~preserving the integrity of the cornea~
A large percentage of the complications reported following LASIK, bladeless or otherwise, were a result of the
inability of the flap to properly heal afterwards. Epi-LASIK is different in that it maintains most of the
structural integrity of the external surface layer of the cornea. This important advancement in
technology was developed to solve some of the potential problems with earlier variants of corrective eye
Epi-LASIK is comparable to LASEK (laser epithelial
keratomileusis). In both types of procedures, the very thin outer protective top part of the cornea, also known
as the epithelium, is detached off of the cornea and then temporarily moved aside while the irregularities of
the central cornea are reshaped with an excimer laser. The main difference is that in LASEK, the epithelium is
cut with a cylindrical blade known as a trephine. The layer is then coated with an alcohol-based fluid to loosen
it away from the underlying corneal tissue (the stroma). In Epi-LASIK, the epithelium is literally pushed aside
with a precise instrument called an epithelial separator. Alcohol is not needed in order to soften or loosen the
With LASIK, the surgeon makes a flap in the cornea using a razor-sharp blade or, as in
the case of bladeless, a laser. In addition to the risk of an imperfect cut (too deep or uneven) there is also
the amount of time it can take the eye to completely heal. The flap is essentially a very thin membrane-like
piece that retains a hinge on the eyeball. When it is lifted during surgery, exposing the stroma, the excimer
laser is then used to ablate the tissue, reshaping the curvature from inside.
As a result of innovations in leading-edge medical equipment, eye doctors have the capability to correct a
broader range of vision conditions. Although these advancements solved a number of the problems experienced with
preceding technologies there were still complications, most of which pertained to the flap and the optical
aberrations attributed to it.
By utilizing a blunt instrument to delicately raise the epithelium, Epi-LASIK avoids potential for damage to it.
The actual cut is so extremely thin that it does not actually penetrate the cornea--this is considered to be much
less invasive than other types of LASIK. This epithelial piece is then gently repositioned back in place. When it
is returned to its original position, the epithelium functions just like a bandage protecting the underlying cornea
as it mends.
Considering the fact that it is markedly more problematic to make the epithelial flap in individuals that have
what are considered "steeper" corneas (translates to a higher degree of nearsightedness), the procedure is a better
course of action for those who have less steep corneas. Another main benefit is that since there is less cutting
involved when the LASIK-style flap is not created, Epi-LASIK, could very well be conducted safely on corneas which
perhaps may be too thin for LASIK.
A bandage contact lens is placed on the eye following Epi LASIK to help maintain the epithelium in position.
This particular contact lens helps to protect the operated area of the eye and as a result makes it possible for
the epithelial tissue to heal and grow back properly.
Advocates of Epi-LASIK also maintain that the procedure results in a lesser amount of post-operative soreness
and irritation. The explanation given is that there isn't any of the associated destruction of corneal cells
because alcohol is not applied to the eye.
Inherent Risks with Eye Surgery
As with any type of eye surgery, there is the potential for undesired outcomes. One of the most common is the
oft reported halo effect. Quite a few patients discover that their night vision following laser refractive surgery
is altered. Ordinarily, this appears in the appearance of halos surrounding lights, increased glare or more trouble
recognizing shapes in the dark. Most of the time, a lot of these symptoms slowly get better on their own. For those
that feel that they cannot function well due to low light, it is recommended that extra precautions are taken
including temporarily suspending night driving.
There is a small risk of infection. Since an incision, albeit microscopic, is made on the eye, it is conceivable
that harmful bacteria could potential cause an infection. Bad infections can have serious repercussions including
vision loss. Such infections are rare due to the fact that antibiotics are applied immediately after the operation
to help reduce the chances of an infection.
Ectasia can cause the cornea to warp and become out of shape, resulting in loss of vision. In some cases, a
corneal transplant may be necessary in order to remedy this problem. It usually only seen in patients that have
abnormal or irregular corneal shapes, or corneal dystrophies. Eye surgeons will inspect their patient's corneas
carefully to ascertain any sort of pre-existing condition of corneal irregularity when it comes to shape and size.
The overall risk of ectasia is low.
What to Expect After Epi-LASIK
Epi-LASIK recovery is, for the most part, slower than recover times for other vision correction surgeries.
In LASEK, it is not uncommon for the flap perimeter to heal in approximately one day. Even so, patients are usually
ordered by their doctor to wear a bandage contact lens for approximately four days to protect the eye.
Vision after the surgery definitely will not be improved instantly. Some report noticeable improvement in as
little as three days, for others it will undoubtedly take more time, in some cases it can be six months before the
desired results are achieved. Recuperation periods tend to be appreciably lengthier when compared to LASIK, which
usually enables people to experience better vision anywhere from the same day up to a week or two later and even to
drive a car by the day after surgery.
As with any laser eye surgery, after Epi-LASIK healing requires following the surgeon's instructions precisely,
given that the overall effectiveness of the procedure as measured by the improvement in vision is directly affected
by the way in which the cornea heals. Proper and consistent application of the eye drops or additional
prescriptions is a key factor.
Who is Eligible for Epi-LASIK
When a doctor recommends Epi-LASIK as the right approach for a particular patient, find out why. As stated
above, it will usually be due to the person's thin or too-steep cornea. It is particularly important to ensure that
your doctor is experienced with this type of procedure because this is probably the most significant factor that
determines the successful outcome of the surgery.
With Epi-LASIK, patients will face a little discomfort which can be alleviated by taking over-the-counter
painkillers or anti inflammatories. The discomfort after Epi-LASIK is reportedly less than that experienced after
PRK or LASEK.