Also known as PRK or LASEK, Advanced Surface Ablation is an incisionless procedure with vision restored within 1-3 days. Book a consultation today and find out if you’re suitable.
Advanced Surface Ablation (ASA) also known as LASEK, is a less frequently performed laser vision correction procedure and can be used to correct myopia (short-sight), hyperopia (long-sight), astigmatism and presbyopia, the age-related requirement for reading spectacles within certain limits of correction. ASA, LASEK and PRK (photorefractive keratectomy) are similar procedures in which no flap or lenticule are created in the cornea, but the excimer laser treatment is applied to the surface of the cornea after the thin surface coat called the epithelium is removed. The epithelium is the waterproof, infection resistant barrier to the cornea and is constantly renewing itself throughout life, a scratch to the surface of the cornea can heal within hours and when removed completely, the epithelium will usually take around 4 days to fully resurface. In PRK the epithelium is removed completely but in LASEK it is pushed to one side then replaced. Both treatments have the same visual outcomes but one may be preferred given the particular circumstances of the treatment. PRK was the first excimer laser procedure performed to correct refractive error and has been in constant evolution over 30 years.
Once the epithelium is painlessly removed, the shape of the cornea can be changed microscopically using the Mel® 90 excimer laser which corrects the refractive error in the same way as it is during LASIK.
ASA is usually performed when the cornea is too thin to support LASIK, where occupational injury is a risk or when it can be combined with therapeutic treatments such as PTK or CXL as part of Athens Protocol treatments for Keratoconus.
On the day you come into the clinic we will run through the procedure again with you so that you will be reassured about the steps. Allow 2-3 hours to be at the hospital so that you have plenty of time. Like SMILE® and LASIK, ASA is not painful and takes around 5-10 minutes per eye to complete, you will be in the laser room itself for around 20-30 minutes and will have a nurse with you throughout.
We will apply drops to numb your eyes and cover the eye that is not being treated. A small device is used to prevent the eye being treated from blinking although it will feel to you as if you are blinking normally. The couch will glide to the Mel® 90 excimer laser and you will be asked to look at a green flashing fixation light. A small well of fluid will be placed on the surface of your eye for 30 – 40 seconds and you vision will be slightly blurry but you will not feel anything. This will be removed and the epithelium brushed back. You will hear but not see the excimer laser which will change the shape of the cornea and after eyedrops are applied at the completion of treatment a contact lens will be placed to minimise any post-operative discomfort.
The entire procedure is painless, although a feeling of pressure on the eyes may be noticed at times. Similar to LASIK, it typically lasts 5-10 minutes for each eye and around 30 minutes for the whole procedure.
After anaesthetic drops are given to numb the eyes you will be taken to the treatment room and asked to lay on the bed. A lid speculum is applied to keep your eyes open and to stop you from blinking. The surgeon firstly removes the corneal epithelium usually with the assistance of a dilute alcohol solution that weakens the attachments of the epithelium. Then the excimer laser is used to resculpt your cornea. A protective contact lens is finally placed on the eye to minimize post-operative discomfort and assist healing.
After surgery, you will rest for a short period and be provided with refreshments before going home. Your eyes will feel gritty and will be sensitive to light so we recommend that you bring (non-prescription) sunglasses with you. We will provide you with antibiotic and anti-inflammatory drops to use as well as pain relief and a reminder of your does and don’t instructions. We ask you to be careful not to rub or touch your eyes and to avoid showering or getting tap water into your eyes for the next few days until your first post-operative review and will provide you with some comfortable eye protection to wear overnight.
You will be able to see immediately after treatment is completed and you sit up although your vision will be blurry. We suggest that you arrange transport home from the hospital.
In contrast to SMILE® and LASIK you will experience more grittiness, discomfort and light sensitivity and your vision will fluctuate more but the final visual outcome will be the same so although you will recover more slowly the outcome of your treatment will not be inferior. ASA treatments can also be combined with therapeutic treatments such as PTK and also treatments to stabilize the cornea such as corneal collagen cross linking (CXL) as part of an Athens Protocol Treatment.
We will invite you back for a check-up within the next few and then again at intervals thereafter, typically 1-2 weeks then at 3 months and 1 year. You can return to normal activities such as exercise and swimming after a few weeks but we can advise you specifically about any activity you wish to resume.
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