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LASEK stands for laser-assisted subepithelial keratectomy. It is sometimes called epi-lasik. It is similar to LASIK except in one important way–no corneal flap is necessary. With LASIK, a corneal flap is created, beneath which the laser removes corneal tissue to correct a prescription. With LASEK, no thick corneal flap is required; the laser removes tissue directly from the surface of the cornea, after the very superficial layer or covering called the epithelium, is temporarily removed. The laser treatment itelf is identical.

Surgical Procedure
Remember that the cornea has many layers. The very surface layer is called the epithelium. This layer behaves very much like the superficial layer of the skin, the epidermis. The epidermis is contantly being shed and replaced with new epidermis. The corneal epithelium likewise is constantly growing and being replaced. The corneal tissue beneath the epithelium is much more firm and thick; it is called the stroma.

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In the lasek procedure, the epithelial or surface layer is loosened with a softening agent made of dilute, medical-grade alcohol. The sheet of loosened epithelium is then carefully pushed aside, much like you would push a throw rug aside to vacuum the carpeting underneath. The exposed corneal stroma is now ready to be lasered.

After the laser correction has been performed, the sheet of epithelium is pushed back into place, to cover the remaining corneal stroma. Usually, a soft contact lens is placed onto the cornea for protection and comfort. Standard antibiotic and non-steroidal anti-inflammatory drops are placed into the eye at the conclusion of the procedure.

Epi-LASIK is very similar to LASEK, in that the surface layer, the epithelium, is separated from the underlying corneal stroma, but it is done using a mechanical device rather than an alcohol treatment.

There are some patients who are not candidates for lasik because they have corneas that are too thin (see Corneal thickness and Pupil size). The stronger a prescription, the more corneal tissue that has to be removed with the laser (the deeper you have to go). There is a limit to how much tissue can be safely removed with laser vision correction. To use an analogy, I can make the walls of a house thinner, but if too thin, they may not hold up the roof. If a person does not have corneas thick enough to safely correct his or her prescription, lasek may be an alternative. Since no corneal flap is needed, the laser removes corneal tissue more towards the surface, leaving more untouched tissue below. The more untouched tissue left behind, the stronger the cornea as a whole.

Other patients may not be candidates for lasik because their corneas exhibit an irregularity which makes lasik unsafe. These corneal dystrophies, as they are known, make the superficial epithelial layer very loose under normal circumstances. With lasik, it is important that the epithelium be left intact at the conclusion of the procedure. Patients with certain corneal dystrophies are ideal candidates for lasek.

Patients who have dry eye may fare better with lasek than lasik. Lasik can be associated with dry eyes; usually, this is a temporary situation. It is felt that the creation of a lasik flap can contribute to dry eyes by compromising corneal nerves. Since no flap is made with lasek, such compromise is less likely.

Some patients prefer to have lasek rather than lasik, simply because they don’t want a flap.

Recovery and comfort with LASEK compared to LASIK
Visual recovery with lasek is slower. It is hard to predict how quickly vision will improve, but improvement begins immediately. Most patients are able to pass the driver’s vision test within a few days of the procedure. Most can return to work within a week.

The lasek procedure is not painful. There is no pain during the actual procedure. Patients may have irritation after the surgery, during the healing period. Even though the epithelium layer is intact, it needs to remodel (like rearranging your clothes to make them fit better). With appropriate use of drops, and pain medications, if necessary, lasek patients can have an uneventful recovery period.

Visual results with LASEK
The visual results are just as good as those with lasik. There is no compromise with the vision.

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