Why are surface ablations increasing in popularity?

There have always been good arguments for surface ablation, but in most cases I have personally preferred LASIK. Yet every year I find myself performing more and more surface ablation cases and I am not alone in this.

The question of which surface technique offers the best comfort, safety, and visual recovery has been much debated. My procedure of choice is now Epi-LASIK with the Moria Epi-K, because of the speed of visual recovery compared with other alternatives.

Why are people going back to the surface?

Finally, there will always be a segment of the population that doesn't want a flap, doesn't want anything to cut their eye, or wants the "safest" procedure available. Despite the excellent safety profile of LASIK, when a patient requests the safest procedure, I choose surface ablation.

Epi-LASIK is not appropriate for anyone with a history of previous refractive surgery, a corneal scar, or any other condition involving damage to Bowman's membrane.

I have also performed Epi-LASIK on a number of keratoconus patients. Once we determine that a patient has keratoconus or is a keratoconus suspect, that individual ceases to be considered a refractive surgery patient - but that doesn't mean refractive surgical procedures are always contraindicated.

For keratoconic patients, we seek to manage their pathological condition with all the tools available to us, including rigid gas permeable contact lenses, Intacs intracorneal ring segments, Epi-LASIK, and corneal transplants. I never perform LASIK on these patients and do not make the decision to do surface ablation lightly. However, a surface laser treatment may offer these patients a way to improve their visual acuity for some period of time before resorting to transplants.