Is LASEK or LASIK right for you?

It can be quite confusing if you are thinking about laser vision correction and want to know which procedure would be best for you. While both LASIK and LASEK can give you excellent vision in a safe and reliable way, some surgeons prefer one or the other, or may indeed only offer one type anyway! How is the prospective patient supposed to decide? What happens in practice is that patients are greatly influenced by what their particular surgeon says, and understandable so. It is always worth seeking a second opinion and comparing the findings and comments of each doctor. Any surgeon worth his or her salt shouldn’t be threatened by this. Some patients feel more confident with one doctor or another, based on perhaps only "chemistry".

LASIK and LASEK are both very effective procedures, and can be used to treat myopia, hyperopia and astigmatism (nearsight, farsight and astigmatism). In terms of final vision, we have a preference for LASEK for mild or moderate myopia, or mild hyperopia, and so avoid the need for making a flap. For higher degrees of refractive error, we generally perform LASIK. When there is a choice, it will depend more on the patients needed recovery time, and feeling about having a corneal flap.

If you choose LASIK (when you have the choice), it will usually be for one of the following reasons:

• faster visual recovery (most patients are at the legal driving standard the next morning, and many are at or close to 20/20)
• minimal discomfort after the surgery (grittiness for about 4 hours)
• less chance of getting an infection
• shorter period using drops post-operatively (about 1 week)
• fewer post-operative visits
• having a higher degree of refractive error

If you choose LASEK, it will generally be for one of the following reasons:

• your corneas are thin
• you want to avoid any flap-related complications (while rare, many of LASIK's complications are related to the flap in some way)
• you do not have enough corneal tissue to treat your full prescription and allow for the thickness of the flap (if you don’t cut a flap, you have perhaps another 50-60 microns available, which means another 3-5 dioptres, depending on the laser)
• the condition of your eyes means that it is better to avoid the high pressure required during the creation of a LASIK flap
• your corneas are very steep, and you want to avoid problems with preparing the flap (flaps may been thin from steep corneas, although this is into discussion)
• waiting a little longer for your vision to settle down is no problem
• you have heard LASEK may produce sharper vision than LASIK (alsoto discussion!)
• you participate in contact sports, and want to avoid trauma to the flap
• your myopia is mild or moderate, and you can have both eyes treated at the same session with LASEK (generally not above -6 to -7 dioptres)

The best choice for you will depend upon specific factors relating to the health and shape of your eyes, your desired speed of recovery, your personal circumstances, and your assessment of the risks of each procedure compared to the benefits. Your surgeon will help guide you through the entire process.
You should note that some centres offering free consultations use opticians (optometrists) rather than ophthalmic surgeons. You no doubt will prefer the depth of knowledge that your surgeon will bring to the discussion. Make sure you have full access to the treating surgeon and all the time you need to talk through the necessary issues. In the end, you will get what you pay for.

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