Just for context and as this article only mentions LASIK and not other options such as (Trans-)PRK and SMILE, the majority of negative side effects one experiences post LASIK are not linked to the ablation/"carving" of the cornea, as they call it, but rather is a result of the need to sever the subbasal nerve plexus in the anterior stroma, which tends to be regenerate in a less comprehensive manner and significantly slower around the margins of the flap compared to other methods.
Flaps aren't inherently dangerous either (flap detachments are very rare, even more so with modern systems that create essentially a cavity where the flap can rest in), but the difference in healing post OP is a lead cause of heightened dry eye after LASIK. Both PRK and SMILE, due to the way they work, are less likely to suffer from this, but every procedure has trade-offs naturally.
With PRK, the epithelium in the area is removed and has to regrow, a process that takes a few days (to get the initial part done, full regrowth takes far longer but isn't noticeable in general). This regrowth can be both rather painful and also rob you of the "instantly perfect sight"-effect many people desire from their laser eye surgery. As the epithelium does regrow naturally however, it is less likely (both in theory and in medical literature) to lead to dry eye and other side effects in the short and long term, making it the preferred choice by many ophthalmologists when choosing such surgery for themselves.
SMILE, on paper, might be able to offer the best of both worlds, but is severely more expensive than either and there is not a sufficient degree of long term research to make a definitive statement that the side effect amount and severity is comparable to PRK, simply because it is rather new. What research is out there is promising though.
Overall, each option is very well tolerated, leads to major QOL improvements and we need to keep in mind that even the more common side effects one may face with LASIK may not affect everyone and still are comparably small considering other medical fields and their elective procedures.
In this context, I'm very excited to see whether this method might have even fewer short and long term side effects than PRK, but like with SMILE, it may take decades to have a conclusive answer.
Edit: Another thing I missed and which was not covered in the article, is the potential that this new method could be applicable to people who, because of a variety of factors, are not eligible for any ablative eye surgery. I myself was at the upper limit for Trans-PRK in regard to the severity of my Myopia and the thickness (or lack there off) of my Epithelium. In that regard, I see far more potential than just reducing already low side-effect risks further.
> [re: PRK] This regrowth can be ... rather painful
I'm here to tell everyone to listen to the doctor about pain medications and sleeping after PRK. I have a repeatedly-demonstrated very high tolerance for pain, and didn't bother to follow the directions.
As a result, I spent about an hour seriously considering whether it would hurt less if I physically scooped out my eyeballs by hand. That's not a metaphor -- I had to mentally restrain my hands.
And the punchline is that 12 years later I again need glasses for computer work, which is what I do all day.
LASIK etc. are not "cosmetic". Being able to see properly without glasses is a substantial thing for some people, from sports participation to not worrying about fogging to not groping around to find your glasses in the middle of the night.
The Doctor clearly saw that my eye hadn't fully healed and therefore diagnosed that it was the reason I wasn't seeing perfectly. Don't get me wrong, it is still far better than when I didn't wear my glasses. So even if it doesn't go back to normal it would still be an improvement.
As I understood it, the procedure in itself won't make you blind—ever. If you get complications—like an infection—then that's another story. I didn't have any.
So I didn't think about the risk-reward as everyone around me just had eye dryness or halos at night. Both of which are very easy to live with.
If you have other questions, I would be happy to answer them. But I'm just one of many thousands person.
I think all Doctors would tell you that you should do the surgery because they have a financial incentive to tell you so. However, I don't live in the USA and a lot of things I read didn't apply to where I went. For example, they prescribe bandage lens for at least 7 days in the USA but I only wore mine for 40 hours. Then a bunch of eye drops and all was fine.
They probably meant elective. It's sort of cosmetic in the sense of preferring your look without glasses I suppose, but you wouldn't call gait-fixing surgery cosmetic.
Same here. Three days of absolute hell. Even a single blue led was too much to bear. And like you I now need reading glasses, but I don't really care: I can see well enough in the distance, I'm not visually crippled throughout the day without my glasses.
I used to have dry eyes afterwards for quite some time (years) as well, but that seems to have gone away at some point.
