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Advanced Surface Ablation (ASA)
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LASIK

Lasik is safe but...
       
            SURFACE IS SAFER

The ideas on this page depend on having a clear understanding of the differences between LASIK and ASA.  If you haven’t already read the LASIK and ASA pages, please read them before you read this section.

Newspaper articles and congressional hearings have highlighted concerns over LASIK.  Controlled studies are undisputed in showing the safety and efficacy of LASIK.  Patient satisfaction rates after LASIK are over 95%.  LASIK is safe. However when a major complication surrounds LASIK, the consequences can dramatically affect a person’s life. 

What are the major problems that can occur after LASIK:

  • Corneal Ectasia — If the cornea becomes too weak to withstand the outward force produced by internal ocular fluid pressure, the cornea bends or bows outward. This produces blurred vision that can not be corrected with glasses.  In the most advanced cases Corneal Ectasia may necessitate a corneal transplant for treatment.   
  • Dry Eye — When a LASIK flap is created, the nerve fibers that supply the surface of the eye are cut. It can take several months for these fibers to re-grow through the LASIK flap. In a typical eye the tear film is minimally affected by this disruption. However, in a patient with dry eyes or a predisposition to dry eyes, the loss of nerve sensation from the surface of the eye can make a dry eye condition worse. The patient may be left with diminished vision and eye discomfort.
  • Epithelial in growth — The outer most layer of the cornea is the epithelial layer. As the eye heals after LASIK, sometimes the epithelial cells will grow underneath the LASIK flap and cause irregular astigmatism and blurred vision.
  • Macrostria and Microstria — When a LASIK flap is formed the outer epithelial layer heals within 12-24 hours. This is the most important factor holding the LASIK flap in place.  However, it can take years for the stromal layer of the cornea to lay down new collagen fibers between the LASIK flap and the corneal bed. This fact is what allows the LASIK surgeon to lift a flap without re-cutting the flap  if the patient needs an enhancement. However, this also means that the flap can slip if the eye is rubbed to hard or traumatized. The folds in the flap are referred to as Macrostria or Microstria depending on size and can cause blurred vision
  • Keratitis - Creating a flap can sometimes precipitate an intrastromal inflammatory reaction. This condition can usually be treated with drops or returning to the operating room for a corneal washout. Rarely, the inflammatory reaction is so great that it causes permanent structural change in the cornea and blurred vision.  

LASIK flaps can be created in two ways: using a mechanical keratome or a laser based keratome. The problems listed above can occur no matter how a LASIK flap is made. However, some problems with creating LASIK flaps are specifically related to the technique used.

Mechanical Keratomes:

  • Buttonholes — Sometimes when a flap is created the thickness will be inconsistent and lead to an area within the diameter of the flap which is left "uncut". When the doctor raises the flap it will appear as a hole in the flap.  Usually when this occurs the patient can be successfully retreated with ASA.

Laser Keratomes:

  • Gas Bubbles — A laser keratome can leave gas bubbles trapped in the cornea and this can delay treatment until they clear.
  • Unliftable flaps — Occasionally the dissection of the flap is insufficient. Attempts to force the flap up can lead to corneal haze.
  • Non-dissected islands — A similar problem as above but only in discrete areas. If the surgeon were to force the flap up a buttonhole would result .
  • Transient Light Sensitivity — Approximately 1% of patients with good vision develop sensitivity to light.  This necessitates wearing sunglasses and treatment with anti-inflammatory drops.

For these reasons, Dr. Price prefers the form of Laser Vision Correction known as Advanced Surface Ablation (ASA) over LASIK. Most of the problems listed above are simply avoided or greatly diminished with ASA. Long term vision results are at least as good and possibly better with ASA. The only concession with ASA is that visual recovery within the first week after surgery is not as fast.

Dr. Price feels a lifetime of good vision is worth investing a little more time in yourself during the surgical process.

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