LASEK and LASIK are laser eye surgeries designed to correct refractive errors causing nearsightedness (myopia), farsightedness (hyperopia), and astigmatism (irregularly shaped corneas). These procedures both use lasers to reshape the cornea so vision is improved.
The main difference between the two involves the use of two lasers in LASIK versus a blade being used to make the incision in the cornea for LASEK. (Learn More) With LASIK, the corneal flap is folded over and then replaced after surgery. With LASEK, an epithelial cut is made in the cornea with a dull blade and then an alcohol solution is used to loosen the flap and hinge it back after the cut is made. LASEK can typically be used more easily on people with thin corneas and doesn't require as much precision as LASIK.
Both epi-LASIK and epi-LASEK are considered surface procedures that don't cut as deeply into the cornea as traditional LASIK and LASEK do. This can potentially mean a quicker recovery and less pain associated with the procedure.
With epi-LASIK and epi-LASEK, a specialized version of the mechanical microkeratome blade, an epi-keratome, is used to create the corneal flap. (Learn More) Epi-LASIK involves removing the epithelial corneal flap and then replacing after surgery, while Epi-LASEK hinges the flap after cutting it and then loosening it with a solution of alcohol to then replace it after the procedure.
Epi-LASIK is one of the least invasive laser eye surgery procedures, but there can be complications with the flap replacement and movement. Epi-LASEK has fewer flap-related issues. (Learn more) Epi-LASEK can have a slightly longer recovery time, but the combination of LASEK and epi-LASIK techniques can make it a more advanced and beneficial procedure.
Epi-LASEK is often considered a combination of LASEK and epi-LASIK technologies that uses the best of both worlds for optimal results.
Comparison Between Epi-LASIK and Epi-LASEK
LASIK (laser-assisted in-situ keratomileusis) is a highly successful corrective surgery for refractive errors. The FDA reports more than 95 percent of patients are content following the procedure.
LASIK involves using two specialized lasers, an excimer laser and a femtosecond laser, to first cut a small flap in the epithelial (outer layer) of the cornea to ablate the stroma (inner layer). This corrects refractive errors by permanently reshaping it. In order to be eligible for LASIK, your corneas have to measure a certain thickness. Dry eyes are a common complication of the procedure.
LASEK (laser-assisted subepithelial keratectomy) uses a specialized blade called a microkeratome to create the corneal flap and then exposes the cornea to alcohol to loosen it. LASEK can be performed on people with thinner corneas and those who suffer from dry eyes and therefore may not be eligible for LASIK.
Epi-LASIK (epithelial LASIK) is similar to LASEK, Mayo Clinic explains, in that it creates a corneal flap using a microkeratome. In epi-LASIK the mechanized blade is dull and called an epi-keratome that creates a very small corneal flap, allowing less of the cornea to be removed than with traditional LASIK for a less invasive procedure.
During the procedure, a suction is placed around the eye to hold everything still while the cuts are being performed. After separating the epithelial flap from the cornea, the laser can then ablate the tissue underneath to reshape it.
In the case of myopia, the cornea is often shaved down because it is too steep, while with hyperopia it may need to be built up because it is too flat. Astigmatism involves an irregular shape to the cornea that can be reshaped by the laser.
Epi-LASIK does not leave behind alcohol damage like traditional LASEK can, the American Academy of Ophthalmology (AAO) publishes, and more epithelial cells can be preserved. There can still be issues with the corneal flap reattachment that LASIK sometimes creates, however. During epi-LASIK, the epithelial flap may need to be discarded altogether, which basically turns the procedure into PRK (photorefractive keratectomy), involving complete removal of the epithelial tissue.
Epi-LASIK makes a miniscule cut with a specialized mechanized blade above Bowman's layer and below the basement membrane in the epithelial of the cornea before the ablation of the cornea is done with a laser. This separates the basal membrane completely from Bowman's layer.
With epi-LASEK, an alcohol solution of approximately 20 percent ethanol can break down the hemidesmosomes that connect the lamina lucida and the lamina densa, the layers of the basal membrane, and lead to smoother cuts, better access for the laser ablation, and fewer issues with the hinging of the corneal flap, per the journal Healio. The smoother layer of the lamina densa can make the surface ablation less invasive and more even for optimal results.
Epi-LASEK combines both LASEK and epi-LASIK techniques for a surface ablation procedure that may have fewer complications, fewer risk factors, less pain, and a faster healing time.
Pros and Cons of Epi-LASIK vs. Epi-LASEK
There are certain major factors to consider when deciding between epi-LASIK and epi-LASEK.
- Healing time and recovery
- Outcome and expectations
These should be discussed with your doctor prior to any surgical procedure. Since both epi-LASIK and epi-LASEK make permanent changes to the structure of the cornea, it is important to be very informed.
Typically, LASIK surgery costs on average of about $2,000 per eye depending on specific measurements and considerations. Epi-LASIK may cost slightly more, as it is a more delicate procedure requiring more precision and training on the part of the surgeon. Since an epi-LASEK procedure includes components of both LASEK and epi-LASIK, it may carry a slightly more elevated cost as well.
In general, corrective laser eye surgery is not covered by insurance since it is usually considered to be an elective procedure. That being said, there are many options for financing laser eye surgery, including payment plans and specialized credit cards or loans. When you factor in the cost of prescription eyeglasses or contacts over time, laser eye surgery can actually save you money in the long run.
Epi-LASIK and epi-LASEK cannot decrease the risk for presbyopia, age-related farsightedness. Your vision can still change with aging, and you may require reading glasses at some point.
When it comes to risk factors and potential complications, both epi-LASIK and epi-LASEK can have postoperative pain and a visual haze. AAO warns that the discomfort from the required suction while epi-LASIK is performed, and the length of time this can take, can be a deterrent for the procedure.
One of the biggest complications of epi-LASIK is the reattachment of the corneal flap, which is often less of an issue with epi-LASEK. Since epi-LASEK uses alcohol to separate the basal membrane, it can expose a smoother layer of the lamina densa that covers the Bowman's layer of the cornea and makes for more even ablation. The alcohol solution also helps to make the epithelial more flexible and thicker, which helps to keep it attached at the hinge. As a result, it will more easily reattach itself after the surgery, making for a faster healing and recovery time.
The Journal of Refractive Surgery publishes that epi-LASEK often allows for better flap re-adherence and does not contribute to postoperative haze or pain. Epi-LASEK is basically an improvement upon both LASEK and epi-LASIK procedures; therefore, it is often preferred.
Both epi-LASIK and epi-LASEK can be options for treating mild to moderate astigmatism, hyperopia, and myopia. They can potentially eliminate the need to wear corrective eyeglasses or contacts. Your ophthalmologist can help you decide on the right course of action for your situation.
LASIK Quality of Life Collaboration Project. (September 2018). U.S. Food and Drug Administration.
Lasik Surgery: Is it Right for You? (March 2017). Mayo Clinic.
Epi-LASIK. American Academy of Ophthalmology.
Epi-LASEK Aims to Minimize Drawbacks of LASEK and Epi-LASIK. (February 2009). Healio.
Experts Revisit Epi-LASIK. (December 2018). American Academy of Ophthalmology.
Epi-LASIK Versus Epi-LASEK. (January 2008). Journal of Refractive Surgery.