LASIK and LASEK
Understanding LASIK and LASEK Procedures
LASIK stands for Laser-Assisted In Situ Keratomileusis. During this procedure, we create a thin flap in the outer layer of your cornea using a specialized laser or blade.
We then lift the flap and use an excimer laser to reshape the tissue underneath. After the laser treatment, we carefully place the flap back in position where it heals naturally without stitches.
LASEK stands for Laser-Assisted Sub-Epithelial Keratectomy. This procedure treats the very top layer of your cornea, called the epithelium, differently than LASIK does.
We loosen the epithelial layer with a dilute alcohol solution, gently move it aside, and then reshape your cornea with the excimer laser. Afterward, we reposition the epithelium and place a special contact lens over your eye to protect it while it heals.
Both LASIK and LASEK use the same type of excimer laser to reshape your cornea. The laser removes microscopic amounts of tissue to change how light focuses on your retina.
- For nearsightedness, the laser flattens the center of your cornea
- For farsightedness, the laser steepens the central cornea
- For astigmatism, the laser smooths out irregular curvature
- The reshaping is permanent and customized to your unique prescription
The main difference between LASIK and LASEK lies in how we access the deeper corneal tissue. LASIK creates a thicker flap that includes multiple layers, while LASEK only disturbs the very thin surface layer.
LASIK typically offers faster visual recovery because the flap acts as a natural bandage. LASEK involves a longer healing process because the entire surface layer must regenerate, but it preserves more of your corneal thickness and may be safer for certain contact sports or occupations.
Who Is a Candidate for Each Procedure?
LASIK works best for patients with moderate to thick corneas and stable vision prescriptions. You should be at least 18 years old, though we often recommend waiting until age 21 when your prescription is more likely to be stable.
- Your prescription has not changed significantly in at least one year
- You have adequate corneal thickness to create a flap safely
- You do not have severe dry eye syndrome
- You are not pregnant or nursing, as hormones can affect your vision
- You have realistic expectations about the results
LASEK may be the better choice if you have thinner corneas or if your lifestyle involves activities that could dislodge a LASIK flap. We often recommend LASEK for military personnel, police officers, firefighters, and athletes in contact sports.
LASEK is also suitable for patients with mild to moderate dry eye, as it causes less disruption to corneal nerves than LASIK. If you have a very high prescription or irregular corneal shape, LASEK might offer advantages over LASIK in specific cases.
Certain health conditions can affect whether you are a good candidate for either procedure. We carefully review your medical history during your evaluation to ensure your safety.
- Autoimmune diseases like lupus or rheumatoid arthritis may slow healing
- Uncontrolled diabetes can affect wound healing and surgical outcomes
- Keratoconus or other corneal diseases typically rule out both procedures
- Active eye infections or inflammation must be treated before surgery
- Some medications, including Accutane, require a waiting period after you stop taking them
Your corneal thickness is one of the most important factors in determining which procedure is right for you. We measure this precisely during your pre-operative evaluation using specialized imaging technology.
LASIK requires enough corneal tissue to create a flap and still leave adequate thickness beneath for long-term eye health. If your corneas are too thin for LASIK, LASEK becomes the preferred option because it removes less tissue and preserves more structural integrity.
What to Expect During Your Evaluation and Procedure
Your evaluation begins with a comprehensive eye exam and specialized diagnostic tests. We map the unique shape and thickness of your cornea, measure your pupils in different lighting conditions, and check for any eye health issues.
- Corneal topography creates a detailed map of your corneal surface
- Pachymetry measures your corneal thickness at multiple points
- Wavefront analysis detects subtle vision imperfections beyond your basic prescription
- Tear film testing evaluates whether you have dry eye that needs treatment first
- Dilated eye exam checks your retina and overall eye health
On the day of your LASIK procedure, we numb your eyes with drops so you will not feel pain. The entire process takes about 10 to 15 minutes per eye, though the laser treatment itself lasts less than a minute.
We use a special device to hold your eyelids open and ask you to look at a target light. After creating the corneal flap, we apply the laser to reshape your cornea, then reposition the flap. You may notice pressure sensations and see blurry or dimmed vision during the procedure, but you should not experience sharp pain.
