Laser Epithelial Keratomileusis (LASEK): Cost & Effects

Contents

In this article, we will look at:

• What is LASEK?
• Eligibility for LASEK
• LASEK procedure
• Side effects of LASEK
• Pre and post-surgery guidelines for LASEK
• Recovery from LASEK 
• Cost of LASEK surgery in India
• Results of LASEK surgery
• More ophthalmology procedures

You can click on any of the links above to navigate to the section of your interest.

What is LASEK? 

The LASEK procedure is suitable for anyone with a very thin or very steep cornea. 

This surgery is a slight variation of the LASIK and PRK procedures. 

In the LASIK procedure, the surgeon uses an instrument called microkeratome to create a thin flap which remains hinged on the eye, enabling him to lift this outside layer of the cornea. He then reshapes the cornea using an excimer laser. The flap is then re-positioned back on the cornea and acts as a natural bandage.
On the other hand, in the PRK procedure, the surgeon removes the entire upper layer of the cornea (epithelium) and then uses targeted laser or excimer laser to correct and reshape the cornea. After the surgery, a clear contact lens which acts as a bandage is placed over the eyes.

Am I eligible or an ideal candidate for LASEK?

LASEK surgery may be ideal for you if:

• You are above 18 years of age, and have a very high degree of short-sightedness which requires the removal of more corneal tissue.
• It is ideal for you if you have very thin corneas, suffer from dry eyes, are concerned about a corneal flap, or if you had eye surgeries such as PRK done earlier.
• If you are a sportsperson, or are in any profession which puts you at high risk of eye injury and you lead a very active lifestyle,

It is not ideal for you if:

• you suffer from eye diseases or retinal/optic nerve diseases such as keratoconus, 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 take steroids or immunosuppressants, or are prone to allergies or keloids.

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

How is the LASEK procedure performed? 

In the LASEK procedure: 

• The doctor administers local anesthesia to numb the eyes.

Please Note: An eyelid holder is used to hold your eyelid open to prevent blinking and restrict any eye movement. 

• The surgeon then uses a fine blade called trephine to make a small cut on the epithelial layer.
• He covers the epithelial layer with a small cone through which he pours an alcohol solution. The eye is then left for around 30 seconds.
• This alcohol solution loosens the rim of the epithelium, making it easier for the doctor to carefully lift and fold back the epithelial flap, and reshape the exposed corneal tissue underneath, using an excimer laser.
• After the reshaping the cornea, the doctor places the epithelial flap back on the cornea.
• A contact lens is then placed in the eye, which acts as a bandage, allowing the rim of the epithelial flap to heal.

The same procedure is repeated with the other eye. 

LASEK is a great alternative for patients who are not able to undergo LASIK surgery due to extremely thin or irregularly shaped corneas. LASEK is also a good option for patients who are not comfortable with the flap in their eyes created during LASIK surgery. 

LASEK surgery is performed to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.

Are there any side effects of LASEK? 

Following the surgery you may experience: 

• the sensation of having a foreign body in the eye for around 4 days
• poor night vision or cloudy vision under dim conditions upto 9 months
• more pain and discomfort compared to the other procedures
• dry eyes which is a common side-effect for which the doctor will prescribe eye drops for use upto six months after the surgery

Other side effects may include: 

• infections
• seeing halos around objects
• sensitivity to bright light
• inflammation
• undercorrection or overcorrection of eye power too may occur, which may require further surgery or dependence on contact lenses or eyeglasses for selected or all activities.
• a more serious side-effect, which could occur after LASEK surgery is thinning of the cornea, over time. Corneal crosslinking treatment helps to arrest such conditions. In this procedure custom-made riboflavin drops saturate the cornea, which is then activated by ultraviolet light. According to studies, this increases the amount of collagen cross-linking in the cornea thus strengthening the cornea.
  

Some of these conditions may require medications and will gradually disappear as the eyes begin to heal. 

Are there any pre-surgery and post-surgery guidelines for LASEK? 

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 LASEK 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 LASEK surgery if you are not a suitable candidate for LASIK 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.

• to stop smoking and drinking alcohol 48 hours before and after the surgery.
• you should not take insulin if you are a diabetic.
• 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.  
•  avoid strenuous exercise, such as heavy lifting, or swimming, that could result in eye injury.
• Wear 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.
• avoid strong sunlight or glare for 4 weeks after the LASEK surgery to avoid haze formation if you are a sportsperson.
• avoid applying any makeup or lotion on the face, and avoid any situation involving dirt for 7-10 days.
• be careful not to get face wash or soap in your eyes while washing your face, or showering. 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 a LASEK procedure? 

You might require to take time off work for at least 7-10 days following the surgery, to allow your eye to heal. 

The initial vision recovery period which is 24 hours for LASIK surgery can be upto 7 days for a LASEK surgery. 

Complete recovery from LASEK surgery can take anywhere between 6 to 9 months. 

Note: LASEK surgery requires a longer recovery time when compared to LASIK surgery. 

What is the cost of LASEK surgery in India? 

Cost of LASEK surgery can vary depending upon the city/locality,  clinic/hospital type & amenities, experience of the provider, the technology used, type of correction required, and refractory status of eye/s etc. Typically, the cost of LASEK surgery in India may range from  Rs. 45,000 to Rs, 1,00,000.

Please consult your doctor to get the exact treatment plan and price quote suiting your unique needs.

Are the results of LASEK surgery permanent? 

The results of LASEK surgery are longstanding. There may be risks of overcorrection or undercorrection involved, in which cases additional surgeries may be advised by the doctor or alternatively glasses or contact lenses may be prescribed in cases of minor vision correction.

LASEK surgery, however, does not prevent the natural loss of vision which occurs due to aging. 

More Topics on Opthalmology Procedures

People interested in this topic  also read: 

• Corrective Eye Surgery Procedures: Cost & Eligibility
• LASIK (Laser-Assisted in Situ Keratomileusis)
• Epi LASIK (Epipolis Laser In Situ Keratomileusis)
• LASEK (Laser Epithelial Keratomileusis)
• PRK (Photorefractive Keratectomy)
• ICL (Implantable Collamer Lens) surgery 
• Blepharoplasty (Eyelid surgery)
• Cataract Surgery

References