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Epi-LASIK Laser Eye Surgery – An Alternative to LASIK

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Epi-LASIK, like LASEK, is a modification of PRK and an alternative to LASIK eye surgery for the correction of nearsightedness, farsightedness and astigmatism.

Epi-LASIK, LASEK and PRK are all considered surface ablation procedures because they do not involve the creation of a LASIK-style flap in the cornea. Surface ablation procedures are sometimes preferred over LASIK because they eliminate the risk of flap complications.

Further, since the laser reshaping of the eye requires less tissue when a LASIK-style flap is not created, Epi-LASIK, LASEK and PRK often can be performed safely on corneas that are too thin for LASIK surgery.

However, all surface ablation procedures require longer recovery periods after surgery than the time it takes for vision to stabilize after LASIK.

The Epi-LASIK Advantage (Over LASEK)

Epi-LASIK is most similar to LASEK. In both procedures, the thin outer protective layer of the cornea (the epithelium) is removed from the central cornea and pushed to the side, with the intention of replacing it after the central cornea is reshaped with an excimer laser.

What differs in the two procedures is how this is done. In LASEK, the epithelium is cut with a cylinder-shaped blade called a trephine and is briefly covered with an alcohol solution to loosen it from the underlying corneal tissue (called the stroma). In Epi-LASIK, the epithelium is pushed to the side with a precise mechanical instrument called an epithelial separator. No use of alcohol is needed to soften or loosen the epithelial cells.

Proponents of Epi-LASIK claim the procedure causes less post-operative discomfort than LASEK. The reason given for this is that there is no toxicity damage to corneal cells because no alcohol is applied to the eye.

As with LASEK, a bandage contact lens is applied to the eye after epi-LASIK surgery to hold the epithelium in place after it has been returned to its original position following the laser treatment.

Studies show the visual outcomes of Epi-LASIK are comparable to those of LASIK, PRK and LASEK.

The Epi-LASIK Procedure

The steps in Epi-LASIK surgery are:

  1. Anesthetic eye drops are applied to the eye to prevent pain during the surgery.
  2. A hand-held epithelial separator is used to lift an intact, ultra-thin sheet of corneal epithelium.
  3. The epithelial sheet is pushed off to the side of the eye and an excimer laser is used to reshape the underlying cornea tissue.
  4. After the laser treatment, the epithelial sheet is returned to its original position and a bandage contact lens is applied.
  5. A few days later (after the epithelial sheet and new epithelial cells have had a chance to securely cover the treated part of the cornea), the bandage contact lens is removed.

After Epi-LASIK Surgery

Immediately after Epi-LASIK surgery, you will be given antibiotic and anti-inflammatory eye drops to reduce the risk of infection and promote healing. You will also be advised to wear a protective shield on the eye during sleep.

A few days after surgery, after the epithelial cells have had a chance to reattach to the eye or grow back, the bandage contact lens is removed.

Expect some discomfort for a few days after surgery. As the epithelium heals, this discomfort will diminish. In most cases, post-operative discomfort can be managed with non-prescription pain medications.

Vision recovery takes longer after Epi-LASIK than after LASIK. In some cases, vision is not satisfactory for driving for a few days after the procedure. Most Epi-LASIK patients attain good vision within four to seven days, but results can vary. In some cases, it can take three to six months for complete visual recovery.

Before consenting to Epi-LASIK surgery, ask your refractive surgeon how long vision recovery is likely to take in your case, and whether you may need to take a few days after surgery to recover before returning to work.

It may be necessary for you to continue using anti-inflammatory eye drops for up to six months after Epi-LASIK surgery to assure a clear cornea and prevent or reduce haziness in the cornea caused by inflammation.

Epi-LASIK Risks and Complications

As with LASIK, PRK, LASEK and other types of refractive surgery, there are risks and possible complications associated with Epi-LASIK.

The risks and complications of Epi-LASIK are similar to those of LASIK, and include:

  • Dry eyes
  • Vision problems, such as poor night vision, glare, halos and haze
  • Incomplete or inaccurate vision correction
  • Infection following surgery

There may be a slightly greater risk of eye infection and corneal haze or scarring after Epi-LASIK, compared with LASIK. But serious complications are rare. One complication that can take months, and even years, to show up is post-surgery ectasia. This condition is caused by weakening of the cornea during surgery, and it results in thinning and bulging of the cornea similar to the eye condition keratoconus. Ectasia is highly unlikely after LASIK, and even more so after Epi-LASIK.

Other Considerations

Epi-LASIK is typically used to correct up to -7.00 diopters (D) of nearsightedness and up to +6.00 D of farsightedness, with or without astigmatism.

During Epi-LASIK, the excimer laser can be programmed to deliver a standard laser treatment (ablation) or a customized, wavefront-guided ablation, like those used in wavefront LASIK.

Though vision recovery takes longer after Epi-LASIK than after LASIK and there is more post-operative discomfort, Epi-LASIK may be the better choice for you—especially if you have a profession or hobby that increases the chance of being hit in the eye (e.g., soldier, police officer, boxer or racquet sports enthusiast)—because there's no risk of a LASIK-style flap being dislodged weeks, months or years after surgery.

Cost of Epi-LASIK

The costs associated with Epi-LASIK are comparable LASIK cost. Because Epi-LASIK is considered an elective surgical procedure, the costs associated with the surgery typically are not covered by health insurance.

You can lower your surgical costs by setting up a Health Savings Account (HSA) at your bank or contributing to flexible health benefits program at work.

Many refractive surgeons also offer financing programs that allow you to pay for the procedure over time at attractive interest rates or interest-free over a limited time frame.

Note: This information is for general education purposes only. It is not to be used as a substitute for medical advice from your eye doctor or refractive surgeon.

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