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Hi! I just discovered your website, thank you for all the infomation! I’m currently a student (21 going 22 this year) and thinking of going through Lasik and have done a bit of research, but there are so many types of Lasik that I’m confused. Some friends recommended the faster way (not sure what it’s called) with shorter downtime, but others recommended Epilasik which is supposed to be safer?
My degree is approximately 275-325 (with 200+ astigmatism), but I’m unsure if it has changed since. Thank you so much for your help!
There is a plethora of refractive surgery options that involve the cornea, and these are commonly lumped together into a common label as “LASIK”. The sheer volume of marketing out there on the internet only feeds this confusion, so I’ll try to clarify this confusion for you. The best option for the individual patient really starts with a comprehensive evaluation by your eye-care provider and an in-depth discussion of your options (which includes cornea-refractive surgery, implantable contact lenses, or even new forms of myopia treatment that does not involve surgery!) with consideration of your current ophthalmic examination, past drug / medical history, social history and occupational requirements.
Since you asked specifically about LASIK, I’ll only discuss cornea-refractive surgery options here, but see the answers to the other questions for other options:
Option 1 is surface ablation. This includes options that are marketed as Epi-lasik, PRK (Photorefractive Keratectomy), Trans-epithelial PRK, and LASEK.
This is a great option for patients that do not desire a cornea-flap for reasons of their occupation or physical pursuits (including military aviators / naval divers, and pugilists involved in close hand-to-hand combat that involves grappling and eye-gouging).
This is also an option that is offered to patients who may not be suitable for other forms of cornea-refractive surgery due to thin corneas, and previous deep cornea-scars. Alternatively, this is a recommended form of refractive surgery for patients who suffer from recurrent corneal erosions that are not responding to conservative treatment.
The recovery time is typically delayed with initial symptoms of pain / irritation / discomfort improving after 3-5 days, whilst vision may take up to 2-4 weeks to clear up, and may take up to 6 months for full refractive stability to be achieved.
Option 2 is femtosecond-laser assisted LASIK surgery. This all-laser procedure involves cutting a flap in the cornea, before the lens-shaped lenticule is permanently ablated to achieve the desired amount of vision correction. The creation of the flap allows the recovery to be much more rapid compared to surface-ablation options described in Option 1.
Recovery time is rapid (typically overnight), with rapid recovery of vision at 1-2 days. Full vision and refractive stability is usually achieved by 3 months.
Due to its rapid recovery and low complication rates, this is the most commonly performed laser-cornea refractive surgery in our practice (and in Singapore), and is generally suitable for almost all patients who are considering it.
Care should be taken to minimise eye rubbing especially in the first week post-surgery.
Option 3 is femto-laser SMILE (SMall Incision Lenticule Extraction) / RELEX surgery. This involves using the femto-laser to cut the lenticule within the cornea. This lenticule is removed from within the cornea through a small pocket incision. This is a great option for patients who do not desire a permanent flap, but yet want the rapid recovery and excellent visual outcome that LASIK surgery offers.
Visual recovery is slightly slower than LASIK, but more rapid than Epi-Lasik at approximately 1 week, and full visual recovery and stability by 3 months.
The advantage of this surgery is that patients do not require a contact-lens placed immediately post-surgery, and do not have to worry about rubbing their eyes straight after surgery!
The incidence of dry eyes is reportedly lower than in the other forms of cornea-refractive surgery discussed above.
For all 3 of these options, your eye-care provider may discuss with you adjunctive treatments including anti-scarring agents like Mitomycin-C, or collagen cross-linking treatments with Ultra-violet activated Riboflavin. The indications and need for such treatments are optimised for each patient and best discussed together with your Ophthalmologist.
Dr E-Shawn Goh
In Singapore and worldwide, the 2 most common types of procedures done by far is:
- LASIK (faster, shorter downtime)
- EpiLASIK (not necessarily safer than LASIK, but often recommended for “very active” people)
There’s a 3rd and “newest” treatment that’s now available, and many LASIK doctors in Singapore are starting to offer it too. It’s called ReLEx Smile.
As covered in my previous answer to a similar question, even though ReLEx SMILE wasn’t a procedure that was widely available when I had my LASIK done, I would not have chosen it as no one really wants to be the “guinea pig” for a relatively newer procedure.
Choosing between LASIK vs EpiLASIK – I encourage you to read up as much as you can online for yourself, as well as chat to doctors (a lot of LASIK doctors organize free talks/consults for you find out more).
There are certain criteria and individual patient factors which may make you more suitable for one procedure over the other, so it’s not a one size fits all.
Some doctors will also have a preference for one procedure over the other. It’s no harm sounding out a few doctors to listen to what they recommend for you – then it really boils down to which doctor you are more comfortable with, and trust more.
LASIK is very much about “case selection”; meaning the doctor’s expertise is in choosing the most appropriate treatment for you to produce the best results and minimise side effects.