Part 7: LASIK vs PRK/LASEK? Which laser procedure is best?
Dave Allamby | Oct 30, 2008 | Comments 18
Continuing from yesterday:
Some surgeons recommend PRK or LASEK (both forms of surface laser eye treatment and basically the same) over LASIK. The article referred to by Kay in her original post and advocating LASEK was written by ophthalmic surgeon Sunil Shah, who was one of the creators of that particular approach (and so has some personal interest in writing about it one presumes).
One of the very vocal and respected advocates of surface laser (PRK) over keratome LASIK was Professor John Marshall in London, UK, a founding father of laser eye surgery back in the 80s. Prof Marshall argued convincingly that the cornea was considerable stronger after PRK compared to mechanical (thicker flap) keratome LASIK.
However, the game has changed with the introduction of femtosecond lasers with much thinner flaps. Even Professor Marshall now supports the move to thin-flap LASIK using a dual laser, blade-free approach.
So if a clinic cannot offer dual laser LASIK (and many still can’t) they may offer PRK/LASEK instead. There are some clinical reasons to perform PRK instead of LASIK but the percentage of these cases has shrunk from 10-15% down to around 5% today, with dual laser technology. Patients much prefer femto-laser LASIK over PRK, as the latter is fairly unpleasant for a few days post-op.
In summary, there are definite clinical reasons why we as treating clinics have moved over to wavefront LASIK and using a blade-free dual laser approach. More accurate treatments so better vision, removal of an older mechanical device technology and improved long-term safety.
Filed Under: Clinics • LASIK • PRK • Safety • Technology
hi Stevie
People should not be guided by £395 headline prices. The reality is that quality laser eye surgery cost £3-4,000+, ...
Dear Dave,
Like most, I've been researching the possibility of surgery for some time, and have slowly noticed the high street ...
hi my husband went to have his eyes done today and the exact same thing happened!
i complained bitterly and pointed ...
Hi Dave,
My girlfriend has just been for a consultation today with a view to undergoing laser eye surgery. Unfortunately owing ...
Hi Terry, I have had a Lasik eye surgery to correct my vision about a year ago. I have been ...
Hi Dave,
I had Lasik treatment on both eyes three months ago. I now need a recorrection. My surgeon told me ...
I also have TLS and am just now (2 years after surgery) getting treated for it. It's common for it ...
I am in the Canadian army and can't decide on which procedure to go with because I am going to ...
Hi Dave
I've been reading all the posts and they sound very helpful. I've been very tempted to get lazer eye ...
I am 17 and would love to be a pilot in the RAF but am myopic. Do you know if ...
Thank you very much for your answer, it really calmed me down a bit.
Best regards,
Eleonora 
Hi Marie
The Clinical Suitability Guidelines followed when patients are assessed for Laser Eye Surgery at Optical Express are set and ...
Dear Dave
Thanks for the reply and the information you have put my mind at ease and my glasses dont have ...
Hi Dave, Thank you for the information; it has certainly given me food for thought and I'm so glad I ...
Dear Dave
That's really helpful - thank you. I plan to book an appointment at your clinic so that I ...
Hi,
I have just had a consultation for laser eye surgery and have been told that Lasek is more suitable due to thickness of the cornea. However, the consultant also mentioned that they will insert a soft lens which will be removed after 3 days. I haven’t come across anywhere or your blog talking about temporary lens insertion. Please advise.
Thanks
Pal
Hi Rashpal, Yes it is routine to insert a soft contact lens at the end of a PRK/LASEK procedure, which will be removed in the clinic after 3-4 days. The lens has no power but acts as a bandage while the epithelium (surface skin layer) heals, and helps the eye be more comfortable. The lens stays in night and day and no need to touch or think about it. If it falls out, it isn’t a problem. The eye will still heal but it will be more painful or uncomfortable during the first 3-4 days.
Best regards
Dave
Hi,
I’ve been diagnosed as having miopia at -10.00 diopters, my docter has recommended Lasek, but I’m concerned about the long downtime and the long recovery period after the operation. Would you recommend that I do Lasik, or is Lasek really my best and safest option long term.
Hi Shelly
With high myopia not all are possible to have LASIK due to limitations of corneal thickness and pupil size. The best chance is with a thin flap (e.g. femtosecond laser flap) and a laser than isnt tissue hungry, such as the WaveLight Allegretto. Other lasers could remove more tissue for the same prescription, so worth checking with a WaveLight using clinic.
LASEK is also possible, but usually surgeons use Mitomycin C to reduce haze formation. Still, longer recovery time and time for vision to settle (few months).
Regards
Dave
Hi, I had wavefront lasik about a year ago. I had astigmatism and quite a high pescription. I have had all post op checks and was advised at the time that an enhancement would probably be necessary due to my high prescription. I have now been told that my enhancement will be lasek and that it is better to have lasek as I have already had lasik. My prescription is now about 1.25-1.50 and I still have an astigmatism. Does this sound right ? I just got the sense that it was a cost issue and not entirely about my best treatment.
