LASIK and PRK – Which is Safer?
I recently received this email with a couple of great questions:
My name is Carlo and I have recently discovered this great blog. I would like to ask a couple of questions regarding eye surgery:
a) Can the creation of a flap in the eye potentially lead to problems? Should PRK and LASEK be better in the long run for patients?
b) Is it true that the LASIK procedure has not been approved for air-force pilots and astronauts in the US but PRK and LASEK has?
There is a lot of confusion on the web about those issues. Could you spend some time clarifying that?
Let’s look at the first question now and I will address the second in a subsequent posting.
The majority of surgeons use the LASIK technique, where a thin flap is created in the top part of the cornea before applying the vision correction laser. More than 90% of laser eye surgery procedures are LASIK rather than surface laser treatments (PRK or LASEK).
There has not been any research to show signifiant differences in results between LASIK and PRK for short sight so whichever you choose to have, the final outcome will be the same. However, for long sight or reading vision correction, LASIK appears to give a more stable results and this is my preferred method for these types of prescription.
But let’s stay with short sight for the moment, where the vision and stability are not affected by the choice of procedure. It then comes down to safety. I personally used to prefer PRK over LASIK due to the small but measurable complications arising from using a blade to cut a flap. At that time, when I asked myself which procedure I would have, it would have been PRK.
However, with the arrival of the very safe and predictable laser flap makers (femtosecond lasers) I no longer subscribe to that view and would personally now choose to have all-laser LASIK. The femtosecond lasers create a very predictable and thin flap time after time, with greater precision and safety than the mechanical keratomes could. Early research also shows improved vision results, especially in reaching the very high target of better than 20/20 vision.
You still need an expert surgeon and a very thorough examination and consultation because there are points we can detect which do predict a bigger chance of having a problem in the long term. Such patients need to be screened out of the LASIK or PRK process and should not have surgery.
So choose an expert centre with an expert surgeon and you will have a safe and predictable experience and result. You can comfortably opt for LASIK over PRK/LASEK without worries for the long term.
Certainly, patients much prefer LASIK as vision is very good within a few hours (even quicker with our Z-LASIK approach) and they can be back at work the next day, rather than needing to take several days off work. Also, most patients find PRK or LASEK to be a pretty painful experience for 2-3 days after correction (the procedure itself is painless).
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hi Maria
yes a consultation is no problem. it will be free, although with a refundable booking fee. you can book ...
Hi Dave,
I am wondering how I would book a consultation with your clinic. I have needed glasses since I was ...
Z-lasik is the improved form of LASIK.Main advantage of this treatment is pain free.Thanx denise for sharing your experience among ...
David,
Thank you for your quick response. I was told that on the day of the surgery that there would ...
Thanks!
Comment by ck on 17 June 2008:
Hi Dave,
What would warrant a PRK over Z Lasik, i thought Z lasik can cut to a very thin flap?
Do you have any statistic of PRK done in your clinic and the percentage of complication arises and the treatment and ultimately the success rate ?
For PRK, is there anything that can help ease the pain ?
For prescription of -3.25 and -3.5, can you give me an estimated cost?
CK
Comment by Dave Allamby on 26 June 2008:
Hi CK
For your prescription, PRK and M-LASIK (blade) for wavefront based treatments would only be £695 per eye. For advanced blade free wavefront Z-LASIK (most popular) would be £1020 per eye.
Z-LASIK flaps are thin, only 100 microns, so we can treat more people this way, rather than being forced to do PRK. However, PRK is a very good procedure for approx -3D but is painful post-op. We do use meds to help that but it is painful to some degree unfortunately.
Hence the popularity of LASIK which is virtually fully pain free.
You will save between £1,000-2,500 compared to other laser chain clinic by choosing FOCUS, for like-for-like treatments.
Regards, Dave
Comment by Chris Perrins on 27 June 2008:
David, I’m coming to see you on 10th July. After much deliberation I really would prefer to have PRK over the flap technique. Are you comfortable with this and do you think the end results will be as good/ predictable? Prescription again is approx -4.50 with some astigmatism. Happy to discuss off-line.
Many thanks, Chris
Comment by Dave Allamby on 28 June 2008:
Hi Chris
Yes, PRK will work very well here. I will email you directly too if you have more questions, no problem. Best regards, Dave
Comment by ck on 1 July 2008:
Thanks Dave. I will consider coming for a consultation in the very near future.
Many Thanks again.
