Advanced Surface Ablation (ASA) is the modern version of the PRK laser vision correction procedure and is the preferred approach in certain patients. ASA utilizes the exact same high technology laser that is used with LASIK. Like LASIK, ASA can be used to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.
Also called LASEK or Laser Epithelial Keratomileusis, this relatively new procedure represents a surgical advancement over PRK. It was first approved by the FDA in 1995. It combines certain elements of both PRK and the more popular Orange County LASIK procedure and may offer some advantages over LASIK for certain patients.
ASA is most commonly chosen for patients with corneas that are too thin for LASIK or when creating or lifting a LASIK flap carries an undesirable risk. This procedure is often referred for patients in special requirement professions such as the military, aviation and the special forces.
With LASEK, instead of removing the epithelium, as with PRK, a flap of surface epithelium is loosened with a diluted alcohol solution and moved aside. The surface under the epithelium is treated with the laser and the epithelial flap is returned to its original position, as with LASIK. A protective, soft contact lens is then placed over the cornea to make the eye more comfortable while it heals.
Healing may be improved using the epithelial flap as a natural protective bandage with LASEK, as opposed to completely removing the epithelium as with PRK. It may also reduce postoperative discomfort and the incidence of postoperative haze. Plus, the margin of safety with LASEK is increased over LASIK as the need for microkeratome (mechanical device used to create the corneal flap) is eliminated.
It usually takes from three to five days for the epithelium to fully heal. Because the return to functional vision is longer than with LASIK, many LASEK patients prefer to have one eye treated at a time.
Although the ultimate visual results after ASA are outstanding and equivalent to LASIK, the first few weeks can be somewhat unpredictable with regard to vision quality and post operative comfort. For most patients, the recovery from ASA resembles LASIK in that the patient quickly achieves a very useful level of vision and minimal discomfort. For others, the discomfort can be more prominent and a slower visual recovery can occur, and for this reason, we advise that during the postoperative period, the patient has minimal visual and occupational requirements. It is also wise to delay travel until comfort and vision have reached suitable levels.
We will ask you to avoid immersion of your eyes in water for weeks. This includes swimming and hot tubs. Otherwise, as your vision improves, you may resume your normal activities without major restriction.
If a person’s cornea is too thin, the degree of myopia too high, or the shape of the cornea abnormal, a laser treatment of the surface of the cornea, Photorefractive Keratectomy (PRK), may be a better option. PRK was the first procedure performed using the excimer laser.
What happens during PRK?
Prior to surgery, drops are instilled to numb the eye. The patient lies down on a reclining chair with a secure headrest to hold the head still. The eye to be operated on is fitted with a speculum to keep the eyelid from blinking. The epithelium, a thin layer of cells that covers the cornea, is completely removed. The process of cell removal can vary by surgeon. The most common way is by using a solution of diluted alcohol to help loosen the cells from the surface where they are manually removed by the surgeon. A light is targeted toward the eye and the patient is asked to fixate or stare at the light so that the laser can be directed precisely to reshape the cornea. The cool laser beam then removes a very thin layer of corneal tissue – thinner than a human hair – and reshapes the cornea. The cool laser beam then removes a very thin layer of corneal tissue – thinner than a human hair – and reshapes the cornea to enable light to focus properly on the retina. The laser treatment time usually lasts less than one minute. Following the surgery, drops are once more instilled in the eye(s) to facilitate healing and prevent infection. A special contact lens is applied that acts like a bandage and must be worn for three to five days, as new epithelium grows back over the treated area during this time. The doctor will remove the special lens during a follow-up visit.
What are the Risks of PRK?
- A loss of perfect clarity of the cornea – usually not affecting vision – that often resolves over time.
- Glare or increased sensitivity to bright light.
- Seeing halos or hazy rings around bright lights, particularly at night.
- Loss of best corrected vision. Although rare (affecting fewer than 1% of patients), your vision with glasses or contact lenses may not be as sharp as before.
- An increase in intraocular pressure (IOP) due to post-treatment medications. This condition is usually resolved by drug therapy or by discontinuing post-treatment medications.
- Over-correction or under-correction of vision
Refractive surgery may not always yield the desired results. In some cases, the surgery can be repeated. PRK will not eliminate the need for reading glasses in patients around the age of 40.
The LASIK Advantage
Unlike PRK, another laser technique for vision correction, LASIK preserves the top layer of cells on the eye. The cornea heals more quickly and vision is restored faster than with PRK. Atlantis Eyecare uses only FDA approved laser technology combined with the diagnostic precision – originally invented by NASA – for use in high-powered telescopes, called WaveFront™ technology.
With less surface area to heal than PRK, LASIK patient recover very quickly, and most experience little, if any discomfort. Functional vision returns very rapidly, with the majority of patients seeing well enough to drive in a day or two without glasses or contact lenses. Most patients elect to have LASIK performed on both eyes at the same time.
Considering LASIK? First you need to know if you are a candidate. Give us a call today to schedule your Free LASIK Consultation.
Refractive Lens Exchange
Refractive Lens Exchange is a very successful technique for resolving vision problems using multifocal IOLs (Intra-Ocular Lenses) and is a popular option for patients who prefer to replace the eye’s lens before cataracts make this a necessity.
The beginnings of cataracts or the onset of presbyopia are both signs that eventually your vision will be affected enough to require surgery and replacement of the eye’s aging or clouded lens.
Rather than endure the inconveniences of close-up vision problems or the gradual deterioration due to cataracts, many of our patients choose to have the affected natural lens replaced with a multi-focal or accommodating IOL.
The advantages of pre-empting the aging process are:
- Eliminating the need for readers and bifocals
- Solving common vision problems such as astigmatism, nearsightedness and farsightedness
- The cornea is untouched making this an excellent option for patients whose corneas are too thin for LASIK
- The IOL can be removed and exchanged at any time to adjust for any future changes in the patient’s vision
- There is no future possibility of developing a cataract or presbyopia
While cataract surgery is often covered by Medicare or other insurance plans, Refractive Lens Exchange, if there is no significant cataract present, is considered an elective procedure and costs can range from about $2,500 to $4,500 per eye or higher, depending on the type of artificial lens used.
Aside from this economic consideration, the RLE procedure is identical to cataract surgery, one of the most commonly performed of all surgical procedures.