Custom Lasik vs 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.

Custom Lasik vs Epi Lasik

Postby Jilly » Tue Jan 29, 2008 2:18 pm

I consulted two lasik centers to have lasik. One suggested that I should have just normal Custom lasik whilst the other one said my cornea is thinner than normal and i should have Epi-lasik. My cornea thickness is R-470 and L-500 according to both lasik centers. I am in a dilemma. Should I have Custom Lasik or Epi-lasik?
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Postby LasikExpert » Tue Jan 29, 2008 5:45 pm

The "custom" portion of your concern is neutral. Custom normally referrs to custom wavefront-guided ablation. Custom wavefront is available whether you elect to have Lasik or a surface ablation technique like Epi-Lasik.

The primary difference between Epi-Lasik and Lasik is whether or not you will have a Lasik flap.

The first step to Lasik is to create a thin flap of corneal tissue. This flap is moved back, the laser removed tissue from the area, and the flap is repositioned over the treatment area.

In Lasik, a mechanical microkeratome is used to create the flap. This is essentially a surgical blade. In All-Laser Lasik a femtosecond laser is used to create the flap. Using precise focusing, the femtosecond laser creates tiny "bubbles" within the cornea. Many of these bubbles next to each other create a perforation that combine to create the Lasik flap.

If you are going to have vision correction surgery, then you should consider very closely the surface ablation techniques of PRK, LASEK, and Epi-Lasik. There are two primary advantages in your situation. One is that without a Lasik flap, you have no possibility of a Lasik flap related complication during surgery or for the rest of your life. Even if the probability of a Lasik flap complication is relatively low, no possibility of a complication is almost always better than low probability.

The other, and possibly more compelling reason, that you should investigate PRK, LASEK, or Epi-Lasik closely is that they will leave more of your corneal thickness untouched. This is very important to keep corneal stability and would improve the probability that a very high eye prescription could be fully corrected. With a surface ablation it would be more likely that you could achieve full correction with your thin corneas.
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Epi Lasik

Postby Jilly » Mon Feb 04, 2008 4:30 pm

According to the brochure given by the lasik center. a unique microkeratome called EpiEdge epikeratome is used to separate the epithelium from the stroma. These seems like cutting is involved too.

Can I ask if according to the measurements I've given earlier, do I really have thin cornea? One center says I have thin cornea and the other one said my cornea thickness is normal. That really confuses me.
Thanks for your advice.
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Postby slim » Fri Feb 08, 2008 10:22 pm

From what I've read/heard for lasik thickness should be low to mid 500 range... Being under 500 I'm surprised they gave Lasik as an option... I'd personally go with a surface proceedure such as PRK, or EPI-Lasik, which is essentially the same as PRK but they try and salvage the epithelium layer .vs. getting rid of it all together and let it grown back fresh as in PRK.
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Postby Pappy » Sat Feb 09, 2008 12:06 am

Without knowing what your eyes are at (and I don't claim to be an expert, far from it actually). It be hard to tell.

The FDA requires that minimum of 250 microns remain unaffected after surgery.

I was also given the option to have either (my cornea depth was 480ish) with a -5.25 diopter on both eyes and no astigmatism. With lasik I would have had 275 remaining (this accounts for flap and laser). It basically meant that should any further correction be needed re-lifting the flap would not help since operating on that remainder would be problematic.

So I opted to have PRK, for a variety of reasons (no flap, less known occurance of dry eye symptoms and a larger safety margin with thin corneas).

The cutting you see mentioned in the brochure really deals with how the epithelial layer is handled. Unlike lasik this cutting does not leave a permanent cut in the cornea. Those epitheleal cells are the fastest multiplying cells in the human body. The lasik cut will leave it's imprint there for ever (it never fully heals). The epi-lasik cut will heal within 3-8 days and smooth out over the next 6-8 weeks assuming all the cells remain viable.

I wish you luck in your research (you should do lots and lots both on sugery, complications, doctors and so on).
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Postby Jilly » Sun Feb 10, 2008 2:19 pm

Thank you for your advice. I will consider EPI-Lasik...
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Re: Thanks

Postby Pappy » Sun Feb 10, 2008 5:55 pm

Jilly wrote:Thank you for your advice. I will consider EPI-Lasik...

Keep in mind while considering that epi-lasik (PRK variants) have a recovery time measured in weeks not days. I would say you should have 2 weeks of not having to do anything (drive, read a computer screen) set aside for the initial recovery. Some people do heal faster than others but it can take up to 6-8 weeks and in some cases 3 months to a year before all the risidual effects normalize.

This site has a nice link to it, it's about 3/4s down:

Lasik and PRK Recovery
The recovery from PRK is vastly different than Lasik. With Lasik, it is probable that fully functional vision will be almost instantaneous, there will be almost no pain, and you can resume most normal activities almost immediately. PRK, on the other hand, provides “fuzzy functional” vision for 3-6 days, functional vision for about another 2 weeks, and you won’t get the really good crisp vision you desire for about 6-8 weeks after surgery. Not everyone can afford this much time with compromised vision. There is much more discomfort associated with PRK, and even today PRK has limitations due to haze, but let’s consider how the haze situation has improved.

I am entering my third week post-op and reached "good" functional vision about 3 days ago. Prior to that the world was a blurr.

Good luck in your search.
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One eye vs. two

Postby catnmus » Mon Mar 03, 2008 1:09 am

If you're going to go for Epi-Lasik, you should consider whether to do one eye at a time, or both at once. I had one done and am about to have the other done. I was only off work for 1 surgery day and 1/2 tired-eye day. I'll definitely have another surgery day off, and who knows about the tired-eye days. So maybe 3-4 days off work.

If I had both eyes done at once, I probably would have had to take 2 weeks or so off work, before I would have had good enough vision to work (I work in an office). And probably another week or two after that before I could drive.

PS these are my experiences and "predictions". Your mileage, and mine after I have my second eye done on Tuesday, may vary. Good luck!
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