Many patients can have either LASIK or LASEK (PRK Epiflap) and want help to decide which one to have.

 Essentially, the 2 operations achieve the same results and cover the same range of prescriptions (+4 to -8 approx.)  However, LASIK is a nicer surgical experience for the patient as there is quick visual recovery and no pain apart from a little grittiness. Fairly clear vision is achieved from about 3 to 4 hours post op and both eyes can be treated on the same day even in high prescriptions. On the downside, there is more risk than any variety of surface laser (PRK. LASEK, Epiflap, Epi-LASIK) as in LASIK a flap is cut with a mechanical microkeratome. Most LASIK complications are flap complications and there is the same risk in treating a small prescription such as a -1 and a large one such as -10. The cut edge of the flap is covered over by epithelium by the next day but the interface always has a potential space. It is useful to think of the analogy of a self-sealing envelope flap - you throw it in the post and it travels across the country without falling to bits. However, at the other end one can lift up the stuck flap with a letter-opener. Although us surgeons find it quite easy, in the first few months especially, to peel open a flap with a similar sort of "letter-opener" , in real life this seems to happen only infrequently. In our very busy clinic we have only had 3 such flap displacements over about 8 years. One was a patient who was punched in the eye 7 days after the surgery when at the pub, another was clawed in the eye by her pet dog, and the third poked a piece of plastic forcefully into his eye. In all 3 cases the patients came to the clinic on the same day and all had excellent outcomes when the wrinkled flaps were re-positioned. It really requires a direct oblique physical blow onto the eyeball to dislodge the flap. However, we advise patients who indulge in physically risky situations to have surface laser rather then LASIK. Such would be rugby players, boxers, karate etc. The American army now accepts both LASIK and PRK but special forces and military pilots must have PRK. (the latter is in case of ejection at high speed, which can be very traumatic on the eyes).

LASEK has a slower visual recovery and is also more painful. Pain is a lot less than it used to be with PRK because of the epiflap technique, silicone contact lenses post op, diluted anaesthetic drops and better oral medication. Most patients have some pain the first day and for days 2 and 3 usually just a little grittiness and photophobia. Patients will see at day 1 post op with LASIK what they will see at day 7 with LASEK, but at 2 weeks post op there is no difference in vision even with large prescriptions. In fact there is a quicker recovery of low light vision with surface laser than LASIK. LASEK/ PRK are back to the baseline pre-operative values by 1 month post-op, whereas with LASIK this normally takes up to 3 months and occasionally longer. Also there are about 25% of LASIK patients who permanently lose a little night vision, whereas this does not normally occur with surface laser. This loss with LASIK is, ,however, very slight, and most patients do not even notice this unless they undergo special testing. You need longer off work with LASEK than LASIK as the special "bandage" contact lenses come out at 3 to 4 days post op. If I operate on a Tuesday, then the contact lenses come out on the Friday and the patients are back to work on the Monday. If the operation is on a Thursday or a Friday, then the lenses come out on the Monday and back to work is Tuesday or Wednesday. The bigger the initial prescription, the slower the visual recovery. It is reasonable to do a bilateral same day LASEK up to about -5. For higher prescriptions than this, I usually do one eye at a time unless the patient has got a couple of weeks free. One is not blind during this time but may not be up to driving standard. 

LASEK has less risk that LASIK because there is no flap cut. However, complications are rare with either operation. So far this year (Oct 2003) I have not had a single LASIK complication and I am doing about 30 eyes one week and 60 the next. Last year I had 3 complications and managed to sort out 2 and a half of them. LASEK only really has one complication which is "haze" (see complications page). I have had one of these in 2003 and another in 2002. Usually haze goes by itself but if it doesn't , then it can be got rid of by another operation.

LASIK seems to be more prone to causing dry eye problems than LASEK. There is a recent article on this topic  here.

For Longsight with either LASIK or LASEK, there is an initial myopic (short-sighted) shift. For the first few days or even up to a couple of weeks, the patient has very good near (reading) vision but it is a bit blurred for distance. Then, as the eyes settle, the distance vision gets better and the reading vision gets worse (depending on the patient's age). Hence we normally warn the patients that they may not be legal to drive the first week after the operation. One can buy cheap glasses for this period if wanted.