When Should You Choose LASEK Over LASIK? Deciding Your Best Option

If you’re considering laser eye surgery, you’re probably asking yourself one of the most common questions patients have: Should I choose LASEK or LASIK? Both treatments can dramatically improve your vision and reduce your dependence on glasses, but they’re not interchangeable. One may be perfect for your eyes, while the other could be unsuitable, unsafe, or simply not ideal for your lifestyle.

Many clinics advertise LASIK more frequently because it offers a faster recovery. But LASEK is often the safer and smarter choice in specific situations especially when the shape, thickness or biomechanical stability of your cornea makes LASIK unsuitable. And while LASIK is the more well-known procedure, LASEK is often the unsung hero. It may take longer to heal, but it preserves more corneal strength and avoids flap-related complications entirely.

This article is designed to give you the clarity you need. I’m going to break down the differences, explain how surgeons decide between the two, and show you exactly when LASEK becomes the safer, more stable or more appropriate option. By the end, you’ll understand how to evaluate your eyes, your lifestyle and your long-term vision needs so you can feel confident about choosing the right treatment.

Let’s start with the fundamentals.

How LASIK Works

LASIK involves creating a thin flap on the surface of your cornea.

This flap is:

lifted
the laser reshapes the underlying tissue
the flap is repositioned

Because the surface layer stays mostly intact, recovery is fast.

Key Benefits of LASIK:

vision improves rapidly (often within 24–48 hours)
minimal discomfort
excellent clarity for suitable candidates

But LASIK Also Has Limitations:

it requires sufficient corneal thickness
it involves a permanent corneal flap
it may increase dry eye symptoms
it is not suitable for certain eye shapes

This is where LASEK becomes a valuable alternative.

How LASEK Works

LASEK does not involve creating a flap.
Instead:

the epithelium (surface skin) is softened
moved aside
the laser reshapes the cornea
the epithelium is repositioned
a bandage contact lens is placed

This preserves corneal structure and avoids flap risks.

Key Benefits of LASEK:

safer for thinner or irregular corneas
no flap-related complications
more biomechanically stable
better for people with active lifestyles
suitable for patients with specific eye conditions

The Drawbacks:

longer recovery
more early discomfort
slower vision stabilisation

Even so, LASEK is often the superior choice for long-term safety.

When LASEK Is the Safer or Smarter Option

Let’s go through the most important scenarios where LASEK is recommended over LASIK.

When Your Corneas Are Thin

This is the most common reason surgeons recommend LASEK.

LASIK requires:

enough corneal thickness
enough tissue for a stable flap
enough remaining tissue after reshaping

If your corneas are naturally thin or if the correction requires significant tissue removal LASIK may risk weakening the cornea.

Why LASEK is safer:

it preserves more corneal tissue
avoids flap creation
reduces risk of ectasia (corneal bulging)
maintains biomechanical strength

If your scans show borderline thickness, LASEK is usually the better long-term option.

When Your Corneal Shape Is Irregular

Some corneas naturally have:

asymmetry
irregular curvature
subtle steepening
uneven thickness

Even if these irregularities aren’t severe enough to be considered keratoconus, LASIK may still pose a risk.

Why LASEK works better here:

the surface treatment is gentler
the deeper layers remain untouched
the cornea experiences less biomechanical stress
shaping remains more controlled

If your scans show borderline irregularities, surgeons favour LASEK.

When You Have a High Prescription

Higher prescriptions require more laser correction. If too much tissue is removed during LASIK, the cornea may weaken.
This increases the risk of long-term instability.

LASEK is safer for moderate to high prescriptions because:

it preserves structural tissue
avoids flap complications
allows more controlled reshaping

You get a safer outcome without compromising clarity.

When You’re More Prone to Dry Eyes

LASIK temporarily affects corneal nerves, which can worsen dryness.

If you already experience:

burning
gritty sensations
fluctuating vision
sensitivity

you may be better suited to LASEK.

LASEK minimises dryness risk because:

no flap is created
fewer nerves are disturbed
the tear film stabilises faster long-term

Many dry-eye patients heal far more comfortably with LASEK.

When You Play Contact Sports or Lead an Active Lifestyle

If you participate in:

martial arts
rugby
boxing
football
high-contact activities

there’s a risk that the LASIK flap could be displaced if you suffer trauma.

LASEK avoids this entirely:

no flap
nothing to lift or dislodge
long-term structural stability

This is why many military personnel and athletes choose LASEK.

When Your Pupils Are Large

If your pupils are naturally large, especially in low light, LASIK may increase:

halos
glare
starbursts
night-vision issues

LASEK often produces smoother optical transitions, reducing these side effects.

When You’re at Higher Risk of Ectasia

Ectasia is the abnormal forward bulging of the cornea.
Certain patients are more prone to it due to:

genetics
subtle corneal weaknesses
high prescriptions
irregular curvature

LASIK increases this risk due to flap creation and tissue removal.

