Craig Ross seems to be on a LASEK mission ! He also is a bit cynical of doctors. Having been in the business of refractive surgery since 1990 and having performed RK, PRK, Lasik, Lasek, CK and a whole host of other refractive procedures, I must confess to performing LasIk for even -0.75D. I have the following points to make:
1) As a tertiary referral centre and trouble-shooter of problems - I have seen Ectasia, grade 3 haze, persistent epithelial defects, recurrent erosions, corneal meltdowns to near perforation and infections following LasEk. These problems (except ectasia - poor selection by the surgeon) are not influenced by the surgeon - and UNpredictable. As a surgeon, I personally prefer to be in control of what I do.
2)LasEk like PRK which it is except in name and should be called "modified PRK" - results in more inflammation post op - with corneal oedema and striae - I would love to see some endothelial counts 3 years postop compared to Lasik and a control group. Also anyone over the age of 50 - careful - following a bout of severe ocular inflammation you may get a cataract a little earlier than most (anecdotal - yet to be investigated by LasEk sages). Anybody out there with a history of Hay Fever - again be careful - besides the problems associated with messing with the epithelium, there is a possibilty of activating Herpes simplex to which you would be more predisposed -and the list goes on. Overall for most LasEk is fine as is LasIK. For the extremely few (more in the LasEk crowd from my observation) the problems can be a catalogue of misery. Additionally are you all aware that alcohol has been found in the eye following LasEk in studies on chickens ? (Personal communication - research investigations in Spain) as has Mitomycin C (also used excessively by LasEk surgeons. Both are harmful to the eye - especially Mitomycin C whose effect takes about 10 years. I expect to see more ectasia following LasEk used in conjunction with Mitomycin C in the future (about 10 years from now) Incidentally are LasEk recipients aware that they might be getting Mitomycin C - which is a cytotoxic medication used in the treatment of cancer. The use of this compound should only be used after specific and INFORMED consent by the patient.
3) Based on my observation: the proponents of LasEk nationally and internationally have probably performed very little LasIk and may(myself being a little cynical) have had an unusually high number of complications in flap creation. Ask them to provide their honest track record and the numbers of procedures performed.
4) I have yet to see a flap move years later ! It takes a considerable amount of force and trauma to move a flap (sometimes even at 6 months -especially large diameter flaps which are my preference). This is supported by studies on US Rangers who are now able to have Lasik performed. There is one case report in the literature of a flap dislodging 3 years after surgery following a road traffic accident. The eye also sustained a vitreous haemorrhage and a retinal detachment. The easiest thing to repair was the flap !
5) Craig is absolutely right about RK which only has a place now in the archives. It was a good procedure in its own day, but does not meet the current standard of care. I am amazed about Craig's level of tenacity in convincing the browsers about the value of LASEK. Maybe I am missing something - on the other hand it may be something to do with wishing the best for our patients which will vary based on individual understanding of science, experience and outcomes and while the jury is out, the choice of procedure will depend on the operating surgeon and ultimately the patient who makes a hopefully informed choice.
In my humble view as a tertiary care provider to the NHS and one that deals with some of the most complex corenal problems in the country, all surgical procedures carry a level of risk. It is for the individual to choose (hard choice based on all the opinions and anecdotes out there- agree with Craig on this one too) the procedure to which they are best suited and the surgeon (most critical) who performs this on them. I do believe most corneal surgeons at respected tertiary referral centres(except Birmingham and St Thomas's) would agree with what has been stated in the points enumerated above.
For those that wish to have LasIk - an obsessive surgeon is essential in order to avoid problems of flap complications and ectasia (not had any in my series - and there is a reason why which I will not get into).
It is possible True EPI-LASIK which is LASEK without the alcohol and which uses a keratome with a modified blade will provide the best of both worlds - I shall not hold my breath...
I have asked for my name to be WITHHELD lest I be accused of advertising or self promotion.
A Corneal Surgeon