LASEK also begins with numbing eye drops and takes a similar amount of time as LASIK. The key difference is how we prepare your cornea before the laser treatment.
After placing a special solution on your cornea to loosen the epithelium, we gently move this thin layer aside. We then apply the excimer laser to reshape your cornea, reposition the epithelium, and place a soft contact lens over your eye as a bandage. You will wear this protective lens for several days while the epithelium heals.
During both procedures, the numbing drops keep you comfortable, though you may feel pressure when we stabilize your eye. Most patients report little to no pain during the actual surgery.
The difference in discomfort becomes more noticeable after the procedure. LASIK patients typically experience mild scratchiness for a few hours, while LASEK patients may have more significant discomfort for the first few days until the epithelium heals.
Recovery, Healing, and Aftercare
Most LASIK patients notice improved vision within hours of their procedure. Your vision continues to sharpen over the first few days, and many people return to work and normal activities within 24 to 48 hours.
- Day one: Blurry vision improves rapidly, mild irritation common
- First week: Vision stabilizes, most restrictions lifted after initial follow-up
- First month: Vision continues to refine, dry eye symptoms decrease
- Three to six months: Final vision outcome typically reached
LASEK requires more patience during recovery because your epithelium needs time to regenerate completely. You will wear the protective contact lens for about three to five days after surgery.
Your vision remains blurry for several days and gradually clears over the first week or two. Most patients can return to work within a week, though some activities must wait longer. Full visual recovery often takes several weeks to a few months, though you will see progressive improvement throughout this period.
LASIK patients generally experience only mild discomfort, often described as feeling like an eyelash is in the eye. This sensation usually resolves within a few hours, and over-the-counter pain relievers are typically sufficient.
LASEK patients may experience more noticeable discomfort for the first three to four days while the epithelium heals. We provide prescription pain medication if needed, and keeping your eyes closed and resting helps minimize discomfort. Once the bandage contact lens is removed and the epithelium has healed, the discomfort resolves quickly.
After either procedure, you need to protect your eyes while they heal. The specific restrictions and timeline differ between LASIK and LASEK.
- Avoid rubbing your eyes for at least one month to prevent flap or healing complications
- Wait at least one week before applying eye makeup or lotions near your eyes
- Stay out of pools, hot tubs, and natural bodies of water for two weeks
- Wear protective eyewear during sports, especially contact sports, as we recommend
- Avoid dusty or dirty environments that could irritate your healing eyes
After your procedure, we prescribe antibiotic and anti-inflammatory eye drops to prevent infection and reduce inflammation. You will use these drops on a specific schedule for about one week.
Artificial tears are essential for both procedures and help keep your eyes comfortable while your tear film recovers. We may recommend preservative-free artificial tears used frequently throughout the day for several weeks or months. If you experience significant dry eye, we may prescribe additional medications to support tear production.
Regular follow-up appointments allow us to track your healing and address any concerns. Your first visit typically occurs within 24 to 48 hours after surgery, and additional visits follow at one week, one month, three months, and six months.
During these visits, we check your vision, examine your corneal healing, measure your eye pressure, and assess your tear film. We also look for any signs of complications and adjust your medication regimen as needed. These appointments are crucial for achieving the best possible outcome.
Risks, Complications, and Warning Signs
While LASIK is generally safe, all surgical procedures carry some risk. Most complications are minor and can be managed effectively, though serious problems can occur in rare cases.
- Flap complications, such as wrinkles or displacement, requiring repositioning
- Undercorrection or overcorrection that may need enhancement surgery
- Glare, halos, or starbursts around lights, especially at night
- Infection, though very rare with proper antibiotic use
- Vision loss, which is extremely rare but possible
LASEK carries its own set of potential complications, though many are similar to those seen with LASIK. The absence of a flap eliminates flap-related problems but introduces other considerations.
Delayed epithelial healing can extend your recovery time and discomfort. Corneal haze, a clouding of the cornea, may develop in some patients, particularly those with higher prescriptions, though modern techniques and medications have significantly reduced this risk. Undercorrection, overcorrection, glare, halos, and infection remain possible, as with LASIK.