CK
Comment by Jacky on 22 August 2008:
Dave,
I am considering to have a Lasek or PRK, but if in the future I want apply for a job as pilot this may presents a problem, as some airline won’t accept candidate who had any eye surgery. So, can Lasek or PRK be easily detectable under examination? and will you know if they will usually do this kind of examination on candidate.
Regards,
Jacky
Comment by Dave Allamby on 22 August 2008:
Hi Jacky
the rules vary according to the kind of licence, either commercial or private. You can fly 3 months after LASIK and 12 months after PRK/LASEK. I am not sure if you get a microscope exam of the cornea or not, but PRK/LASEK is not typically visible at all for most mild to moderate prescription.
Here is a summary as I understand it:
The CAA have recently relaxed the rules for Class 1 certification following LASIK surgery so that it is possible to have unrestricted certification at 3 months post-operatively if refraction at 2 and 3 months shows stability (less than 0.75 dioptres variation) and no glare or any other side-effects are noted.
A report stating the refraction at 2 months must be provided. The greatest pre-operative Refractive Error is -5.00 for Class 1 and -8.00 for Class 2. For Class 1 there must be follow up at the Aeromedical Section (AMS) which is the CAA at Gatwick for UK at 3 and 12 months post operatively and for Class 2 local ophthalmological review at 3 and 12 months. Further reviews are only required if stability of refraction is in doubt or there are side-effects.
For PRK the rules are unchanged that is 12 months post operative review. At this stage it is possible to get unrestricted certification. A further follow up at 24 months is required.
Comment by Alex on 23 September 2008:
Hi Dave
I have not been able to wear contact lenses for 7 years now due to a low tear break up test of about 9 seconds. Does this mean I would not be able to have lasik or PRK and also does this mean I have ‘dry eye’. I have not been categorically told I have dry eye though.
Kind regards
Comment by Dave Allamby on 23 September 2008:
Hi Alex
A normal tear break up time is 10 seconds or longer so yours is slightly low and that can go along with being unable to tolerate contact lenses for prolonged periods.
We can often help the eyes to be more lubricated, improve the tear film and increase the tear break up time allowing you to go ahead with LASIK or PRK.
We will know more after a consultation and advise you fully.
Regards
Dave
Comment by roby on 20 November 2008:
I found this site really informative.
I’m 25,I have -2,25 myopia and a little of dry eyes (schimer’s test after 5 minutes: 4mm and 7mm in the right and left eye).
A doctor told me I’m a good lasik candidate, but I read somewhere Lasik can worsen dry eyes, so I’m a little afraid.
It’s a problem? It would be better PRK?
thanks a lot, bye
Comment by Dave Allamby on 20 November 2008:
Yes Roby
those readings are a bit dry. you may be able to treat the eyes first to improve the dryness. also taking flax seed oil capsules daily (2-4g) can help prepare you prior to treatment.
Thin flap femtosecond LASIK (blade free, Z-LASIK) can reduce the duration and degree of post op LASIK dryness so that would also help. WIth these measures you might still be a good candidate for LASIK. Will need to see your eyes at a consultation to know more.
hope that helps your questions
Dave
Comment by roby on 21 November 2008:
Thanks for your answer.
Right now I’m taking Medilar (1 pill a day) supplement under the suggestion of another doctor since some months and also Supradyn multivitamin (just my idea) since 2 weeks.
I’m Italian so you are a bit far for me
The Lasik surgeon I went to seems to know his stuff, he also told me he would use a femtosecond laser, but I found many stories on the net of dry eyes after Lasik and got a bit scared.
Thanks again for your answer and helpfullness.
Comment by Linda on 21 November 2008:
Dear Dave
I think your blog is an excellent idea – it makes the whole process much less daunting. I have a number of questions and apologise if you have already covered them before.
I am a 56¾ year old woman who has been struggling with glasses for many years. I am now in the same position as Rick Wakeman, needing a different pair of glasses for every aspect of my life. I very recently (1 week ago) tried contact lenses (one long sight and one short sight) and am still adjusting to them and trying to get both eyes working together.
My latest prescription is
sphere cylinder
right +1.25 -0.00
left +1.00 -0.00
reading addition 1.75 : 1.75
I apparently have short and long sightedness, astigmatism and presbyopia. What would you recommend for me?
Secondary questions
I think you mentioned somewhere that the eyes deterioration stabilises around the age of 60. Would it be better to wait until then to have the procedure so that I dont need to have it done again?
Will I need to stop wearing my contact lenses before the procedure?
In the past, I have had a herpes infection in the eyes – would this preclude me from having treatment?
I am currently undergoing investigation for goitre. Would this have any bearing on anything?
