Laser-assisted sub-epithelial keratectomy, or LASEK surgery, is an alternative to other vision correction surgeries. It is also referred to as PRK (photorefractive keratectomy), and the two terms can be considered interchangeable.
LASEK treats short-sight (myopia, or near sight in the US), long-sight (hyperopia, or far sight in the US), and astigmatism. It can also treat the need for reading glasses, known as presbyopia.
LASEK is usually only recommended when LASIK surgery is not suitable.
LASEK eye surgery’s benefits are long-lasting as it permanently changes the shape of the front of your eyes. Many patients treated for short-sight and astigmatism can get a lifetime of improvement for their far vision. As the person ages, however, they will most likely need corrective eyewear because of long-sightedness and the need for reading glasses in middle age.
LASEK offers the same benefits as other vision correction surgeries. For some patients, it will be ideal, although it’s not the best choice for everyone.
How Long Is LASEK Meant To Last?
After healing, the results of LASEK are meant to last as it is considered a permanent vision correction solution. However, factors such as astigmatism, presbyopia, regression and other age-related vision issues may affect the long-term results of LASEK.
Most treatments for a typical amount of short-sightedness, e.g. -2 to -4 dioptres, retain their benefit for many years, possibly forever. This is the case, particularly for patients who are definitely past the age where myopia can progress, i.e. 25 or older.
However, the effect of the surgery may reduce over time, known as regression, which is most often found in patients with a high degree of myopia (short-sight), i.e. -5.00 dioptres or greater.
Typically, only part of the initial benefit is lost, between 10-20%. The patient’s vision will still be 80-90% better than it was. Enhancement surgery may be possible once the prescription is stable.
Sometimes the patient becomes slightly short-sighted again, but not because of regression.
It happens because the underlying prescription worsens, meaning the short-sight progresses after treatment while the laser result is stable.
Myopia progression is more common with younger patients, e.g. in their early 20s.
The prescription appeared stable at the time of surgery, but the patient ultimately got a little more short-sighted over the next 3-5 years.
At Focus Clinic, we offer a 10-year guarantee with free re-treatment for short-sighted patients to protect them from the risk of becoming more short-sighted over time.
Most clinics only offer one year of free aftercare and re-treatment.
How Long Is The LASEK Procedure?
The LASEK procedure only takes five to ten minutes per eye, but your team must take several preparatory steps beforehand.
Your ophthalmologist or optometrist will thoroughly examine your eyes and perform a health check at your assessment consultation.
If you wear contact lenses, your surgeon will tell you to stop wearing them for a set time before the operation, often seven days, as they change the shape of your cornea.
Before the procedure, we’ll give you some topical anaesthetic drops to numb your eyes thoroughly.
Next, the surgeon will use medical-grade alcohol on your cornea’s topmost skin layer (epithelium) and then remove it, detaching it painlessly from the tissue beneath.
The epithelium is then rolled back while the eye surgeon works on the corneal tissue using an excimer laser. Upon completion, the top layer of cells is returned to its place and reattached. (See below to learn how LASEK differs from PRK.)
You shouldn’t feel any pain during the procedure, although you might experience a sensation of pressure on your eye. If you’re particularly nervous, we can offer a mild sedative to help you relax, but most patients don’t need this.
Once the procedure has been completed, you can relax in our recovery room for around an hour, allowing us to ensure everything starts settling as expected.
Once you’re ready to go, you’ll need to get a lift home as you won’t be allowed to drive, and you’ll likely need around a week off work until your vision settles.
How Long Does LASEK Take to Heal?
LASEK surgery requires four to seven days for the cornea’s surface skin layer to heal.
You typically wear a night and day contact lens until the epithelium has healed. The clinic will remove the lens after several days.
Your eyes will be painful during the first 48 to 72 hours, so keep your calendar clear for the first few days to allow your eyes to heal. You will be prescribed special eye drops, anti-inflammatories and pain medication to help relieve the discomfort.
