Info Library

/ When to Choose EPI-LASIK (PRK) Over LASIK

When to Choose “Soft Brush” Epi-LASIK (Modern PRK) Over LASIK Treatment
by Craig S. Bindi, MD

“Soft Brush” Epi-LASIK is a popular “bladeless” laser vision correction procedure, which does not
require making a LASIK flap or using ANY sharp instruments during the procedure, which has
eliminated any chance of a LASIK flap problem. Epi-LASIK goes by many different names, including
Advanced Surface Ablation, Photo Refractive Keratectomy (PRK), and LASEK. To avoid confusion,
I will just refer to it as Epi-LASIK. On this page, I explain my rationale for sometimes preferring
“Soft Brush” Epi-LASIK instead of LASIK as the treatment of choice for certain patients.

Both Epi-LASIK and LASIK have proven to be effective methods for laser vision correction.
While the initial recovery is usually slower with Epi-LASIK compared to LASIK, the final vision result
is the same with either method. In my ophthalmology practice, I currently perform about 70% LASIK
and 30% Epi-LASIK. Given the fact that LASIK has a quicker recovery and less discomfort, why would
anyone choose to have Epi-LASIK instead of LASIK? The reason is that in some cases, Epi-LASIK may
be safer than LASIK.

Though LASIK offers some distinct advantages over Epi-LASIK, including faster visual recovery,
faster healing, and less discomfort, Epi-LASIK may be the treatment of choice for certain
clinical situations, such as:

• Patients with thin corneas or irregularly shaped corneas

• Patients predisposed to extreme trauma (i.e. boxer)

• Soldiers in the US Marines/US Army are preferred to have Epi-LASIK/PRK instead of LASIK

• Patients with certain corneal dystrophies

• Patients with very large pupils

• Patients that have had radial keratotomy, retinal tears or glaucoma surgery

• Any patient who just doesn’t want a LASIK flap!

Why is “Soft Brush” Epi-LASIK/PRK sometimes safer than LASIK?
For patients with certain corneal measurements, there may be an elevated risk of a LASIK problem.
For these patients, it is safer to select Epi-LASIK, which avoids the problem all together. What’s the
downside? With Epi-LASIK, there is a slower initial recovery and more initial discomfort. However,
recent improvements in our “Soft Brush” Epi-LASIK techniques have greatly reduced the initial
discomfort that was associated with the original PRK procedure. We have fine-tuned our
post-operative Epi-LASIK regimen to make the initial healing phase as comfortable and quick
as possible for our patients. When I recommend Epi-LASIK, it is because long-term safety is more
important than achieving an instant recovery. Ultimately, this is a clinical decision that requires
experience and judgment.

The Procedure Is Slightly Different
In “Soft Brush” Epi-LASIK, rather than creating a LASIK flap, the surface epithelial skin cells are
brushed away before the excimer laser reshapes the exposed surface of the cornea. With modern
techniques, the epithelium can be removed with an automated polishing brush, dilute alcohol
solution or a motorized instrument. I prefer to use an automated soft brush device, called an
Amoils “Soft Brush” Polisher. I never scrape or “cut off” the epithelium, but may use dilute alcohol
for Epi-LASIK in eyes that have had previous surgery, such as radial keratotomy. In Epi-LASIK,
the actual procedure is completely painless, but patients usually report moderate discomfort
during the first 3-4 days, as the corneal epithelial skin cells heal over the laser-treatment area.
A soft bandage contact lens is placed for comfort during this time. Good functional visual recovery
takes about a week or two, but like LASIK, it can take several weeks to improve to optimal levels.
I tell my Epi-LASIK patients to expect eye soreness for 3-4 days and somewhat blurry vision for
the first 6-7 days. I use Mitomycin-C medicine immediately after the laser treatment to help the
cornea heal better. The main option with Epi-LASIK is whether the procedure should be combined
with Wavefront Technology or Standard laser vision correction.

Wavefront Epi-LASIK (Modern PRK) for sharper night vision, better visual contrast and higher
chance of “better than 20/20” vision. Wavefront LASIK Technology is especially recommended for
patients with large corrections, larger pupils, poor night vision or very high expectations

Standard Epi-LASIK has a long track record for being safe and can effectively treat basic vision
problems, such as mild to moderate nearsightedness, farsightedness and astigmatism. Standard
LASIK does not utilize the advancements of customized Wavefront technology