Lasik Alternatives in the Bay Area
LASEK, PRK, and EPI-LASIK in San Jose
Are you searching for lasik alternatives in the Bay Area? Dr. Mark Mandel offers three popular lasik alternatives: LASEK, PRK, and EPI-LASIK. These lasik alternatives are offered to patients who are not suitable for the traditional lasik procedure.
LASEK is not a misspelling of LASIK, but a minor modification of the PRK procedure. PRK was the first laser procedure to be approved by the FDA in 1995. PRK and LASEK use the same lasers, the same computers, and reshape the cornea in the same way as the LASIK procedure. The main difference is that in PRK/LASEK there is no corneal flap. Although the healing takes longer for PRK/LASEK than for LASIK, the visual results are the same.
PRK and LASEK Comparison
In PRK, the surface cells (epithelium) of the cornea are polished and removed. In LASEK these cells are traditionally loosened with alcohol, laid out of the way in a sheet (not a LASIK flap) and then used to recover the corneal surface after the laser has been applied to the surface of the cornea. Since 1999, Dr. Mark R. Mandel removes the cells with alcohol but does not replace the sheet of devitalized epithelium. EPI-LASIK is essentially the same procedure as LASEK (not to be confused with LASIK), but the epithelial “sheet” is created using a special modification of the microkeratome used to make the (deeper) LASIK flap. After PRK or LASEK, a bandage contact lens is placed on the eye for about one week as the surface cells heal.
Should I Get LASIK or PRK?
LASIK and PRK are both effective procedures for improving your vision and reducing reliance on contacts or eyeglasses. While LASIK is the more popular procedure, PRK can be a better choice for certain patients.
Differences between LASIK and PRK
Each laser vision correction procedure uses an excimer laser to reshape the cornea and allow light to be more sharply focused onto the retina, thereby improving vision. The main difference between LASIK and PRK is that in PRK no corneal flap is created. Instead, the surface cells of the cornea are polished and removed, and the laser is then applied directly to the surface of the cornea. The disadvantage of PRK is that it requires a longer healing time — but it can be the best option for people that are not good candidates for LASIK.
Reasons to Choose PRK
Patients with very thin corneas may be unable to safely undergo the creation of the corneal flap during LASIK. Other abnormalities in the cornea can also make PRK a better option than LASIK. Patients who have high-risk occupations or hobbies where they are likely to incur an eye injury that could damage the healing corneal flap may also prefer to have PRK.
Results for PRK vs. LASIK
Both PRK and LASIK provide the same results for correcting vision. The main difference is that it may take up to four weeks for vision to become clear after PRK. For this reason, many patients elect to have PRK performed on one eye at a time, with the procedures spread three to five weeks apart.
About Lasik Alternatives
All of the LASIK alternatives (PRK, LASEK or EPI-LASIK) are known as “surface procedures.” They are performed for patients who are not good candidates for the LASIK procedure and for the occasional patient who would otherwise be a good candidate for LASIK, but requests an alternative instead. The main indication for a LASIK-alternative procedure is a cornea which is too thin to safely undergo a LASIK flap, or a cornea with relatively normal thickness but which has a mildly abnormal configuration such that it may not be safe to perform LASIK. Additionally, for some patients in high-risk occupations or with high-risk hobbies where they are likely to incur a physical eye injury with potential damage to the flap, they may be better suited for LASEK or PRK.
For all of the LASIK alternatives the excimer laser is programmed the same as for the LASIK procedure, but because the laser is applied directly to the surface of the cornea, there can be no flap complications such as microfolds, or intra-operative or post-operative flap trauma. The disadvantage of this is that it may take up to 4 weeks for the patient’s vision to become clear. Therefore, unlike LASIK, most patients elect to have PRK, LASEK or EPI-LASIK in just one eye at a time. A corrective contact lens is worn in the unoperated eye until the vision is clear enough in the operated eye and then the second eye undergoes surgery. This is typically 3 to 5 weeks after the first eye. If a patient does not wear contact lenses, then the unoperated eye can be corrected with a spectacle lens while clear glass can be placed in the spectacle over the operated eye during the healing process.
Most of the risks and complications of the PRK, LASEK or EPI-LASIK procedures are the same as for the LASIK procedure. Therefore, patients must view Dr. Mandel’s DVD and read the outlines on the complications on LASIK prior to undergoing PRK, LASEK or EPI-LASIK. The additional complication that can occur following PRK, LASEK or EPI-LASIK, but not in LASIK patients, is the potential for scarring on the surface of the cornea. This scarring, if left untreated, can significantly decrease visual acuity and quality of the vision. It may also induce regression back toward nearsightedness and/or astigmatism.
Possibility of Scarring
In order to diminish the possibility of scarring, since 1999, Dr. Mandel has been performing PRK, LASEK or EPI-LASIK with the intra-operative use of Mitomycin-C. Although not FDA approved for this procedure, it is common and standard practice among experienced refractive surgeons. Mitomycin-C is a cancer chemotherapeutic agent, which, in this case, is used to prevent scarring of the surface of the cornea following PRK, LASEK or EPI-LASIK. We have not observed nor are we aware of any complications that result from the off-label use of intra-operative Mitomycin-C in the concentrations and for the time periods for which we use it in refractive surgery.
Like all corneal refractive procedures, after receiving a LASIK-alternative procedure, a certain percentage of patients require an enhancement for overcorrection, under correction, or induced astigmatism. Your probability of needing an enhancement is based on many factors such as your degree of nearsightedness, farsightedness and/or astigmatism, as well as individual healing factors that cannot be predicted. If you require an enhancement, this is usually performed 6 to 8 months after your initial procedure to ensure that the refraction is stable. If an enhancement is required, a repeat PRK or LASEK with Mitomycin-C will be performed.
Learn more about LASEK, PRK & Epi-LASIK
Dr. Mark R. Mandel at the team at OPTIMA Eye, are committed to helping their patients achieve the quality vision they deserve. They offer LASEK, PRK and Epi-LASIK as an option for patients who don’t quality for LASIK surgery. To learn more about these procedures, or to schedule a consultation, contact OPTIMA today at 877-210-2020 ext. 3