From my experience it was hell of a whole week, specially the first 5 days. And every kind of light was aggressive for me.
My eyesight took ~3 weeks to be able to read properly on screen without zooming 400%.
I didn't freak out because my doctor told me that the healing process really depended on everyone's body.
2 years later I have absolutely not regrets from doing that surgery despite probably still always reminding myself as one of the worst week of my life during recovery.
First 30 or so hours were pretty inconvenient: dry eyes, bandage lens that would cause itching and general photophobia. The Doctor removed my bandage lens after less than 48 hours and the same day I resumed my normal life. I was still sensitive to light but I could read screens without issues at all.
> As the epithelium does regrow naturally however, [PRK] is less likely (both in theory and in medical literature) to lead to dry eye
This is exactly opposite to how I understood and experienced healing after Trans-PRK. My eyes are still very dry 6 months post surgery. Being at the upper limit of Trans-PRK yourself, did you actually go through with the surgery? If yes, how was your healing process? I would be very interested in chatting about it, since I am not particularly happy with mine, and wondering what can be done (and whom to blame).
Sorry to hear that it did not go well for you. Yes, I did go through with it, was in April of 2024 (Trans-PRK via a Schwind AMARIS) and I did have a rather painful recovery, especially on day two and three after the surgery.
From there on, the pain and foreign object feeling quickly subsided alongside the remaining "haze" and by day five, I neither had any subjective pain, nor any major issues reading text (both typed and digital). Had multiple check-ins of course, both at the clinic which performed the surgery and with my decades long ophthalmologist, no issues were found there either. Subjectively, I do not experience a heightened severity in dry eye symptoms for what that is worth.
Also had a clinical rotation in Ophthalmology just this month (small world, though was why I felt the urge to comment) and the attendings did assess my epithelium as having regrown evenly too.
What could have gone wrong for you and how to go about this, I really can't say and I am sure you have already considered /pursued it, but I can only suggest getting a second opinion from another established ophthalmologist, including looking at the eye drop regiment prior to the surgery and during, as well as post recovery.
Thanks for the elaborate answer. Reading about Schwind AMARIS it seems to be using SmartSurf which claims faster healing than conventional TransPRK. I can't assess how much of this is marketing speech or if it's basically the same as TransPRK.
In any case, I agree that a second opinion would be most helpful.
I couldn't tell one way or another, but honestly didn't choose that particular system for any reason beyond that being what was on offer where I live. My very limited reading prior to surgery though would indicate that currently there is no source showcasing a difference in subjective recovery experience between TransPRK and this Smartsurface. What has been used as a source when covering the technology is mainly focused on the first three months [0], rather than longer term as you are describing and does in my opinion not actually showcase a difference between Smartsurface and TransPRK specifically [1]. Full disclosure, I only include the name of the system because it felt like an HN thing to do. It wasn't some value judgement that these machines are superior or that others are inferior.
[1] If you look at the source they are referencing, it compares TransPRK to aaPRK after three months and they were using Schwind machines, though did not clarify whether this was using Smartsurface. Very cursory search engine use tells me that this is toggleable, so an option on these machines. Even if this study did use Smartsurface though, that doesn't answer whether outcomes are different in TransPRK with Smartsurface vs TransPRK without Smartsurface. Additionally, I do not know whether this option was used in my case.
This is why I decided to go with PRK. Recovery time is rough, but after a week I was able to go back to work as a programmer. Well worth it to avoid the complications of severing the nerves in my cornea.
This is the first I've heard of this. In my area it seems comparable in price, within 1.5x the cost of LASIK. Considering how relatively cheap it is (a couple months' rent, or a fraction of the price of a car, to correct your vision for decades) I've never seen cost mentioned as reason to choose one over the other.
I can only speak for Austria, but the difference, if SMILE had been an option, would have been at the lower end € 3400,- compared to the PRK I got and roughly € 3200,- compared with LASIK, for what that’s worth, more than double the cost. Yes, that falls under multiple months rent, but to me that is more reason why one would consider the cost as well.
Maybe “severely more expensive” wasn’t the best wait to phrase it, but the difference is still quite steep and this can be a decision maker for many people. Especially as currently it appears that medium term/6-month outcome between PRK and SMILE are very comparable, or even slightly better in PRK [0].
