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Epi-Lasik Laser Eye Surgery

Epi-Lasik Comparison to Lasik, Bladeless Lasik, LASEK, and PRK


Click to see video of Epi-Lasik.Similar to PRK and LASEK, Epi-Lasik creates a flap of the epithelium that is moved aside and replaced over the area treated with the excimer laser. Click for video.

Video courtesy University of Illinois Eye & Ear Infirmary.  

Epi-Lasik is a sub-version of surface ablation like PRK that is more similar to LASEK with some percieved advantages over Lasik and Bladeless Lasik.

Epi-Lasik Proceedure

A microkeratome with a blunt blade is utilized to mechanically cleave the epithelium from the Bowman's membrane, leaving an expose area for excimer laser ablation. Epi-Lasik preserves the structural integrity of the stroma and is heralded as minimizing patient discomfort when compared to PRK and LASEK, shorten the length of time before visual recovery, and reduce the incidence of corneal haze associated with other surface ablation procedures, such as PRK and LASEK.

Laser refractive surgery has gone through an evolution beginning in the early 1990s with PRK. PRK uses an excimer laser was fired directly through the Bowman's layer and into the stromal layer of the cornea to reshape its curvature effecting the refraction of the patient. PRK tended to be very uncomfortable because of the eye's wound response. Discomfort continues until the epithelium grew back over the ablated area. Newer techniques limit patient discomfort, but rarely eliminate discomfort completely. Additionally, because of corneal haze due to wound response, the safe refractive change with PRK was limited to approximately + 3 D to -6 D correction. Newer techniques have expanded that range, but corneal haze is still an issue that needs to be accommodated.

Lasik Improvement

Lasik was the next evolution in laser refractive surgery. Lasik involves a precise incision into the stromal layer of the cornea, creating a flap. The flap is lifted exposing the stroma, where the excimer laser ablates the tissue, reshaping the curvature from within. Lasik effectively fools the cornea into not knowing that it has surgery, so the procedure is virtually painless and given the control of the depth of flap, Lasik has the ability to correct a much wider range of correction (+5D to -15D). While Lasik solved many of the issues surrounding PRK and widened the range of correction, it has its own set of complications and refractive issues. The majority of the complications relate to the flap itself and the optical aberrations, which are attributed to it.

Return to Surface Ablation

Ever in search of a better procedure, ophthalmology returned to surface ablation solutions, primarily LASEK. The primary methodology around this procedure was to attempt to separate the epithelial layer from the top of the cornea, ablate the underlying tissue with the excimer laser and replace the epithelium on top of the cornea making it act as a biological bandage contact lens. This greatly reduced the pain seen in PRK and eliminated the flap-related issues plaguing Lasik. Although LASEK reportedly improved patient comfort and reduced the probability of corneal haze, the alcohol solution required to release the epithelial cells from the underlying cornea mortally wounds all cells, delaying vision recovery and creating an unstable epithelial layer until the cells are replaced.

Studies Inconclusive

Epi-Lasik attempts to provide the best of both Lasik and PRK/LASEK. By using a blunt blade to lift the epithelium in a single sheet, the epithelium is a much more viable entity. The repositioned epithelium acts as a bandage while the underlying cornea heals. Although current studies are inconclusive if patient outcomes are better with Epi-Lasik when compared to PRK or LASEK, many studies have shown that the surface ablation class of Epi-Lasik, LASEK, and PRK provides slightly better long-term outcomes than Lasik and Bladeless Lasik.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.


Recent Epi-Lasik Medical Journal Articles...

Related Articles

Long term results of Epi-LASIK and LASEK for myopia.

Cont Lens Anterior Eye. 2013 Oct 12;

Authors: Yuksel N, Bilgihan K, Hondur AM, Yildiz B, Yuksel E

Abstract
PURPOSE: To evaluate the long term clinical and confocal results of mechanical (Epi-LASIK) versus alcohol-assisted laser epithelial keratomileusis (LASEK) for correction of myopia.
SETTING: Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey.
DESIGN: Retrospective study.
METHODS: Twenty-two eyes treated with LASEK and twenty eyes treated with Epi-LASIK were evaluated with a mean follow-up duration of 45 months. Mechanical separation of the epithelium was performed with Lasitome epithelial separator, and alcohol-assisted separation with 25s application of 18% alcohol. Laser ablation was performed with the ESIRIS laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12 months; and every year subsequently. Main outcome measures were uncorrected visual acuity (UCVA), manifest refraction, haze, and gray scale value in confocal microscopy, efficacy and safety indexes.
RESULTS: Preoperative myopic spherical equivalent refraction was -4.65±1.74D in the LASEK and -3.87±1.30D in the Epi-LASIK-treated eyes (p=0.36). Of both LASEK and Epi-LASIK-treated eyes, 95% achieved 20/25 or better final UCVA. The grade of haze and mean gray scale value in confocal microscopy were similar in LASEK and Epi-LASIK-treated eyes at all postoperative periods. The efficacy index was 0.94 in LASEK group and 0.96 in Epi-LASIK group (p=0.44). The safety index was 1.01 in LASEK group and 1.02 in Epi-LASIK group (p=0.42).
CONCLUSIONS: Both LASEK and Epi-LASIK offer safe and effective correction of myopia in the long term.

PMID: 24128385 [PubMed - as supplied by publisher]

 


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