Epipolis Laser In Situ Keratomileusis (Epi-LASIK ): Cost & Effects

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What is Epi LASEK? 

Epi LASIK surgery can be considered to be a cross between LASIK and LASEK but also differs from them. 

In LASIK surgery the surgeon uses an instrument called microkeratome to create a thin flap which enables him to lift the outside layer of the cornea. The cornea is then reshaped by him using an excimer laser. The flap is then re-positioned back on the cornea and acts as a natural bandage.
LASEK surgery involves the surgeon using a fine blade called trephine to make a fine cut on the epithelium and then using alcohol to loosen it, so that the surgeon can fold the epithelium aside and work on the cornea underneath. The epithelium remains attached to the eye. 

How is the Epi LASIK procedure performed? 

  • At the outset, the doctor administers local anesthesia to numb your eyes
  • The surgeon then uses an instrument called epikeratome, a blunt, plastic swaying blade to lift an extremely thin flap of the epithelium. The blade does not penetrate the cornea as it does in LASIK surgery.
  • Then, instead of alcohol, which is used in LASEK surgery, the surgeon, uses an epithelial separator to separate the thin hinged flap from the cornea and fold it aside.
  • He then shapes the cornea using an excimer laser, following which the epithelial flap is placed back above the cornea.
  • A contact lens is placed on the eye which acts like a bandage, allowing the epithelial flap to heal.

The same procedure is repeated with the other eye. 

Am I eligible or an ideal candidate for Epi-LASIK surgery?

Epi LASIK is a perfect procedure for you if:

  • you are above 20 years of age,
  • have an extremely active lifestyle,
  • are working in the police force or military, in the airlines as a pilot or cabin crew, as a fireman,
  • If you are a sports person.
  • if you have thin corneas, and suffer from dry eyes, or are in any profession where you face the possibility of eye trauma.
  • if you seek to preserve more of your cornea tissue for enhanced surgeries in the future, as your eyes age.

Since this procedure does not involve the creation of a thicker flap above the cornea, you can opt for this procedure if you seek to avoid flap-related complications such as infections, inflammations, flap dislodgement or flap wrinkles.

This surgery is not for you:

  • if you are pregnant or nursing.
  • if you suffer from eye diseases or retinal/optic nerve diseases such as keratoconus, glaucoma, cataracts, corneal disease, herpes simplex, herpes zoster, or from autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, or Lupus, or conditions such as diabetes, arthritis, collagen vascular disease,
  • you are also not a good candidate for Photorefractive Keratectomy (PRK) if you take steroids or immunosuppressants, or are prone to allergies or keloids.

Please Note: You need to have stable vision for a year before the date of the surgery. 

Are there any side effects of Epi-LASIK surgery? 

Some common side effects of Epi LASIK surgery include:

  • blurry vision for 3-4 days after the surgery
  • dry or itchy eyes, mild pain or burning sensation
  • seeing starburst lights
  • double vision
  • feeling of foreign body in the eyes
  • seeing halos around light sources, and sensitivity to light

These symptoms will gradually improve as the eyes heal.  Slightly serious but rare side effects include:

  • infections, or inflammation
  • overcorrection or undercorrection are some other side effects which may occur due to the surgery. When overcorrection occurs nearsightedness gets altered to farsightedness, and it is vice versa for undercorrection. These residual vision error conditions can be corrected through enhancement or retreatment surgeries. If however, your cornea is too thin or steep the surgeon will advise you to refrain from additional surgeries and will instead prescribe you glasses or lenses to correct your vision.

Unlike LASIK surgery, after the Epi-LASIK procedure, which is a surface surgery, there are no flap-related complications. 

Are there any pre-surgery and post-surgery guidelines for Epi-LASIK surgery? 

Prior to going for an evaluation by an ophthalmologist, it is recommended to stop using contact lenses for four weeks and switch to wearing glasses. Wearing contact lenses over a long period of time changes the shape of the cornea. The cornea then takes a long time to assume its natural shape.  It is similar to how a watch band leaves an imprint on the hand when worn for a long time. Therefore, an evaluation and surgery based on the cornea which has not assumed its natural shape can have negative implications. 

During the evaluation you need to discuss in depth with your doctor about whether you are a good candidate for Epi LASIK surgery, what are the alternative surgeries you can opt for, what are the risks and complications involved, what can you expect after the surgery, and what are the pre and post surgery guidelines. 

The doctors usually advise Epi LASIK surgery if you are not a suitable candidate for LASIK surgery. 

You also need to abstain from contact lenses at least 6 weeks prior to the surgery. 

On the day of the surgery:

  •  avoid applying any cream, lotion, or makeup on your face.
  • you need to discontinue any cold or allergy medicines at least 4 days prior to the surgery.
  • If you take any blood thinners you need to check with the doctor whether you need to stop taking them for sometime prior to the surgery.
  • You will need to stop smoking and drinking alcohol 48 hours before and after the surgery.
  • On the day of the surgery, you should not take insulin if you are a diabetic.
  • You will need to arrange for being driven home after the surgery.

