A Laser Eye Surgeon’s Confession: I Love LASEK

Yes, you read that right. I love LASEK. I fully admit it. When done properly it is a great procedure.

Quick story: I recently had a Navy veteran in for a Laser Vision Correction consult. He told me that the Navy requires LASEK to be performed on all of its pilots. So if you are going to land a plane on a ship, you have to go with LASEK (or equivalent) instead of LASIK. Who would not want the same LASEK technique used on them as the Navy demands for its pilots?

To review, there are 2 FDA-approved laser eye surgery techniques, LASIK and LASEK. Lasik involves cutting and making a flap in the deeper layers of the cornea while LASEK involves loosening up the surface skin cells of the eye, creating a surface flap. Either the deeper LASIK flap or the superficial surface flap is moved to the side and a programmed laser treatment is applied that basically etches the patient’s glasses prescription into the cornea. The actual laser vision correction portion for both techniques is the same. They only differ in how deep you go into the cornea. Here’s a visual example of whay I’m talking about:

Laser Vision Correction - LASIK and LASEK

To clarify, I’m not talking about old PRK from the 1990s, when it took patients 3 weeks to get back to work with a miserable recovery period. Those days are over. Newer techniques such as LASEK and Advanced Surface Ablation now make flap-free laser eye surgery a great option.

Don’t get me wrong, Lasik (which by definition involves a corneal flap) is great, but modern LASEK is so much smoother to me.

The advantages of LASEK over LASIK include:

  1. Less dry eyes. I hear of patients having bad dry eyes for 6 months after LASIK . Wow! I cannot remember the last time I had persistent post-op dry eyes after LASEK.
  2. More long term data and better established safety profile. LASEK has been around for 20 years now and the safety of the procedure is unparalleled. In fact, if we laser eye surgeons have any doubt about a case such as thin corneas or dry eyes the trend is to change to LASEK and not take any risks with cutting a flap LASIK.
  3. Faster and more forgiving surgery. With LASEK I don’t have to deal with lifting a corneal flap and making sure patients don’t rub their eyes (risking dislocation of my flap afterwards). Sometimes I get panicked phone calls from patients, “Doc, I rubbed my eyes and I’m worried I ruined my surgery.” I have to admit it’s really nice to reassure them that with LASEK that is not an issue and that they will be fine. In fact, my classic line to patients is, “Just don’t rub dirt in your eye after surgery and you will be fine.”
  4. Patient fear. I think this is the most important aspect of laser eye surgery.
    Rule #1 of laser vision correction: the patient is afraid.
    Rule #2: they are still afraid.

Like anything else, medical offices morph and change. I now find myself saying that I specialize in those that are afraid of Laser Eye Surgery. Rather than dance around the issue of people being afraid of having somebody operate on their otherwise healthy eyes, I prefer to address it openly. Time and again when performing minimally-invasive LASEK, patients have asked me right before surgery, “You’re not going to cut me, right?” When I look them in the eye and say no, they relax and are visibly relieved. That reassurance to them is priceless.



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