Dry eye is one of the most common side effects of both LASIK and LASEK. The surgery temporarily disrupts the nerves that signal your eye to produce tears, leading to decreased tear production and increased dryness.
Symptoms typically peak in the first few months and gradually improve as your nerves heal. LASEK may cause less severe dry eye than LASIK because it affects fewer corneal nerves. We manage dry eye with frequent artificial tears, prescription eye drops, and in some cases, punctal plugs that help retain tears on the eye surface.
Most post-operative symptoms are normal, but certain warning signs require immediate attention. Contact our office right away if you experience any of the following symptoms.
- Sudden vision loss or significantly worsening vision
- Severe eye pain that does not improve with prescribed medication
- Increasing redness, discharge, or signs of infection
- Flashing lights, new floaters, or a curtain over your vision
- Any trauma to your eye, such as being hit or poked
Both LASIK and LASEK have excellent long-term success rates, with most patients achieving 20/20 vision or better. Studies following patients for 10 years or more show stable outcomes and high satisfaction rates.
Your vision may change over time due to natural aging processes unrelated to the surgery. Many patients eventually need reading glasses for near vision after age 40 due to presbyopia, which affects everyone regardless of whether they have had laser vision correction. Some patients may need an enhancement procedure years later if their vision changes, though this is relatively uncommon.
Frequently Asked Questions
Both procedures have excellent safety records when performed on appropriate candidates. LASEK eliminates flap-related complications and may be safer for people with thin corneas or those at risk for eye trauma. However, LASIK has been performed more frequently and has a longer track record, with millions of successful procedures worldwide. The safer choice depends on your individual anatomy and lifestyle.
- LASIK has been performed millions of times with a well-established safety record
- LASEK eliminates flap complications but may have a higher risk of corneal haze
- Your corneal thickness and lifestyle activities influence which option is safer
- Both procedures have low overall complication rates in appropriate candidates
LASIK offers considerably faster visual recovery, with most patients seeing well enough to drive and work within one to two days. LASEK requires more patience, with blurry vision lasting several days and full recovery taking weeks rather than days. The trade-off is that LASEK preserves more corneal tissue and may be the only safe option for some patients.
The slower LASEK recovery may be worthwhile if you need to preserve corneal tissue or if your occupation puts you at risk for eye trauma. We help you weigh the recovery time difference against the other benefits of each procedure based on your personal circumstances and vision goals.
If your corneas are too thin for LASIK or you have other factors that make LASIK risky, LASEK often becomes a viable alternative. We determine your candidacy based on comprehensive testing and your individual eye characteristics. Some patients who are not suitable for either procedure may be candidates for other vision correction options that we can discuss during your evaluation.
In rare cases where neither LASIK nor LASEK is safe, we may recommend alternative procedures such as photorefractive keratectomy or implantable contact lenses. Your comprehensive evaluation will identify all appropriate vision correction options for your specific situation.
Most insurance plans consider laser vision correction an elective cosmetic procedure and do not provide coverage. However, some plans offer discounts through specific providers, and you may be able to use funds from a flexible spending account or health savings account. We can provide detailed cost information and discuss payment options during your consultation.
- Health savings accounts often allow you to use pre-tax dollars for the procedure
- Flexible spending accounts may cover laser vision correction costs
- Some employers offer vision benefits that include discounts on laser surgery
- Many surgical centers provide financing plans with monthly payment options
If you are over 40, you likely have or will develop presbyopia, the age-related loss of near focusing ability that requires reading glasses. Laser vision correction corrects distance vision, nearsightedness, farsightedness, and astigmatism, but it does not prevent presbyopia. We can discuss monovision options, where one eye is corrected for distance and the other for near, though this approach does not work well for everyone.
Some patients choose monovision correction, where one eye is set for distance and the other for reading, though this does not suit everyone. We can discuss all options for managing both your distance vision and near vision needs during your consultation, including what to expect as your eyes continue to age naturally.
Getting Help with LASIK and LASEK
If you are considering laser vision correction, we encourage you to schedule a comprehensive evaluation to determine which procedure is right for you. Our eye doctors will assess your candidacy, answer your questions, and help you make an informed decision about your vision care.