WHY THE NON-CUTTING LASEK WILL ALWAYS BE MUCH SAFER THAN THEIR OLDER CUTTING LASIK


Lasik   Lasek



The cornea is cut and a flap is flipped back





The center of the cornea is reshaped with the laser




The flap is placed back, but due to the deeper cut, never gets fully healed and can get dislocated by trauma.
  


No cut or flap is made. The surface layer is removed.





The center of the cornea is reshaped with the laser




The surface cells grow back within 2-4 days. The eye is stronger and not at risk from trauma.

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Lasik   Lasek (“e” = “Extraordinary Safety” )
Recover 1 day quicker Pros

10x safer than LASIK, 0% chance of flap complications, non-cutting, more advanced, can safely treat higher Rxs and thinner corneas, does not cause dry eyes, higher chance of better than 20/20 because WaveScan not altered by flap

Older cutting procedure,  flap complication is the more common type of complication, can have debris under flap, if you have an infection it’s inside your eye so harder to eradicate, causes dry eyes by cutting corneal nerves, eye weaker and more prone to trauma (flap can come back up) for the rest of your life (flap never fully heals)

 Cons Compared to LASEK recovery is 1 day slower in epi-LASEK and 2 days slower in LASEK, you need to keep your eyes closed more over the weekend, patient needs to be more compliant about medications as they are used for a longer period of time (which allows more “fine-tuning” of the final Rx, which is actually a good thing)


A metal blade or laser (i-LASIK, IntraLase) is used to cut a flap into your cornea, which is flipped back and put back.  Common flap complications include: incomplete flap (surgery cannot be completed), buttonhole flap (central vision may be damaged), epithelial ingrowth (can cause flap melt and permanently poor vision), debris under flap (if severe may require flap to be lifted and irrigated), flap striae or wrinkles (can cause double-vision), traumatic flap dislocations (flap can be torn off during contact sports), etc.

 Flaps

In both LASEK and epi-LASEK (“Advanced Surface Ablation,” or a more advanced way to perform a surface ablation than PRK, which was the original laser procedure, 10 years before LASIK) there is no cutting at all, and no flap created in the 1st place.  therefore, you cannot have ANY flap-related complications EVER (and the list on the left is only a partial list) because you don’t have a flap cut to begin with!  so LASEK is 10x safer than LASIK –by definition, no debate about this, period.

You will see relatively well by the next day, and should be close to your preoperative corrected acuity (the vision you see in glasses or contacts), which is typically 20/20, by day 2 or 3		 Recovery Time

You will be legal to drive when you sit up from the laser (20/50 – 20/4), and will hit your preoperative corrected vision, which is usually 20/20, by day 4 or 5

If you have LASIK on a Friday, you can return to work the following Monday		 Return to work

If you have LASEK on a Friday, you can return to work on Tue. (Monday if you have epi-LASEK)
There is a lot of pressure during the cutting part, as it’s necessary to pump the pressure up in your eyeball to about 100 mm Hg to make a sharp cut (this also causes you to go blind for a few seconds).  Afterwards, there is no discomfort. You have to wear a bandage contact lens overnight. Pain


There is no pressure during the procedure, as no cut is being made, so your eye doesn’t have to be pumped up at all (in LASEK) or only mildly (to 55 mm Hg in epi-LASEK.  Therefore, you never go blind during the procedure, and there is no “pressure” sensation.  You have to wear a bandage contact lens over the weekend, so this causes some dryness sensation until it is removed the following Mon. /Tue. (you’re supposed to take artificial tears frequently so you don’t feel dry)
  Conclusion  

LASEK and epi-LASEK are safer than LASIK in every patient.  This is not a debatable point; it’s a FACT.  The simple reason is that cutting a flap, either with a metal blade (LASIK) or laser (i-LASIK or IntraLase) is a mechanical process, and is fraught with potential complications.  Therefore, by not cutting a flap in the 1st place, LASEK and epi-LASEK avoid fully 90% of all potential complications.

Patients who cannot have LASIK and MUST have LASEK for safety reasons:
Patients with:

  • large pupils (because the laser treatment zone can extend farther than the flap diameter)
  • thin corneas (because cutting a flap uses up too much tissue, so there’s not enough to treat with the laser)
  • flat corneas (if you’re cornea is too flat, the cut cannot be made safely without causing a buttonhole)
  • irregular astigmatism (cutting into your eye always weakens it, and may make your astigmatism worse)
  • forme fruste keratoconus (cutting weakens your eye, worsening KC and causing your eye to bulge out)
dry eye (cutting a flap cuts your corneal nerves, causing an abnormal blink reflex, worsening dry eyes)


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Some of which include:
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  • Project by Project
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  • St. Vincent’s Elderly Hispanic Homecare Program
  • Ocean Beach Community Fund, Inc
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