LASEK vs LASIK: Differences & How to Choose

LASIK and LASEK are two separate procedures that help reshape the cornea of the eye for permanent or long-term vision correction. 

Although LASIK and LASEK have similar names, it is important to understand that there are distinctions between these two forms of eye correction surgeries. While both procedures address abnormalities in the shape of the cornea, the methods that are used slightly differ.

What Is LASIK?

LASIK (laser-assisted in-situ keratomileusis) is a type of laser eye surgery that incorporates a special type of cutting laser to reshape the cornea. With laser precision, the LASIK procedure has the primary aim of reshaping the dome-shaped clear tissue located at the front of the eye in an effort to permanently improve vision.

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What Is LASEK?

LASEK (laser-assisted subepithelial keratectomy) is a type of laser eye correction surgery that addresses the top layer of the cornea. This procedure aims to loosen and move the top layer of the cornea in order to reach the middle layer, which is reshaped. Then, the top layer is ultimately reattached.

LASEK is often pursued by individuals who have thin corneas, as these people are often not candidates for LASIK surgery.

Benefits of LASIK & LASEK

The number one benefit of both LASIK and LASEK procedures is that they result in permanent vision improvement. Many patients who undergo LASIK and LASEK no longer have to wear glasses or contact lenses. 

Since both procedures correct vision as it is at the time of the surgery, they don’t guarantee that you will have improved vision for the rest of your life. Age-related vision changes can cause vision deterioration in the future. 

LASIK Pros

LASIK is among the most common elective procedures with a very high success rate and a low complication rate. 

LASIK is fast. Many eye care professionals complete the procedure in about 20 minutes. LASIK often corrects vision to at least 20/40 (though 20/20 or better results are common) and is considered a minimally invasive procedure. LASIK can permanently correct refractive errors via state-of-the-art technology.

LASIK recovery is considered relatively painless, although dry eyes may occur as a potential short-term side effect, which can be alleviated with artificial tears. Most patients are able to get back to their normal routines the day after surgery.

LASEK Pros

LASEK is considered to be slightly more invasive than LASIK as well as a longer healing time. Patients experience dry eyes less commonly after the LASEK procedure than patients who undergo LASIK eye surgery. 

Perhaps the most beneficial aspect of the LASEK procedure is that there are no corneal flap complications after the procedure that are normally associated with LASIK. There is also zero risk of excessive outer cornea removal as well, whereas there is a risk of such complications during a LASIK procedure.

LASIK & LASEK Disadvantages 

As with any form of surgery, there are certain risks involved that patients should be aware of before moving forward with any sort of eye surgery, including LASIK and LASEK. Although both forms of laser vision correction have very high success rates, there are examples of adverse events associated with both procedures.

Potential complications of LASIK surgery include the following:

• Dry eyes
• Corneal flap issues
• Infection

After LASIK surgery, there are dangers of the corneal flap becoming infected or dislodged due to any type of contact or sharp blow. It’s important to set yourself up for success by avoiding contact immediately after surgery. 

Drawbacks to LASEK surgery include the following:

• Longer healing time (3–5 days typically)
• Potential pain or discomfort for a few days
• Possible corneal structure compromise

During LASEK surgery, if the corneal structure is compromised, this can result in blurred or hazy vision. 

Candidacy

Consult with an eye care professional to determine if you are a candidate for either LASIK or LASEK surgery. They will assess the structure of your eyes as well as your medical and vision history.

LASEK surgery can be optimal for patients who live with significant myopia (commonly referred to as nearsightedness), which requires removal and reshaping of a larger portion of the central cornea. 

LASIK can correct myopia, hyperopia (farsightedness), and astigmatism. As a result, LASIK can treat a wider variety of eye conditions than LASEK.

Candidates for LASEK surgery often have thin corneas that prohibit them from pursuing LASIK surgery. For both types of surgery, it’s important for the individual to be in good overall health. Patients who experience eye infections frequently are generally not considered the best candidates for either procedure.

Those with autoimmune disorders are also not good candidates for LASIK or LASEK surgery, as complications are more likely to occur during and after surgery.

Additional Differences Between LASIK & LASEK 

LASIK utilizes a femtosecond laser that is able to apply focused and precise pulses to separate the corneal flap and access the stromal tissue of the eye.

LASEK is considered to be a type of photorefractive keratectomy (PRK). An excimer laser is used to create surface-level excisions on the cornea of the eye in lieu of a corneal flap. Ethanol or diluted alcohol solution are then used to loosen the outer layer of the cornea. After brushing the tissue away, the laser is used in an effort to reshape the underlying stroma.

With LASEK, the epithelial flap is thinner when compared to that of a LASIK procedure. This flap remains attached at the corner of the eye, ultimately being replaced during the conclusion of the LASEK procedure.

Choosing the Right Procedure for You

Whether LASIK and LASEK is right for you will depend on your eye structure and refractive error. The first step is to consult with a professional ophthalmologist and/or an eye surgeon in order to determine candidacy. MyVision.org offers many resources to help answer questions about LASIK surgery, including how to find the best surgeon and what type of LASIK may be right for you. Consulting with an eye care professional prior to undergoing LASIK will ensure all your questions are answered, and you have all the instructions and directions you need to set yourself up for a successful procedure. We can help you find a highly rated LASIK surgeon near you.

The choice could ultimately be made for you if you are not a candidate for one but happen to be a candidate for the other. For instance, if you have thin corneas, LASEK would be the better choice between the two procedures. 

Many eye surgeons provide complimentary consultations, which provides a zero-risk scenario for those in pursuit of vision correction. If you aren’t a good candidate for a particular surgery, ask about alternatives.

References

1. Laser‐Assisted Subepithelial Keratectomy (LASEK) Versus Photorefractive Keratectomy (PRK) for Correction of Myopia. (February 2016). Cochrane Database of Systematic Reviews.

2. Laser In Situ Keratomileusis. (July 2022). StatPearls.

3. Anatomical and Visual Outcomes after LASIK Performed in Myopic Eyes with the WaveLight® Refractive Suite (Alcon® Laboratories Inc., USA). (October 2020). Journal of Ophthalmology.

4. Clinical Evaluation of LASEK for High Myopia Correction Between the Triple-A Profile and the Zyoptix Tissue Saving Profile. (April 2019). Journal of Ophthalmology.

5. Analysis of the Efficacy, Predictability, and Safety of LASEK. (December 2002). Investigative Ophthalmology & Visual Science.

6. Safety, Efficacy, and Stability Indices of LASEK Correction in Moderate Myopia and Astigmatism. (October 2004). Journal of Cataract & Refractive Surgery.