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Different Types of LASIK

A Comprehensive Guide to LASIK and
Other Vision Correction Methods

LASIK (Laser Assisted In-situ Meratomilusis) has become one of the most popular vision correction procedures over the past 20 years. It is quick, relatively affordable and can achieve excellent visual outcomes under experienced hands. However, there are a bundle of different acronyms and terms used to differentiate different types of Laser Vision Correction. Here, we explain a few of them with their unique features and benefits:

All-Laser LASIK

(Also Known as Bladeless LASIK)

During a LASIK procedure, the surgeon creates a flap in the cornea (clear dome in front of your eyes), underneath this flap another laser is used to reshape your cornea. This is generally a safer option compared with the older technology of using a microkeratome (a blade) for the flap creation. Learn more here!

Contoura LASIK

(Topography-Guided LASIK)

This is a relatively new option that can potentially offer vision that is better than 20/20. The magic is in the topography guidance, whereby the treatment is guided by the unique shape of the patient’s cornea. Our corneas have micro-irregularities that contribute to blurring of the image. Dr. Cohen takes pride in being one of the first surgeons in the Tri-state area to offer this technology to his patients. Learn more about Contoura!

PRK

This is considered the least invasive way to correct your vision, since there is no cutting of a flap with a blade or a laser. So it is both bladeless and flapless surgery. Instead of creating a flap the laser treatment is applied directly to the surface of the cornea after removing the epithelial layer.
The epithelial layer regenerates within a few days and the vision is restored. This procedure is perhaps most applicable to candidates that have thinner corneas or otherwise are not candidates for LASIK. Since less tissue is manipulated the chances of late complications of LASIK like keratoectasia are significantly diminished. The downside is that the healing period is significantly longer than LASIK. Whereas most LASIK patients can see 20/20 the very next day with PRK the healing is more prolonged and there could also be some pain or discomfort in the eyes the first few days. Even after the healing of the epithelium it takes a variable amount of time for the vision to reach 20/20. This time is on average two weeks, but can vary anytime between 1-6 weeks depending on the individual. Also, PRK has its own risks including corneal scarring which can happen with higher prescriptions. After the PRK procedure some patients may be advised to restrict exposure to the sun for a few months or use sunglasses while outdoors.
Overall, PRK is another tool in the surgeon’s hands to deliver better vision to the right candidate. It cannot be uniformly considered superior or inferior to LASIK but the choice needs to be custom tailored to the patient.
At the CEI our comprehensive screening exam is designed to not only check your candidacy for LASIK, but to determine if it is at all safe to operate on you and if so, what surgical modality will achieve the best results with the lowest risk.

LASEK

(No Blade, No Flap Surgery)

This procedure is very similar to PRK except that the epithelium is being repositioned after the treatment, rather than just removed. Many would argue that once the epithelium is removed, it is considered devitalized tissue and putting it back does not make much sense, since it may interfere with or delay healthy epithelial regeneration. Others would argue that the epithelium could provide enhanced comfort while it is being replaced. Mostly see LASEK and PRK as very similar procedures.

IntraLASIK

A type of All Laser LASIK performed with the Intralase Femto laser (somewhat older device and terminology)

EpiLASIK 

An outdated practice. Similar to LASEK except that the epithelium is being removed with a device similar to the microkeratome used in old fashioned LASIK. This procedure has been mostly abandoned due to problems inherent in a mechanical cutting or scraping device.

Thin Flap LASIK

A thin flap LASIK is very similar to All Laser LASIK except that the flap thickness is somewhere between 70-90 microns (each micron is 1/1000th of a millimeter) instead of 90-120 microns. The argument is that a thinner flap will be less likely to interfere with the thickness and integrity of the cornea. However, a thinner flap could also lead to other types of complications like increased incidence of flap Striae and problems with the shape and integrity of the flap itself during the surgery. Most surgeons agree that a difference of 20-30 microns does not justify the extra risk sustained by a thinner flap. This option could still be viable for people that are borderline candidates between LASIK and PRK.

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