LasikExpert wrote: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.