LASEK, Laser Epithelial Keratomileusis, is a relatively new laser vision procedure that combines elements of PRK and LASIK. LASEK is used to treat low to high levels of nearsightedness, farsightedness and astigmatism. The Laser Eye Center of Los Angeles and Orange County chose LASEK as a treatment option because it may offer some advantages over PRK and LASIK, including reduced risk of flap complications and postoperative haze.
Instead of removing the epithelium, like in PRK, the surgeon loosens the epithelial flap with a diluted alcohol solution then moves it aside. The surgeon treats the surface under the epithelium with the laser then returns the epithelial flap to its original position. Studies indicate that using the epithelium flap as a natural protective bandage with LASEK, as opposed to completely removing the epithelium as with PRK, may improve healing and the incidence of postoperative haze. Because the microkeratome is not used in LASEK, as in traditional LASIK, the risk of flap complications is significantly reduced.
In the nearsighted eye, the cornea is very steep. When treating nearsightedness, the surgeon flattens the steep cornea by removing tissue from its center. This moves the point of focus from in front of the retina to directly on it.
In the farsighted eye, the cornea is very flat. To treat farsightedness, the surgeon removes corneal tissue outside its central optical zone to make the cornea steeper. This moves the point of focus from behind the retina to directly on it.
The cornea in an astigmatic eye is elongated, resembling a football. To treat astigmatism, the surgeon shapes the cornea into a sphere, like a basketball. This eliminates multiple focusing points within the eye and creates one point of focus on the retina. Astigmatism can be treated at the same time as nearsightedness and farsightedness.
LASEK is for Those Who:
- Want to reduce or eliminate their dependence on glasses or contacts.
- Are at least 18 years of age.
- Have had a stable eye prescription for at least one year
- Have no health issues affecting their eyes.
- Have wide pupils.
- Have corneas too thin for LASIK.
Before the Procedure:
Make arrangements before the procedure to have someone drive you home. Your eyes will be blurry for a short while after surgery. Also, set up an appointment for the day after your procedure for a follow-up examination.
Arrive at the Laser Eye Center about an hour before surgery. After check-in, you may receive a sedative to help you relax. The nurse will clean the area around your eyes and apply a sterile drape. Next, the nurse will administer anesthetic eye drops to numb your eyes. When your eye is completely numb, the nurse will position an eyelid holder between your eyelids to keep you from blinking during the procedure.
During the Procedure:
During LASEK, the doctor will cut the epithelium using a fine blade, called a trephine, into an ultra-thin flap. Next, the doctor will cover the eye with a diluted alcohol solution for about 30 seconds to loosen the edges of the epithelium. Once loosened, the doctor will gently push the epithelial flap out of the way to reveal the stroma, the mid-section of the cornea.
You will be asked to look directly at a target light while the doctor reshapes the corneal stroma with an excimer laser. The laser treatment takes less than a minute or two, depending on the amount of correction needed. After the cornea is altered, the doctor will reposition the epithelial flap and cover the eye with a temporary bandage contact lens to keep the epithelium in place and reduce post-operative discomfort.
Finally, the doctor will examine your eye with a slit-lamp microscope. You will be given additional eye drops and your eyes may be shielded for protection. At first, your vision may be blurry; so remember to arrange in advance for someone to drive you home.
After the Procedure:
Relax for the rest of the day. You may experience mild to moderate discomfort for two or three days. You will be given instructions on how to manage this discomfort before you leave. Most patients resume normal activities within two to three days. Some people may experience sensitivity to light, watering or swelling for a few days following their procedure.
The day after your procedure, you should return for a follow-up examination. Most people may see well enough to drive the next day but we recommend that you do not operate a vehicle until you have been examined. You should be able to resume your normal activities the day after surgery.
Vision can fluctuate for up to six months, but most people can see well enough to pass a driver’s license vision exam following their procedure.