Why LASEK is a safer alternative:

eliminates flap risk
preserves structural strength
minimises biomechanical stress

If your surgeon suspects even a mild risk, LASEK is the recommended option.

When You’ve Already Had Previous Laser or Eye Surgery

If you’ve had:

LASIK
PRK
SMILE
cataract surgery
lens replacement

your corneal structure may already be altered.

LASEK is the preferred enhancement method because:

no flap lifting
surface reshaping blends safely
suitable even after lenticule removal (SMILE)
safe following intraocular surgery

Enhancements are safer and more predictable with LASEK.

When You Want to Preserve Long-Term Corneal Strength

Some people simply prioritise long-term stability over speed of recovery.

LASEK offers:

better structural preservation
lower long-term risk
no flap-related issues
more stability for future eye health

If you want the most biomechanically conservative option, LASEK is ideal.

When You’re Not a Suitable LASIK Candidate

There are many scenarios where LASIK is simply not safe. LASEK is often the answer.

Your surgeon may recommend LASEK if you have:

thin corneas
mild corneal irregularity
early dry eye symptoms
high prescriptions
risk of ectasia
incompatible corneal thickness ratios
borderline topography

In these cases, LASEK may not just be an alternative it may be the only safe option.

How Surgeons Decide Between LASEK and LASIK

The choice is rarely based on a single factor. Surgeons look at dozens of measurements to ensure you get the safest and most predictable results.

Here’s what they evaluate.

Corneal Thickness (Pachymetry): A key measurement. If the residual stromal bed would be too thin after LASIK, LASEK is chosen.

Corneal Topography: Shows curvature and shape. Irregularities often push the decision toward LASEK.

Corneal Tomography: Provides 3D imaging. Reveals hidden weaknesses that make LASEK safer.

Epithelial Mapping: Shows surface thickness variations. Guides planning for LASEK to ensure smooth shaping.

Tear Film Evaluation: Dry eyes? LASEK is preferred.

Pupil Size Measurement: Larger pupils may push the decision toward LASEK.

Prescription Stability: If your prescription isn’t stable, neither procedure should be done. But if stable, suitability depends on corneal safety.

Corneal Biomechanics: LASIK reduces biomechanical strength more than LASEK. If your biomechanics are borderline, LASEK is chosen.

Lifestyle Assessment: High-impact lifestyle? Choose LASEK.

Long-Term Vision Expectations: If you’re younger, or want the most stable long-term option, LASEK is often recommended.

Why Speed of Recovery Shouldn’t Be the Only Factor

It’s easy to choose LASIK because:

vision returns fast
there is minimal early discomfort
you can return to work sooner

But speed shouldn’t overshadow safety.

LASEK offers long-term advantages:

more stability
fewer complications
more suitable for borderline cases
more controlled biomechanics

If you choose a procedure based only on short-term recovery, you may overlook what matters most for decades to come.

Common Misconceptions About LASEK vs LASIK

Let’s quickly clear up a few myths.

Myth 1: LASEK is outdated.

Not true it has evolved significantly and remains essential for many patients.

Myth 2: LASIK is always better.

Not at all suitability matters more than popularity.

Myth 3: LASEK causes more long-term issues.

Incorrect LASEK can be safer long-term due to no flap and preserved strength.

Myth 4: LASEK is too painful.

Discomfort is temporary and manageable; long-term results are excellent.

Which Procedure Gives Better Long-Term Results?

Both can deliver excellent clarity, but:

– LASIK gives faster results.

– LASEK gives more stable results.

If your corneas are strong and thick, both may be fine. If your corneas are borderline or irregular, LASEK wins.

Frequently Asked Questions:

