That's a very relevant question. There is no absolutely complication free option, and even the safest option of no laser treatment / collagen cross-linking alone may leave you with a residual risk of corneal ectasia, albeit miniscule.
Between the two options you detailed, there is a theoretical advantage to performing EpiLASIK as there would be more residual tissue that would theoretically contribute to corneal stability.
However if the overall findings suggest that the risk of ectasia is low, then the relative speed of healing / visual recovery would tilt the discussion towards Femto-LASIK / KXL.
At the other extreme, if the risk of ectasia is significant, I would recommend you consider collagen cross-linking, and subsequent implantable collamer lens to correct your refractive error.
Ultimately, you will have to weigh up the relative advantages of each treatment option prior to deciding. You should decide this together with your ophthalmologist with consideration of your specific examination findings.
E-Shawn Goh
