SURFACE LASER (LASEK & PRK)
THE OLDEST FORM OF LASER EYE SURGERY
What is surface laser eye surgery?
Surface laser is the variety of procedures that work directly on the outer surface of the cornea. PRK is the acronym for Photo Refractive Keratectomy, the precursor to LASIK eye surgery. Like LASIK eye surgery, PRK uses an Excimer laser to reshape the cornea. However, PRK works directly on the outer surface of the cornea.
Another name for a similar procedure is LASEK and epi-LASIK
Surface laser is safe and effective but has a very slow recovery and may leave patients with a tendency to recurrent erosion (pain in their eyes on waking in the morning)
At Custom Vision Clinic we now rarely perform surface laser eye surgery, because newer procedures offer similar benefits (like being able to treat those with thinner corneas or those who engage in contact sports and work). Keyhole laser eye surgery, where the laser reshapes the cornea without the need to make a flap, is called ReLEx SMILE ™.
This procedure has all the great benefits of LASIK (fast visual improvement and short recovery time) with the associated benefits of not cutting a flap in the cornea (no flap complications, less dry eye, improved comfort during the operation) and none of the downsides of surface laser eye surgery (more discomfort and shorter recovery time).
What surface laser treats
Who is suitable for surface laser eye surgery?
Ideal candidates for surface laser eye surgery include those patients who – for various reasons – are not suitable for LASIK.
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How does surface laser treatment work?
The vision correction treatment begins with anesthetic drops applied to numb your eye and prevent pain during the procedure. A lid speculum is placed in the eye to hold the lids apart for the procedure, eliminating possibility of blinking.
The surgeon will then gently remove the surface corneal cells (epithelium) and proceed with the laser aspect of the procedure. The laser is computer driven for accuracy and precision and it is programmed based on the patient’s refractive error such as nearsightedness, farsightedness, or astigmatism.
The eye correction surgery takes less than one minute for most patients. After the procedure a soft bandage contact lens is placed on the eye for three to five days until the epithelial layer regenerates.
Advantages and disadvantages of surface laser eye surgery
Advantages of surface laser eye surgery over other procedures
- Uses less tissue*
- Allows patients who are non-candidates with LASIK to have a laser refractive treatment
- No flap created so no chance of a flap complication. Less than 1% chance of enhancement required*
- The patient can resume all physical activities within 2 weeks*
*This is no longer an advantage when compared to ReLEx SMILE ™ laser eye surgery
Disadvantages to LASIK
- Healing takes longer than LASIK (driving vision in 4 to 14 days)
- Slight risk of haze (little risk with modern laser and adjunctive chemical therapy)
- Delayed epithelial healing
Frequently asked questions about surface laser eye surgery
Results at a glance
My eyesight following the operation is brilliant and better than I thought possible, and this is all down to your excellent surgeon Mr James Ball and not to forget all the very dedicated people around him who make these operations possible.
Two of the best decisions I ever made in my life were firstly to have lens exchange and secondly to have Mr James Ball carry out my operation.
Within minutes I could tell there was a difference. But now, only a couple of months later, my sight is better than it was seven years ago! I can even read the really tiny print on the car sales ads! If you want that confidence you probably felt when you were younger, this is the ideal solution. Thanks to the treatment, I feel rejuvenated, independent and much younger!
Many thanks for all your care and kindness. To me it appears a miracle that I can see so well. I feel very grateful. It is impossible to fully express my thanks.
May I offer grateful thanks for your expertise in operating on my eyes. It was intimated to me that you were the best, and from the results I am now enjoying, I am convinced that this is correct.
You are truly innovative. Thank you very much for curing the problems I have been having with my reading and near vision.
My work was becoming almost impossible. I had refractive lens exchange to both eyes with multifocal lens implants last July. I can now see better than 20/20 for distance and can read the tiniest print in newspapers - all without glasses! I have started reading for pleasure again, and I feel that my performance both at work and on the golf course has improved.
