LASIK vs. LASEK: Comparing the Risks and Difficulties

Filed in archive LASEK , Other Types of Refractive Surgery on March 27, 2010

This procedure was billed as LASEK,
however if you notice, they
completely remove the epithelium
and do not replace it, which is more
like the PRK procedure. Based on our
research the epithelium is
completely replaced
in LASEK.

The biggest difference between LASIK and LASEK is in the creation of the corneal flap. But this is a really big difference! With LASIK, a corneal flap is made by cutting into both the epithelium and the stroma of the cornea, the thicker tissue under the outermost layer, the epithelium. A hinge is left, and like a door the flap is opened and folded back so that an excimer laser can ablate the corneal tissue, reshaping the cornea to result in clearer vision.

This flap is extremely thin, however much thicker than an epithelial flap produced in LASEK. The LASIK flap often remains in place, but with the potential to move around, to become infected, and to produce future vision problems.

In LASEK, the epithelial cells regenerate completely in time, healing the epithelial flap. Healing of flap edges begins immediately, and there can be noticeable improvement within even one day of surgery.

With LASIK, due to differences in use of the microkeratome by the surgeon, flap edges can be shaped in such a way as to inhibit seamless healing. Not so with the epithelium, which regenerates rapidly.

Some of the benefits of LASEK are:

• May offer quicker nerve regeneration time
• Almost all risks of flap complications are removed
• Less risk of dry eye
• Works for people with thin or steep corneas, where LASIK is not recommended

Some Disadvantages of LASEK as compared to LASIK are:

• Longer recovery time. Recovery time is significantly slower than in LASIK
• There may be more pain in recovery than with LASIK. Studies have shown that the amount of pain involved with LASEK is not consistent from one patient to another.
• Fewer surgeons practice the "off label" procedure, since it is generally used for people who are not good candidates for PRK or LASIK, rather than as a preferred type of refractive surgery.