All-Laser LASEK is an All Laser, No Cut, No Blade, No Flap procedure. Instead of a flap being cut on the cornea, no flap is created and the laser to reshape the cornea to optimize your vision is done directly on the surface of the cornea. To view a video of this procedure, click here.
What are the benefits of All-Laser LASEK over LASIK? Many! Below are 10 reasons why LASEK is just better.
LASEK can safely treat patients with thin corneas, because no flap is made at all, leaving much more tissue available to treat with the laser, and preserving more corneal tissue untouched for greater structural strength after the procedure. Eyes that have had LASEK are more structurally sound after the procedure as compared to LASIK1. A testament to this fact is that certain branches in the military allow ONLY allow for surface ablative treatments such as LASEK to be performed on soldiers, NOT LASIK!
Similar to the above, it preserves much more corneal tissue. LASEK can be safely performed on patients with higher levels of prescription than LASIK.
In order to create the flap necessary for LASIK, you need approximately 100 microns of cornea on the low end. Additionally, some corneal tissue will be strategically removed in the laser ablative treatment. This is dependent upon your prescription. You have to multiply your prescription by 15 microns to get the total tissue that will be removed. Assume you have a prescription of -8.00 diopters and your corneal thickness is measured by pachymetry to be 500 microns. In this case, 8 times 15 microns gives us 120 microns that will be removed. From a 500 micron cornea, 100 microns will be cut to make a flap. So 500 microns minus 100 microns for the flap and 120 microns for the laser treatment will leave 280 microns of structurally sound cornea to withstand trauma. The minimal limit in the most liberal centers is 250 microns. (We are conservative and prefer a limit of 300 microns.) This is only 30 microns above this liberal limit. With LASEK, the flap is eliminated. Because the 100 micron flap is not created, you will have 100 microns more of corneal tissue. Thus you will have 380 microns of structurally sound tissue left on the cornea, which is 130 microns above the accepted limit. This is over 4 times as much structurally sound tissue above the low limit of 250 um to withstand trauma for the rest of your life AND protect you from having the most feared complication of any laser surgery – corneal ectasia.
Most patients experience temporary Dry Eye Syndrome2 (DES) after any refractive procedure, whether LASIK, LASEK, or PRK. In the majority of cases, these patients actually had some DES symptoms BEFORE their procedure. For instance, complaints of dry and uncomfortable contacts is classic for DES, and this is often the reason people often seek vision correction procedures in the first place.
Many studies have shown less DES after LASEK compared to LASIK, because no flap is made. Why is this the case? Because no flap is created, corneal nerves are not cut the way they are in LASIK and thus less corneal nerves need to regrow or heal after the procedure to restart the normal blink reflex. Increasing water consumption and using artificial tears while decreasing caffeine, alcohol, and antihistamines prior to surgery and into the postoperative period can promote better wound healing. Patients with DES either before or after surgery can be treated with dissolvable collagen punctal plugs, which are inserted at the Slit Lamp in the exam room in a painless procedure that takes literally seconds. They work to prevent tears from leaving your eye similar to closing the drain of your bathtub to prevent water from exiting. This procedure is covered by your insurance company.
All refractive surgeons should discuss the risks of dry eyes with their patients prior to surgery. It is not a matter of getting dry eyes or not, it is a matter of how dry they will get after surgery. Typically, patients that undergo surgery do not notice it. However, those patients with preexisting dry eyes are more likely to notice it. The important thing is for the doctor to be able to recognize and treat this condition so that healing can take place effectively and safely and vision can be restored sooner. A cornea specialist is an expert in detecting this sort of change on the cornea.
The most common serious complication in LASIK is an intraoperative flap complication, which occurs in about 1 in 1000 cases. This can occur no matter what type of keratome is used, whether bladed (such as Bausch & Lomb's Hansatome) or laser (such as IntraLase). Common flap complications in the OR include partial flaps, irregular flaps, "button-hole" flaps, and total (amputated) flaps--all of which can cause PERMANENT visual problems.
In contrast, with LASEK, there is NO FLAP AT ALL, so there can be NO FLAP COMPLICATIONS. You have to realize that with All-Laser LASIK or I-LASIK, your eyes are still being cut, only with a laser instead of a blade; and as such you could still have intraoperative and/or postoperative flap complication.
