What is Epi-LASIK and how does it compare with other laser vision correction modalities?
A growing number of the country's refractive surgery leaders are now choosing to perform epi-LASIK on an increasing number of their patients for laser vision correction. The cornea, a thin clear layer covering the front of the eye like a window, is the part of the eye where laser vision correction is performed. The cornea is composed of 3 layers, the outer epithelial layer, the middle or stromal layer (which comprises about 90% of the total corneal thickness), and the inner or endothelial layer.

There are currently 4 different laser vision correction modalities:
  • PRK (Photorefractive Keratectomy)
    The epithelium is removed by scraping, by a brush, or by the laser itself prior to laser correction

  • LASEK (Laser Assisted Sub Epithelial Keratectomy)
    Dilute alcohol is used to loosen and remove the epithelium prior to laser correction

  • LASIK (Laser In-Situ Keratomileusis)
    A flap is cut through the upper third of the middle or stromal layer of the cornea prior to laser correction
    An automated separator (not a blade) gently slides the epithelium off the cornea prior to laser correction. This separation occurs along a natural occurring membrane in the cornea.
The analogy of the bed-sheet and mattress can help explain the difference between LASIK and epi-LASIK: epi-LASIK only lifts the sheet (the epithelial layer of the cornea) and leaves the underlying mattress intact, while the flap created in LASIK is cut into the upper part of the mattress (the stroma of the cornea) and lifts both the bed-sheet and upper mattress together as a unit.

Epi-LASIK is safer than PRK and LASEK
In PRK, the mechanical injury to the epithelium causes significant pain, longer visual rehabilitation, and potential haze of the cornea. In LASEK, the toxicity of the alcohol reduces the survival rate of the remaining cells in the cornea stroma. Following epithelial cell injury with PRK or LASEK, the cell walls break open causing release of cytokines or chemical mediators that communicate with other cells. These cytokines in turn activate keratocytes located in the stroma. Once keratocytes are activated, they initiate programmed cell death. Activated keratocytes have been demonstrated to initiate haze and regression (reversal) of the laser effect on correction. Epi-LASIK eliminates the need for alcohol and scraping, thereby decreasing the risk of haze, pain, and light sensitivity after the procedure.

Epi-LASIK is safer than LASIK
Although complications with LASIK surgery are rare, when they do occur, they are often associated with the microkeratome cutting blade. These include creation of an incomplete flap, inconsistent flap thickness, striae/folds of the flap, inflammation and debris in the interface of the flap, late flap trauma, etc. Epi-LASIK makes laser vision correction (LVC) safer by replacing the microkeratome's cutting metal blade with a plastic separator that gently pushes the epithelial cells to one side in preparation for laser correction. LASIK cutting of the stroma produces 2 parts that will never completely seal. Because epi-LASIK separates, and not cuts, along a natural separating plane in the cornea, the structural stability of the cornea is preserved.

In addition, recent studies show that the creation of a stromal flap leads to increased higher order visual aberrations post-operatively, which can contribute to halos and night vision problems. This is because the flap is created by a mechanical device which does not cut a consistent flap. Because epi-LASIK creates the flap more superficially and along a natural membrane, these aberrations are significantly decreased.

Dry eye symptoms associated with LASIK are the most common cause of post-operatively dissatisfaction and can occur in nearly 60% of patients. This is because creation of the LASIK flap in the corneal stroma cuts through the area where the nerves enter the cornea, thereby severing more of the nerve fiber bundles which leads to dry eyes. Because epi-LASIK separates far more superficially, most of the nerves remain intact, thereby decreasing the incidence of dry eye after laser vision correction.

  • Preserves the structural stability and integrity of the cornea because there is no intra-stromal cut as in LASIK
  • Lower risk of potential intra-operative and post-operative complications associated with creation of stromal flap in LASIK
  • Less haze than PRK/LASEK
  • Faster visual rehabilitation than LASEK
  • Eliminates need for alcohol and other injury in removal of the epithelium
  • Lower risk of extended dry eye problems
In summary, epi-LASIK is safer than the other current laser vision correction modalities while maintaining the excellent visual outcomes associated with laser vision correction.

Epi-LASIK is a good option for patients who do not want a surgical flap on their cornea, who want minimal risk and desire no cutting, as well as patients who might otherwise not be good candidates for LASIK procedure because of corneal thinness, dry eyes, and/or vocational/extracurricular activities that could lead to flap trauma, such as participation in martial arts or contact sports. Patients who should not have epi-LASIK are those who have had previous refractive surgery, previous cornea surgery, or corneal transplantation. The minimum age for surgery is 18 to 21 years of age and candidates should have a stable glasses/contact lens prescription for at least one year.

WHAT CAN I EXPECT AFTER THE SURGERY? A bandage contact lens is place on your eye after surgery to allow for healing. After surgery, you will have to wear a protective eye shield and can usually return to work or normal activities within the next several days. Vision generally begins improving in about a week's time. Restrictions include:
  • No swimming or hot tub use for a week
  • No make-up, lotions, perfumes for a week
  • No eye rubbing for 6 weeks
  • CALL for a free screening appointment to determine if you are a candidate for laser vision correction at 501-223-3937.

    How We Are Different than Most Refractive Practices
    Laser vision correction is surgery on the cornea of the eye. Dr. Blair is a cornea specialist with extensive training in corneal surgery. In some laser centers, you often do not meet the surgeon until just before your procedure. Many patients do not realize that the chain centers delegate the most important part of the surgical pre-operative planning to non-surgeons. In contrast, Dr. Blair is involved in the whole process, starting from the initial free screening consultation and continuing through the post-operative period. THIS IS CRUCIAL to achieving the best result. Only your surgeon can customize your Laser Vision Treatment to fit your needs.

    Dr. Blair will take the time to explain the risks to you. If she feels you are high-risk, she will give you an honest opinion that you should not have the surgery. On the day of surgery, you are given a cell phone number so you can have immediate access to Dr. Blair if any problems should arise.

    We understand that the decision to undergo a surgical procedure on your eyes is a very big decision that should not be taken lightly. You will evaluate the results of your surgery for the rest of your life.

    Studies show that the 2 factors keeping patients from considering laser vision correction are safety issues and financial issues. With epi-LASIK, the safety profile of the procedure is increased over other laser vision correction modalities.

    To help with the financial considerations, we offer the following:

  • 0% same-as-cash no-interest financing for 12 months
  • FLEX Plans - Flexible Medical Spending Accounts accepted - you can put aside as much money as you want, and it comes out automatically from your payroll and is Pre-Tax.
  • Credit Cards - We accept Visa, MasterCard, and Discover.
  • Corporate Discount Program - If you (or any family member of yours) work for a company with more than 50 employees, you can qualify for our Corporate Discount Program, where everyone in that company will save 10% on their laser vision correction with us - and you will save 15% just for getting this Program set up!

  • In addition, we offer discounts to the following groups. This also applies to family members. (NOTE: If you fall into more than one group, discounts can not be combined).

  • Professional Courtesy (MD, OD, RN, LPN): $100
  • 911 Thank-You (police, fire fighter, EMT): $100
  • Teachers: $100
  • Other Health Care Workers: $100

  • Pleasant Valley Ophthalmology    11825 Hinson Road, Suite 103    Little Rock, AR 72212-3404
    Office  501-223-3937    Fax  501-223-8656    disclaimer

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