And the FINAL comment on this subject goes to the Corneal Surgeon!!

I think Craig has made his point and continues on with his immense level of cynicism. My response is partially in defence to Brian and also to try and allay browser anxiety that may stem from confusion as a result of this discussion.

If Craig is really interested in evidence based medicine, then the only way to know which procedure is better is to perform a prospective randomised controlled trial. Quotes from surgeons and one liners from papers are hardly science and not very different from a viewpoint expressed by a surgeon to a patient at the time of consultation.

Looking at Randomised controlled trials: Ophthalmology. 1998 Aug;105(8):1512-22, discussion 1522-3.loss of BSCVA was greater in PRK (11.8% vs 3.2%) I do not know of any other prosepctive, randomised controlled trials comparing the two procedures or LASEK vs LASIK for that matter - perhaps Craig can enlighten me.

Whatever the college guidelines state - the fact is the jury is still out and we shall only know in the long term e.g. what effect alcohol has on the cornea as well as the marked inflammation and corneal swelling following PRK, epiLasik LasEk or whatever anyone calls the procedure.

He forgets we are in the business and intimately involved scientifically, surgically and for that matter financially. If I were convinced LasEk were a better procedure and charged what is being charged at private run centres (NOT the high street) my margins would be far greater (at least double and there may be one extra visit compared to LasIK - our patients attend for a minimum of three visits and as many as needed for a year). So again - I must be a bit daft -as a surgeon I take "more" risk (Craig's viewpoint - not mine) and earn less !!! How did all us LasIk surgeons manage to get to where we are today ???


For the benefit of browsers:
1) the cornea is not split (only the hydrokeratome cleaves the cornea and is yet to become commercially available), the keratome cuts (does not SHEAR - inappropriate description) the cornea below the level of the epithelium
2) Optical zones may be 6.5 and greater depending on the laser used and choice by surgeon
3) Risks of ectasia are present in BOTH procedures - careful selection by the surgeon - preferably one that understands the cornea is probably the most important part of the WHOLE process.
4) All this needs to be put into perspective: I have yet to see Ectasia to the frequency that has been suggested - I have seen 3 in post- Lasik eyes from other centres and 4 post LASEK. My oldest patients are now 8 years out and when I commenced I did the really high ones typically from -6.00 and up perfoming PRK in those below until I realised Lasik did a better job (as did I with more experience). Incidentally I perform almost 100 grafts a year (lamellar and penetrating) and have not done a penetrating graft on any patient who has had a mishap from LasIk.

Doctors including ophthalmic surgeons (their wives and children) as patients also make choices - amazingly with all the so called comparative data (much of it retrospective) out there supposedly showing little difference, they still come asking specifically for Lasik !!!

A Corneal Surgeon