NY'S ONLY NO FLAP ALL LASER VISION CORRECTION...

[JasonB]

Hi i know i can't make names...but i just saw the website of a famous new york surgeon that now offers an all laser lasek procedure...sayin that over 90% of complications are caused by cutting a flap and by eliminating this step, they have eliminated over 90% of all complications.

I would like to know your opinion about that...

[LasikExpert]

I am assumming that you are talking about LASEK as you spelled it, not Lasik.

LASEK is the same as PRK except that in LASEK the soft pliable outer layer of corneal cells (epithelium) is saved and repositioned over the treatment area. Unlike Lasik, there is no flap of the deeper corneal stroma tissue. All LASEK would be all-laser.

All-laser Lasik is when a femtosecond laser is used to create the Lasik flap, rather than a surgical blade.

A derivitive of PRK is trans-epithelial PRK. In PRK the epithelium is removed and discarded, usually by applying an alcohol solution to disrupt the cells and scraping them off the cornea. With trans-epithelial PRK the excimer laser is used to remove the epithelium. This would be all-laser PRK.

I have a personal bias toward the surface ablation techniques of PRK, trans-epithelial PRK, LASEK, and Epi-Lasik. The reason is that without a Lasik flap, there is no possibility of a Lasik flap related complication. Even if the probability of a Lasik flap complication is small, no possibility is almost always better than a low probability. The vision recovery is longer and there is more discomfort, but it seems worth it in the long term.

[JasonB]

I am assumming that you are talking about LASEK as you spelled it, not Lasik.

LASEK is the same as PRK except that in LASEK the soft pliable outer layer of corneal cells (epithelium) is saved and repositioned over the treatment area. Unlike Lasik, there is no flap of the deeper corneal stroma tissue. All LASEK would be all-laser.

All-laser Lasik is when a femtosecond laser is used to create the Lasik flap, rather than a surgical blade.

A derivitive of PRK is trans-epithelial PRK. In PRK the epithelium is removed and discarded, usually by applying an alcohol solution to disrupt the cells and scraping them off the cornea. With trans-epithelial PRK the excimer laser is used to remove the epithelium. This would be all-laser PRK.

I have a personal bias toward the surface ablation techniques of PRK, trans-epithelial PRK, LASEK, and Epi-Lasik. The reason is that without a Lasik flap, there is no possibility of a Lasik flap related complication. Even if the probability of a Lasik flap complication is small, no possibility is almost always better than a low probability. The vision recovery is longer and there is more discomfort, but it seems worth it in the long term.

Thanks for your answare. Yes i was talking about "trans-epithelial PRK" because this is what they do...i was just wondering, since i was reading an opinion about this approach from this same NY medic who spoke about the problematics of this all laser PRK approach what was your opinion on it...this is what he said :

dear sir

as a layperson, you should never just surf around on the internet for an hour, and then presume you have sufficient medical expertise to know which laser or treatment is best for you

i was in medical training for a decade, and then a decade more after that in practice, so my assessment of which procedure is best for you will always be 100x more informed than your own--sorry to be so blunt about this, but this is the hard truth

the procedure you are talking about, while it sounds wonderful and safe and new on the weblink you provided, HAS ALREADY BEEN AVAILABLE IN THE US FOR OVER A DECADE

with the visx s4 ir laser i currently own and use, i can perform a "no touch" transepithelial ablation in your eyes--indeed, i was doing so way back in 1993-1996

the problem with this approach, is that every patient's epithelium is a different depth, which is difficult to accurately measure, so you wind up lasering not just the epithelium, but also part of the cornea, which "uses up" some of the treatment, which is bad as the epithelium grows back--all the laser treatment should be onto the cornea

the 2nd problem is that the depth of the epithelium varies over the cornea, and is thicker in some areas, and thinner in others. again, this is individual, and not predictable or measurable exactly.

