Doctor's Answers (2)
Epi-LASIK (which is essentially photorefractive keratectomy/PRK) refers to laser treatment of the surface of the cornea, after the surface layer of epithelial cells has been peeled away.
After treatment, the surface of the eye/cornea is ‘raw’ and has no epithelial covering. This epithelial layer grows back eventually, but the time it takes to grow back and become normal again is what causes the delayed healing of epi-LASIK/PRK versus conventional bladeless/femtosecond laser LASIK.
For the first 2-3 days, there is often pain and tearing after epi-LASIK, as there is no epithelial covering. This pain disappears after 2-3 days, as the cells cover the corneal surface by then. However, this first layer of epithelial cells is not smooth, leading to blurry vision. The time it takes for this layer to regain its normal smoothness could take a few months. However, it does not mean that vision is very blurry all this while and then suddenly clears up at 3 months. In fact, it tends to show quite a bit of improvement in the first few weeks, and then the rate of improvement gradually slows down as the vision gets clearer. At around 3 months or so (sometimes longer), vision returns to normal and stabilizes.
Therefore, yes, during the first few months, some patients may feel uncertainty and anxiety with epi-LASIK. They may wonder when and whether the vision will get better, or how much more the vision can improve. At this time, it is worth remembering that previous studies have shown that vision after LASIK and epi-LASIK is the same after full recovery. It can require some degree of patience and faith while the eye is still healing, that eventually vision will clear up. It is also worth noting that this blurriness during recovery is not due to spectacle power-ie it will not improve with glasses or contact lenses. It is due to ‘roughness’ of the first epithelial layer, that eventually smoothens out.
Whether a particular patient will have enough tissue to do an enhancement after the first procedure depends on a number of factors, such as the initial corneal thickness, the amount of myopia/astigmatism that was treated, and how much enhancement needs to be done. It therefore needs to be assessed on a case by case basis, especially in borderline cases.
It is also worth noting that epi-LASIK enhancement will mean the whole thing all over again, with another round of healing that could take a few months. It is for all these reasons that conventional bladeless femtosecond LASIK is still by far the more popular procedure, with enhancement recovery just as fast as the original procedure.
At the end of the day, whether to go ahead is a decision that you have to make and be comfortable with. Questions to consider include: What is it about glasses or contact lenses that bother you? Do they stop you from pursuing certain activities that you like to do? Do you think the convenience of not wearing them outweighs the inconvenience of going through with eye surgery and the recovery down time? The answers will be different for different people. But for those where glasses/contact lenses are a significant inconvenience, laser refractive surgery for eligible patients remains a very good alternative.
This is a more common scenario than you think. Many patients were previously unsuitable for femto-lasik (bladeless Lasik), and had no other options for refractive surgery.
Today, there is a plethora of options available to you, including epi-lasik or an implantable collamer lens!
Epi-lasik / surface ablation refractive surgery would have been offered to you as it helps to preserve sufficient cornea tissue to minimise the risk of future ectasia (progressive cornea thinning leading to severe and worsening irregular astigmatism / myopia) and / or recurrence of ametropia.
The recovery period may be slightly prolonged in comparison to femto-lasik, however vision is still reasonable and sufficient for activities of daily living including driving, computer work, reading and general sports.
Most patients do report light-sensitivity and photophobia for 2-3 days immediately after surgery, and other variables of vision (including color saturation, contrast, and side-effects of glare / haloes) are usually worse at dawn / dusk and night-time, but these gradually improve over the next several months and eventually stabilise after 3-6 months.
The most important point to note is that almost all of the myopia / astigmatism will be corrected immediately after surgery. The immediate post-operation period is commonly associated with light-sensitivity and tearing. However, the finer aspects of the vision mentioned above will gradually improve over the next several weeks, but do NOT cause significant impairment to your vision. You will be able to resume all normal activities after several days when the light-sensitivity improves.
As you mentioned, the refraction will usually have stabilised after 6 months. In the rare situation where you may need a future enhancement, this may be considered on an individual basis. You are best advised to discuss this with your surgeon before hand!
I mentioned the option of an Implantable Collamer Lens as well. This is a great procedure to help patients like yourself who want a fully reversible procedure that does not have the concerns and side-effects you had brought up.
You should have an in-depth discussion about your options with your surgeon and find a suitable solution together!