You mention in your blogs that some people have thin corneas. Is the cornea like skin, in that it gets thinner as a person ages? If this is the case, does shaving away some of the cornea in middle age cause problems as the person ages, ie does it contribute to the ‘thinness’ of aging?
If you treat one eye for short sight and one for long sight, how would it leave a person who later loses the sight in one eye?
Thank you for your time.
Comment by Dave Allamby on 24 November 2008:
Hi Roby
One Medilar a day is low. You can increase to three a day and see how that helps the tear film. Also add flax seed oil capsules, 2 a day.
Regards
Dave
Comment by Dave Allamby on 24 November 2008:
Hi Linda
If your eyes were healthy, you should do well with laser blended vision, as long as you do not hate the CL trial. However, it does not actually predict that well who will do well with the better optics of our custom approach (customised optics) laser treatment. Have treated many patients with presbyopia, who did not tolerate contact lens monovision.
However, unfortunately, having had prior herpes in the eyes, you would not be suitable for laser eye treatment. Just not worth the risk. However, the good news here is that you may be suitable for a lens based procedure (clear lens exchange or PRELEX) to treat both distance and reading vision. It is similar to a cataract procedure where a small plastic lens is inserted in the eyes in place of your natural lens. It is done with only anaesthetic drops and takes about 10 minutes to do, quite painlessly.
let me know if you would like to get a consultation for this approach
best regards
Dave
Comment by Dawn Maguire on 24 January 2009:
Hi, Can you give me a price based on my prescription please, for the
Z-Lasik surgery,
right eye: SPH -2.25 cyl-0.25 axis 107.0 near +2.00
left eye sph -2.50 cyl -0.25 axis 95.0 near +2.00,
also can you let me know if there is a cost for the consultation, Thank You
Regards Dawn
Comment by Dave Allamby on 24 January 2009:
Thanks Dawn, of course. wavefront Z-LASIK for distance only correction is £1,145 per eye, still needing reading glasses. If you are look to be free of both distance and reading glasses, Z-LASIK blended vision is £1,995 per eye.
Regards, Dave
Comment by Sarah on 24 January 2009:
Hi again Dr Allamby,
I,ve posted before with a query about costs for Z lasik and am booked in for treatment in April (can,t wait !).Based on my prescription you quoted £1145 for one eye and £1245 for the other and suggested a mini blended vision procedure leaving a slight myopia in one eye to lessen the need for reading glasses as I get older. Reading other posts, you have quoted £1995 per eye for Z lasik blended vision.Sorry to be a pain but can you confirm if your quote was for distance correction only or for the mini blended vision procedure? (My apologies if I have mis-read your initial reply…just goes to show how much I need your help to correct my vision!!)
Many thanks for your patience!
Sarah
Comment by Dave Allamby on 25 January 2009:
Hi Sarah
I am sure you are excited about your treatment with us in April! You will be delighted, I know. To confirm the price, we charge mini-blended vision at the distance vision price, not the full blended vision amount. So it will be as I quoted before. We do this for patients who are what we call ‘pre-presbyopic’, where the reading is still good, but reading glasses are not that far away. A mini-blend will help postpone the need for reading glasses for a few years, but while giving you fantastic distance vision too.
See you soon! Regards
Dave
Comment by jan on 12 February 2009:
Hello David, I have had a consultation with optimax this week, but am still unsure. The outcome, I was suitable for Intralase Wavefront Lasik, but still need reading glasses, at a cost of 3,570 (both eyes) or a cheaper option of 1,880 for epi-lazek, not sure if the wavefront treatment was inc. I was then asked ‘how much I would consider paying for the treatment’? Not quiet what I had expected. So I’ve now found you, and seems I may be able to have treatment, and not need glasses, for the moment anyway. I am 51 with a prescription; R.sph+1.25 cyl-0.25 ax105 +2.
L.sph+1.50 cyl-0.50 ax 70 +2. If I am going to spend all this money I want to be sure of getting the best there is out there. I know it is not all about the money, if i’m not confident with optimax’s payment plans, I rather lost confidence in there whole approach.
It is great that you take time to answer all these question, makes decisions a little easier. Ty Jan.
Comment by jan on 12 February 2009:
Thank you. Yes, I have left my details, i’m sure your staff will be contacting me. I believe it is better to be in the best of health and I have an abscess on a tooth, it is being removed in 2 wks, so as soon as that is out, (I feel it won’t be quiet as painless as eye surgery:-(( ). See you soon, Jan.
