A new laser procedure was developed in 1999 called LASEK (The procedure is also called EPI-LASIK). Please note the letter E not I as used in LASIK. LASEK is a modification of PRK and LASIK. No microkeratome is used and no cut is made with a blade in the middle or stromal layer of the cornea.

A small ring is placed on the surface epithelial layer of the cornea and filled with a few drops of an alcohol solution. (Figure 1 >>)

A thin flap of only the surface epithelial cells of the cornea is created avoiding any cutting of the deeper stromal layer. This very thin flap of epithelial cells is left attached at either the upper or nasal (nose) side of the cornea and the flap is folded back
(figure 2 >>).

Next, the cornea is reshaped by using the excimer laser to treat the surface of the stromal layer under the epithelium. This is called excimer laser ablation (figure 3 >>). The epithelial layer or flap is then unfolded and replaced over the treated cornea. The surface epithelial cells regenerate and adhere rapidly after the procedure (figure 4 >>).

Thus, in LASEK only the surface of the stromal layer of the cornea is ablated by the laser, exactly like PRK. In fact, some surgeons prefer to call this procedure advanced surface ablation rather than LASEK. Note: the deepest layers of the stroma are left untouched and intact because no cut has been made with a microkeratome. Because the laser ablation starts at the surface of this stroma layer, there is more stroma which can be treated. This may allow treatment of patients who could not safely have LASIK because too much tissue would be removed leaving a higher risk of cornea ectasia. (Discussed in the LASIK section.)

There are disadvantages to "E"K (LASEK) also. Ocular irritation and discomfort may be worse than with LASIK. This is usually easily managed with treatment including weak anesthetic drops and the use of a bandage soft contact lens for the first three days. Vision may be more blurry than with "I"K (LASIK) for the first 4-5 days. There may be a higher incidence of haze or cloudiness of the cornea for patients having very high degrees of nearsightedness (myopia) having "E"K (LASEK), up to 3%. Through the use of topical mitomycin, an antibiotic placed on the cornea for a few seconds at the end of the laser treatment, to prevent haze, even patients with high degrees of nearsightedness can be treated very successfully.

Final visual results with LASEK appear as good as or better than the "I"K (LASIK) for patients up to -6.00 to -8.00 of myopia. Surgeons are reporting excellent post "E"K (LASEK) vision for myopia up to -12.00. It is noteworthy that 96% of nearsighted people in the United States are -6.00 or less as mentioned above and special techniques can reduce the 3% risk of cornea haze for the 3-4% of nearsighted patients in the range of -6.00 to -12.00. For the rare patient over -12.00, other techniques should be considered. You should discuss this with the doctor during your consultation visit about laser vision correction.

After diligent research, observation of our own patients, and consideration, Dr. Nepple feels strongly that a surface ablation procedure is the safest procedure for people having laser vision correction. LASEK (which many practitioners are beginning to call "E"K as contrasted to LASIK called "I"K) offers a number of advantages over the other older surface ablation procedure, namely PRK. It is thought the presence of the replaced epithelial flap after the laser correction treatment moderates the immune response, resulting in less haze and better vision. The method of LASEK is done to allow faster healing and better comfort. Additional advantages of "E"K (LASEK) instead of PRK include faster healing time, visual recovery, and increased post laser comfort. Should a complication occur involving the epithelial flap during "EK", the procedure can be changed easily to PRK laser vision correction with excellent final vision for the patient.

Summary of the advantages of "E"K (LASEK) or EPI-LASIK: