Which LASIK procedures are recommended for astigmatism, and what are the considerations?

Doctor's Answers 3

There are 3 main types of lasers:

  1. surface ablation (aka PRK, epi-LASIK, LASEK)
  2. LASIK
  3. and Relex SMILE.

All 3 are able to correct levels of astigmatism of about -4.00.

However, the degree of astigmatism isn't the only limiting factor. More importantly, we also have to consider corneal shape and thickness. All factors are important for consideration before the surgeon decides on what is best for you in terms of safety as well as stability of the cornea after the lasers.

For example, one may have sufficient corneal thickness and low levels of astigmatism, however, should the shape of the corneal be indicative of a higher risk of instability after the lasers that may lead to complications, lasers may not be recommended at all.

Any laser procedure which corrects myopia or hyperopia, can also usually correct astigmatism. This includes LASIK, PRK/epiLASIK and SMILE.

In general, I think LASIK or PRK/epiLASIK gives better results because of the availability of automatic cyclotorsion control, and also the ability to use sophisticated ablation patterns such as bitoric ablation patters.

Automatic cyclotorsion control gives more accurate treatments because it will automatically match the treatment pattern/axis to the eye position, which can change from a sitting to a lying down/supine position. Bitoric ablation patterns can potentially give a wider optical zone especially in the steeper meridian, thus reducing the risks of visual side effects such as halos.

Just for clarification, LASIK is LASIK. The differences mainly have to do with how the flap is created (eg blade vs bladeless), and this has no impact on the refractive correction whether myopic, hyperopic or astigmatic. The other difference has to do with the excimer laser machine that is being used, but most current generation machines such as the Schwind Amaris have the features above as mentioned.

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Dr E-Shawn Goh

Ophthalmologist

Femto-LASIK and surface ablation epi-Lasik are equally efficacious in correcting astigmatism.

Most patients if suitable for both, do opt for Femto-Lasik due to the shorter recovery time and a higher degree of comfort.

The main consideration for both procedures is the risk of astigmatism returning for both procedures. If suitable, patients may be recommended an adjunctive procedure called collagen cross-linking which has been demonstrated to be efficacious in reducing the degree and frequency of astigmatism recurrence.

Similar Questions

Can one wear coloured contact lens after LASIK or TransPRK?

Just wanted to add in a word of advice about coloured contact lenses. Coloured contact lenses contain extra pigment to give the contact lens its colour. Depending on the manufacturer or brand of these contact lenses, the application process of this pigment on the contact lens might not be done well or properly. This is especially so if the coloured contact lens is not FDA-approved or have not been through any stringent regulations or certification.

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Answered By

Dr Claudine Pang

Ophthalmologist

How long is the recovery period for Epi-Lasik before my vision stabilizes? Can I still go for enhancement after Epi-Lasik?

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.

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