Following the surgery:

  • you need to take care not to rub your eyes. In fact, wearing an eye shield during sleep will be ideal so that you do not inadvertently rub your eyes.  
  • You should avoid strenuous exercise, such as heavy lifting, or swimming, that could result in eye injury.
  • Wearing sunglasses for a week after the surgery, even while indoors, is a must. Ideally, glasses should be worn for the first six months after the surgery to avoid UV rays and avoid haze formation.
  • If you are a sportsperson you should avoid strong sunlight or glare for 4 weeks after the LASEK surgery to avoid haze formation.
  • You need to avoid applying any makeup or lotion on the face and avoid any situation involving dirt for 7-10 days.
  • While washing your face, or showering, you need to be careful not to get face wash or soap in your eyes. In fact, you need to keep water and shampoo away from your eyes for at least 7 days after the surgery.
  • Avoid swimming and hot tubs for at least a month after the surgery.
  • You will need to apply eye drops in your eyes at regular intervals as prescribed by the doctor.

How long will it take to recover from for Epi-LASIK surgery? 

It will take 6-7 months for the eyes to heal completely.

Note: Epi LASIK requires a slightly longer period of recovery than LASIK.

What is the cost of Epi LASIK surgery in India? 

Epi LASIK surgery in India can cost anywhere between Rs. 30,000 to Rs. 50,000. 

Are the results of Epi-LASIK surgery permanent? 

The effects of Epi LASIK are permanent. However, Epi LASIK cannot prevent the natural deterioration of eyesight that happens with age. 

More Topics on Opthalmology Procedures

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References

1. Katsanevaki V, Kalyvianaki M, Kavroulaki D, Pallikaris I. One-Year Clinical Results after Epi-LASIK for Myopia [Internet]. 2018 [cited 6 April 2018]. Available from: http://www.aaojournal.org/article/s0161-6420(06)01323-6/abstract

2. Torres L, Sancho C, Tan B, Padilla K, Schanzlin D, Chayet A. Early Postoperative Pain Following Epi-LASIK and Photorefractive Keratectomy: A Prospective, Comparative, Bilateral Study [Internet]. Healio.com. 2018 [cited 6 April 2018]. Available from: https://www.healio.com/ophthalmology/journals/jrs/2007-2-23-2/%7B806690bc-b99d-4822-ad70-195cb623f33d%7D/early-postoperative-pain-following-epi-lasik-and-photorefractive-keratectomy-a-prospective-comparative-bilateral-study

3. Yuksel N, Bilgihan K, Hondur A, Yildiz B, Yuksel E. Long term results of Epi-LASIK and LASEK for myopia [Internet]. 2018 [cited 6 April 2018]. Available from: http://www.contactlensjournal.com/article/S1367-0484(13)00275-0/abstract

Would you like to consult a doctor for Epipolis Laser In Situ Keratomileusis (Epi-LASIK ) ?

Questions answered by trusted doctors

Verified User
Can vision varies till 3 months Now i am having 6/18 vision It has been 45 days Please help me out My pre epilasik power was -8 in one eye -7 in one eye -7 eye was treated with lasik and -8 was treated with epilasik( surface abalatiin) Lasik treated was very good vision Epilasik treated eye was 6/18 vision now Foctor said u will get 6/12
Dr. A K Goel
Ophthalmologist/ Eye Surgeon, Moradabad
whatever you do -8 number is likely not to be fully corrected.
Verified User
Hi my age is 32, My corneal thickness is 494 RE & 497 LE having a SPH of -6 CYl -1.5 axis 175 both eyes Consulted some doctors and I’m so confused now where to go and whom to consult. 2 doctors have told me not to perform surgery and continue with spectacles 1 has told that epi lasik or Lasek can be done and 2 doctors have suggested ICL to be done I’m clueless about this now and need help regarding the type of surgery and the doctor also. Preferably in Bangalore only
Dr. Bhavik C Zala
Ophthalmologist/ Eye Surgeon, Ahmedabad
You can go for ICL or clear lens extraction the residual refraction can be treated with epilasik  as per you and your ophthalmologist opinion ..... other things only can tell only after detail examination of you.. 
Dr. A K Goel
Ophthalmologist/ Eye Surgeon, Moradabad
Yes best option for you is specs.
The other option being  contact lenses
Lasik may leave some residual number
Epilasik or Femto lasik is likely to be error free
ICL is sure not leave any residual error.
Verified User
I am having the number in right eye 2, then if i want to remove the same then which sugery is best lasik or epi lasik ?(
Dr. A K Goel
Ophthalmologist/ Eye Surgeon, Moradabad
epilasik is better.  but in you cad even  simple lasik will be equally good and a bit economic.
Dr. Vaibhev Mittal
Ophthalmologist/ Eye Surgeon, Sangrur
Hello

Both are equally good

Epilasik is preferred if corneal thickness is less

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Did you know?

Recovery from Epi-LASIK surgery takes longer

Recovering Epi-LASIK surgery takes a significantly longer time than LASIK. After a LASIK surgery there is a noticeable improvement in vision 24 hours after the surgery. Vision improvement after an Epi-LASIK surgery is usually noticeable around 7 days after the surgery. Usually you can drive within a week after surgery. Some patients experience the final results possibly three or six months post the surgery.

Epi-LASIK surgery is not meant for everyone.

Epi-LASIK surgery is not meant for everyone. When your doctor suggests you undergo an Epi-LASIK, discuss the reasons and the pros and cons. Epi-LASIK is suggested for people who have thin corneas, with insufficient tissue for a good LASIK flap. It is considered to be a safe option for people whose hobbies or professions make them prone to being hit in the eye (such as sports people, soldiers, police officers etc.) as there is no risk of the flap being dislodged and there is less weakening of the cornea.

Possible complications of Epi-LASIK

Though relatively uncommon, Epi-LASIK sometimes can result in complications such as, over/undercorrection, seeing halos or starbursts around light sources, loss of epithelial flap, visual fluctuation, double vision, and epithelium erosion.

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