The Laser Eye Surgery Message: Clearing Up the Confusion ~ Blog #2

The Procedures

In the final blog of this 2-part series, we’ll explore the individual procedures available for laser eye surgery today which include:  LASIK, PRK, LASEK, ICL’S and Clear Lens Extraction.  This will include a definition, in laymen’s terms, the indication of each surgery as well as the advantages and disadvantages, for each procedure.

Clearing up the Confusion_LASIK or PRK*If you haven’t read Blog 1 in this series, catch up now!  Blog #1:  The Basics

LASIK: 

Definition:

The acronym, LASIK, stands for laser-assisted in-situ keratomileusis.  In this procedure, a flap of the topmost layer of the cornea is precisely created utilizing a femtosecond laser, which is gently peeled back.  The VISX Star S4 excimer laser then precisely re-profiles the corneal bed underneath the flap to correct your visualaberration.  The specific type of re-profiling is customized by Dr. Mandel for each patient’s unique visual needs.  The flap is then gently placed back in its original position.  The inner layer of the cornea acts like a natural pump, so no sutures are necessary.  The entire procedure takes about 5 minutes per eye.

There are 2 different ways to create a corneal flap in LASIK:  bladed, and the all-laser, blade-free LASIK method.  Bladed LASIK is performed using a microkeratome, which is an oscillating blade.  The most advanced method used by Dr. Mandel is the all-laser LASIK method.  This method is bladeless, utilizing a specialized femtosecond laser to create the corneal flap.  So, when you see “LASIK” and “All-Laser LASIK” as separate headings on the internet, the difference is in the flap creation.

Indications:

Correction of nearsightedness, farsightedness and astigmatism.  For patients who choose monovision, presbyopia can also be treated.

Advantages of LASIK:

  • Immediate return of vision.  Our nearsighted patients typically drive and go to work the day after the procedure.  Our farsighted patients have a slightly slower recovery because they are usually slightly overcorrected initially.
  • Minimal discomfort post-operatively.

Disadvantages of LASIK:

  • A flap is created, which can biomechanically weaken the cornea.
  • Flap creation of the cornea could be problematic initially in patients who participate in contact-sports such as boxing, karate and kick-boxing, if they do not wear protective goggles.
  • Since a flap is created in LASIK, there is a larger emphasis placed on corneal thickness.  Patients with thinner corneas may not have enough corneal tissue to undergo this procedure.  These patients may be evaluated for PRK surgery or surface laser vision correction.

PRK:  

Definition:

The acronym, PRK, stands for photo-refractive keratomilieusis.  PRK may also be referred to as surface laser vision correction.  In PRK, instead of creating a flap, the epithelium is gently removed with an oscillating brush.  The rest of the procedure is the same as for LASIK, as the excimer laser is used to re-profile the cornea.  After the excimer laser is completed, the corneal bed is irrigated and a bandage soft contact lens is placed over the cornea.  For some PRK cases, a special medicine known as mitomycin is used to prevent haze formation post-operatively.

Indications:

The same as for LASIK. (see  above)

Advantages of PRK:

  • Since no flap is created, there is minimal weakening of the cornea.  Therefore, this is the safest of all laser vision correction procedures.
  • Can be performed on thinner corneas which do not qualify for LASIK.
  • May be the recommended procedure for patients who participate in contact-sports.

Disadvantages of PRK:

  • The bandage contact lens needs to be worn for the first week after the procedure to allow the corneal epithelium to regenerate.
  • While the epithelium is regenerating, you are looking through an abrasion, which is much like looking through a dirty windshield.
  • Steroid drops are required for a longer period of time, compared to LASIK.
  • Optimal visual acuity is slower to return post-operatively, compared to LASIK.
  • There is some discomfort post-operatively.  However, with Dr. Mandel’s customized post-operative PRK regimen, this discomfort has been dramatically minimized and is usually felt only on day 3 and sometimes day 4, post-operatively.

LASEK:  

In LASEK, instead of removing the epithelium, as with PRK, or creating a flap which includes both the epithelium and the stroma of the cornea, a flap is created only in the epithelium of the cornea.  Once the flap is lifted, the excimer laser is used to re-profile the cornea.  Once the re-profiling is complete, the flap is gently placed back in its original position.  A bandage soft contact lens is placed on the cornea.

Indications:

The same as for LASIK and PRK.  (see above)

Advantages of LASEK:

The same as for PRK. (see  above)

Disadvantages of LASEK:

Same as for PRK (above), but includes these additional disadvantages:

  • Visual recovery is slower than LASIK and PRK.
  • When alcohol is utilized to loosen the epithelium of the cornea in LASEK, it can cause more discomfort post-operatively than with the PRK procedure.

ICL (IMPLANTABLE CONTACT LENS)

Definition:

Just like it sounds, the ICL is a contact lens that can be implanted within the eye.  It is surgically implanted in the small space between the iris and the natural lens of the eye.

Indications:

Correction of nearsightedness, farsightedness, astigmatism.  For those patients who choose monovision, presbyopia can also be treated.

Advantages of the ICL:

  • Surgeons are not limited by the thickness of the cornea, so prescriptions that are outside the parameters of LASIK, PRK and LASEK can be treated with the ICL.
  • There is no flap created, so the induced weakening of the cornea is minimized.

Disadvantages of the ICL:

  • Unlike LASIK, PRK and LASEK, this is an intra-ocular surgery.  This puts the patient at a higher risk for intra-ocular inflammation as well as infection, post-operatively.
  • It can cause pupil distortion, glaucoma and damage to the cornea.
  • Since the ICL rests in front of the natural lens, it can cause early development ofcataracts due to the ICL causing trauma by hitting the lens.

CLEAR LENS EXTRACTION (A.K.A.:  REFRACTIVE LENS EXCHANGE) 

Definition:

Clear lens extraction is very similar to traditional cataract surgery with a lens implant.  The only difference is that the natural lens of the eye has not become clouded with a cataract.  In both surgeries, the natural lens of the eye is reduced to tiny pieces using either a vibrating instrument (similar to a jack-hammer) or a laser.  Those pieces are then removed from the eye through a tiny incision which usually requires no sutures.  The power of the lens implant is customized for each patient.

Indications:

Correction of nearsightedness, farsightedness.  For those patients who choosemonovision, presbyopia can also be treated.

Advantages of Clear Lens Extraction:

  • Surgeons are not limited by the thickness of the cornea, so prescriptions that are outside the parameters of LASIK, PRK and LASEK can be treated with the ICL.
  • There is no flap created, so the induced weakening of the cornea, although minimal with LASIK, is minimized with this procedure.

Disadvantages of Clear Lens Extraction:

  • Just like the ICL, this is an intra-ocular surgery which puts the patient at a higher risk for intra-ocular inflammation post-operatively.
  • How it differs from an ICL, in this regard, is that it is performed further back in the eye.  This can put the patient at risk for complications such as dislocated implants, retinal detachment and intraocular infection which although rare, could result in blindness.
  • The intraocular lens cannot correct for astigmatism.  This requires a secondary procedure of either LASIK or PRK weeks after the initial clear lens extraction procedure.

We hope this blog series has helped clarify the many options that are available for laser vision eye surgery today.  Dr. Mandel specializes in IntraLase all-laser LASIK and PRK laser vision correction.  Of course, the only way to tell whether or not you qualify for laser vision correction, and to determine which procedure is recommended for you, is to be evaluated.  Call us, at 888-866-3681, to schedule your free evaluation with corneal specialist and laser eye surgeon, Eric R. Mandel, M.D.

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