Laser Eye Treatment

Before you have Lasik eye surgery (or PRK) you need to understand the difference between the two types of eye surgery, and the impact on your vision.

The original form of excimer laser treatment is known as PRK (photorefractive keratectomy). In PRK, the laser energy is applied to the surface of the cornea, so no additional cutting of the cornea is required. The most popular variation of excimer laser eye treatment is called LASIK (laser in-situ keratomileusis). In LASIK eye surgery, a thin flap of tissue is raised in the front of the cornea, and the lasik surgery is then applied to the tissue beneath the flap.

When the lasik eye surgery is applied to the tissue deep within the cornea instead of to the surface, the vision recovery is much quicker. Patients usually see quite well the day after lasek surgery, as opposed to waiting one or more weeks after PRK.

Neither PRK nor LASIK surgery involves any pain during the procedure, but LASIK eye surgery patients experience less post-treatment discomfort. In fact, many lasic surgery patients take no pain medicine after the procedure. PRK laser eye surgery patients will typically take pain medicine for a day or two. Most of the pain fibers in the cornea are in the surface portion. In PRK, the surface of the cornea is treated with the laser. In LASIK eye surgery, the surface of the cornea is not treated, but is folded back so that the laser treatment is applied to the deeper tissue, resulting in very little post-treatment pain.

Lasik eye surgery

LASIK eye surgery requires an additional surgical step, the creation of the flap. The flap is created with an instrument known as a keratome, which cuts and then folds back a thin layer of the front of the cornea. Creation of the flap takes about twenty seconds. During this time, most people have a feeling of “pressure” on the eye, though some people do feel slight pain. After the laser treatment is complete, the flap is pushed back into its original position. No stitches are used, because the flap is held in position by natural corneal suction.

For most patients, the creation of the flap is the most worrisome aspect of excimer laser treatment. These flaps have been created for other eye procedures for over twenty-five years, so their use in lasik eye surgery is common place. Difficulties can occur with the flap, but in the hands of an experienced surgeon occur less than 1 percent of the time. Most of the complications with the flap are mild and can be easily treated.

By far the most common problem is having the flap slide a little, causing wrinkles in the flap. When this occurs, it is most typically during the first day after the laser eye procedure, before the flap has had a chance to firmly set into position, and is corrected by lifting and repositioning the flap. Improper creation of the flap, resulting in either a partial or irregular flap, is the most serious complication and could conceivably lead to the need for further lasik surgery or could prevent the doctor from performing the laser portion of the treatment.

Most people prefer the LASIK eye surgery procedure because of the rapid vision recovery and minimal post-treatment pain. However, some people are not good candidates for LASIK eye surgery, but are suitable for PRK laser eye surgery. These would include people with very thin corneas, people with hobbies or occupations (such as boxing) where there is a good likelihood they will be hit in the eye, or people with specific, unusual conditions of the cornea. Although these patients might prefer to have LASIK eye surgery, the PRK procedure would be a better choice. The decision of which technique is best in your situation must be made by you and your doctor.