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LASEK Eye Surgery

LASEK, also know as advanced surface ablation, is an excellent laser eye surgery alternative for those who are not suitable for LASIK.
Advanced Surface Ablation (ASA) involves removing tissues in the outer layer of the eye, before using a laser to reshape the cornea. It is an umbrella term used to describe a number of different treatments for different conditions. Here we’ll explain what ASA means, explore the different types, and explain how the treatment can help you.

What does the term “advanced surface ablation” mean?

Advanced surface ablation is a complicated-sounding term, but it’s actually quite simple. ASA can be defined as follows:

  • Advanced – laser technology is used to perform this procedure
  • Surface – refers to the surface of the cornea, the transparent layer that covers the eye
  • Ablation – tissue removal.

So, advanced surface ablation is the term used for the process of taking away the outermost cells of the eye (the epithelium), in order to treat the part of the cornea underneath known as the stroma, with a laser.

What happens during advanced surface ablation?

Advanced surface ablation is a quick procedure, typically taking around 10-15 minutes from start to finish. Both eyes can be treated at the same time.

  • Mr Barsam gently removes or pushes back part of the corneal epithelium (the surface cells of the cornea). The area removed is kept to a minimum, to help the eye to heal following the procedure.
  • Using an ultra-precise Wavelight Allegretto excimer laser, he reshapes the cornea in keeping with the patient’s prescription.
  • Finally, a bandage contact lens is placed onto the cornea for 3-5 days until healing is complete.

Different types of ASA

Advanced surface ablation can be used for a number of different procedures, but there are two main types:

  • PRK (photorefractive keratectomy)
  • LASEK laser eye surgery

These are both laser eye surgery procedures used to correct refractive errors such as short-sightedness (myopia), long-sightedness (hypermetropia), astigmatism as well as reading vision problems (presbyopia), where a laser can be employed to reshape an irregularly shaped cornea.

What is PRK?

PRK stands for photorefractive keratectomy. It’s a laser vision correction procedure commonly carried out to treat myopia, hypermetropia and astigmatism.

PRK was the first type of laser eye surgery to be developed. Like LASIK, it involves using a laser to reshape the cornea and correct the patient’s vision.

With PRK, however, instead of using a laser to create a corneal flap, the surgeon completely removes the epithelium (the clear outer layer of the eye) in order to reach the cornea. This grows back within a few days.

Although LASIK has largely replaced PRK as the laser eye procedure of choice, PRK may be recommended if you have thin corneas and are therefore not eligible for LASIK laser eye surgery.

close up of green eye patient due to for LASEK

What is LASEK?

LASEK laser eye surgery is similar to both PRK and LASIK.

During this procedure, the surgeon avoids removing the entire epithelium. Instead, after applying anaesthetic to the eye, a laser is used to cut the surface layer, which remains attached and is simply peeled back to reach the stroma within.

Like PRK, LASEK may be recommended for patients with thinner corneas. Although LASEK patients face a longer recovery period than LASIK patients, it’s a less invasive process than PRK, and can avoid the flap complications that may be experienced by those undergoing LASIK.

What is epi-LASEK?

Epi-LASEK works in much the same way as LASEK but it creates a much thinner incision in the cornea. epi-LASEK is another term that is sometimes used to describe the LASEK procedure. You might also hear people talking about E-LASEK. These all refer to the same thing. The E- and epi- prefixes simply refer to the epithelium, because the LASEK procedure involves peeling it back before operating with a laser.

Case studies

What’s it like to undergo advanced surface ablation?

” Allon is not only a fantastic surgeon, but his approach before, during and after surgery has been professional, caring, and personable.”

One of Mr Barsam’s patients keeps a journal of her experience and successful treatment in this advanced surface ablation case study.

Other treatments involving advanced surface ablation

Sometimes, advanced surface ablation can be used for procedures that are more complicated than straightforward laser vision correction.

A pioneer in this field, Allon Barsam uses advanced surface ablation in cases of:

  • post corneal graft astigmatism
  • corneal dystrophies
  • recurrent corneal erosion syndrome
  • anterior corneal scarring

advanced surface ablation pdf thumbnail In a very small selection of patients, Mr Barsam has also performed advanced surface ablation on patients with keratoconus who are intolerant to contact lenses. In these cases he has combined the procedure with corneal collagen crosslinking.

Allon Barsam is now involved in developing innovative uses for advanced surface ablation in cases of corneal scarring following viral keratitis. You can read a publication on this treatment here.

Dr Geraldine McKeever

“Allon has truly changed my life and I would say to anyone thinking of having sight correction at a large impersonal hospital or chain to think again and to contact Mr. Barsam. You only get one pair of eyes and so you should think very carefully whom you entrust them to. ”