LASIK vs LASEK: Which Eye Surgery is Better?

What is laser eye surgery?

Laser eye surgery is a type of refractive surgery, which means treatment to remove the need for glasses or contact lenses, such as short-sightedness. Modern laser eye surgery includes three main treatments:

• LASIK
• LASEK (also known as PRK)
• SMILE lenticule extraction

Each procedure has pros and cons, and suitability for each laser vision correction technique varies depending on your prescription, eye anatomy and lifestyle.

This complete guide will compare LASEK surgery with the main alternative laser eye surgery treatment, LASIK. When it comes to vision correction, both treatments are considered safe and effective.

Understanding LASIK vs LASEK

LASEK, LASIK (and SMILE) procedures are all performed on the cornea, the clear window at the front of your eye.

To simplify a little, there are two main layers. This is like a wall in your house where the bulk of the wall is made of tough bricks. The bricks are covered in a thin top layer of plaster to make the wall smooth.

Your cornea is the same. The brickwork in your cornea is made of tough, transparent collagen called the stroma. The top corneal layer, “plaster”, is a thin coating of skin known as epithelium.

If you plan to change the corneal curvature to correct short sight, long sight or astigmatism, you have to change the brickwork, i.e. the thick collagen layer.

What is LASIK treatment?

LASIK requires the flap to be repositioned expertly and smoothly without creating microscopic wrinkles called striae. This is where having a very experienced surgeon is essential.

The healing process is relatively swift, with many patients experiencing clear vision within hours after surgery. Many opt for LASIK eye surgery because there is less pain after treatment, which is the most appropriate method for most people.

What is LASEK?

This method only uses an excimer laser plus an alcohol solution to loosen the corneal skin (epithelium), which involves a longer recovery.

LASEK treatment is often recommended for individuals with thin corneas or who participate in contact sports【25†source】.

What prescriptions can LASEK and LASIK treat?

LASEK and LASIK are very flexible treatments and can treat a wide range of prescriptions. Both procedures can correct:

• Short-sightedness
• Long-sightedness
• Astigmatism
• Presbyopia (needing reading glasses)

The treatable approved range for each is shown in the table below. Short-sight (myopia) is the most suitable refractive error (need for glasses) for laser eye treatment, where the WaveLight laser can treat up to -14.0 dioptres.

Please note that many surgeons will switch to offering implantable contact lenses (ICLs) for very high prescriptions as a better solution for suitable patients. Click here to read our complete guide to ICLs.

Comparing LASIK vs LASEK

Here’s a summary of the difference between LASIK vs LASEK treatment.

LASIK & LASEK Success Rates

LASIK & LASEK boast high success rates, with over 95-99% of patients achieving 20/20 vision or better post-treatment. However, it’s crucial to note that vision changes over time, and some patients might still need glasses or contacts sometime after correction.

Click here for a detailed guide to success rates for laser eye treatment.

In a recent clinic research paper that compared LASIK with PRK (which has the same outcomes as LASEK), the final visual result was identical in both cases. You can see that LASIK gets good vision by the following day, while PRK (LASEK) takes three months to match it. Beyond three months, the results are the same.

Pros and Cons

LASIK

• Pros: Quick recovery, minimally invasive, and effective for myopia, hyperopia, and astigmatism. It also reduces the risk of complications like hazy vision.
• Cons: Potential side effects include dry eyes and a higher risk of corneal flap complications.

LASEK

• Pros: Suitable for individuals with thin corneas and may present a slightly lower risk of dry eye.
• Cons: Longer recovery time, potential for discomfort, and risk of corneal haze due to corneal scarring after surgery. Please note that the now widespread use of mitomycin C (MMC) has drastically reduced the chance of getting haze.

Your choice between LASIK or LASEK will depend on several factors, including corneal thickness, overall eye health, lifestyle, and age. It’s recommended to consult with an eye surgeon to make an informed decision tailored to your specific needs.

Determining Candidacy for LASEK vs LASIK

Who is Suitable for LASIK?

Not everyone is an ideal candidate for LASIK surgery. Ideal candidates are typically those with stable vision prescriptions, healthy corneas of adequate thickness, and free from eye diseases such as severe dry eyes or cataracts.

If you have any pre-existing medical conditions, this may prevent you from having laser eye surgery. Common contraindications for laser vision correction are shown in the table below.

It’s essential to have a detailed consultation with an eye surgeon to assess suitability, as elaborated in our complete LASIK eye surgery eligibility guide.

Who is Suitable for LASEK?

LASEK is often recommended for individuals who are not ideal candidates for LASIK, particularly those with thinner corneas. LASEK can be an excellent option for those who are at a higher risk of corneal flap complications from LASIK. For more details, see our LASEK eye surgery eligibility guide.

Preparing for LASEK and LASIK

For LASIK:

Preparation for LASIK involves a thorough eye examination, including corneal mapping and a complete review of your eye health. It’s crucial to follow the pre-surgery instructions, which might include discontinuing the use of contacts and avoiding certain medications. Read more about preparing for LASIK in our dedicated guide.

For LASEK:

LASEK preparation also includes comprehensive eye exams and may have an additional focus on corneal thickness and health. Patients should adhere to their surgeon’s specific guidelines, especially regarding contact lenses and medications. Explore our comprehensive guide on preparing for LASEK surgery for detailed information.

