PRK or Epi-Lasik......

If you are thinking about having Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL eye surgery, this is the forum to research your concerns or ask your questions.

PRK or Epi-Lasik......

Postby rgonyer » Thu Jan 11, 2007 5:15 am

Alright,

So I am ready to get refractive surgery. I have done tons of research, and have decided that a variety of surface ablation is right for me. I am okay with the longer recovery time to avoid the issues with the flap.

Of the 3 well known local places that do refractive surgery, only one recommends epi-lasek (Fox eye in Cedar Rapids, IA) versus traditional lasik. The issue I have is this. They call it Epi, however they said they have recently stopped putting the epitheal layer back over the eye after surgery, stating that it is the opinion of the surgeon that it heals better without it. How can they still advertise this as Epi?

I have 3 other coworkers that have had their eyes done at this location, by this doctor, over the past 5 years. All are extremely happy with their outcome.

My contact perscription is -2.75 and -3.

How and why might they call it Epi if the epitheal layer is not replaced?
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Postby ssmarsh8 » Thu Jan 11, 2007 8:59 pm

Hi. I've also all but decided on surface ablation over Lasik (going in 1/25). My surgeon's office also has done away with epi-Lasik/Lasek due to healing complications.

I believe (and Glenn will of course tell us if I'm right) that the epithilium is moved/displaced with different methods in epi-Lasik vs. PRK. Even though your office now has the same outcome for both--the complete removal of the epithilium without replacing it--maybe their technique in removing it is different from the PRK method of scraping/rubbing it off? Maybe they use a laser for this point in the process? Or maybe they just haven't updated their marketing materials and figure you don't know the difference. ha

I have a similar prescription (-1.75 and -2.0) and am happy to see another Lasik-eligible person going down the surface ablation route. One of the things that stresses me about it is that EVERYONE is mad for the Lasik, and on some level I feel like I must be nuts for straying from the pack. I'm like, if I'm right in following Glenn's advice (and research I subsequently checked out), why in the world aren't there more people choosing PRK? You wouldn't think that convenience would play such a factor in something so precious as your eyesight, you know? Well, best of luck.
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Postby rgonyer » Thu Jan 11, 2007 9:45 pm

Thanks! Best of luck to you as well.

Honestly, I think it just depends on where a person goes first. Most of the eye surgery places out there now will recommend LASIK first if it's an option, mostly because people don't have the time to wait to heal from PRK or other surface ablation. And I don't necessarily think it's a bad recommendation.

When I raised the same questions as you at the office (why are you doing Epi when everyone else is doing Lasik?), their reply was this: Lasik and surface ablation procedures are both very, very safe as far as elective surgeries go. However, a very large percentage of the *small* number of problems that occur with Lasik have to do with the flap. To me, I want to eliminate as much risk as possible, even if it is a tiny percent. If you are one of the unlucky ones that has a flap complication, they can be a major deal.

Another thing that played into my decision is the fact that my perscription is fairly light, and one of the downsides to surface ablation is hazing. Luckily, the less correction you have, the less this tends to be a problem. At our correction level, haze is much less risky.

In addition, my eyes are on the dry side which also leads me to surface ablation.

So to me, the benefits (less risk of dry eye and no flap risks at all) outweight the drawbacks (minor chance of hazing, longer recovery time).

I don't think Lasik would have been a bad decision for me, but I like the total package of surface ablation better.

Ask me again after I've had it! If I can't drive for 2 weeks, that will be a serious problem and maybe I'll be singing a different tune. Two of my friends that had it at the same place as I am getting it, had the surgery on Thursday, and were able to drive to work on Monday. They weren't 100% recovered, but seeing well enough to be able to function just fine. This is what I am hoping for.

One downside for me to the surface ablation is that I got a better overall feeling from [one physcian than another] but my research reveals that they are both excellenet surgeons. [The one I liked more] typically only does Lasik, and [the other] does Epi (or PRK if that's what it really is) so that's why I chose [the other].

