Difference in different types of Laser Eye Surgery

Each of the different methods of laser eye surgery has its own good and bad points. This goes to say that an operation such as LASIK may be the right choice for one person, but not for another.

When we consider the difference between the major types of laser eye surgery it is important to understand that even though the overall procedure can be different, the same laser can be used in all of the operations. The choice as to which type of surgery you should have will depend on a number of factors. The surgeon will take all these into account and decide upon which treatment will give you the best possible outcome.


Looking at the different types of laser eye surgery, it is easiest to split them into procedures that involve removing part of the cornea, and those that don’t.

LASIK & Intra-LASIK

Of all the procedures, LASIK is the most invasive, making a deep cut into the cornea. This is advantageous with regards to the final outcome, as the deep tissue of the cornea does not grow back. This leads to excellent vision correction that is often permanent. It also has the fastest recovery time of any of the procedures, as the surface epithelium of the cornea is left undamaged.

Also within this group we can place the Intra-LASIK procedure, as this also involves a flap being made in the front of the cornea. Where this procedure differs from the others is that instead of using a microkeratome (very sharp razor blade) to make the flap as in LASIK, a laser is used. Some surgeons believe this gives greater accuracy when making the flap, thereby ensuring a better outcome to the surgery.

Once the flap has been made, both LASIK and intra-LASIK are in essence the same operation.

Epi-LASIK, LASEK and PRK

Moving on from LASIK and intra-LASIK we can now look at Epi-LASIK, LASEK and PRK. These three operations are part of the class that removes part of the cornea. However they are separate from LASIK and intra-LASIK because they only remove the outer layer of cells, called the epithelium, before the laser remodelling occurs. This is a much thinner cut than used in LASIK and intra-LASIK.

Within this group the ways the epithelium is removed also changes. In contrast to epi-LASIK where the epithelial covering is cut using a very thin plastic blade, LASEK involves making a flap in the epithelium using a specialised instrument called a trephine. Either way is seen as satisfactory to remove the epithelium. Exactly how the epithelium is folded over changes between the two as well. Whereas in LASEK alcohol is used to soften the epithelium before it is folded back, epi-LASIK utilises a tool known as an epithelial separator. It is suggested that the alcohol used to soften the epithelium in the LASEK procedure can damage the delicate covering, causing problems after the surgery. It is for this reason that epi-LASIK avoids using any alcohol.

In contrast to both epi-LASIK and LASEK procedures where surgeons are cautious in the cutting and folding of the epithelium, in the PRK operation they cut off and discard the covering altogether. This may seem harmful, but the epithelium is able to completely regenerate over a number of a few days, leaving no long lasting side effects. The only problem with the PRK procedure is that due to removing the epithelium, the eye takes longer to heal.

Laser Corneal Reshaping

Apart from the differences noted above, there is little difference in the actual procedure of corneal reshaping. All the operations tend to use the same lasers and can all be done with wavefront technology to give even better results. In all of the laser eye surgery procedures, your eye will be immobilised, usually with a little suction cup that is stuck to the front of your eye. The surgeon will ask you to look at a coloured light as they use a laser to remove parts of the cornea. This part of the procedure is usually painless, as you will be given anaesthetic eye drops to numb your eye.

Recovery Periods after Laser Eye Surgery

The only other major difference between the procedures is the recovery period, mainly the length of time before you will be able to see again. Of all the procedures, LASIK and intra-LASIK have the fastest recovery times, as they do not damage the front covering of your eye, the epithelium. Once the epithelium is removed, in procedures such as PRK or LASEK, the length of recovery time you require post operatively increases from one day with LASIK to up to a week. If you decide to have either PRK or LASEK, to aid the recovery of your epithelium the surgeon will ask you to wear a protective contact lens and patch over your eye for around 3 days. This is not usually required in LASIK procedures as recovery only takes on average less than 24 hours.

During the recovery time, the eye care instructions you are given will be the same for all operations. It is important that you don’t expose your eye to bright lights and that you take enough rest. Throughout the recovery and even for the first few days when your eye returns to normal, you will be given some drops to put in your eye to prevent any swelling or infection. It is important that you follow these steps carefully to make sure the results of the surgery are the best as possible.

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