Monday, April 10, 2006

LASIK or epi-LASEK laser eye surgery?

Having booked my consultation I'm now finding myself thinking more and more about laser eye surgery. From a hazy 'oh yes, that would be good' to now really concentrating on the risks and benefits, the pain, the recovery time, the after care treatment, the chance of success... and all those other things that start your head swimming if you don't organise your thinking.

My main question at the moment is whether I prefer the idea of LASIK or epi-LASEK laser eye surgery. Here are the basics of the two as I understand them:

--------------------------------------LASIK----------------------------
Anaesthetic is dropped into your eyes to prevent any pain. You will then have a layer of your cornea surgically cut and 'flapped over'. The laser reshapes your cornea beneath and then your 'flap' is placed back onto your eye. It will stay in place by natural suction but you will need to wear a protective eye shield for around 24 hours to prevent yourself from rubbing your eyes and disturbing the flap as it settles back.

Pain: Less than epi-LASEK laser eye surgery as the flap of cornea is put back right where it was before. Pain is usually said to come on a few hours after surgery and last for around 24 hours. Most things I've read have likened the 'pain' to just a level of discomfort - like having grit in the eye or an uncomfortable contact lens.

Recovery time (when can I go back to work?): I've read that people can often go to work the next day after LASIK laser eye surgery! Realistically I think I could have the surgery on a Thursday or Friday, have the weekend off and then be fit for work on the Monday - obviously so long as all goes well. Clear vision is usually within 2-3 days.

Risks: Because there is a physical cut made into your cornea there are much more risks with this form of laser eye surgery. Besides the potential for surgical mishap (who doesn't shiver at the idea of someone cutting into their eye?) there is also issues about the flap growing back not exactly as it was before. The cornea is also thought to be weaker following the surgery and it's not recommended for anyone likely to encounter physical contact - sportsmen / police officers etc.

Next after care appointment: You go back the day after your surgery to check all is well.

My concerns: Potential for dry eye and concerns about working with VDU's.

---------------------------------------Epi-LASEK--------------------
After anaesthetic drops are put in your eyes, an alcohol solution is put into your eye to weaken the cells so that a layer of your cells (epithelium) can be moved aside. The laser reshapes your cornea and then the cells which were moved are replaced. You wear 'bandage lenses' non stop for 3 days to keep your epithelium in place.

Pain: Little is felt for the first 24 hours thanks to the anaesthetic drops, but then it comes on a lot stronger for around 3 days. I have yet to read what people compare the level of pain to - but then we all have different pain thresholds so it wouldn't be a great guide anyway.

Recovery time (when can I go back to work?): I would need to take at least a full week off and possibly would only just be able to drive again after 7 days following epi-LASEK laser eye surgery.

Risks: Much less than LASIK laser eye surgery because there is no cutting made, but the risks of the laser and vision - overtreatment, undertreatment, halos etc are all still there.

Next after care appointment: You go back after 3 days to have your 'bandage lenses' removed and to check all is going well.

My concerns: Length of time for recovery - will I be fit to drive after a week?
Pain - how much and how controllable will it be?


Links:
Royal College of Opthamologists - Patients Guide to Excimer Laser Refractive Surgery [PDF download]
www.optimax.co.uk

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