Advantages of Lasek and Epi-lasik over Lasik and PRK
There are several advantages of Lasek and Epi-lasik over Lasik and PRK.
Limitations of PRK are postoperative pain, prolonged or slow visual rehabilitation and the corneal haze in which its incidence will increase with higher refractive error. Stabilization period of vision is long in PRK.
Lasik overcome PRK due to less or no postoperative pain, faster recovery period and less corneal haze even in high myopia.
Lasik has complications like complications related to microkeratome and flap creation, interface related complications ,which are the complications that occur in the space between the cornea flap and the residual corneal bed.
Example of interface complication is diffuse lamellar. Also in patient with thin cornea, the risk of corneal ectasia will increase. Read more about Lasik Complication.
Doctors can consider lasek and epilasik when the patient is not a good candidate for lasik treatment as in:
1- Patient with thin cornea but there is no sign of keratoconus because keratoconus is contraindication for lasek and epilasik.
With thin cornea,the remaining part of the cornea after laser ablation in lasik will not be enough to protect the cornea from minor trauma and also will not protect the cornea from normal intraocular pressure which will keep pushing forward on the thin cornea causing cone shape cornea and high refractive errors and also these patient will be at risk of perforated cornea with minor trauma
2- Patients with steep and flat cornea. Because the risk of flap related complications will increase
3- Patients with narrow palpebral fissure or deep set eyes because the microkeratome won't fit properly on the cornea
4- Patients who are more predispose to trauma like military personal and athletes because the flap will not healed completely and with trauma there will be a chance of flap dislocation.
5- Patients with large pupil will have high order aberrations like halos and glare after lasik. To prevent these high order aberrations, the size of ablation zone should be larger than the pupil size but in lasik the size of ablation zone has limits to preserve corneal tissue and so they are not good candidate for lasik but they can undergo lasek or Epi-lasik because with them the size of the ablation zone can be made larger than the pupil size.
6- Patients with dry eye are at high risk to develop severe dry eye post lasik than after lasek or Epi-lasik because the lasik flap will cut through corneal nerves which play a role in tears secretion.
7- Patient with glaucoma can be at high risk in lasik due to high intra-ocular pressure that is created with suction ring which can add more pressure on optic nerve and can cause further damage.
Although lasek and epilasik have some advantages over lasik but still lasik has some advantages over them.
With lasik there will be less postoperative pain, the recovery period is faster in lasik. Visual stabilization with lasik is faster and the incidence of corneal haziness is extremely low after lasik.
Due to extensive use of steroid in Lasek and Epi-Lasik, there will be a risk of inducing glaucoma after those two procedure but still the incidence can be reduced by which can be prevented by continuous monitoring of intraocular pressure and by using weak steroid.