What are some differences between LASIK and
EPI-LASIK and PRK?

A special device called an epi-keratome slides over the surface of the cornea, just underneath the epithelial layer of cells, while suction is applied. It creates an extremely thin, hinged flap of epithelium that is folded back during laser surgery.  After the laser portion of the procedure, the flap is repositioned, and a bandage soft contact lens is placed on the eye, allowing it to heal.

During LASIK surgery, a special blade or laser creates a corneal flap consisting of the surface epithelial tissue and the deeper stromal tissue of the cornea, which is not removed, but put back in place after surgery. During EPI-LASIK surgery, an even thinner flap consisting of only the surface “epithelial tissue of the cornea” is created.  No  actual cutting is needed to create this flap. The epithelial tissue is gently “pushed” out of the way using a special instrument that is not sharp. This "epithelial flap" is laid back in position following the laser portion of the surgery.  The epithelial flap improves comfort during healing, but is no longer necessary after a few days, since the eye creates a new layer of epithelium as it heals. Both procedures have their benefits and drawbacks. In PRK surgery, there is no attempt to preserve the surface "epithelial" layer.  A new layer of  epithelium grows over the surface of the cornea over a few days. There tends to be less post-operative discomfort with either LASIK or EPI-LASIK surgery than with PRK.

It is any eye surgery used to improve the refractive state of the eye and decrease dependency on glasses or contact lenses. The most common methods today use lasers to reshape the cornea. Popular procedures include LASIK, PRK and EPI-LASIK.  Cataract surgery, though not a corneal procedure, is also a form of refractive surgery, since the implant that replaces the cataract can also correct, usually with great precision, the cataract patient’s refractive error.  Cataract surgery accomplishes two goals: It eliminates the cataract and concurrently eliminates the refractive error.  Thus, patients undergoing cataract surgery generally do not need LASIK or other corneal refractive procedures to eliminate near sightedness or far sightedness.

LASIK, EPI-LASIK, and PRK are refractive surgical procedures designed to reduce or eliminate the need for eyeglasses or contact lenses for clear distance vision.  Most patients who have these procedures are between age twenty and forty five.  Patients older than about forty-five years old will need reading glasses for close vision, if their distance vision is fully corrected.  Some patients in this age group may choose to correct one eye fully for distance and have the other (usually non-dominant eye) “under-corrected” in order to retain some close reading ability.

Is Refractive surgery completely safe?

No surgery is 100% safe.  However, refractive surgery has been performed on millions of people.  Most are very happy with their result.  Although relatively uncommon, the following are some of the more frequently reported complications of LASIK, EPI-LASIK, and PRK:

1. Over/under correction
2. Visual acuity fluctuations
3. Halos around light sources
4. Starbursts around light sources
5. De-centered ablation
6. Corneal haze
7. Epithelium erosion
8. Loss of epithelial flap
9. Irregular LASIK flap causing loss of best visual acuity
10. Dislodged LASIK flap
11. Unstable cornea
12. Infection

Refractive surgery is not for everyone.  However, most patients, who currently wear glasses or contact lenses can benefit from refractive surgery.  There is no one procedure that is right for everybody.  EPI-LASIK may be a better choice for patients with thin corneas that do not have enough tissue for a LASIK flap.  Also, people who are at increased risk of being struck in the eye may find that EPI-LASIK is safer than LASIK, since there is there is no stromal flap that could be dislodged by direct trauma in EPI-LASIK.  EPI-LASIK is not subject to the risk of “flap related” complications, since there is no LASIK flap.  However, visual recovery is a bit faster with LASIK than with EPI-LASIK, and EPI-LASIK patients are somewhat less comfortable in the first several days following the procedure than LASIK patients.