According to several eye surgeons, Epi-LASIK is a viable alternative to photorefractive keratectomy with alcohol or mechanical scraping, boasting faster recovery time and pain that is manageable with medication.
Dr. Hardten, an OSN Corneal/External Disease Section Member, said epi-LASIK makes epithelial edges that are well-demarcated. These edges could explain why the healing process is faster than with PRK, which uses alcohol or mechanical scraping to remove the epithelium. He said the best candidates for the procedure are those who qualify for surface ablation but cannot have LASIK, such as those who have thinner than normal corneas. Although femtosecond laser technology may expand the number of patients who can have LASIK, including some with thin corneas, surface ablation procedures are best in some cases.
He emphasized that the microkeratome should be well- centered. He said, just as with LASIK, it is important to carefully examine the limbus and pupil for centration and for a “hinge” for the epithelium.
“For most of the patients, I go ahead and take the epithelial sheet off, so I try to center the cut of the epithelium and the removal of the epithelium on the pupil, so I have a nice, large area for the ablation,” he said. “In most cases, with the procedure itself, you get an area of exposure of the stroma that’s adequate for the ablation. But in some patients, if you didn’t get it properly centered or the flap is smaller than desired, then you may need to move the epithelial manually in some areas, to make sure you have exposure of Bowman’s layer and the stroma to all areas you’re going to be treating with the laser.”
"What we’ve found is that the visual recovery is a little bit faster than PRK, maybe on the order of a day or a day and a half faster,” said Dr. Davis, an OSN Practice Management Section Member. “Faster visual recovery is probably the biggest benefit.”
According to Dr. Lindstrom, OSN Chief Medical Editor, when surface ablation is indicated or patients request a surface ablation procedure, he now uses epi-LASIK routinely.
“I still do a lot of LASIK, and our group still does a lot of LASIK,” he said. “We’re impressed with the outcomes that we get from femtosecond LASIK, but when it comes to doing a surface ablation, I’m impressed that epi-LASIK is a significant advance over alcohol-assisted manual removal.”
Benefits of epi-LASIK
Dr. Lindstrom said the epi-LASIK procedure has several measurable benefits, including faster visual recovery and more rapid epithelial wound closure.
Some surgeons have reported less pain with epi-LASIK than with standard PRK. We basically found minimal pain with either standard PRK or epi-LASIK because of our medical regimen,” Dr. Lindstrom said. “It has been a significant benefit to our patients to have the faster visual recovery and more rapid epithelial healing. This has made us more comfortable recommending bilateral, same-day surface ablation, which is a convenience for patient, surgeon and laser center.”
“One of the objections to surface ablation is pain, and we’ve learned how to manage that,” Dr. Lindstrom said. “The other is slow visual recovery, and the Moria device has speeded up visual recovery. It’s still not as fast as LASIK, but it’s a lot faster than the surface ablation we use to perform. In addition, the cornea re-epithelialized faster. Those pluses of epi-LASIK make me less resistant to doing surface ablation.”