Epi-LASIK Eye Surgery: Uses, How It Works & Outcomes

Epi-LASIK eye surgery is a type of refractive surgery. It is similar to LASIK but a thinner flap is cut into the eye, not going deeper than the epithelium. 

This makes it a good option for patients who may have thinner corneas, helping to prevent corneal ectasia. 

The Goal of Epi-LASIK Eye Surgery

Epi-LASIK (epithelial laser-assisted in situ keratomileusis) surgery is an advanced surface ablation procedure meant to correct refractive errors in the eye. One advantage it has over traditional LASIK is that the flap that is cut into the eye is much thinner. 

Many experts prefer it over traditional LASIK, as it offers similar benefits without some of the risks present with LASIK. 

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Epi-LASIK Surgery Candidates

Epi-LASIK eye surgery can correct refractive errors, including these:

• Myopia (nearsightedness)
• Hyperopia (farsightedness)
• Astigmatism

Epi-LASIK is an option for a wider range of candidates. The thinner flap that is created means a candidate whose cornea may be too thin for LASIK may still qualify for epi-LASIK. Even if you can safely get LASIK, you may want to ask your doctor about epi-LASIK, as some argue it is simply a better option.

Generally, patients who have previously had refractive surgery on the same eye will not be good candidates for epi-LASIK.

What to Expect With Epi-LASIK

During your initial consultation, your doctor will dilate your eyes with special eye drops. This helps them better view your eyes and determine whether you’re a candidate for epi-LASIK. If you qualify for the surgery, it will be scheduled.

During your surgery, you will be given medication to stay relaxed and pain-free. A device is used to expose and secure your eye. 

A device is then used to slowly and precisely cut a very thin layer from the top of your eye. Epithelial separators are used to isolate this layer using suction. 

At this stage, the doctor uses a laser to reshape your central stroma, which allows light to refract more precisely into your eye. This is what will improve your vision. 

Then, the doctor carefully puts the flap back in place. You will wear a special contact lens, called a bandage contact lens, that helps to keep the flap secure while it heals. 

Epi-LASIK Recovery

While comparable to LASIK in terms of risk, epi-LASIK may produce more discomfort and take longer to heal from than LASIK. Your doctor will likely prescribe anti-inflammatory medication to reduce pain and any inflammation. 

Epi-LASIK is considered to have less pain in recovery and a faster healing time than PRK.

Pain and general discomfort shouldn’t be severe, but you may be uncomfortable at some points during the early stages of recovery.

Epi-LASIK Outcomes 

Your vision is unlikely to improve right away following epi-LASIK. 

In the initial month, most patients see a dramatic change in their vision, assuming the surgery was a success. Over the next three months, your vision will improve further, generally reaching the best visual acuity you will achieve during this time. 

Overall, final visual acuity is often better than it would be with LASIK, although still largely comparable. 

Risks of Epi-LASIK

Most eye surgery carries the risk of bleeding, infection, or swelling. These problems can be serious if not addressed, although doctors prepare for them ahead of time. 

Doctors often prescribe anti-inflammatory and antibiotic eye drops to sharply reduce the risk of infection and inflammation becoming serious complications. Again, these are risks with any eye surgery.

Overall, epi-LASIK eye surgery is one of the safest options for correcting refractive errors. It involves less drastic cutting of the eye compared to LASIK, and it is considered comparatively easy to perform. 

While the alternative options discussed below are medically viable and not unjustifiably risky, they do tend to carry more risk than epi-LASIK.

Laser Surgeries to Correct Refractive Errors

Here are breakdowns of the major types of laser surgeries to correct refractive errors:

Epi-LASIK

Epi-LASIK surgery is a relatively recent advancement in laser eye surgery that combines elements of LASIK surgery with PRK surgery. It gets its name from the cut made to the epithelium of the eye. After the cornea is reshaped, the cut flap of the eye is put back in place. 

Epi-LASIK surgery is not the perfect refractive error correction procedure because all options carry their own disadvantages, but it is attractive in terms of outcome, the relatively low risk of serious complications, and the fact that it can help people for whom LASIK isn’t an option. 

LASIK

LASIK generally uses a laser to cut a flap into the eye and reshape the cornea. While similar to epi-LASIK, the cut is slightly deeper with a much more distinct flap. 

LASIK carries a slightly higher risk of serious complications, although that risk is still very low. 

LASIK carries incredibly high rates of patient satisfaction. It is also a surgical option worth discussing if you are considering epi-LASIK surgery.

LASEK

LASEK (which stands for laser epithelial keratomileusis) is a procedure designed to combine the advantages of LASIK and PRK surgery. 

It involves using a diluted alcohol solution on the cornea to produce an epithelial detachment. A flap is then created and a laser reshapes the eye. The epithelium is then put back in place.

PRK

PRK (photorefractive keratectomy) also uses a laser to change the shape of the cornea. It is a good option for people with dry eyes or thin corneas that make procedures like LASIK nonviable. 

The epithelium of the eye is carefully removed with one of several options, such as a brush, laser, or alcohol, and the cornea is then reshaped with a laser. 

When Is Epi-LASIK the Best Option?

Epi-LASIK may be the best option for patients with thin or irregularly shaped corneas. Even if you’re a candidate for LASIK, epi-LASIK may still represent a safer option that can produce similar or better results.

Talk to your eye surgeon about which laser eye surgery makes the most sense in your situation. 

Epi-LASIK FAQs

What makes epi-LASIK different from LASIK?

The primary difference between these procedures is that epi-LASIK surgery involves cutting a much thinner flap into the eye, often making it a viable option for those with thinner corneas. While LASIK may weaken the cornea, epi-LASIK should not.

Is epi-LASIK the same procedure as PRK?

No. While the procedures have similarities, PRK does not involve cutting a flap in the cornea. Instead, the epithelium is removed. 

Epi-LASIK surgery involves cutting a very thin flap into the eye in order to reshape the cornea. The flap is then put back in place.

How long does it take to recover from epi-LASIK surgery?

A patient can expect more or less total recovery within three months, experiencing the final or close to final level of visual acuity achieved by the surgery within this time. Within a month, a patient will likely already see a significant change in their vision, often (but not always) at levels at or near 20/20.

References

1. A Closer Look at the Epi-LASIK Procedure. (August 2004). Review of Ophthalmology.

2. Epi-LASIK: The Procedure, Pain Management and Patient Results. (September 2005). Ophthalmology Management.

3. Epi-LASIK Versus Epi-LASEK. (January 2008). Journal of Refractive Surgery.

4. Experts Revisit Epi-LASIK. (2006). American Academy of Ophthalmology.

5. Comparison of Visual Outcomes After Femtosecond Laser-Assisted LASIK Versus Flap-Off Epipolis LASIK for Myopia. (July 2020). BMC Ophthalmology.

6. Epi-LASIK Offers Fast Recovery Time, Improved Patient Comfort. (September 2007). Ocular Surgery News.

7. LASEK. (September 2021). American Academy of Ophthalmology.

8. What Is Photorefractive Keratectomy (PRK)? (April 2022). American Academy of Ophthalmology.

9. One-Year Outcomes of Epi-LASIK for Myopia. (May 2021). Journal of Refractive Surgery.