What types of laser surgery are available?
There are two principle types of laser eye surgery although there are lots of different names for laser eye surgery which is very confusing. For example, there is “LASIK“, “LASEK“, “PRK”, “Epi-LASEK” – all very confusing.
To simplify it one should think about it as there being surface treatments, so this essentially laser the surface of the cornea. And that’s what’s more commonly known as PRK or LASEK. In that procedure, the thin, filmy skin, known as the epithelium, is removed from the cornea and then the short-sightedness, astigmatism or long-sightedness is applied on the surface of the cornea. And then, depending on the technique the surgeon prefers, the skin is replaced and the cornea then recovers. That’s a very effective treatment for patients who have maybe a slightly dry eye or a thinner cornea, but the downside of this procedure is that the recovery is slower, so that for the first two, three, four days the eyes are watery and gritty, as if you got your contact lenses in upside down and inside out and you slept in them. So it does take 3 or 4 days until the eyes fell comfortable and then probably about 4 weeks for the vision to really crisp up. So one can be driving after 4 or 5 days, Patients have to understand that it takes a good month to get that crispness, but the outcome with that technique is excellent.
The alternative to a surface treatment is what’s known as LASIK. And LASIK traditionally was done using a surgical blade to create a very thin layer on the surface of the cornea. It’s now done with a laser, called a femtosecond laser. The femtosecond laser is placed on the eye and it creates a layer of microbubbles. A hundred microns in the depth of the cornea. So that’s just one-tenth of a millimetre – it’s a tiny amount. And then the surgeon will lift that flap through the layer of bubbles, lift the flap up and then on the underlying cornea apply the shortsighted, astigmatism or longsighted treatment and then replace the flap. The recovery from that is very quick, so patients are driving the next day.
So you may ask: “Why doesn’t everybody have the laser procedure; the recovery is quicker?” And the reason is that everybody’s eyes are different. And what we’re very careful about is that we make sure we select the right treatment for the right patient. And so we often can’t tell until we’ve done all the diagnostics and we’ve made our calculations on the laser with the computer what procedure is best for which person.
More about Robert Morris
Rob Morris is a Consultant Ophthalmic Surgeon at The Grange Eye Consultants. His special expertise is in cataract and refractive surgery, including Refractive Lens Exchange, and adult squint. He has over 30 years experience in treating people with eye problems. Rob Morris founded Grange Eye Consultants to manage the increasing demand for more complex refractive surgery. He leads clinical trials investigating novel eye treatments. He is currently Medical Director at Optegra Eye Hospitals.