LASEK Eye Surgery: How It Works, Uses & More

LASEK is a kind of refractive surgery that usually involves the use of a solution to help detach the epithelial layer of the eye, which is then scraped to the side using a special tool. Once the eye is reshaped and the refractive error corrected, that flap is moved back. 

This flap is very different from the one created with LASIK. 

Purpose of LASEK

LASEK eye surgery is a type of refractive surgery, used to correct refractive errors like these:

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

The primary benefit of all laser eye surgeries to correct refractive errors is that they offer more permanent correction. Often, there is no need for corrective eyewear following the surgery. 

Looking for the Best LASIK Near You?

Find a LASIK Surgeon

LASEK vs. LASIK vs. PRK

LASEK, LASIK, and PRK all involve the use of lasers to correct refractive errors, but they have key differences.

LASEK

LASEK stands for laser epithelial keratomileusis. It generally involves using a diluted alcohol solution to produce an epithelial detachment. 

Once the solution has had time to work on the epithelial layer of the eye, it is then scraped with special tools. After that layer is removed, the chroma can be reshaped. 

Several different methods for the procedure exist, including the McDonald technique, which does not use the alcohol solution people typically associate with LASEK. 

The epithelium is then carefully repositioned back over the site.

LASIK

LASIK stands for laser-assisted in situ keratomileusis, and it is another type of refractive surgery. 

LASIK involves the use of a laser or fine blade to cut a flap into the upper levels of the eye, exposing the cornea. The cornea is then reshaped, correcting vision, and the flap is put back in place.

PRK

PRK stands for photorefractive keratectomy. This type of refractive surgery uses tools or an alcohol solution to remove your eye’s epithelium, similar to how LASEK surgery does. Then, the exposed cornea is reshaped using a laser. 

In this procedure, the epithelium is not replaced, although it will heal on its own during a patient’s recovery.

Who Is a Candidate for LASEK?

LASEK eye surgery may be a better choice for patients who have thinner corneas in some circumstances. It can also sometimes be a good choice for people with severe myopia. 

As an option for refractive error correction, it is perhaps most comparable to PRK, with experts debating which of the two options is usually best. 

Regardless, LASEK is a safe and medically valid option for the correction of refractive errors. 

Benefits of LASEK Eye Surgery

No flap (at least not in the same sense as with LASIK) is created during LASEK surgery, which is an advantage for those with thin corneas. 

LASEK is also associated with a lower risk of ectasia, a condition where the cornea becomes too weak and a form of astigmatism can develop. 

Disadvantages of LASEK

One of the bigger disadvantages of LASEK is that recovery is somewhat slow compared to recovery from LASIK. LASEK recovery is also usually more painful than LASIK recovery.

In addition, there is the potential for subepithelial haze, where a haze develops that can obscure vision. This usually fades over time, but it can rarely lead to long-term vision problems.

LASEK is also associated with a higher risk of persistent epithelial defect and infection when compared to similar refractive surgery options. It also has many of the same risks associated with other types of eye surgery.

Preparing for Your Surgery

LASEK involves the same pre-op care as other laser eye surgeries.

• Stop the use of contacts three to seven days before your surgery.
• Talk with your doctor about what to expect during surgery.
• Don’t apply face creams or cosmetics the morning of the surgery.
• Stay off certain medications several days before your surgery.

The LASEK Procedure

LASEK is a relatively quick procedure. You’ll be awake for the procedure, but medication is used to make the procedure painless and help keep you calm.

Once you are properly medicated, a device is used to secure the eye and keep it open. Usually, a solution will be applied to your eye. This is to help the doctor remove a thin layer from the eye, which they will scrape with a special tool. This exposes the part of the eye they will reshape with a laser. 

Once the eye is reshaped, the scraped layer is carefully put back, which helps the healing process. 

When the surgery is complete, the doctor will apply a special contact lens, called a bandage lens. This protects the eye as it heals, and you’ll wear this lens for three to four days. 

