LASEK Eye Surgery

Although LASIK is recognized as the most widely used laser-assisted vision correction surgery, it is not recommended in certain instances.

For instance, LASIK can pose risks to individuals with thin corneas or those who lead active lifestyles, which can make their eyes more vulnerable to damage [1].

If you are looking to become less reliant on glasses or contacts but have been told that you are not a good candidate for LASIK, LASEK (laser-assisted subepithelial keratectomy) may be an option for you.

How Does LASEK work?

The outer layer of the eye called the cornea helps you see clearly by bending light that reflects off of objects so that the light directly lands on the retina. The shape of the cornea can affect where the light falls in relation to the retina [2].

A type of refractive error called nearsightedness occurs when the cornea is too curved and light lands in front of the retina instead of directly on it. This causes closer objects to be clear and distant objects to be blurry.

In contrast, farsightedness occurs when the cornea is too flat and light lands in the back of the retina, resulting in clearer distant objects and blurrier nearby objects.

LASEK corrects these refractive errors by altering the shape of the cornea so that light falls on the retina. It does this by first creating a thin “flap” out of the outermost layer of the cornea called the epithelium. The “flap” is pushed aside and the bits of underlying cornea tissue are removed with a laser to correct its shape. The “flap” is then replaced and heals with time [1].

Who Is a Candidate for LASEK?

An ideal candidate for LASEK should be someone with nearsightedness, farsightedness or astigmatism who no longer wants to be dependent on glasses or contacts. LASEK can even be used for individuals with significant nearsightedness, unlike LASIK [3].

Additionally, a good candidate should not have any of the following [4]:

  • A prescription that has changed in the past year
  • Current or recurring infections
  • Corneal disease or other eye diseases
  • Uncontrolled glaucoma
  • Severe cataracts
  • Uncontrolled diabetes
  • Autoimmune disease
  • Medications that can result in poor wound healing
  • Pregnant or nursing

What to Expect Before Surgery

Before your surgery, your eye doctor will take a detailed medical history, including a list of medications you take. Your doctor will also take measurements of your cornea, pupil size and refractive error to determine your eligibility for the procedure and if LASEK is right for you.

Your doctor will ask you to remove soft contact lenses at least 7 days and hard contact lenses 30 days before surgery [5].

What to Expect During Surgery

LASEK can typically be done in an eye doctor’s office or an outpatient surgery center. The whole procedure lasts about 30 minutes, which includes prep time [6].

You will be awake but will be given numbing eye drops, so you should not expect pain during the surgery.

Your eye will be held in an eye holder to keep it open and you will be asked to look at a light to prevent your eye from moving.

LASEK consists of the following steps [5]:

  1. Alcohol is used to gently detach the epithelium from the underlying layers of the cornea to create a thin “flap”.
  2. The “flap” is brushed aside and a computer-controlled laser uses your measurements to precisely remove pieces of the cornea until it is altered to the desired shape.
  3. The “flap” is replaced and reattaches itself.

What to Expect After Surgery

After surgery, a soft contact lens will be placed over your eye to aid with the healing process. This lens will be removed when the epithelium heals, which typically takes about 4 days [5].

You should have someone pick you up after the procedure and expect to go home and rest after. Because it takes time for the epithelium to heal, it may take anywhere from 3-7 days to restore well-enough vision to drive or do normal daily activities [7]. You will likely need to take time off from work during this time.

You will have several follow-up appointments with your doctor to check your progress in the days, weeks and months following your surgery [5].

Potential Side Effects and Risks

Although LASEK is considered a safe procedure, you may experience side effects that may last several days or weeks after surgery.
Some of these side effects include [5]:

  • Discomfort
  • Blurred vision
  • Corneal haze
  • Halos and Glare
  • Epithelial defects
  • Under and overcorrection
  • Infection
  • Vision regression

When Should I Expect to See Results?

LASEK tends to have a very favourable outcome that is comparable to other similar procedures. You can expect to see improvements in vision between 3-7 days and stability in your vision between 3 weeks and several months following surgery [7].

Follow-up reports from patients show that 94% of people have 20/40 or better vision one year after surgery [5].

You can expect the results from LASEK to last long-term. However, as you age, you may experience changes in your vision that may require touch-up procedures called enhancements [7].

Alternatives to LASEK

Although LASEK is ideal for candidates with thin corneas, its longer recovery time is a downside for many people. Alternative laser treatments that produce comparable results include PRK and LASIK [1].

PRK is similar to LASEK because it involves the removal of the epithelium. However, instead of reattaching the epithelium after the procedure, it gets completely removed. This results in increased healing time (because the epithelium has to regrow) and a higher incidence of corneal haze. Because the cornea is not used to create a “flap,” PRK is ideal for individuals with thin corneas [1].

LASIK is also similar to LASEK because it involves the creation of a “flap.” However, the “flap” is thicker because it is created from more layers of the cornea than just the epithelium. This makes it not well suited for individuals with thin corneas and may result in “flap” complications. LASIK tends to have a shorter healing time compared to LASEK and PRK [1].

Here are some advantages and disadvantages of these treatments [1,8]:

LASEK:

AdvantagesDisadvantages
Good for thin corneasLonger healing time compared to LASIK
Less postoperative pain compared to PRKMay have more postoperative pain compared to LASIK
Reduced “flap” complications compared to LASIK

LASIK:

AdvantagesDisadvantages
Quick healing timeNot ideal for thin corneas
Lower incidence of corneal hazeCan have “flap” complications

PRK:

AdvantagesDisadvantages
Good for thin corneasMore postoperative pain and longer healing time compared to LASIK
Ideal for individuals with an active lifestyleHigher incidence of corneal haze

 

What is the Cost of LASEK?

LASEK is considered an elective procedure and will not typically be covered by insurance. The cost of the procedure varies by several factors, such as the region where you live, the technology the surgeon uses, the surgeon’s expertise and whether your fees include preoperative and postoperative fees [9]. The average cost tends to be $2,000 per eye [9].