Posted by: Manhattan LASIK Center

LASIK is one of the most widely performed and successful laser vision procedures available today. Every year, many people who are ready to break free from corrective eyewear and permanently correct their vision choose LASIK.

One of the most important steps of the procedure is the creation of a corneal flap, which is a step that is unique to LASIK. Keep reading to learn more about LASIK and why it is necessary to create a flap during the procedure.

What is LASIK?

LASIK is a laser vision procedure that can correct the most common refractive errors like nearsightedness, farsightedness, and astigmatism. Refractive errors occur when the shape of the cornea prevents light from correctly focusing on the retina, resulting in blurry or distorted vision.

The procedure corrects vision by removing and reshaping corneal tissue. It involves two main steps:

  • Creation of a corneal flap on the surface of the cornea, the epithelium, using a femtosecond laser.
  • Removing and reshaping the tissue in the middle layer of the cornea, the stroma, with an excimer laser.

During the procedure, the flap is gently lifted to access and reshape the inner layers of the cornea, correcting vision. Once that step has been completed, the flap is repositioned and will naturally heal on its own, without the need for stitches.

What is the LASIK Flap Made Of?

The LASIK flap is made of corneal tissue. The cornea is composed of five layers of tissue, each with a different function.

The layers of the cornea are:

  • Epithelium: The outermost layer of the cornea, which provides a protective barrier and maintains the smooth surface.
  • Bowman’s Layer: This thin, transparent layer anchors the epithelium and provides structural support.
  • Stroma: The middle and thickest layer of the cornea, the stroma is composed mainly of water and collagen, and gives the cornea its strength, elasticity, and shape.
  • Descemet’s Membrane: This thin, underlying membrane separates the stroma from the endothelium.
  • Endothelium: The endothelium is a layer of cells that pump water out of the cornea to maintain clarity and prevent inflammation.

The layers altered during LASIK are the first three layers of the cornea: the epithelium, Bowman’s layer, and the outer part of the stroma. The flap is extremely thin and remains attached by a small hinge during the reshaping process.

How Long Does It Take the LASIK Flap to Heal?

Healing times for the LASIK flap are remarkably quick due to the eye’s ability to repair itself naturally. Immediately after the flap is repositioned, it begins to re-adhere to the underlying corneal tissue naturally.

Typically, the LASIK flap heals along the following timeline after a LASIK procedure:

  • First 24-28 hours: The epithelium starts to seal over the flap as the healing process begins.
  • First few days to a week: While there may still be some swelling, the flap is mostly healed.
  • First few weeks: The flap continues to heal fully, helping patients to experience significantly clearer vision.
  • Six months to a year: Although cases are rare, it can take up to six months or a year for some patients’ flaps to fully heal.

To ensure healthy healing and prevent complications, it’s important to closely follow all post-procedure care instructions, which include avoiding rubbing the eyes, using prescribed eye drops, and attending all follow-up appointments to monitor the healing process.

Can the LASIK Flap Be Damaged After Surgery?

It is possible to damage the LASIK flap after surgery, particularly during the early stages of healing. Damage to the flap can increase the risk of potentially serious complications, which include:

Dislocation

Forcefully rubbing the eyes or exposing them to trauma shortly after surgery can result in dislocation of the flap.

Epithelial Ingrowth

The epithelial cells can grow under the flap, causing irritation and blurry vision.

Flap Wrinkles

Disturbing or misaligning the flap can cause small wrinkles that may affect vision.

In many cases, post-surgery flap issues are treatable with a secondary procedure to lift and reposition the flap.  Flap dislocations that occur years after LASIK are rare, but can happen, often to patients who play high-impact sports or who have been involved in an accident.

The potential for long-term dislocation is one of the main reasons that individuals involved in contact sports are sometimes advised to consider vision correction procedures that do not require a flap.

Are Flap-Less Procedures Better Than LASIK?

As more procedures to correct vision become available, flap-less vision correction procedures, such as SMILE (Small Incision Lenticule Extraction) and PRK (Photorefractive Keratectomy), have gained attention as alternatives to LASIK.

SMILE

SMILE is a minimally invasive procedure that requires only a small incision on the edge of the cornea. It corrects vision by creating and removing a small disk, a lenticule, of corneal tissue.

SMILE is often a safer, more effective option for individuals with thin corneas, dry eyes, and more severe degrees of myopia or astigmatism. It offers comparable results to LASIK, but it can take longer for clear vision to fully stabilize.

PRK

During a PRK procedure, the top layer of the cornea, the epithelium, is completely removed to access and reshape the underlying corneal tissue. Recovery from PRK takes much longer than with LASIK or SMILE, as it takes time for the epithelium to regrow.

PRK may be recommended for individuals with thin corneas, chronic dry eye, those in high-risk occupations, or those with higher eye prescriptions. Like SMILE, it offers similar results to LASIK without the risk of flap complications.

The creation of a flap during LASIK is necessary to achieve fast, effective, long-lasting results. While most patients experience no flap complications after LASIK, there are other procedures to permanently correct vision if the creation of a flap is a concern.

Do you want to learn more about LASIK or determine if you might be a good candidate? Schedule a LASIK consultation at Manhattan LASIK Center in Manhattan, NY, today!