Comment by Dave Allamby on 12 February 2009:
Hi Jan, agree best to wait until abscess done – the LASIK will be very easy compared to that!! See you then
Dave
Comment by Divya on 13 February 2009:
Hi Dave
I would like to have blended vision/monovision laser surgery, as I am 49 years old and at the moment wear varifocal glasses. Would I have to try monovision contact lenses first to see how I get on with them or is there a simple test that you can do personally to determine my suitability for this treatment?
My prescription is Right Sp -3.25 Cy -2.25 Axis 15
Left Sp -2.25 Cy -2.75 Axis 160
Reading addition +1.75
Would appreciate your expert opinion.
Thanks
Divya
Comment by Dave Allamby on 16 February 2009:
Hi Divya
I know we have ordered some contact lenses for you already. The best thing is to come in and see me briefly where I can test your eyes and also do a short test with contact lenses as planned, only for an hour or two, and see how you respond. Will have a better idea then. Pls call in and ask for Amy, who can arrange a time when I will be there
Regards
Dave
Comment by Sue Rumbul on 16 February 2009:
Hello
I’ve just booked into the Focus Clinic for a consultation (9 March) but I am curious to find out beforehand roughly what the possible outcome would be and also a rough price. My prescription is -8.00 in each eye with a slight astigmatism. I would like the surgery that will have the best possible outcome (Wavefront Lasik?) and do not want a blade to be used as I’m a complete wimp! Thanks in advance. Sue
Comment by Sue Rumbul on 17 February 2009:
Thanks very much. It’s great to know that I could achieve such a great result. It’s quite exciting!
Comment by Erin on 18 February 2009:
Hi Dave..
Love your blog and your transparent way of doing business !
Dave, I am a 22yo from Perth, W Australia and will be touring Europe and arriving in London on May 14 this year. I have been wanting to get Laser eye surgery for some time now and have been assessed as ‘suitable’ by ‘Laser Sight’ in Perth. However, as it is cheaper in the UK (specifically at Focus !) I was hoping to get the laser treatment at your clinic in May. My script has changed from R -1.5, -1.75, 90 and L -1.75, -1.25, 80 on 7/8/2007 to R -1.75, -1.75, 90 and L -2.25, -0.75, 80 on 5/2/2009.
The treatment I would want, as I am touring, would be the one that offers the quickest recovery time, is the least painful and uncomfortable and the most up to date technology. Having read your blog, I believe that would be Wavefront blade free at around £820 per eye. Can you please advise on the following:
1.Am I a suitable candidate for laser eye surgery ?
2.Can I book a free ( LT01) consultation followed by an immediate assessment/surgery on or about May 15 2009. Time is of the essence !
3.Lasik or Lasek
4.Wavefront blade free or other
5.Have you a clinic in Glasgow or Edinburgh Scotland (because I will be there too ?)
6.Follow up within a day and week are ok with my schedule – how important are the 3 and 6 month follow ups ?
7.Is Focus affiliated with any Laser eye surgeries in Perth, WA ?
Thanks – look forward to hearing from you..
Erin
Comment by Dave Allamby on 18 February 2009:
Hi Erin, and thanks! Your trip sounds fantastic.
You sound suitable from all that you have said – and the best approach is wavefront blade free LASIK. It will be the best approach for your higher astigmatism in the right eye. We are a stand alone specialist clinic in London, so sorry, no other centres around the UK. For Australia, my nearest LASIK surgeon friend is in Melbourne.
Pricing is higher than the £820 you mentioned because of the astigmatism in the right and sl higher power in the left so may not give you a huge saving compared to home. The right eye is £1245 and the left £1145. Might be easier for you to do in Perth?
The important visits are the one day, one week and one month for safety. The three and six month visits are about confirming that your focus is on target. Chance of needing an enhancement at our centre would be no more than 1%.
Best regards
Dave
Comment by Erin on 19 February 2009:
Thanks for the quick response, Dave…
I have done a bit more research re Laser surgery in Perth but somehow I feel more assured having it done at Focus !
So, to help me start planning, I have a few more questions :
1. Is the pre-surgery consultation fee included in the quote?
2. Because I will be travelling and not in London to receive a 3 and 6 month check up, would you consider a small discount?
3. How do I go about booking the assessment/consultation followed by the surgery on or around May 15?
Thanks again,
Erin
thanks
Erin
Comment by Dave Allamby on 20 February 2009:
Hi Erin
No problem. To answer your Qs, consultation is included in the fee, and there would be £100 off the total price if you are having the 3 and 6 month check ups back in Australia. The closest regular treatment day is May 19th, Tuesday but may be possible with my consultant surgeon colleague on the 15th. I myself am away on the 14-15th.