Who Should Have LASEK?
LASEK (or PRK) is typically only recommended if you are not a suitable candidate for LASIK eye surgery.
It is an alternative for patients with steep or thin corneas but is also a better option for patients with eyes at an increased risk of injury, such as boxers or mixed martial artists.
It’s sometimes suggested for patients with dry eye syndrome, although with modern LASIK, post-operative dry eye is similar between the two procedures. Additionally, further treatments can allow patients to undergo LASIK, such as IPL therapy for pre-existing dryness.
Who Isn’t A Good Candidate For LASEK?
As good as LASEK is, it’s only for some. Your ophthalmologist will need to know your medical history to check the risks.
Some of the people who should avoid LASEK and other forms of corrective eye surgery are:
- Children under 18: As children go through adolescence, their bodies undergo a lot of change, including their eyes. As a result, the benefits of LASEK in children might be temporary and unpredictable.
- People with an unstable prescription: If a younger person’s vision fluctuates, it’s usually a sign that the prescription is worsening. Many eyes have stabilised by age 25, and almost all by age 30. At Focus, we don’t allow patients to undergo treatment unless their glasses have been stable for a year or longer.
- People with certain health conditions: some health problems, including diabetes, lupus, and rheumatoid arthritis, can adversely affect the outcomes and healing after LASEK surgery—other options, such as ICL implants, may be a better alternative.
- Pregnant women: Pregnant and nursing women are not advised to have LASEK or other vision correction. Pregnancy hormones can cause changes in the prescription, resulting in still needing glasses after surgery. Prescribed medications during and after surgery may not be suitable during pregnancy or breastfeeding because of risks to the baby.
How Is LASEK Different From PRK And LASIK?
LASEK, LASIK, and PRK are corrective refractive eye surgeries that aim to reshape the cornea permanently; however, there are some differences between the procedures.
During LASIK surgery, a corneal flap is created with a femtosecond laser before an excimer laser is used to reshape the shape of your eye and correct your vision. The upper epithelial skin layer remains in place. Vision recovery is much faster, and post-op discomfort is limited to a few hours rather than days.
During LASEK, the surgeon uses an alcohol solution to loosen and detach the surface skin layer of the corneal (epithelium). An excimer laser is then used to reshape the cornea and correct your vision, and the epithelium is then replaced and will heal on its own.
PRK is similar to LASEK, and the two terms are often used interchangeably. The technical difference is that the cornea’s surface layer is removed instead of replaced. The excimer laser is still used to reshape the cornea, and new epithelial cells grow back to repair the eye within five days.
The reason that LASEK evolved from PRK was to reduce the risk of haze (surface scarring). It was found that replacing the epithelial skin layer modified wound healing and reduced the incidence of haze after surgery.
However, most surgeons now perform PRK, removing the epithelium and allowing it to grow back naturally, after discovering that the drug mitomycin C (MMC) could prevent haze formation.
MMC is now widely used to prevent post-ablation haze around the world. MMC was first shown to be beneficial in PRK in a 2000 research paper and has essentially removed the need to perform LASEK.
Many clinics may still describe offering LASEK as the term is established, but the procedure performed is likely PRK with MMC. Your consent form and discussion will clarify this.
Is LASEK Surgery Worth It?
With an outstanding 5 out of 5 rating on Trustpilot, our LASEK patients agree that LASEK is worth it.
While almost all of our patients achieve 20/20 vision (we have a published 100% 20/20 success rate for LASIK), the effects of all laser eye surgery can wear off as we age.
Depending on your degree of refractive error, you may need to wear corrective glasses or contact lenses in the future, but your prescription will be less.
If you’ve been considering laser eye surgery and think LASEK (or PRK) might be the right choice for you, book your free telephone consultation with a member of our team. They’ll happily discuss your treatment options based on your prescription and personal circumstances.