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?
Cheerio!
Daphne Han