Hi Donna
At one year after we would normally lift up your existing flap and laser under it as in your original LASIK correction, unless there was not enough tissue remaining to be safe. That may be the reason for offering LASEK. You need to ask your surgeon the reason for opting for LASEK rather than a flap lift.
Thanks
Dave
Dave, I do have capsular opacification & do understand what YAG is. I also have a refractive error & know that if I don’t have PRK, Lasik or Lasek, I will still have to wear glasses. However, I think I still need a little more clarification. Although PRK, Lasik or Lasek would eliminate the need for glasses, would the YAG procedure still have to be done because of the capsular opacification or will one of the refractive procedures fix that problem at the same time?
Hi Josi
Yes, you would still need the YAG capsulotomy, which acts inside the eye. The other laser procedures only work by reshaping the cornea at the front of the eye. Think of the latter as manually focusing a camera to get a sharp image, whereas the YAG treatment is like taking the lens cap off. You would need both to get fully clear vision.
Hope that clarifies! Best regards
Dave
I had the Nydek lasik surgery done in 1998 (opted for monovision). In October 2009 I had cataract surgery on both eyes & opted for the ReStore lenses. Now I’m told that due to haze/scar tissue that formed on the capsules holdig the lenses in place, I have to have additional surgery such as YAG capsulatomy, PRK or Lasik/Lasek (not sure which he said) because glasses/contact lenses can’t improve my vision. The ultimate choice is mine. Overall, which procedure do you think would be the best choice, especially taking safety/side affects/results into consideration. I am a 61 yr. old female. My doctor advised that there’s a higher risk of retinal detachment using the YAG capsulatomy procedure vs the other procedures. That procedure is not this first choice.
Dear Josi
If you have capsular opacificaction (of the bag holding the lens) then the procedure you need is YAG laser capsulotomy. You will only need PRK, LASIK or LASEK if you have a refractive error, i.e. you still need glasses to improve your vision.
Best regards
Dave
I have had previous RK 8 cuts. And now have astigmatism and vision is getting blurry in one eye, the other eye is good. I have been told Lasik is not a good option. Is PRK or Lasek an option? What may be the complications. I seem to be getiing a little hesitation from some doctors.
Hi Vincent
RK can lead to a somewhat unstable cornea and LASIK is not a good idea as can leave the flap in wedge shaped pieces (‘pizza slices’). PRK is a better option. About 50% of RK patients drift into longsight by 10 years after the procedure, so getting blurry near vision, or blurry both near and distance vision. The results are less predictable than virgin PRK so hence the hesitation. Also you are lasering away some collagen fibres from an already weakened cornea, which may or may not be significant. Any doctor will want evidence that the cornea is not still changing shape or refraction.
Best regards
David
I can’t decide between wave-front lasik and prk. The doctor said chances of being back in contacts/glasses is 1 in 10,000 with lasik and 1 in 100,000 with prk. I don’t really do sports, so theres no real chance of contact with my eye. I have done all kinds of research and don’t know which procedure is best. My fiance is having prk b/c he is a wrestling coach. Everyone seems to be pushing me towards regular lasik..I have thick corneas, so prk isn’t necessarily neccessary, right? I think I’m overthinking this!
Hi Gina
The final vision will be the same between PRK and LASIK. The chance of returning to glasses is about 1/100 for both procedures, not the figures you were quoted.
Safety is the same. 98% of our treatments are blade free wavefront LASIK, from patient’s preference – no pain, little downtime. Yes, generally we only do PRK for some contact sports people, thin corneas and some very high prescriptions.
The choice though is a personal one too – so up to yourself!!
Regards
Dave
Hi Alenoosh
I have explained this pretty well in my blog postings. Outcomes are the same. We do 96% femto LASIK and 4% PRK and only do the latter in cases of thin corneas.
Dave
Hi
What is the main difference between femto-lasik and PRK ? Which one do you suggest for your patients most ?
My doctor has told me that I’m a good candidate for eye correction surgery , but this clinic does not perform femtolasik surgery but they do PRK. In this case , I want to know if the difference between femtolasik and PRK is really big ( I mean will my cornea become more thinner than with femtolasik ) ? I’m kind of worried about this since I have read about cornea problems after surgery.
Thanks in advance for your guidance.
Alenoosh Baghumian
Hi, would there be any visual difference with LASEK over LASIK? WOuld you still perform LASIK with intralase for someone involved in contact sports such as boxing?
Thanks,
Paul
Hi Paul
For short-sight corrections without significant astigmatism, the result at 6 months post-op will be the same. WIth higher astigmatism, I prefer to perform LASIK over LASEK as the chance of enhancement is higher and this is more easily done with LASIK. For contact sports, it’s a good question. For boxing I tend to go with LASEK/PRK unless it is recreational with always using face guards and upper weight gloves where you could argue a case that the flap contacts risks are low, plus adhesion for femtosecond flaps have been shown to have significantly higher adherence at 10 weeks post-op in animal studies.
Best regards
Dave