Monthly Archives: January 2010

Recovery after No-Flap Laser Vision Correction: PRK and Epi-LASIK

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Laser vision correction surgeries can be divided into flap and no-flap categories.

Flap treatments include LASIK and Intra-LASIK. These treatments involve creating a corneal flap, lifting the flap, and then applying the excimer laser energy to reshape the tissue under the flap. The corneal flap is then replaced. Creating a corneal flap carries some risk of flap problems at the time of surgery or possible flap shift after surgery. The flap allows for more rapid recovery of vision and less discomfort in the first few days.

The long term results are equally good according to many studies that compare flap to no-flap treatments. No-flap laser vision correction treatments, PRK and Epi-LASIK, have gained in popularity over the past few years due to the longstanding safety record of surface no-flap treatments. PRK was introduced over twenty years ago in North America. For PRK the surface cells called epithelium cells are removed with a brush or spatula. Epi-LASIK is a newer treatment that uses an epikeratome to remove the surface cells to prepare the surface for laser reshaping.

No-flap laser vision correction carries a lower risk than flap treatments and will take longer to recover from than flap treatments. No-flap treatments like PRK and Epi-LASIK require an investment of time for healing in return for an added level of safety with excellent long term results. The recovery from no-flap treatments can be divided into days 1-4, 3 days to 1 week, 1 week to 8 weeks,2 months to 1 year.

Days 1-4 following PRK and Epi-LASIK are when the surface epithelial cells regenerate. During this time a bandage contact will remain in place to help with comfort. The amount of discomfort in the first few days will range from mildly gritty or sore to more significant burning, stinging, and light sensitivity. During these first few days following a no-flap laser vision correction treatment it is important to use medicated drops as directed, to use copious lubricating drops, and to plan to rest as much as possible with the eyes closed. Most people will find the comfort and vision worsens over the first few days following surgery. Many people find that the worst of the discomfort occurs in the second 24 hours after treatment and then improves. Pain medications including special eye drops are provided for use if needed. While not everyone will need these pain relievers, a minority of people will be staying in a dark room with their eyes closed for a day or two.

Days 3 to 7 will be a period of vision improvement. In most cases the epithelium will be healed and the bandage contact lens will be removed on day 3 or 4. Following Epi-LASIK many people may be legal to drive within 5 days. With PRK the healing may result in vision in the legal to drive range at about 7 to 10 days. It is important to know that legal to drive is a few lines away from 20/20, so some people will chose to wait longer before driving. While many people will return to usual activities in this time, some modifications may be necessary such as more breaks from computer work or avoiding night driving. During this time fluctuations of vision may be present and the vision will continue to improve. Post-operative examinations are usually done every 1 to 2 days until the bandage contact lenses are removed.

Weeks 1 to 8 are a time of continued sharpening up of vision. During this time symptoms of dryness, night vision problems, and overall vision will improve. Some people will continue to need frequent lubrication drops. Most surgeons will recommend continuation of steroid eye drops to aid in healing. While many people will be very happy with their vision within several days after surgery, others will be happier after 1 to 2 months following surgery. Patience with healing is important following PRK and Epi-LASIK.

Post-operative vision checks are usually scheduled every 1 to 2 months for 3 to 6 months. In most cases it is advisable to wait up to 6 months before considering an enhancement surgery (touch up). The majority of people will have a stable correction following PRK or Epi-LASIK for many years following laser vision correction.

When considering a no-flap laser vision correction treatment it is important to understand the benefits of safety and excellent long term results in return for a longer recovery than with flap procedures. The majority of people have excellent results with PRK and Epi-LASIK.

For more information or to schedule your free laser vision consultation, contact Western Laser Eye Associates today.