In summary:

Both LASIK and LASEK involve using an excimer laser to reshape the cornea. The procedures are relatively quick and are usually completed within 10-15 minutes for both eyes. Patients are awake during the surgery, and anaesthetic drops are used to numb the eyes.

Post-Surgery Recovery and Care

Recovery from LASIK:

Post-surgery, LASIK patients may experience immediate vision improvement, with most achieving optimal vision within a few hours to a day. The recovery process is generally quick, and detailed aftercare instructions are crucial for a smooth healing process.

Recovery from LASEK:

The recovery period for LASEK is slightly longer than LASIK, typically spanning a few days. Patients might experience discomfort and blurred vision during the initial stages of healing. Following the surgeon’s aftercare instructions is vital for proper recovery.

Understanding the Risks and Complications

LASIK Risks:

While LASIK is safe, potential risks include dry eyes and flap-related complications. These risks should be thoroughly discussed with your surgeon.

LASEK Risks:

LASEK also carries risks, such as dry eyes and the potential for nighttime glare. Patients need to understand these risks to make an informed decision.

Aftercare and Long-Term Considerations for LASIK vs LASEK

LASIK Aftercare:

After undergoing LASIK laser eye surgery, patients typically have a follow-up appointment within 24 to 48 hours. It’s essential to adhere to the aftercare regimen, which includes using prescribed eye drops to prevent infection and inflammation and promote healing. During the initial recovery phase, avoiding strenuous activities and exposure to irritants like dust and water is also crucial.

LASEK Aftercare:

LASEK eye surgery patients usually experience a more prolonged recovery while the corneal epithelium heals, requiring more intensive follow-up care. This includes using various eye drops to aid healing and prevent complications. It’s important to avoid rubbing the eyes and to protect them from potential irritants.

Lifestyle Adjustments

Post-LASIK:

Most LASIK surgery patients can resume normal activities within a few days, though they should avoid high-impact sports and activities that risk eye injury for several weeks. It’s also advised to take precautions against digital eye strain and UV exposure.

The healing after LASIK procedures is very well understood as this is the most popular laser treatment in the world.

Post-LASEK:

Vision recovery from surface laser treatments, including LASEK and PRK, might require a few rest days and limited screen time. Patients should also take precautions to protect their eyes from UV rays and avoid activities that could strain or injure the eyes.

Patients who have LASEK can resume contact sports sooner because the top corneal layer of the cornea does not have a flap. In effect, the outer layer of the cornea is as strong as it was pre-operatively. The thin layer of skin covering the corneal tissue bonds down more strongly after excimer lasers have removed some of the cornea.

Long-Term Effectiveness

Vision Stability:

LASEK and LASIK eye surgery provide long-lasting laser vision correction results, typically stabilising within a few months post-procedure. Excimer treatment to remove collagen tissue makes a permanent change in the shape of the cornea.

While the correction is permanent, it’s important to note that eyes can still undergo natural changes due to ageing or other health factors.

Regular Eye Examinations:

Regular eye exams with a medical professional are crucial post-treatment to monitor eye health and vision changes. For LASIK, this might include several check-ups during the first six months, while LASEK patients may need slightly less monitoring initially as no flap is made in the cornea.

Future Considerations:

As you age, you might still need reading glasses due to presbyopia, a common age-related vision change. Understanding these potential changes is important for long-term vision care planning.

For detailed comparisons with other laser eye surgery options, such as SMILE and PRK, visit our comprehensive section on laser eye surgery comparisons.

Understanding the Costs of LASIK and LASEK

The cost of treatment varies depending on several factors, including the technology used, the surgeon’s experience, and the geographic location of the clinic. It’s important to consider these factors when evaluating the price of laser treatment.

View our guide on understanding LASIK eye surgery costs for a detailed breakdown.

Many clinics offer financing plans to make the surgeries more affordable. Patients should also inquire about potential insurance coverage, though it’s worth noting that most insurance plans do not typically cover elective surgeries like LASIK and LASEK.

Frequently Asked Questions

1. Is laser eye surgery painful?

Answer: LASIK has minimal discomfort. Anaesthetic drops numb the eyes, and most people experience mild pressure during the procedure. However, after LASEK eye surgery, expect to have some discomfort or pain for 2-4 days. LASEK procedures are identical to PRK in terms of pain.

2. How long does the treatment take?

Answer: The laser procedure for both LASIK and LASEK typically takes less than 15 minutes for both eyes.

3. What is the success rate of these surgeries?

Answer: LASIK and LASEK have high success rates, with most patients achieving significant vision improvement.

4. Can I return to work immediately after treatment?

Answer: Patients who have LASIK may return to work within a day or two, whereas LASEK patients might need a few more days due to a longer recovery period.

5. Are there any long-term side effects?

Answer: Long-term side effects are rare, but as with any procedure, there are potential risks which should be discussed with your surgeon.

6. Will I need reading glasses after treatment?

Answer: As you age, you may still require reading glasses due to presbyopia, which is a natural part of ageing.

For more answers, visit our comprehensive LASEK FAQ page.