Epi-LASIK: A Guide to Consider Before Going Under the Laser

What is Epi-LASIK Surgery?

Epithelial laser in-situ keratomileusis, commonly known as Epi-LASIK, is a new refractive surgery that combines the benefits of conventional LASIK (laser in-situ keratomileusis) and LASEK (laser epithelial keratomileusis).¹

It’s more similar to LASEK because the treatment involves the epithelium flap rather than a thicker corneal flap. The flap is the portion of the cornea that is cut and pulled back to allow for laser treatment. 

Epi-LASIK is considered less invasive and safer than LASIK because it doesn’t require a deeper incision in the cornea.²

Just like LASIK, Epi-LASIK treats the following:

• Nearsightedness (myopia)
• Farsightedness (hyperopia) 
• Astigmatism

You’re a good candidate for Epi-LASIK if you meet the following:

• Are 18 years or older
• Don’t qualify for LASIK surgery, which requires a thick cornea
• Have good general health
• Have no eye diseases
• Have large pupils
• Want to avoid a thicker flap as used in traditional LASIK
• Have trauma-related eyesight problems
• Don’t want to wear contact lenses or eyeglasses

Epi-LASIK Procedure

Like LASIK, Epi-LASIK surgery involves changing the shape of the cornea to enhance focus. The cornea is the clear part of your eye that focuses light on the retina, enabling clear vision.³

Let’s look at what to expect before, during, and after LASIK surgery.

Before Surgery

Before the procedure, your eye doctor will evaluate your qualifications for the procedure.

You’ll be expected to abstain from your contact lenses for some time to allow your cornea to adjust to its standard shape:

• If you use soft contact lenses, stop wearing them two weeks before the first evaluation.
• If you use toric soft lenses or rigid gas-permeable (RGP) lenses, stop wearing them at least three weeks before the evaluation.
• If you use hard lenses, stop wearing them four weeks before the initial evaluation.

Your eye doctor may need to evaluate you several times before the surgery to ensure you’re fit for the procedure. They will also discuss the benefits, risks, and expectations after the procedure.

During Surgery

During the LASIK procedure, you will sit in a reclining chair, and your doctor will clean your eye in preparation for the procedure.

Your doctor will then use an instrument called an epithelial separator with a thin blunt edge to create a thin epithelial flap.⁴

The epithelial flap will then be separated from the other corneal layers to allow for laser treatment underneath.

After the cornea has been reshaped, the doctor will then reposition the flap and apply a special bandage contact lens to hold the flap in place. This promotes comfort, prevents injury, and enhances the healing process. 

The process may take 2 hours, including preparation, after-surgery care, and the required paperwork. However, the treatment procedure takes 30 minutes or less.⁵

The soft contact lenses act as a bandage and will be removed during your early follow-up visits.

After Surgery

After Epi-LASIK surgery, you may not have perfect vision immediately. 

However, research shows that most patients achieve a 20/40 or better vision by day three. Others may take longer (3 to 6 months) to achieve the intended visual outcomes.

Usually, most people can return to normal activities, such as driving within a week after surgery.

It’s essential to follow up with your surgeon at least 24 hours after surgery and consistently after that for monitoring. Also, strictly follow your medication regimen as prescribed by your doctor.

Side Effects & Risks of Epi-LASIK Surgery

Some potential side effects include:

• Mild pain
• Blurred vision
• Halos around light sources
• Sensitivity to light
• Watery eyes/excess tearing
• Clouding of the cornea (corneal haze)

Epi-LASIK has fewer risks compared to LASIK. This is because there is no deep penetration into the cornea. 

The few complications of Epi-LASIK include:

• Under correction or over correction
• Flap complications (rare)
• Epithelium erosion (loss of corneal epithelium)

Difference Between Epi-LASIK and LASEK

The main difference between LASEK and Epi-LASIK is how the flaps are created and handled. 

Epi-LASIK minimizes the drawbacks of the LASEK procedure.

During the LASEK procedure, an alcohol solution softens the corneal epithelium and separates it from the corneal stroma (central layer of the cornea). The cornea is then reshaped with an excimer laser.

In epi-LASIK, the surgeon uses an instrument known as an epithelial separator to create the flap. The epithelial separator is a device that has an oscillating blunt plastic blade.

The tool separates the flap and folds it back to expose the stroma to allow for laser treatment.

Your surgeon will not use the alcohol solution to treat the epithelial flap during the Epi-LASIK procedure. Most surgeons prefer Epi-LASIK because the alcohol solution is harmful to epithelial cells. It can also prolong the healing time.

Studies show that both procedures are effective in treating myopia (nearsightedness).⁶

Pros and Cons of Epi-LASIK

Pros:

• Can treat thin corneas
• Comparable quality of vision as LASIK
• Low risk of flap complications
• Low risk of dry eyes
• Easy procedure to perform
• Quick recovery (within days)

Cons:

• Longer healing time than LASIK
• Slight discomfort after surgery

Pros and Cons of LASEK

Pros: 

• Ideal for thin corneas
• High chances of success
• Can achieve 20/40 vision or better 
• Long-lasting 

Cons:

• Possibility of under-correction or overcorrection
• Thinning of the cornea (overtime)
• Prolonged recovery period (6 to 9 months)

Results & Success Rates

Epi-LASIK and LASEK are similar in terms of visual outcomes. 

However, Epi-LASIK minimizes the drawbacks of LASEK, such as eliminating alcohol use.⁷ The recovery time for Epi-LASIK is also shorter. 

Compared to LASEK treatment, which may take 5 to 7 days to recover, most patients report good eyesight three days after the Epi-LASIK procedure.⁸

How Much Does Epi-LASIK Cost?

Epi-LASIK is considered elective surgery and is unlikely to be covered by insurance.

Just like LASIK, PKR, and LASEK, initial examinations may be partially covered by your vision insurance. 

A traditional Epi-LASIK procedure may cost you anything from $500 to $1,000 per eye. Custom Epi-LASIK surgery may cost up to $2,000 per eye. This cost may differ based on the facility, location, or surgeon. 

Is Epi-LASIK Right For You? 

If you have a thin cornea and want a procedure that guarantees quick healing, Epi-LASIK is the best option for you. 

You’re not a good candidate for Epi-LASIK if you:

• Are below 18 years of age
• Are pregnant or nursing
• Are taking medications that may affect healing
• Have diseases such as diabetes that may affect healing

Contact your eye doctor if your vision is getting blurry and affecting your quality of life.

Alternative Vision Correction Options

• Implantable collamer lens (ICL) or Visian ICL
• Photorefractive keratectomy (PRK)
• Small incision lenticule extraction (SMILE) 
• Intraocular lens implant (IOL)
• Refractive lens exchange surgery (RLE)