Is Bladeless LASIK or EpiLASIK more suitable if I have a weak cornea that is at risk for corneal ectasia?

Doctor's Answer

Photo of Dr Daphne Han
Dr Daphne Han

Ophthalmologist

If you are assessed to be at risk of corneal ectasia, no matter how low, it definitely pays to be more vigilant about the type of procedure you undergo.

The type of machine that made the assessment may read differently from another machine. However, once any one machine flags out a suspicion, a responsible LASIK surgeon should certainly discuss your options with you.

In fact even scans that turn out to be normal is not a 100% guarantee for surgical outcome free of ectasia, which basically is warpage of the cornea.

The risk of ectasia can be reduced by cross linking, both in LASIK as well as epiLasik. However, in general, if your eye power is higher than around 500deg myopia, especially if the astig is also quite high, epilasik is not so great as you may be at risk of cornea haze post op. In general, epilasik also does not work so well for higher astig as it is less predictable than lasik.

You may want to consider Smile as well. In terms of ectasia risk, smile should be safer than lasik, with less downtime compared to epilasik. It can also combine with cross linking. But again it still thins the cornea.

Another option that I usually recommend for those with eyes at risk of ectasia is the ICL. As this operation does not thin the cornea, there is practically zero risk of inducing ectasia. Many of my patients in this situation accept this proposal, and hence we get away with the worry of ectasia.

Last but not least, please avoid rubbing your eyes. Eye-rubbing is notorious for inducing both astigmatism and ectasia, particularly in young eyes.

All the best for your eye treatment!

Dr Daphne Han

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