Is Epi-Lasik or LASIK more suitable for the moderately active?
I’m your average joe. I work during the week and exercise (gym, soccer, basketball, etc…) on the weekends, and maybe even sneak in a few basketball games on Wednesday nights. Is it true that EPI-LASIK is more suitable for the active? Also, I’ve been off Accutane for a year, with some remedication due to flare ups in between. Do you recommend getting Lasik at this point? Thank you very much.
Hi! As a general principle, anyone who is still on Accutane should avoid any form of cornea-based refractive surgery which includes EpiLasik, LASIK and SMILE due to the high risk of prolonged dry eyes after the surgery. Washout period after stopping medication should be at least 3-6 months, depending on how dry the eyes still are during pre-op assessment.
In principle, even implantable contact lens (ICL) which only makes a roughly 3mm incision on the cornea, may lead to some post-op dry eyes. However, compared to refractive cornea lasers, ICL patients should fare better for such side-effects.
Between LASIK and epilasik, epilasik is more old school due to post-op pain and slower recovery. I still offer it as it is the most "tissue-saving" amongst the refractive laser procedures.
If you have not heard of SMILE before, it is a newer form of refractive laser that treats myopia (up to 1000 degrees, FDA approved) and astigmatism, and in general combines the low downtime of LASIK and the flaplessness of EpiLASIK. As it is less invasive (think of it as a keyhole form of LASIK) it is more suitable than LASIK for those who have dry eyes and who participate in activities that put them at risk of flap displacement (in these respects SMILE is more similar to Epilasik). Smile also preserves cornea stability more than lasik, as there is less weakening of the cornea without a flap.
Although cases of LASIK flap displacements post-op are rare, many experienced LASIK surgeons would recall coming across a handful of such cases. The ones that came to me, still fresh in my mind, happened several years after original surgery, some from car accidents /eye trauma. Most of such cases do recover to a satisfactory extent after repair surgery. But if one can zero such risks, why not?
Glad that you are keeping an active lifestyle. It is true to some degree that this may have some impact on the choice of laser vision correction (LVC).
Traditionally, most surgeons would steer patients involved in contact sports towards advanced surface ablation (ASA) techniques which include Epi-LASIK, PRK or LASEK. However, ReLEx SMILE has become the latest addition to the options available for a flapless treatment.
With regards to your concern of being previously on Accutane, it is true that surgeons are reluctant to offer LASIK whilst patients are on it due to concerns about post-operative dry eye. A year is a decent amount of time to be away from regular Accutane.
However, it is still important that your LVC suitability assessment includes looking for signs of dry eye syndrome in which case you may be asked to stop Accutane for a longer period of time or to consider alternative forms of refractive surgery.
Key is to share as much information as possible with your eye surgeon. To be sure, lifestyle choices and current medications are but two of many other factors to consider before a surgeon can consider your eyes fit for LASIK.
Dr David Chan
Both forms of cornea refractive surgery are equally viable for this group of patients. The previous concern that patients had about displacement of the cornea flap in vigorous sporting activities are unfounded, and with modern femto-laser assisted flap-creation, the incidence of flap movement and other similar complications have all but disappeared.
Generally speaking, patients on Accutane experience a high-incidence of dry skin and other mucous membranes, most importantly of the eye. The incidence of blepharitis, dry eyes and delayed cornea healing / delayed visual recovery after refractive surgery may result.
I would advise that patients avoid Lasik or any form of cornea refractive surgery whilst they are currently on Accutane or similar Vitamin-A medications for nodular acne, especially if they are symptomatic for dry eyes or blepharitis. Performing cornea refractive surgery at this juncture would only exacerbate their dry eye symptoms, and result in less than optimal recovery of their ocular surface.
This “no-go” period of surgery includes the period whilst on medication, and extends for a period of up to 4 months after cessation of their medications.
Epi-Lasik or Lasik for the Moderately Active?
I did consider Epi-LASIK for the reasons you described, because online research will suggest that Epi-LASIK is better for “sporty” and more active people. It’s also incidentally the procedure that pilots in the SAF have to go for per their job requirements, because there’s no risk of cornea flap dislocation.
So I went into the consult at 50-50 between both procedures, and in the end really chose LASIK after the consult, and having highlighted my concerns.
What sealed it for me was the faster recovery time with LASIK, a less painful procedure (Epi-LASIK can take 2-4 weeks or more for visual recovery, and the first week can be quite painful), and the fact that he was confident that LASIK was still a very appropriate treatment for me in spite of my concerns re: sports.
So my best advise is that you should have a similar discussion when you meet your doctor.
Post procedure, have you noticed a change in your lifestyle/activity because of that?
No. Zero. I’m back to everything I did before, including snowboarding, surfing, etc.
I’ve been off Accutane for a year, with some remedication due to flare ups in between. Do you recommend getting Lasik at this point?
Almost all doctors/dermatologists would recommend staying OFF Accutane for at least 6 months before LASIK, due to it’s effects on slower wound recovery.
I mean, it’s your eyes; wouldn’t want to mess about with that right?
There’s also a good body of evidence for the 6 month window with references quoted at this link here.
Having said that, I recently found out that one of the readers of this site was told by her LASIK doctor that it was okay to proceed with LASIK, even though she was within the 6 months window.
Even though I specifically advised her against it, she went ahead anyway as it was for her wedding, and she couldn’t wait. Personally, I wouldn’t take that risk.
I don’t know if you mean you took Accutane again when you said “remedication”; if so, the timer starts from Day 0 of 6 months again.
Hi, in general both epi-LASIK/PRK and LASIK are suitable for the activities you mention, ie gym, soccer and basketball. The issue with LASIK is that with the flap, there is a risk that if the cornea is poked very hard at the flap edge there is a chance it might move and require urgent treatment to reposition.
Having said that, the chance of this kind of incident happening is extremely low, even when people engage in these sports professionally. There are professional footballers, basketballers, tennis players etc. who have had LASIK done (while actively playing) with no problems after surgery.
Perhaps, as a rough rule of thumb, people who practice martial arts competitively and where no eye/face protection is worn may want to consider a flapless procedure like epiLASIK/PRK or SMILE over LASIK.
Accutane use tends to make the eyes very dry, even if you are just using small amounts/short courses to deal with flare ups after the main course of Accutane is finished. The American Academy of Ophthalmology recommends stopping Accutane for at least 6 months before any laser refractive procedure, and I tend to agree with this guideline. There are sometimes patients who may need to wait even longer than this, if the eyes remain very dry.
To sum up, the choice between epiLASIK and LASIK for many moderately active people is mostly a personal one, balancing the pros of the flapless procedure versus the prolonged time to visual recovery with epiLASIK. SMILE is a consideration but the pros and cons of this should also be considered. With regard to Accutane, it is best to stop using it entirely for 6 months, and then re-evaluate the state of eye dryness before considering any laser refractive surgery.