Patients who are nervous, "blinkers," "squeezers," those who have never worn contacts before are not used to things near or in their eyes. Those who are afraid of "getting cut" in the OR, those with a strong blink reflex, and those with deep set eyes or small eyes may not be good candidates for LASIK. This is because they can squeeze during the cutting portion of the procedure and cause an intraoperative flap complication. There is NO chance of this with LASEK.
After LASIK, another 1 in 1000 patients has significant problems associated with their flap. Flap wrinkles or striae occur in nearly 1 in 100 patients, but are usually clinically insignificant. However, when they are significant, they can cause visual distortion or double vision. Debris under the flap is also usually insignificant, but occasionally, it can be too big to resorb so the flap needs to be re-lifted in the operating room and the debris surgically removed. Epithelial in-growth can also be a significant problem, sometimes requiring re-operation to prevent flap melts.
All of these problems are ELIMINATED with LASEK, because THERE IS NO FLAP!
More of the cornea is exposed for treatment than with LASIK. Because there is no flap edge, LASEK is a better choice for patients who require a larger treatment diameter because of large pupils or higher degrees of correction. Not having to worry about a flap edge is also advantageous in CustomVue WaveFront, as otherwise some of the custom ablation actually goes over the flap bed, and is wasted on the unexposed cornea. This can also contribute to better night vision after LASEK compared to LASIK.
CustomVue WaveFront involves measuring a patient's eye over literally hundreds of points, and determining exactly what prescription is needed at each individual point--rather than averaging one prescription for the entire eyeball at every point, which is what is done with glasses or contacts. Similar to a fingerprint of your finger, this is like a unique eyeprint for your eye.
CustomVue WaveFront also corrects "higher order aberrations" that are not measured or treated in glasses or contacts (see www.VISX.com). This is why, after CustomVue WaveFront corrections, many patients see even better afterwards than they did with glasses or contacts! However, it is important to know that the WaveFront measurement is made before surgery. Creating a flap by any means, whether IntraLase or with an automated microkeratome, lifting it up, and replacing it afterwards has been shown in many studies to induce new "higher order aberrations" that cannot be treated because the measurement is performed before the flap is made, lifted, or put back! This means that you can never correct all "higher order aberrations" in a LASIK, because you are producing errors from the surgery itself that are never even measured!
In LASEK, by comparison, NO FLAP IS CREATED, so NO HIGHER ORDER ABBERATIONS ARE INDUCED by making, lifting, or replacing the flap.
Even years after LASIK, the corneal flap never fully heals, and can be raised with a surgical instrument, or with other objects. Therefore, it is always safer to perform LASEK, rather than LASIK in patients with "high risk" or active lifestyles. Remember, certain branches of the military ONLY allow for surface ablative procedures such as LASEK and do not allow their personnel to have LASIK because of the long term risks.
Your actual chance of needing an enhancement is roughly the same as your prescription in diopters, so if you are a -4.00, you have a 4% chance of needing and enhancement, but if you are only a -2.00, your enhancement chance is only 2%. Dr. Shah's enhancement rate is below the national average because of the meticulous attention he pays to detail. He may have your eyes measured more than once to ensure he has the best readings for your treatment. Measure twice, laser once! However, if you do need an enhancement, it can be performed with relative ease because a flap does not need to be relifted.
If you have gotten to the bottom of this page and can see the benefits of LASEK, you are obviously serious about vision correction! We are experts in LASEK and even LASIK if you choose. We will thoroughly evaluate your eyes and determine your candidacy for laser vision correction in the most comprehensive and ethical way. For a free consultation, please contact us.
References
1 LASIK eye surgery. Available: https://www.mayoclinic.org/tests-procedures/lasik-eye-surgery/about/pac-20384774
2 Dry eyes. Available: https://www.mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes/syc-20371863
Written by Dr. Shah
Everything about this practice is fantastic: the staff, doctors, professionalism and location. From dealing with medical issues involving the eyes to yearly optometric exams this is the place to go.
Dr. Semaan provides excellent care and goes out of his way to ensure your vision is the best it can be.
