When I chose to adopt Epi-LASIK in my practice over four years ago, my primary motivation was to improve patient safety by avoiding some of the complications associated with traditional LASIK. Since I began using the technique, I have found that Epi-LASIK has enabled me to help patients get back to work and other activities in their lives quickly, with very little discomfort, and with excellent refractive outcomes. Word-of-mouth referrals to my practice have also increased since I adopted Epi-LASIK, which shows that patient satisfaction for this procedure is high.

When I ask my patients how long they have been considering laser vision correction (LVC), they typically say "a few years." This response suggests that an immediate visual improvement is not their foremost objective; rather, what they really want is the safest possible route to spectacle independence. This mindset is in keeping with my own approach: safety first.

With this in mind, I not only perform surface ablation but I also operate on just one eye at a time, and I treat the fellow eye between two and seven days after the initial procedure. I have found that my patients understand that the convenience of performing bilateral surgery does not outweigh the very small but real risk of a device-related complication or infection affecting both eyes during a bilateral procedure.

What made me move to Epi-LASIK?

I perform LVC procedures using the latest laser and wavefront aberrometry technology. Other than the occasional PRK procedure, 100% of my LVC cases are now Epi-LASIK.

I am not alone in adopting the technique. Although surface ablation procedures in LVC are not performed as commonly here in the US as in some other countries, the percentages continue to increase. In 2001, approximately 5% of LVC procedures conducted in the US were surface ablation. From 2002 to 2005, the percentage hovered between about 6% and 10%, and by 2006, surface ablation accounted for approximately 14% of LVC procedures.¹

Figure 1

As was the case for many physicians who have changed to surface procedures, I was personally first attracted to Epi-LASIK because it does not compromise the cornea's biomechanical properties; rather than cutting the cornea, it cleaves the epithelium from the underlying Bowman's membrane (Figure 1).

The lower rate of complications and dry eye, as well as the possibility that Epi-LASIK may induce fewer higher-order aberrations, were also important considerations for me when I was deciding whether or not to adopt the procedure. Although it is true that the rate of flap complications with modern LASIK is low, a procedure that does not create an intrastromal flap obviously has absolutely no possibility whatsoever of flap-related complications, and patients appreciate this fact.

In my opinion, Epi-LASIK itself has several advantages over other surface ablation procedures. First, it leaves a much smoother, more regular bed for laser ablation when compared with PRK, and leaves no affected cells covering the treatment area. In addition, corneal re-epithelialization occurs more rapidly. The technique also allows for a more comfortable and faster visual recovery, as well as faster healing overall.