LASEK (laser-assisted sub-epithelial keratectomy or laser epithelial keratomileusis) is an up-to-date type of laser eye surgery. It is a modification of an older version of the surface based excimer laser treatment called PRK (Photorefractive Keratectomy).
Both methods interact with the epithelium (the top layer of the cornea) to gain access to the bottom layer of the cornea called stroma. Any successful laser eye surgery involves reshaping stroma with the laser by creating a “flap” – an incision in epithelium enabling access to the stroma. While PRK removes epithelium entirely, LASEK only brushes it away for the time of the procedure and then repositions it back to heal.
LASEK procedure first loosens the top layer of a cornea with alcohol, which is raised as a flap with a blunt instrument and sponges. Then the laser energy is applied to the exposed layer of stroma to reshape it and afterwards the epithelium is put back. The final step is a placement of a contact lens on the cornea that acts like a bandage for the next few days. The procedure itself is done under local anaesthesia; however, there may be some pain for next 2 to 3 days after the procedure, while the surface of the cornea should heal within 4 days. During the next few weeks, vision may get worse than before the treatment, but it should improve quickly.
LASEK’s big advantage is that it does not involve incisions like older method LASIK or complete removal of the top layer of cornea like in PRK.
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Who is the best candidate for LASEK
First, the candidates must be at least 18 and in good health overall. People with uncontrolled diabetes, autoimmune or collagen vascular disease or taking medicines compromising the immune system should not undergo the procedure. The same applies to the patients with keratoconus, glaucoma, cataracts, corneal disease and certain retinal and optic nerve diseases along with conditions like herpes simplex or herpes zoster. The doctor should be informed if you have amblyopia (lazy eye), strabismus (muscle imbalance) or any recurrent, residual or current eye condition, as well as the tendency to keloid scarring of the skin as that, may influence the healing process. In general, patients should not have any eye injury or infection. Even back problems or claustrophobia may prevent you from the surgery. LASEK is not performed on pregnant or nursing women, due to their unstable hormones level. Stability of vision is also a requirement for the procedure, the candidate ought to have stable vision for at least a year before the surgery and the patient should not have a continuous dry eye condition. Prior to the surgery, you will be also required to avoid wearing contact lenses and the exact time will be determined by your doctor.
How the procedure looks
The surgery is done under local anaesthesia where the eye is numbed by the anaesthetic drops. Then the surgeon positions a small eye-guard called speculum between the eyelids to keep your eyes open and unblinking and you will be asked to look on a target light inside the laser. Next, the top layer of the cornea is loosened with the alcohol for around 30 seconds to create a flap which will allow the surgeon to shape the deep layer of the cornea with the laser. The treatment takes less than a minute and the laser is controlled by the computer. The final step is the repositioning of the epithelium and applying contact lenses that act like a bandage.
The procedure is painless, however, you will feel that your cornea is being touched/brushed.
Recovery time after LASEK
Healing time after LASEK takes from 4 to 7 days with the check-up at the clinic on the 4th day after the treatment to remove the healing contact lenses. For one week you will be applying the drops and there might be soreness of the eyes for 2-3 days after the surgery. LASEK requires taking at least a week off, as your vision may be blurry for few days after the procedure, however, most of the patients are able to drive and return to work within 2 days.
Risks and complications after LASEK
Below you will find the list of typical post-surgical complications of LASEK:
• Blurry vision, halos and glare
• Dry eye
• Infections or irritation of the eyes
• Overcorrection, undercorrection or regression of vision which may require another surgical procedure or wearing glasses/contact lenses
There are few cases when the flap created from the topmost part of the cornea is too thin to be repositioned and needs to be removed completely as in PRK. Not considered of being a risk, if you are short-sighted with high degree, there is a higher likelihood of having a hazy vision after the surgery.
Recovery after LASEK is longer than after LASIK, as the alcohol used during the procedure causes tissue damage to the topmost layer of the cornea which slows down the healing.
LASEK aftercare and post-surgical instructions
As mentioned before, the time to heal after LASEK is prolonged due to the use of alcohol solution dissolving the epithelium and it may take from 4 to 7 days. During the first few days, your vision may be blurry and it is recommended to take at least one week off, while people with high degree of myopia may need even more time to recover. The best results are achieved between one to four weeks.
You will also be required to have a doctor’s appointment during the first week after the surgery, then again around the second week, and further after 6 weeks, 3 months and 6 months.
• You may expect discomfort and soreness up to 4 days after the procedure, usually, it alleviates significantly around the 3rd day
• Healing contact lenses are placed straight after the surgery and removed by an ophthalmologist during the check-up visit within 4 to 7 days after the procedure
• You will require putting drops for next few days
• Your vision will return from 30 minutes 3 or 4 days after the surgery (in case of high prescription it may take longer), so you can drive after your vision become stable again
• On the first day relax and rest your eyes as much as possible, you may read, watch TV or use the computer
• Avoid strenuous activity for first 24 hours after the surgery
• You are not allowed to wear eye makeup and use lotions for one week
• It is best to take one week off from work, however, you may come back to work when you feel able to
• Avoid getting water in your eyes for a week after surgery and you should refrain from swimming for one month
• Avoid sunlight and ultraviolet radiation
LASEK success rate
The aim of the laser eye surgeries, in general, is the correction of myopia, hyperopia, and astigmatism reducing dependency on glasses or contact lenses.
Two-third of patients after the surgery can see 6/6 (20/20) or at least better without the corrective lenses and 96% can see well enough to drive the car.
Cost of LASEK surgery
LASEK in Poland starts from £470 per eye while in the UK prices start from £1200 per eye.
If you decide to correct your eyesight with the surgery, you should consider having your LASEK abroad, as it may be much cheaper. If you wish to undergo eye surgery in Poland, feel free to contact Beauty Poland and we will help you with organising the procedure.