LASEK is Safer Than LASIK Eye Surgery
A letter to a new patient from Dr. Emily Chynn of Park Avenue Laser, the finest LASIK surgeon in New York City.
Dear Jeff,
Your contention that “there is no literature supporting the increased safety and improved vision of LASEK vs LASIK” is simply false the fact that you spent 5 minutes on Google and pulled a grand total of two studies, one in the optometric literature, is not sufficient in fact, the fact that you only got two studies should tell you something (i.e, your search was too cursory).As I told you, when searching medical literature, you cannot use Google, as it does not index the great majority of scientific literature again, your assumption “if it’s a good study, then it will get lay press and then be on google” is patently false. I never do this for patients, as I don’t have the time for it, plus I really think that if patients want to search, they should do it themselves.Nevertheless, our conversation got me so worked up and upset that a smart layperson like you can google for 5 minutes and think they are an expert on a subject or have received a comprehensive summary of the facts out there. That I am breaking my rule and citing some studies for you#1: Use something like www.pubmed.com when doing medical literature searches, NOT GOOGLE!
As I said, if you as an editor paid a writer to turn in a comprehensive report on any subject and that person said as lit search he ONLY Googled you would do well to fire him same is true, even more so, when dealing with medical literature searches
FACT:
VISION IS BETTER AFTER LASEK + WAVEFRONT THAN AFTER LASIK + WAVEFRONT
REASON:
- Wavefront captures and treats Rx to the nearest 0.01D, and also higher order aberrations, and 50 different Rxs per eye
- Wavefront has been proven to change significantly after cutting and lifting a flap (you should accept this intuitively)Wavefront in LASIK surgery is captured BEFORE NOT AFTER cutting the flap–therefore, the wavefront you treat is not the one that is accurate after cutting the flap (ie, you should really cut the flap, lift it up, do the Wavefront, save it, then shoot it–but nobody does this for through-put reasons–it would take so long you could only treat 1-2 patients per day)
- Wavefront you shoot in LASEK is the SAME wavefront you captured before the procedure–what you shoot is what it is/what you want
Here is the article proving this (by the person I did my fellowship under, by the way, Doyle Stulting, whom i just spoke to today):
Outcomes of Wavefront-Optimized Surface Ablation
Presented at: American Academy of Ophthalmology Annual Meeting, November 2006, Las Vegas, Nevada.
Purpose
To compare early visual outcomes after wavefront-optimized advanced surface ablation (ASA) with those after wavefront-optimized LASIK.
Design
Retrospective comparative series.
Participants
One hundred thirty-six eyes undergoing ASA and 136 preoperative refraction–matched eyes undergoing LASIK from June 2004 through October 2005.
Methods
Database review of preoperative characteristics, including patient age, gender, refraction, and central corneal pachymetry; perioperative information, including type of surgery, flap thickness (for LASIK cases), ablation depth, and residual stromal bed thickness; and postoperative information, including uncorrected visual acuity (UCVA) at 1 day, 1 week, 2 weeks, and 3 months, refraction at 3 months, and complications. All ASA patients had topical mitomycin C applied intraoperatively.
Main Outcomes Measures
Postoperative UCVA, best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE) refraction, speed of visual recovery, and postoperative complications.
Results
Surface ablation patients were younger (35.4 years vs. 39.8 years, P = 0.0002) and had thinner corneas (514 μm vs. 549 μm, P<0.0001) preoperatively. Average UCVA was significantly better after LASIK at 1 day (20/26.8 vs. 20/50.4, P<0.0001) and 2 weeks (20/24.4 vs. 20/33.3, P = 0.0002) postoperatively. However, by 3 months postoperatively, UCVA was better after ASA (20/20.8 vs. 20/22.7, P = 0.05), and 81.5% of patients achieved 20/20 or better UCVA after ASA, compared with 70.5% after LASIK (P = 0.05). More ASA eyes had postoperative UCVA that achieved or surpassed preoperative BSCVA than LASIK eyes (66% vs. 41.6%, P<0.0001). There were 53 patients who underwent bilateral simultaneous ASA. By 1 week, 87.5% had 20/40 or better UCVA in at least one eye and 62.5% had 20/40 or better UCVA in both eyes. By 2 weeks, 86.8% had 20/40 or better UCVA in one eye and 82.6% had 20/40 or better UCVA in both eyes.
Conclusion
Initial visual recovery is more rapid after LASIK; however, by 3 months postoperatively UCVA and SE refractions were better after ASA. Advanced surface ablation is an effective alternative to LASIK, and based on early visual recovery, bilateral simultaneous surface ablation is a reasonable alternative to sequential surgery for the majority of patients.
FACT:
- These are all the common complications of LASIK
- They all involve the flap to some extent
- They are thus all ELIMINATED in LASEK without a flap:
- Flap dislocation
- Flap striae
- Flap wrinkles
- Button hole flap
- Incomplete flap
- Free flap
- DLK
- Persistent inflammation under flap after Intralase
- Epithelial ingrowth under flap
The FACT is that 90% of all refractive complications involve THE FLAP which are ELIMINATED with our non-flap procedures. There are also other safety benefits of LASEK vs LASIK:
1. Thicker cornea afterwards
2. Stronger eye
3. Less chance of iatrogenic (induced) keratoconus and/or ectasia
Looking forward to your recontacting us if you should decide to go ahead with the more advanced, safer procedure, and good luck if you decide to do a LASIK, which is what I had done myself in 1999 (almost a decade ago), but stopped doing 5 years ago. As few things involving high-tech in this world have remained cutting edge for 10 years–LASIK included.