I'm very doubtful about the presented figures there. The author clearly has an agenda and does not present any sources. Additionally it is completely missing ReLEx/KLEx (SMILE etc) methods which afaik are pretty popular.
It seems that ASA is a wide term for methods of moving the epithelium and replacing it after the procedure. I had this with one of my treatments. It is far more pleasant. It makes sense that it is growing in popularity.
I'm not candidate for LASIK or any other eye surgery due to the thinness of my cornea :( I would love to see this new approach. Maybe I'll be a candidate for it.
I had PRK 15 years ago. I also woke up multiple times last night because my eyes felt like they had a bad sunburn (eyes so dry they stick to your eyelids + REM sleep.)
Some unsolicited advice: wait for widespread adoption, and review data on long term side effects from sources without a conflict of interest before you have a procedure like this. I went from 20/150 to 20/15 for a few years (which was pretty cool) but they're 20/40 now so I wear glasses/contacts when I leave the house anyway. Glasses and/or contacts aren't that bad.
If it makes you feel better, your dry eye is more likely caused by genetics than it is PRK. Many people end up with dry eye without having had any kind of laser eye surgery. I highly recommend putting some Hylo-Night / VitA-POS gel in just before bed. It lasts well into the next day.
Yeah it's probably a combination, which might explain why my experience isn't the norm. Ever since I had it done, any poke, foreign objects like sand, etc. is much more painful than before, so the pain from dryness gets amplified. I've used eye drops and gels, but the most effective thing is just avoiding things that mess with electrolyte levels, like alcohol, medications, and certain foods.
My wife wasn't a candidate for LASIK due to her eyes being so bad they would have had to burn off the entire cornea to fix it. But she got ICL surgery, which is when a new lens is inserted into the middle of an eye, similar to the surgery for cataracts. $9k out of pocket, but she has 20/20 vision now.
I am wondering whether EMR could help people with keratoconus (degenerative cornea condition). Due to cornea thickness laser correction surgery is not performed in such case.
There are also intrastromal corneal rings to correct myopia (but not astigmatism) -- in the US (Intacs) for -1 to -3 diopter, while in the EU they go up to -6. They're inserted though a small hole to surround the cornea, and they can be removed. So overall less effective than lasers, but also more safe (though much less common, so harder to find a high-traffic expert surgeon).
Flaps aren't inherently dangerous either (flap detachments are very rare, even more so with modern systems that create essentially a cavity where the flap can rest in), but the difference in healing post OP is a lead cause of heightened dry eye after LASIK. Both PRK and SMILE, due to the way they work, are less likely to suffer from this, but every procedure has trade-offs naturally.
With PRK, the epithelium in the area is removed and has to regrow, a process that takes a few days (to get the initial part done, full regrowth takes far longer but isn't noticeable in general). This regrowth can be both rather painful and also rob you of the "instantly perfect sight"-effect many people desire from their laser eye surgery. As the epithelium does regrow naturally however, it is less likely (both in theory and in medical literature) to lead to dry eye and other side effects in the short and long term, making it the preferred choice by many ophthalmologists when choosing such surgery for themselves.
SMILE, on paper, might be able to offer the best of both worlds, but is severely more expensive than either and there is not a sufficient degree of long term research to make a definitive statement that the side effect amount and severity is comparable to PRK, simply because it is rather new. What research is out there is promising though.
Overall, each option is very well tolerated, leads to major QOL improvements and we need to keep in mind that even the more common side effects one may face with LASIK may not affect everyone and still are comparably small considering other medical fields and their elective procedures.
In this context, I'm very excited to see whether this method might have even fewer short and long term side effects than PRK, but like with SMILE, it may take decades to have a conclusive answer.
Edit: Another thing I missed and which was not covered in the article, is the potential that this new method could be applicable to people who, because of a variety of factors, are not eligible for any ablative eye surgery. I myself was at the upper limit for Trans-PRK in regard to the severity of my Myopia and the thickness (or lack there off) of my Epithelium. In that regard, I see far more potential than just reducing already low side-effect risks further.