Why would a person choose Epi-Lasik over Lasik?

There are several reasons to choose Epi-LASIK over any procedure that involves cutting a "flap" in the cornea. The two procedures in which the cornea is cut are 1) LASIK in which an exquisitely sharp stainless steel blade is used to cut the cornea and 2) “bladeless” or “Intralase” in which a laser is used to cut the cornea. Both procedures will irretrievably weaken the structure of the cornea just by the act of cutting the flap, because in the healing process, the edges of the flap typically seal overnite, but the inner face of the flap takes many years to heal to the underlying bed of the cornea. It is questionable as to whether or not this healing process will ever restore the cornea to its original structural integrity.

In both LASIK and Epi-LASIK, the second part of the procedure – laser reshaping of the cornea to create the change in focusing of light rays on the retina – the removal of a small amount of the tissue from the deeper layers of the cornea will weaken it slightly, but this amount of tissue removal is usually so slight that its effect on corneal strength can barely be detected.

Epi-LASIK is the modern version of PRK, which is the Laser Vision Correction procedure initially approved by the FDA in 1995, does not involve any cutting of the cornea and therefore does not diminish the structural integrity of the cornea.

Corneal weakening is only one reason that Epi-LASIK is a safer procedure than LASIK. Other reasons are: 1) less dry eye induced, 2) lower potential for complications in the absence of a flap, 3) better potential quality of visual results because perfect healing of a flap is a non-issue.

To my mind, the only disadvantage of Epi-LASIK is a slightly longer recovery period, 3 days vs. 1 day. During those three days, limitations are minimal. I instruct my patients that when they are using their eyes for reading, computer work, or TV viewing, to stop after 20 minutes and close their eyes for one minute.



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