About the Author

author photo

Mr. Dave Allamby FRCS FRCOphth is a London-based LASIK laser refractive surgeon and heads up FOCUS Laser Vision. 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 rock giant Rick Wakeman and broadcaster Paul Ross. FOCUS is a world-leading clinic in the treatment of presbyopia, or age related loss of close vision and offers LASIK laser eye treatment for short sight or long sight.

See All Posts by This Author

LASIK and PRK - Which is Safer?

June 15th, 2008 • Related • Filed Under

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).

Share/Save/Bookmark

Technorati Tags: , , , , ,

    • There Are 7 Responses So Far. »

    1. 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

    2. 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

    3. 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

    4. 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

    5. 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

    6. 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

    7. 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.

    Post a Response