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Laser Options

Methods: Deep Ablation vs Surface Ablation

ASA, LASIK, LASEK, epi-LASIK and PRK, commonly referred to simply as laser vision correction or refractive surgery, are similar surgical methods designed for the correction/elimination of myopia, hyperopia, and astigmatism performed by an ophthalmologist using a laser. In all cases the Excimer Laser is used to reshape the cornea to improve ones vision without glasses or contacts. The difference in these methods is at what layer of the cornea the laser “reshaping” is performed: on the surface or under a flap. The advantages and disadvantages of one procedure over the other are discussed below. Dr. Nelson highly recommends Surface Ablation over LASIK.

Deep Ablation: aka LASIK

LASIK is similar to other surgical corrective procedures except that it involves the “cutting” of a flap of corneal tissue on the eye prior to performing the “vision correction” with the excimer laser. It is performed as follows:

Flap creation: A corneal suction ring is applied to the eye, holding the eye in place. Once the eye is immobilized, the flap is created. This process is achieved with either a laser or blade. A hinge is left at one end of this flap. The flap is retracted away in preparation for the Excimer Laser Procedure.

Laser remodeling: The second step of the procedure, where the actual visual “correction” is performed, uses an excimer laser to reshape the cornea. The laser vaporizes and “shapes” the cornea in a finely controlled manner without damaging the adjacent tissue. No burning with heat or actual cutting is required to remodel the tissue. The layers of tissue removed are only tens of microns thick and are dependant on the patients prescription.

Repositioning of the flap: After the laser has reshaped the cornea, the flap is repositioned over the treatment area by the surgeon and checked for the presence of air bubbles, debris, and proper fit and adhesion to the eye. The flap remains in position with the aid of a contact lens until natural adhesion of the flap occurs over several days. Touching or rubbing the eye after the procedure may dislodge the flap and/or cause wrinkling of the flap.

Advantages: Less disruption of surface cells and thus vision clears faster. Reduced likelihood of discomfort during the initial healing period (1-5 days).

Disadvantages: Greater potential for complications due to the additional steps of cutting and repositioning the tissue flap. An additional laser is required to cut the flap. Potential for flap wrinkling and dislocation after the procedure. Flap creation can be uncomfortable due to the suction pressure applied. Flap creation may weaken the eye by thinning its outer layers.

Surface Ablation: aka ASA, LASEK, epi-LASIK & PRK

Surface Ablation is a variation of LASIK that acheives the same vision correction procedure without cutting a flap in the eye. The reduced potential risks of this approach over LASIK surgery has led to a growing resurgence in its popularity. Instead of cutting (laser or blade) a flap in the cornea, the laser correction is performed painlessly on the “surface.” The surface cells (epithelium) then rapidly “heal over” in a few days time. This spares the patient from the potential complications associated with having a “flap” created in the eye.

Because Surface Ablation does not require flap creation the cornea’s structural integrity is less weakened. Reduced thinning of the cornea preserves the eyes integrity and allows for more patients to qualify for laser vision correction.

Surface Ablation patients do not experience the risks of having a torn, dislocated, or wrinkled flap which may occur (especially with trauma), at any time after having traditional LASIK. You do not need to worry about rubbing your eye or bumping it after surgery and having the LASIK flap slip or wrinkle because there is no flap. Also, the cornea’s nerve endings that help control tear secretion are not cut so there may be less of a issue with dry eye.

Advantages: Reduced complication rate: potential flap complications, during and after the procedure, are eliminated since no flap is created. Faster (only one laser treatment required not two) and more comfortable procedure (no suction ring used). Eyes without flaps have “stronger” corneas.

Disadvantages: Requires additional time for the for the vision to clear as the surface cells heal. Increased likelihood of discomfort during the initial healing period (1-5 days).