As for how they remove the epithilium, I believe I read somewhere that it didn't matter how they remove it - if it's not replaced it's not epi-lasek, it's PRK.

I believe my surgeon uses an epikeratome, which is a blunt blade to shave the epi off. I have also heard of doctors using a sharp knife as in lasik to remove the epi. And one other method is to use alcohol, but I have heard that alcohol can cause a longer recovery.

I'm going to flood them with questions at me pre-op exam tomorrow afternoon, that is for sure!

Moderator's Note: This post was edited for content. The names of the physicians and clinics were removed.
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Postby Kean » Thu Jan 11, 2007 10:14 pm

rgonyer,
What you've described I believe is called lamellar epithelial debridement (LED), basically it's creating and removing an Epi-Lasik flap. I've seen somewhere else where docs refer to this as PRK (probably for simplicity sake) in cases where the epi-Lasik flap cannot be placed back.

Epi-Lasik flap is created using an epi-keratome. Unlike a microkeratome, it's a blunt blade used to separate the epithelial sheet and do not cut into your stromal. As for PRK, I know there's manual scraping with a knife, brush, and alcohol debridement too. I have read some docs prefer LED over Epi-Lasik based on their patient's results (that'll be your doc ;). Other than the way the epithelial sheet is removed, LED and PRK are practically the same kind of surface ablation surgery.

Whether to keep the epithelial sheet, some are still debating. I've researched many top experts/docs and these experts recently seemed to lean towards removing it altogether. You probably wish that each of these experts would agree on one method for removing the epithelial sheet, well, they each have their own preference and in some cases his/her unique method. Ha.. some of you may wish you can custom order your surgeon, surgeon A+D does the pre-op prep, surgeon B does the epithelial flap, surgeon C does the ablation, and surgeon D provides the contacts and does the post-op medication prescription. (ha-ha ;)
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Postby rgonyer » Sat Jan 13, 2007 10:10 pm

Then what advantage is there to LED over PRK? I can get PRK very easily around here, two pretty well respected doctors that do near by. LED or Epi, there is only one choice, and well, you can read my other post to get my feelings on that.

If PRK is essentially the same thing as LED or Epi, I think I would opt for that route.
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Postby LasikExpert » Sun Jan 14, 2007 12:58 am

The difference between Epi-Lasik and PRK is all in the epithelium.

Epi-Lasik uses a microkeratome with a blunt blade to create a "flap" of epithelium. This flap is put back over the treatment area after the laser removes tissue, but all these cells are mortally wounded. They will be replaced with new cells.

PRK simply removes the epithalium and allows it to immediately regenerate.

There are many who believe the Epi-Lasik method is superior, however there are also those who feel it is not really beneficial.
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Postby Kean » Thu Jan 18, 2007 5:58 am

<<Then>> Ha.. that was my research a while back. After a lot of research, I didn't find conclusive evidence that one method is advantageous over another in terms of vision outcome. Each surgeon claims he/she gets the best result using one particular method to remove the epithelial sheet (which became their preferred method). One believes in using the knife, another believes in alchohol debridement, and another prefers the epi-keratome. The only thing I can tell you is I didn't find any that prefers the brush, and have came across a couple of articles/interviews that lightly touched upon why the brush should not be used (which may induce inflammation reaction).

Having said that, a couple of experts dislike alcohol debridement and they explain it could slow recovery (was not a study with stats, just some brief explaination). Of course, that one expert who prefers alcohol debridemenet due to the smooth surface it leaves, explains that slow recovery can be countered by creating a smaller flap (eg. 7.5mm instead of 9mm).

So when you ask, how is LED advantageous over PRK? LED can *probably* provide a slightly faster recovery over PRK if alcohol debridement is done (with the same flap diameter). Otherwise, not much (based on what I have gathered). All the best!
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Postby rgonyer » Thu Jan 18, 2007 12:54 pm

Well, today is the day, I'll let you all know how it goes the next time I can see the screen well enough!

My surgeon uses a epi-keratome to remove the epithelium. He typically does not replace the flap, except for people that require a lot of correction. This leads me to believe that this is really PRK, but either way I wanted to go surface ablation instead of LASIK anyway.