I can get one of my team to email to you directly to arrange dates etc. if you like.
Regards
Dave
Comment by Svetlana Collett on 12 March 2009:
Hello Dave,
I booked my consultation for 25th of March, received the information pack and was disappointed that I would not talk to the surgeon during the consultation. Now I have found this fantastic blog and feel as if I’ve already had half of the consultation!
Still, I am doing my research and have a few questions. My prescription is:
Right -7.00cyl -1.50 axis10
Left -6.50cyl-1.50axis15
What would the price be for Z-LASIK and PRK? I would like to have Z-LASIK but a bit paranoid about the flap not healing and corneal nerves damage resulting in dry eye. I suppose it is a bit early to worry since I don’t know if I am suitable for either, but would like to be prepared to make an informed decision. Is there some clinical research or any literature I could look up?
Best Regards
Svetlana
Comment by Dave Allamby on 13 March 2009:
Hi Svetlana, and thank you!!
We haven’t seen problems with the Z-LASIK flaps thus far actually. Plus dry eye issues seem rarer with the blade free flaps and with fewer symptoms than even PRK patients, so that is a nice bonus from the technology upgrade.
Pricing for your prescription as given is £1645 for the right eye and £1545 for the left, for Z-LASIK blade free. For PRK it would be £1295 and £1195 respectively.
Best regards
Dave
Comment by Irfan on 14 March 2009:
Hi Dave!
I have sent and email to (info [at] focusclinics [dot] com)
But since they haven’t answered yet I might as well ask you.
My sight has been stable for a two-three years now.
Last year I did check-up here in Sweden with a clinic for LASIK surgery (blade) but din’t had the guts to go through with it.
I did some internet research and found that the ziemer laser seems to be the best one out there.
So I decided to wait until I found a clinic with Z-LASIK and that I did, in Estonia.
They offer both eyes for €2100, about £1865.
So I went ahead and bought the flight tickets and now I’m seriously considering FOCUS Laser Vision.
I think they told me here I had about -1.25 on the left and -1.50 on the right, I doubt I have more than -2.00.
The lenses I use Focus Visitint (also known as Serene, Focus Monthly).
1. How long do I need to be lens free before the surgery?
2. How much for Z-LASIK at FOCUS Laser Vision for me?
3.
I want to do this as soon as possible
How soon can FOCUS Laser Vision offer me surgery?
4. Since I passed the check with microkeratome here in Sweden I guess that means Z-LASIK is OK too?
Comment by Dave Allamby on 14 March 2009:
Hi Irfan
Thanks for your mail. Z-LASIK with ourselves would be £845 per eye for either -1.25 or -1.50, so £1690 for both eyes. The main factor will be attending for post-ops checks. If you were here for one week, we can do the consult, surgery, one day and one week checks during that stay. You would need one more check a couple of months later. You would need to leave your lenses out for 5 days prior to coming to us. We can do all this within two weeks if needed. If you were OK for blade LASIK before you should be fully suitable for Z-LASIK, but of course we will do a thorough check ourselves to be sure.
Best regards
Dave
Comment by Irfan on 14 March 2009:
Hehe! I just called before I saw your message and the girl on the phone told me you guys will call me on monday, hope so!
Coming to London isn’t a problem at all for me, there are flights from my town everyday.
“If you were here for one week, we can do the consult, surgery, one day and one week checks during that stay.”
I don’t quite see what you mean with this, stay in London for a week?
Are you saying consult and surgery on the same day? If not, can’t it be done on the same day???
Comment by Dave Allamby on 14 March 2009:
Hi Irfan
The two essential safety check ups are the next day after surgery and again after 3-7 days. You cant miss either of these. Of course you could fly back for the one week check, but may be easier for example to have the consultation on a Monday, surgery on Tuesday, check ups on Wed and Friday and fly home on Friday pm. You would next need to attend 6-8 weeks later. Alternatively, you could have consult Monday, surgery Tuesday, check up Wednesday and go home Wed pm, and then fly back after one week for next check.
We dont do same day consult and treatment for safety reasons, as we need to dilate your eyes at the consultation.
Regards
Dave
Comment by Irfan on 14 March 2009:
Great, I’ll wait for FOCUS Laser Vision to call me on monday!
Thanks Dave!
Comment by Irfan on 17 March 2009:
Hello again Dave!
The check up 3-7 days after surgery, could I do that here in Sweden with memira clinic?
Comment by Dave Allamby on 17 March 2009:
Hi Irfan
you would be best to check with that clinic if they do post-op appts from surgery elsewhere and what the charge to you would be.
thanks
Dave