What's In a Name?  LASIK, LASEK, PRK, All Laser LASIK, ILASIK
By Richard Burns, MD

Refractive surgery has dramatically expanded over the last few years. The 2 approaches to improving vision without the need for glasses or contacts are corneal based (LASIK, LASEK, PRK, ILASIK) and lens based (Refractive Lensectomy, Premium Lenses such as ReStor, Toric, and Crystalens).

Corneal based procedures use a laser to reconstruct the cornea. The cornea is the clear window in front of the eye.  If you wear contacts, this is where you would place a contact lens. The first laser procedures on the cornea began with PRK, or photorefractive keratectomy, which means light activated removal of corneal tissue to achieve a different correctable vision. This is a very effective and safe procedure that millions went through when we first started doing this procedure in the early 90's. To reshape the cornea an Excimer laser is directed to the cornea surface and removes tissue painlessly. The recovery time takes about a week and there can be some moderate discomfort for a few days.

 LASIK came about by combining 2 procedures (the cutting of a flap in the cornea with the Excimer laser) and rapidly grew in popularity because of the quickness of vision recovery and the relatively painless post operative course. The cutting of the flap is done in a painless fashion with an ultra-thin microsurgical blade. Once the flap is cut, it is raised up and the Excimer laser is applied to the bed of the cornea. This reshaping, because it is done underneath the surface, allows for a quicker (1 day) recovery of vision and very little, if any, discomfort. This procedure rapidly gained favor from 1997.

 As we performed more of these we recognized that there were some people who would do better with different procedures. To try to reduce the discomfort of the PRK procedure, yet avoid some of the problems associated with the flap creation, a new procedure evolved called LASEK. This procedure created a miniflap with the help a very diluted alcohol solution, thus avoiding the metal blade used to cut the flap. This procedure (LASEK) combined more safety than LASIK with less discomfort than PRK. Vision recovery was similar to PRK, about a week. This procedure was popular in early 2000.

The latest procedures have seen a resurgence of PRK to about 20% of the corneal based procedures, as well as the combination of the multi-laser approach of the All Laser LASIK, or ILASIK. ILASIK is the brand name created by the manufacturer, AMO, which combines the Intralase laser with the VISX Excimer laser. The Intralse laser 'cuts' the flap by using a YAG laser to place tiny microbubbles exactly 80 to 120 microns beneath the surface of the cornea. These bubbles then march across the cornea, effectively separating the corneal tissue and allowing a flap to be lifted and then treated with the Excimer laser. This all laser LASIK procedure is the top procedure available for the best personal vision for most people.

 Today the Excimer laser has significantly improved, allowing us to treat tiny imperfections 25 times better than the standard Excimer, whether done by PRK or All Laser LASIK. Plus, it is safer with the tracking devices that take away the need for the patient to worry about fixating during the procedure.

 Not all surgeons do the all laser procedure and some only do one kind of procedure. In order to make sure you have all the best options available to you, make sure you find a surgeon who performs all of the procedures available today. There are always reasons why some people are not candidates for different procedures as there are some complications that can occur (glare and halo, dry eye). During the pre-operative evaluation process your surgeon will discuss with you whether you are a candidate and which procedure is best for you.

Richard Burns, MD can be reached at California Eye Professionals, 951-296-9300.