the problem with this is that if you try to do a trans-epithelial ablation, you get "break through" in some areas (showing up as black instead of the purple autofluorescence you get from the laser hitting the cornea stroma), not in others. so, again, you wind up wasting part of your treatment energy on the cornea, and part on the regenerating epithelium--not what you want

the only solution then is what we did way back in 1995, which was to intentionally undertreat the epithelium, laser only 35 microns when we know the epithelium is usually 40-50, then manually scrape away the final 5-15 microns with a blade/spatula--thereby totally messing up the smooth results we wanted from an "all laser" procedure to begin with

the way i do laser vision correction is an all-laser, non-cutting approach, just like the link you sent. the difference is we remove the epithelium totally in 1 smooth layer ("en-bloc"), and then put 100% of the laser treatment where we want it--onto corneal stroma--so we get the full effect we want, instead of undercorrecting by lasering some epithelium.

[LasikExpert]

The second doctor appears to be talking about Epi-PRK, which removes the epithelium in a single layer using a mechanical microkeratome with a blunt blade. Regular PRK uses an alcohol solution to disrupt the epithelium, and then it is manually removed.

In my opinion - and I'm not a doctor - trans-epithelial PRK, LASEK, Epi-PRK, and every other iteration of epithelium manipulation is so much expensive luggage. Studies have not consistently shown any of these techniques to be superior to traditional PRK. Some show better, some show no difference, but in the long-term the results are pretty much the same.

It is easy to get caught up in hype and personal bias. Everyone is looking for a way to differentiate themselves from the competition.

[dyap2001]

Hi,

I just had my second consultation, and I happened to visit the same "NY'S ONLY NO FLAP ALL LASER VISION CORRECTION" center. Basically, I got the same message: PRK is outdated, the first type of laser corrective surgery, and LASEK is newer and much better".

I've been doing a lot of reading on this site and here's the thing: I think what he's doing is PRK. In all his videos (he has patients post their videos) the epithelium is totally removed with the blunt plastic spatula. I thought for the procedure to be LASEK, the epithelium had to be saved and repositioned.

He offers epi-LASEK too, in which case he actually does replace the epithelium that's removed by a machine, but that's more expensive.

I have no problem with PRK, it just seems that this doctor is advertising PRK as LASEK. If the epithelium isn't replaced, then it's PRK right? Thanks for your opinion.

-David

[dyap2001]

Hi,

I just had my second consultation, and I happened to visit the same "NY'S ONLY NO FLAP ALL LASER VISION CORRECTION" center. Basically, I got the same message: PRK is outdated, the first type of laser corrective surgery, and LASEK is newer and much better".

I've been doing a lot of reading on this site and here's the thing: I think what he's doing is PRK. In all his videos (he has patients post their videos) the epithelium is totally removed with the blunt plastic spatula. I thought for the procedure to be LASEK, the epithelium had to be saved and repositioned.

He offers epi-LASEK too, in which case he actually does replace the epithelium that's removed by a machine, but that's more expensive.

I have no problem with PRK, it just seems that this doctor is advertising PRK as LASEK. If the epithelium isn't replaced, then it's PRK right? Thanks for your opinion.

-David

One more thing. On the doctors blog, someone actually asked him some of the "50 questions to ask your doctor" and he answered them. One of the questions was the following:

"What percentage of your LASEK surgeries become PRK surgeries because the epithelium cannot be peeled back?

0%; we do this routinely as we performed a study on 100 eyes (50 patients) showing they actually heal quicker this way; many other MDs have replicated this work, so now most of the top Advanced Surface Ablation surgeons are discarding the epithilium (this does NOT make it a PRK, but I will have to discuss this with you in person)."




BS?

[LasikExpert]

I suggest that you ignore the LASEK, PRK, Epi-Lasik, Transepithelial PRK debate. In the long term your results are likely to be the same. Focus on all of the other issues, including the doctor you find most qualified and with whom you are most comfortable, and then go with what that doctor recommends.

[dyap2001]

I suggest that you ignore the LASEK, PRK, Epi-Lasik, Transepithelial PRK debate. In the long term your results are likely to be the same. Focus on all of the other issues, including the doctor you find most qualified and with whom you are most comfortable, and then go with what that doctor recommends.

Thanks Glenn. All the reading and details to consider can sometimes obscure the bigger picture.