LASEK Eye Surgery Recovery & Aftercare

As the anesthesia wears off, your eye may feel uncomfortable for a few days as it undergoes the early stages of the healing process. It may itch, but it is important to avoid touching the eye as much as possible. 

Talk to your doctor about the level of discomfort you can expect and potential options to deal with it without disrupting your healing.

For the first week or so, your doctor may have you use antibiotic or anti-inflammatory eye drops. This helps to prevent complications as the protective layer of your eye grows back. 

In the initial weeks of your healing, it is normal for your vision to slowly improve. Talk to your doctor about when to expect your final level of visual acuity, which most patients experience after about three months. 

Make sure to follow all instructions provided by your doctor and to see them for any follow-up visits they recommend. They will track your progress and make sure your eye heals correctly. 

If you experience any strange changes in your vision or abnormal levels of discomfort or pain, contact them immediately. 

Side Effects & Risks of LASEK

A small number of LASEK surgeries result in the development of a subepithelial haze, which can cause permanent or long-lasting astigmatism due to the eye healing incorrectly.

LASEK surgeries have a risk of microbial infection. This infection, called microbial keratitis, can cause permanent damage to your eye if not addressed. Luckily, most eye infections are easy to treat with antibiotics if addressed quickly. 

Similar to LASIK, dry eyes, eye irritation, undercorrection, overcorrection, and halos around lights are risks associated with LASEK.

While LASEK carries the potential for risks like any surgery, it isn’t a notably dangerous procedure. An overall loss of visual acuity is possible but very rare. 

LASEK Eye Surgery FAQs

Is LASEK better than LASIK?

LASIK is much more popular than LASEK. It is usually the preferred option due to its faster recovery time. LASEK is usually the better option when someone has a weak or thin cornea. 

Is LASEK safer than LASIK?

Both LASEK and LASIK are considered safe procedures. LASIK has a faster healing time, so it is generally preferred when both surgeries are an option.

Is LASEK more painful than LASIK?

Yes, LASEK may involve more discomfort and pain than LASIK. The healing process is also longer.

How does LASEK differ from LASIK?

The biggest difference between the two surgeries is how the surgeon accesses the part of the eye they need to reshape. LASEK relies on a solution detaching the epithelium and then using another tool to medically scrape it. LASIK uses a precise blade or laser to cut a flap into the eye, and the flap is then moved to access the cornea for reshaping. 

How long does LASEK take?

A LASEK procedure takes under an hour, usually less than 20 minutes. 

How long do the results of LASEK last?

Once a patient has completely healed in about three months, the results of the surgery are permanent. Unless your vision deteriorates for some other reason, such as age-related vision loss, your visual acuity will remain at the same level.

References

1. Ectasia After LASIK. (January 2008). American Academy of Ophthalmology.

2. 10 Years Follow-Up After LASEK in High Myopia Using the Wavelight Allegretto Excimer Laser. (May 2010). Investigative Ophthalmology & Visual Science.

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

4. LASIK. (March 2018). U.S. Food and Drug Administration.

5. People Considering Laser Eye Surgery Should Be Warned of Risks, Says NICE. (April 2006). The BMJ.

6. Bandage Lenses Validated as Post-LASIK Treatment. (February 2019). Review of Optometry.

7. Laser‐Assisted Subepithelial Keratectomy (LASEK) Versus Laser‐Assisted In‐Situ Keratomileusis (LASIK) for Correcting Myopia. (February 2015). Cochrane Library.

8. The Prevalence of Infectious Keratitis after Keratorefractive Surgery: A Systematic Review and Meta-Analysis Study. (July 2020). Journal of Ophthalmology.

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

10. Laser-Assisted Subepithelial Keratectomy (LASEK) Without Alcohol Versus Photorefractive Keratectomy (PRK). (October 2003). European Journal of Ophthalmology.

11. Epi-LASIK Versus LASEK and PRK. (April 2012). Journal of Cataract & Refractive Surgery.