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My eyesight following the operation is brilliant and better than I thought possible, and this is all down to your excellent surgeon Mr James Ball and not to forget all the very dedicated people around him who make these operations possible.
Two of the best decisions I ever made in my life were firstly to have lens exchange and secondly to have Mr James Ball carry out my operation.
Within minutes I could tell there was a difference. But now, only a couple of months later, my sight is better than it was seven years ago! I can even read the really tiny print on the car sales ads! If you want that confidence you probably felt when you were younger, this is the ideal solution. Thanks to the treatment, I feel rejuvenated, independent and much younger!
My work was becoming almost impossible. I had refractive lens exchange to both eyes with multifocal lens implants last July. I can now see better than 20/20 for distance and can read the tiniest print in newspapers – all without glasses! I have started reading for pleasure again, and I feel that my performance both at work and on the golf course has improved.
Laser eye surgery has changed my life. Now, having had laser, I wake up in the morning and I can see and it’s unbelievable.
Laser eye surgery has greatly improved my quality of life. I’ve been able to discard my glasses after thirty years!
If you are thinking of having Laser Eye Surgery, try these guys – they really are the best in their field.
I felt I was treated as an individual and all my questions were answered. From my experiences – I can highly recommend Mr Ball.
Wonderful, Wonderful, Wonderful! I am so grateful to you and your team. Thank you very much indeed.
Thank you for your skilled interventions which have given me my sight back.
To me it appears a miracle that I can see so well. I feel very grateful. It is impossible to fully express my thanks.
Thank you very much for the treatment you gave me – I can see so well now, and reading has once again become a real pleasure.
It was intimated to me that you were the best, and from the results I am now enjoying, I am convinced that this is correct.
You are truly innovative. Thank you very much for curing the problems I have been having with my reading and near vision.
I had LASIK on both eyes at Custom Vision Clinics, and can now see better than 20/20, without my glasses or contact lenses. More importantly, I now feel that I can get more out of my busy life.
At the consultation, Mr Ball found that I had early cataracts. Following cataract surgery at Custom Vision Clinics, I am almost completely independent from glasses.
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Further information about laser eye surgery
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MORE USEFUL INFORMATION
Read more about laser eye surgery
New refractive surgery guidelines from The Royal College of Ophthalmologists, together with patient information on Laser Vision Correction, Phakic Intraocular Lens Implantation, Refractive Lens Exchange and a Checklist for patients will be published in April 2017. Click here for more information
Take this checklist to your consultation with your refractive surgeon performing the procedure. Discuss each item with your surgeon to help you make the decision that is right for you before having
refractive surgery. Click here for more information
The Royal College of Ophthalmologists’ Laser Vision Correction Patient Information booklet (PDF). Click here for more information
SMILE corrects myopia and astigmatism, or a combination of both refractive errors with only a very small incision at the corneal surface. This high-precision procedure is the latest development in the refractive laser treatments. Includes videos, treatment steps, and questions and answers.
Click here for more information
LASIK treats refractive errors by folding away the top layer of the eye and re-shaping tissue underneath. If a femtosecond laser is used, this type of procedure is called Femto-LASIK. Includes videos, treatment steps and questions and answers. Click here for more information
PRK/LASEK procedures remove a thin cell layer from the top of the eye so the laser can reshape the underlying cornea. This surgery may be an option for those who are not eligible for LASIK or those who look for the most economic option for refractive laser surgery. Includes videos, treatment steps, and questions and answers. Click here for more information
About the author
Mr James Ball | Consultant Ophthalmic Surgeon
MA (Cantab) MB BChir FRCOphth CertLRS
I am a Consultant Ophthalmic Surgeon at Custom Vision Clinic, St James’s University Hospital, and Nuffield Hospital. My major interest is in refractive surgery and finding the best treatment suitable for each patient.