Part 6: LASIK vs PRK/LASEK? Which laser procedure is best?

We discussed in the last post about the two options you have: LASIK or PRK (surface laser), and how 90%+ of treatments are done via LASIK.

LASIK comes in two flavours now: blade or blade-free. The older traditional LASIK technique uses a mechanical device containing a blade (called a keratome or microkeratome) to cut a flap during the first part of the procedure. The newer, more advanced method is to use a special laser (known as a femtosecond laser) to create a flap without a blade.

Femtosecond lasers can create a LASIK flap without a bladeThese femtosecond lasers are hugely expensive (about a quarter of a millions pounds each!) so expect to pay more for this technology. Some clinics have not yet invested in femto lasers due to the high cost involved and continue to use a blade.

The benefits of a laser flap over a blade flap are becoming clear: more accurate treatment, better healing of the flap, greater strength in the cornea post-op due to significantly thinner laser flaps and greater residual thickness. Blade flaps have been used for many years and have been proven safe to date, but thinner laser flaps have added better accuracy and strength. You will see a gradual phasing out of blade flaps over laser flaps over the coming few years.

More tomorrow!

Filed Under: LASIKPRKSafetyTechnology


About the Author: Mr. Dave Allamby FRCS FRCOphth is a leading London-based laser eye surgeon. You may have seen him on the This Morning TV show with Phillip Schofield and Fern Britton or read one of several articles in the national press, recently for treating Denise Van Outen, rock giant Rick Wakeman and broadcaster Paul Ross. David is Medical Director at Focus Laser Vision, known as a world-leading clinic in the treatment of presbyopia, or age related loss of close vision. Focus Laser Vision is also London's only clinic to offer next-generation Z-LASIK laser eye treatment for short sight, long sight or astigmatism.

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  1. Chad says:

    I am in the Canadian army and can’t decide on which procedure to go with because I am going to get one or the other on my summer break. I will have 20 days off, roughly. I am leaning towards prk even though I have an extremely low prescription. I do not want flap complications as I will be taking up muay Thai and already rock climb and scuba dive. But with this new type of LASIK it sounds like flap complications are not a real concern. I will also be trying to get on a jump(para) course in the near future. Any recomendations on which way I should lean towards before I go too a clinic. You seem to be more honest than most and are not just going for a money grab. So I don’t want to go on empty handed. And will trust your opinion.

    • Dave Allamby says:

      Hi Chad
      You will be better off with PRK if you are planning Muay Thai training. Other activities shouldn’t be a problem, but having done MT myself for years know first hand the blows to the eye you can get!
      Best regards

      • julie says:

        Hello Dave,
        My precription is minus 12[glasses]and I would like to know if you could do Lasek?Can you estimate how much corneal tissue would have to be removed?By way,what residual stromal thickness do you regard as a safe minimum.The general guidance is 250 microns but I know some clinics differ.
        Kind regards and thank you for your help.

        • Dave Allamby says:

          Hi Julie
          Thank you for your email. -12.00D is of course an extreme prescription, and only treatable if the patient has thicker than normal corneas, plus average to small pupil size in the dark (scotopic pupil diameter).
          The 250 microns residual bed thickness is for LASIK, not LASEK/PRK, and has been replaced by clinics such as ours with the thicker 300 microns. For LASEK/PRK the standard residual stroma should be 350 microns. If you are over 40, we sometimes can target, e.g. -2.00 diotres rather than zero, say that there is very clear near vision at a normal desk working/reading distance – but will still need glasses for driving/TV etc, but a much more useful vision, and not visually handicapped as with -12.00D.
          Hope that helps you. You will need a consultation to see what is possible, and get the relevant measurement.

    • Kelcy says:

      Hi, Chad/Dave,

      I know this is from a while back, but I just came across this and am in the same boat. I’ve been doing Muay Thai for about 6 years now, and am not about to give it up. I have opted for PRK so I won’t be constantly worrying about getting hit in the eye during training, but am concerned about the healing process. How long before you were back in training? I don’t want too much time away from the mats, but of course my eyes must come first. How long before I could do any sort of exercise, even if I just went in and did bag work? Would impact like running or hitting jar my eyes in a negative way?

      Thanks so much,


      • Dave Allamby says:

        Hi Kelcy. Allow a week before normal exercise, bag work, running etc. These activities won’t affect the healing process. With PRK, of course, there is no flap to dislodge so you could begin sparring again also. I would allow 2 weeks for that, but wear head protection.

  2. Olivia Flanagan says:

    Dear David, I have a prescription of -2 and -2.25 and I have looked into Lasik before, only to be told that I have borderline thin corneas and am therefore better suited to Lasek. Might Z Lasik improve my chances of being able to have my eyes treated, given that the flap creation is so much more efficient and accurate?

    • Dave Allamby says:

      Hi Olivia
      Do you know the thickness measurements? Less than 500 microns and most surgeons will opt for PRK/LASEK which is wise. With only a small refractive error of only -2.25 it was not the size of treatment that indicated PRK/LASEK but sounds like the measurement itself being sub-500. You will do very well with surface laser treatment but needs a few days off.
      With best regards

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