Potential Reason to Choose PRK instead of LASIK

It’s hard enough as it is to wake up in the morning. Now add to that the possibility of waking up feeling like you have a small rock in your eye, accompanied by excessive tearing, light sensitivity, and blurry vision. Your eye was fine when you went to bed last night, but this morning you can barely get it open due to the pain and light sensitivity. When you stop to think about it, you may have had this problem before, perhaps on a lesser scale.

A number of conditions can cause this, but your symptoms could stem from a problem with the very front layer of your cornea, the epithelium. These symptoms can be due to a weakness of the adhesions of this epithelium to the underlying tissue, a condition called anterior basement membrane dystrophy, or ABMD (also sometimes referred to as epithelial basement membrane dystrophy, or Cogan’s dystrophy). When our eyes are closed at night, our corneas tend to retain extra water and swell. This leads to an extra “stickiness” of the epithelium. If the epithelium is not firmly attached to the underlying tissue, as in ABMD, this “stickiness” can result in the lids pulling off part of the epithelium when you open your eyes in the morning. When this occurs, it is referred to as recurrent corneal erosion (RCE) syndrome. It can be quite painful until it heals and could even lead to some permanent corneal scarring.

Fortunately, several treatment modalities exist to lessen these symptoms and help prevent recurrence. At Tylock-George Eye Care and Laser Center, your doctors are prepared to correctly identify this problem and give you the treatment you need to help you heal well and to feel a lot better while you are healing.

IntraLASIK is one of the procedures frequently performed at our clinic, where we treat people from all over Dallas, Fort Worth, and North Texas. This procedure is also referred to as simply LASIK, but IntraLASIK specifically refers to our use of all-laser LASIK with the Wavelight Refractive Suite. People with prior symptoms consistent with RCE syndrome should approach IntraLASIK with extreme caution. At Tylock-George Eye Care and Laser Center, we rigorously screen potential candidates for IntraLASIK to ensure that it will be a safe procedure for them. Some people have the weak corneal epithelial layer of ABMD without ever having had the problems of RCE syndrome. Creating and manipulating the flap with LASIK can exacerbate a weak cornea and push people with mild ABMD into having the problems of RCE.

For this reason, any person with even mild signs of ABMD should not have IntraLASIK. We identify those at risk during our pre-operative examination process and encourage them to instead have photorefractive keratectomy, or PRK. Instead of creating a flap, PRK first removes the weak epithelial layer. Next, the excimer laser reshapes the underlying corneal layer. A bandage contact lens is placed on the eye and the epithelium grows back over a period of three or four days. The layer of the cornea reshaped by the laser presents a slightly rougher surface for the epithelium to adhere to and, following several weeks, the epithelium can actually be healthier than it was prior to PRK. Some people choose to have a variation of this procedure performed just to treat ABMD and RCE syndrome, even if they do not need glasses. This procedure is referred to as phototherapeutic keratectomy, or PTK.

If you have experienced the symptoms listed above and are also interested in LASIK, please proceed with your “eyes wide open.” Consultation with your doctors at Tylock-George Eye Care and Laser Center will ensure that you do not end up going through with a LASIK procedure that you should not have. PRK is an excellent alternative, resulting in the same, precise vision correction as LASIK with a much better safety profile for those with ABMD.