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When is "Soft Brush" Epi-LASIK (PRK) the treatment of choice over LASIK?

By Craig S. Bindi, M.D.

"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 only approved for Epi-LASIK/PRK
• Patients with certain corneal dystrophies
• Patients with very deeply set eyes or small opening eyes
• 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 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

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