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A growing number of the country's refractive surgery leaders are now choosing to perform epi-LASIK on an increasing number of their patients for laser vision correction. The cornea, a thin clear layer covering the front of the eye like a window, is the part of the eye where laser vision correction is performed. The cornea is composed of 3 layers, the outer epithelial layer, the middle or stromal layer (which comprises about 90% of the total corneal thickness), and the inner or endothelial layer.
There are currently 4 different laser vision correction modalities:
- PRK (Photorefractive Keratectomy)
The epithelium is removed by scraping, by a brush, or by the laser itself prior to laser correction
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LASEK (Laser Assisted Sub Epithelial Keratectomy)
Dilute alcohol is used to loosen and remove the epithelium prior to laser correction
- LASIK (Laser In-Situ Keratomileusis)
A flap is cut through the upper third of the middle or stromal layer of the cornea prior to laser correction
- EPI-LASIK
An automated separator (not a blade) gently slides the epithelium off the cornea prior to laser correction. This separation occurs along a natural occurring membrane in the cornea.
Epi-LASIK is safer than PRK and LASEK
In PRK, the mechanical injury to the epithelium causes significant pain, longer visual rehabilitation, and potential haze of the cornea. In LASEK, the toxicity of the alcohol reduces the survival rate of the remaining cells in the cornea stroma. Following epithelial cell injury with PRK or LASEK, the cell walls break open causing release of cytokines or chemical mediators that communicate with other cells. These cytokines in turn activate keratocytes located in the stroma. Once keratocytes are activated, they initiate programmed cell death. Activated keratocytes have been demonstrated to initiate haze and regression (reversal) of the laser effect on correction. Epi-LASIK eliminates the need for alcohol and scraping, thereby decreasing the risk of haze, pain, and light sensitivity after the procedure.
Epi-LASIK is safer than LASIK
Although complications with LASIK surgery are rare, when they do occur, they are often associated with the microkeratome cutting blade. These include creation of an incomplete flap, inconsistent flap thickness, striae/folds of the flap, inflammation and debris in the interface of the flap, late flap trauma, etc. Epi-LASIK makes laser vision correction (LVC) safer by replacing the microkeratome's cutting metal blade with a plastic separator that gently pushes the epithelial cells to one side in preparation for laser correction. LASIK cutting of the stroma produces 2 parts that will never completely seal. Because epi-LASIK separates, and not cuts, along a natural separating plane in the cornea, the structural stability of the cornea is preserved.
In addition, recent studies show that the creation of a stromal flap leads to increased higher order visual aberrations post-operatively, which can contribute to halos and night vision problems. This is because the flap is created by a mechanical device which does not cut a consistent flap. Because epi-LASIK creates the flap more superficially and along a natural membrane, these aberrations are significantly decreased.
Dry eye symptoms associated with LASIK are the most common cause of post-operatively dissatisfaction and can occur in nearly 60% of patients. This is because creation of the LASIK flap in the corneal stroma cuts through the area where the nerves enter the cornea, thereby severing more of the nerve fiber bundles which leads to dry eyes. Because epi-LASIK separates far more superficially, most of the nerves remain intact, thereby decreasing the incidence of dry eye after laser vision correction.
EPI-LASIK: ADVANTAGES
- Preserves the structural stability and integrity of the cornea because there is no intra-stromal cut as in LASIK
- Lower risk of potential intra-operative and post-operative complications associated with creation of stromal flap in LASIK
- Less haze than PRK/LASEK
- Faster visual rehabilitation than LASEK
- Eliminates need for alcohol and other injury in removal of the epithelium
- Lower risk of extended dry eye problems
WHO IS A CANDIDATE FOR EPI-LASIK?
Epi-LASIK is a good option for patients who do not want a surgical flap on their cornea, who want minimal risk and desire no cutting, as well as patients who might otherwise not be good candidates for LASIK procedure because of corneal thinness, dry eyes, and/or vocational/extracurricular activities that could lead to flap trauma, such as participation in martial arts or contact sports. Patients who should not have epi-LASIK are those who have had previous refractive surgery, previous cornea surgery, or corneal transplantation. The minimum age for surgery is 18 to 21 years of age and candidates should have a stable glasses/contact lens prescription for at least one year.
WHAT CAN I EXPECT AFTER THE SURGERY? A bandage contact lens is place on your eye after surgery to allow for healing. After surgery, you will have to wear a protective eye shield and can usually return to work or normal activities within the next several days. Vision generally begins improving in about a week's time. Restrictions include:
CALL for a free screening appointment to determine if you are a candidate for laser vision correction at 501-223-3937.No swimming or hot tub use for a week No make-up, lotions, perfumes for a week No eye rubbing for 6 weeks
How We Are Different than Most Refractive Practices
Laser vision correction is surgery on the cornea of the eye. Dr. Blair is a cornea specialist with extensive training in corneal surgery. In some laser centers, you often do not meet the surgeon until just before your procedure. Many patients do not realize that the chain centers delegate the most important part of the surgical pre-operative planning to non-surgeons. In contrast, Dr. Blair is involved in the whole process, starting from the initial free screening consultation and continuing through the post-operative period. THIS IS CRUCIAL to achieving the best result. Only your surgeon can customize your Laser Vision Treatment to fit your needs.
Dr. Blair will take the time to explain the risks to you. If she feels you are high-risk, she will give you an honest opinion that you should not have the surgery. On the day of surgery, you are given a cell phone number so you can have immediate access to Dr. Blair if any problems should arise.
We understand that the decision to undergo a surgical procedure on your eyes is a very big decision that should not be taken lightly. You will evaluate the results of your surgery for the rest of your life.
FINANCING
Studies show that the 2 factors keeping patients from considering laser vision correction are safety issues and financial issues. With epi-LASIK, the safety profile of the procedure is increased over other laser vision correction modalities.
To help with the financial considerations, we offer the following:
In addition, we offer discounts to the following groups. This also applies to family members. (NOTE: If you fall into more than one group, discounts can not be combined).
Pleasant Valley Ophthalmology 11825 Hinson Road, Suite 103 Little Rock, AR 72212-3404
Office 501-223-3937 Fax 501-223-8656 disclaimer