Is LASIK the best laser vision correction procedure for you?

When considering laser vision correction there are many things to understand and decide.  After your evaluation and examination, you may be deemed a candidate for both LASIK and PRK/ASLA.  Making the decision between LASIK and PRK/ASLA can be difficult, but there are some important differences to consider.  To help understand the procedures and to assist with your decision, I will highlight some of theses considerations.

Recovery Time

How much down time you are able to take out of your routine will likely impact your decision.

LASIK has a very rapid recovery time, requiring only a couple of days off work.  This includes the day of surgery and the following day to attend your postoperative clinic visit.  This visit is important to ensure the LASIK flap is sitting well and healing in the correction position.  Your vision is usually very good on the day after surgery.  It may fluctuate a bit and improve slightly over the next week.  You will be able to do your routine activities within a week of surgery, but must avoid any eye rubbing or activities that may result in touching the eye. 

PRK has a longer recovery time, requiring several days to a week off work.  It is best to not make any plans for the first two days after surgery.  The eyes can be quite light sensitive and sore.  You will be given some tablets and ice packs to help control the inflammation and pain.  A contact lens will be placed in the eye at the end of surgery to help the surface epithelium heal.  Your vision will be blurry while the epithelium heals, which can take between 3 days to a week.  The contact lens will then be removed and the vision will be improved.  The epithelium must remodel and become smooth before you achieve your best vision, which can take several weeks. 

As you can see there is a significant difference in the recovery times between the two procedures.  Some people prefer to avoid having a flap with LASIK and are more patient with the recovery time of PRK.  Others don’t mind having the flap and want the quicker recovery time offered by LASIK. 

Lifestyle and Activities

There is a potential for the LASIK flap to dislodge after surgery.  This risk is particularly important for people who participate in contact sports or in activities where there is the potential for the eye to be touched or poked.  The risk of flap dislodgment is low, but you may want to consider PRK/ASLA if you are concerned with this risk. 

Associated eye conditions

Dry eye syndrome is a condition where the eye is lacking tears or the tears may be abnormal are not lubricate the eye properly.  A dry eye can have symptoms of intermittent blurry vision or feel like grit or sand is in the eye.  You will be screened for dry eyes during your assessment.  These screening tests are thorough, but are not perfect in picking up all cases of dry eyes.  LASIK surgery leads to a reduction in tear production, which is usually managed with lubricant eye drops.  If you have a preexisting dry eye syndrome, LASIK surgery can lead to worsening of your symptoms.  This may require long term treatment with lubricating drops or gel and may require other treatment options.  If you have concerns about dry eye, PRK/ALSA may be a better option, as it is less likely to cause these symptoms. 

Epithelial basement membrane dystrophy (EBMD) is a common condition that may be present in your cornea without you being aware of it.  This condition often has no symptoms, but can be picked up on a screening eye examination.  It is important to know if you have EBMD as this can increase the risk of the surface cells on your cornea (the epithelium) sloughing during the LASIK procedure.  If epithelial sloughing occurs during the procedure, it can increase the risk of having an under-correction, inflammation under the flap (known as diffuse lamellar keratitis), or epithelial cells growing under the flap (known as epithelial ingrowth).  PRK/ASLA would be a better procedure if you have EBMD to reduce the risk of possible these possible complications.