Surface ablation emerging as safe alternative for select patients

April 17 - Washington, DC - LASIK remains the refractive procedure of choice for the majority of refractive surgeons and patients worldwide. However, surface ablation is a reasonable alternative that may even offer some advantages overall and be a preferred technique in select patients, said Helen K. Wu, MD, at the American Society of Cataract and Refractive Surgery meeting.

"Patients and refractive surgeons alike generally regard PRK as second best to LASIK, but those opinions are influenced more by the fact that PRK is perceived as an older technique and do not necessarily have anything to do with differences in results," said Dr. Wu, New England Eye Center, Tufts University School of Medicine, Boston. "Both surface ablation and LASIK have distinct advantages and disadvantages, but many of the prior limitations of surface ablation have been addressed by evolving techniques and technology."

LASIK has a convenience advantage since it allows simultaneous bilateral surgery, but other benefits of LASIK, including better postoperative comfort and reduced risks of haze and regression, especially with higher corrections, have been addressed with advances in surface ablation, including the introduction of such techniques as corneal chilling, use of adjunctive intraoperative and postoperative medications, development of better bandage contact lenses, improved lasers, and the introduction of the epithelial sparing techniques of LASEK and epiLASIK.

Compared with LASIK, surface ablation has the advantages of being a simpler and faster procedure, avoids flap complications, and enables easier enhancements, especially when those retreatments are performed late. Moreover, PRK "shines" over LASIK with respect to faster corneal reinvervation, more rapid return to preoperative nerve density and corneal sensitivity, and less postoperative reduction in tear production. In addition, iatrogenic corneal ectasia, the most potentially serious complication of refractive surgery, is more likely after LASIK versus PRK.

"For these various reasons, surface ablation is now more attractive than it was before, and it may be the better choice in patients with thin corneas, dry eyes, or who participate in contact or ball sports," Dr. Wu said.