Hopefully I don't regret it over the next few days!

Thanks
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Postby ssmarsh8 » Thu Jan 18, 2007 3:38 pm

Best wishes for perfect eyesight and a speedy recovery.
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Postby rgonyer » Thu Jan 18, 2007 3:39 pm

Thank you!
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Postby rgonyer » Fri Jan 19, 2007 4:35 pm

Well it's done! (And I'm happy to be able to see the PC screen, lol.)

Surgery went fine (so I'm told), everyone was very nice and informative throughout the process. The surgery took place around 2:30.

The pain on the ride home was incredible.... I had no idea! In the hour and a half ride home, I had a towel over my face and the protective goggles they gave me. Everything was soaked with tears... haha.

When I got home, I crawled into bed and managed to get to sleep. When I woke up around 8 to go wander around, I was amazed. Most of the pain was gone and I would now call it "mild". In addition, I could see pretty darn well already, which I did not expect.

I played on the computer a bit, sent some emails to friends letting them know how I was, drank some water, did my drops, and went to bed with my goggles on, not expecting to sleep much.

My wife woke me up this morning as she was leaving, I had slept through the night! This morning my eyes felt great, they weren't all stuck together like I expected them to be, and my vision was still pretty decent. So I have been up bumming around the house for most of the morning.

Slowly, the discomfort is getting a little bit worse, and so is my vision (both of which I expected).

In any case, the only thing that was worse than I expected was the immediate post-op pain. Aside from that, I'm very happy that I'm able to do a few things today, I definately did not expect that to happen.

I'll try to keep you all updated, assuming anyone is interested ;)

I'm still concerned about my pupil size and halos, but I guess time will tell. My artificially dialated size was reported to be 9mm, does that even seem right??? My low light measurement before dialation was reported to be 6.5mm, but it really wasn't that dark in the room.
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How is day 2?

Postby GodsClay » Sat Jan 20, 2007 4:03 pm

Hello!

I've been reading so many posts recently, but I keep coming back to yours. I have not had surgery yet, but I am just really curious as to how you are doing.

Your posts also helped me realize more ~ the differences in Lasik and Lasek. Unlike you, I am looking at the Lasik -
My OD is -1.75 -1.25 x78
My OS is -2.50 -.75 x 75

I use progressive bifocal glasses and I do not know what the reading is on the bifocal part.

My age (52 old female) will mean that I will need reading glasses. He said that I should get the +2.00 readers for after the surgery.

I am still in the thinking stage - though I've made an appointment for surgery next Friday 1-26-06.

Though my readings are not as bad as many others I see in this forum, I'm excited at the thought of not having my entire world in a blur, with only a very small area of clarity WITHOUT my glasses. My thoughts are that reading glasses are worth not having to wear - and pay for - expensive prescription glasses the rest of my life.

Enough rambling though .....

Hope you let us know how day 2 is going for you.
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Postby rgonyer » Sun Jan 21, 2007 5:36 pm

Sorry I haven't been able to update much, it's been tough to look at the PC screen. Now I know why people opt for Lasik! ;) I'm still happy I made this decision, it's just a bit nerve racking waiting for my vision to "come around". It's tough no to wonder "Am I going to be stuck this way???"

I can probably see well enough to drive, but my fine vision and close up vision are definately not great. To be exepcted only 3 days post op, I suppose. My vision was actually the best on the day following the surgery, and it has mostly gotten worse since then.

I'll be headed in tomorrow morning for my first follow up. I'll try to give a report after work.
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Postby LasikExpert » Sun Jan 21, 2007 7:58 pm

Keep the faith. What you describe is quite normal. This is the time when you have what I call "functional fuzzy" vision.
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Postby rgonyer » Mon Jan 22, 2007 12:08 am

Thanks, I'm trying ;) It can be tough after a few days when you expect continuous improvement and are not really seeing any. Would ghosting be considered normal in this recovery stage? I've had it on and off in both eyes.
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