removal or lifting of the epithelium, which ablates the epithelium along with the corneal tissue to be resculpted. The epithelium grows back.

LASIK tends to produce better results than LASEK or PRK, there's a reduced number of side effects such as corneal haze and it's less painful to the patient. This explains much of the procedure's rise to popularity in the mid-90s and early 00s. Although LASIK solved some of the issues that kept some patients from being able to undergo PRK and offered better results in terms of vision correction, LASIK also has some unique complications of its own. Most of these complications involve the flap that must be cut into the outer layer of the cornea and then put back into place after the surgery. LASEK solves some of these problems because it does not rely on a flap, but the chemicals used in the procedure to weaken the epithelium drastically delays recovery of vision and can be uncomfortable.

Epi-LASIK offers the advantages of LASIK and LASEK and may be the right choice for people who want laser-assisted refractive surgery but aren't good candidates for either of those procedures.

In Epi-LASIK, the surgeon first uses some antisethtic eye drops to numb the eyes and mitigate any pain the surgery may cause. After this is done, the surgeon will then use a device called an epikeratome to peel off a thin layer of the patient's epithelium. This thin covering is then put aside, and then the surgeon uses an excimer laser to fix any imperfections in the epithelium. After the operation is finished, the epithelial layer must be put back into place by the surgeon and aided to adhere to the spot by a special bandage contact lens.

After the Epi-LASIK procedure, most patients will usually begin noticing improvements in their vision within a few days. The vast majority of patients can actually begin driving on their own after about a week. The improvement curve in vision can take anywhere up to several months, however, with gradual improvements over that time. While LASIK has a quicker recovery time, there are far fewer complications with Epi-LASIK because the procedure does not penetrate the cornea.

In general, the benefits of Epi-LASIK are fewer complications, a lower rate of dry eye and the ability to treat patients who have thin corneas. Like any procedure, there are complications with Ep-LASIK which include flap complications (but at a much smaller rate than LASIK), glare or halos and either undercorrection or overcorrection of the patient's vision.

In the past, Epi-LASIK has cost more than than traditional LASIK procedures, but in recent years prices have become more standardized for the various forms of laser-assisted refractive surgery.

To determine which type of, if any, laser-assisted refractive surgery is right for you, consult with an eye doctor. He or she can provide you with a series of tests that can determine the extent of your vision problem and any conditions that may rule you out as a candidate for laser eye surgery. To find a reputable eye doctor who can assist you, check out this Web site http://www.usaeyes.org/lasik/doctor/locate-lasik-doctor.htm.