Does LASEK take longer to heal than LASIK?
Yes, LASEK generally takes longer to heal because the surface layer of the cornea needs time to regenerate after being moved aside during the procedure. Most patients notice functional vision within a week, but it may take several weeks for their eyesight to stabilise fully. LASIK, by comparison, allows much quicker visual recovery because the flap created during surgery heals rapidly. Although the slower recovery of LASEK can feel inconvenient, many patients and surgeons still prefer it when long-term corneal strength and safety are the priority.
Is LASEK more painful than LASIK?
LASEK can cause more discomfort during the first few days because the surface cells of the cornea need to heal, and this exposed area can feel sensitive or irritated. Patients often describe sensations like stinging, watering and light sensitivity. These symptoms are temporary and usually well managed with prescribed eye drops and pain relief. LASIK tends to involve minimal discomfort because the surface layer remains mostly undisturbed. However, this short-term comfort sometimes comes at the cost of long-term corneal stability, which is why many surgeons still recommend LASEK for specific eye types.
Is LASEK safer for thin corneas?
Yes, LASEK is considered a safer option for people with thin corneas because it avoids creating a flap and preserves much more of the corneal structure. When the cornea is naturally thin or when someone has a high prescription that requires more tissue removal, performing LASIK may leave the cornea biomechanically weak. This increases the risk of long-term complications such as ectasia. LASEK, by reshaping the surface without cutting a flap, minimises this risk and maintains corneal stability more effectively.
Can LASEK give the same visual results as LASIK?
Yes, the long-term visual clarity from LASEK is comparable to that of LASIK for most suitable candidates. While LASIK delivers faster results in the first few days, both procedures generally achieve excellent clarity once healing is complete. The main difference lies in the healing timeframe rather than the quality of the final outcome. Many patients who choose LASEK because of thin corneas, irregular topography or dry eyes are relieved to find that they achieve the same level of sharpness they would have expected from LASIK, just over a slightly longer period.
Is LASEK better if I already have dry eyes?
Yes, LASEK is often preferred for people with dry eyes because it causes less disruption to the corneal nerves responsible for tear production. LASIK temporarily severs more of these nerves while creating the flap, which can worsen dryness or delay recovery of the tear film. LASEK avoids this issue and tends to allow the tear film to stabilise more naturally during the healing process. This makes it a more comfortable and suitable choice for patients who already struggle with dryness or sensitivity before surgery.
Can I have LASEK if I play contact sports?
Yes, LASEK is widely recommended for people who participate in contact sports because it eliminates the risk of flap displacement. Since LASIK involves creating a permanent corneal flap, any strong impact or accidental trauma during activities like rugby, martial arts or boxing could potentially disturb it. LASEK has no flap at all, which means the cornea remains structurally stronger long-term. Athletes, military personnel and individuals with highly active lifestyles often choose LASEK for this added safety.
Does LASEK reduce night-vision issues compared to LASIK?
For some patients, yes. Individuals with naturally large pupils or certain corneal shapes sometimes experience more halos, glare or starbursts after LASIK, particularly in low light. Because LASEK reshapes the surface without disturbing deeper layers of the cornea, it can produce smoother optical transitions and reduce the likelihood of these symptoms. While both procedures can occasionally cause night-vision disturbances, LASEK may offer a gentler surface correction that benefits patients who are more prone to these issues.
Can I have LASEK if I’ve already had eye surgery before?
Yes, LASEK is often the preferred choice for patients who have undergone previous eye procedures because it avoids the risks associated with lifting or creating a new flap. If someone has had LASIK, SMILE, PRK or even intraocular surgeries like cataract or lens replacement, the corneal structure may already be altered. LASEK provides a safer enhancement method because it works at the surface level and integrates well with tissues that have undergone previous procedures. Surgeons often rely on LASEK as the safest way to perform retreatments or enhancements.
Is the long-term safety of LASEK better than LASIK?
For many patients, yes. LASEK preserves more of the corneal strength and avoids all flap-related complications, making it a more biomechanically stable option long-term. This is especially important for younger patients, people with borderline scans or individuals who want to minimise the risk of ectasia later in life. While LASIK is extremely safe for suitable candidates, LASEK provides an added margin of protection for those whose corneas need more conservative treatment. Over decades, this preservation of structural integrity can be a significant advantage.
How do I know whether LASEK or LASIK is right for me?
The only way to determine the best choice is through a detailed consultation that includes corneal mapping, tomography, epithelial thickness analysis, tear-film assessment and a full lifestyle review. The decision isn’t based on speed or popularity but on the health and stability of your corneas. If scans reveal thin tissue, irregular curvature, borderline biomechanics or signs of dry eye, surgeons usually recommend LASEK. If your corneas are strong, thick and symmetrical, LASIK may be suitable. The safest option is always the treatment that aligns with your eye measurements and long-term visual goals.

Final Thought: Which Vision Correction Option Is Right for You?

Choosing between LASEK and LASIK isn’t just about speed of recovery it’s about long-term safety, stability and what’s genuinely best for your eyes. While LASIK remains popular for its quick healing, LASEK can often be the smarter, safer choice for people with thinner corneas, irregular topography, dry eyes, active lifestyles or borderline scans. Understanding your own eye measurements and lifestyle needs is the most reliable way to decide which procedure will give you the safest and most predictable results.

The best next step is always a detailed consultation with an experienced surgeon who can assess every aspect of your eye health. With the right guidance, you can feel confident about choosing the treatment that protects your corneal strength while giving you clear, lasting vision. If you’re considering Lasek surgery in London and want to know whether it’s the best option for your eyes, you’re welcome to reach out to us at Eye Clinic London to book a consultation and discuss your suitability in detail.

References:

Liao, J. and Chou, P. (2020) ‘Comparison of corneal biomechanics after LASIK and surface ablation procedures’, Journal of Clinical Medicine, 9(6), p. 1857.
Available at: https://www.mdpi.com/2077-0383/9/6/1857
El Bahrawy, M., El-Samadouny, M. and Hartwig, A. (2022) ‘Long-term outcomes of LASEK in patients with thin corneas’, Vision, 6(3), p. 52.
Available at: https://www.mdpi.com/2411-5150/6/3/52
Taneri, S., Oehler, S. and Dick, H.B. (2018) ‘LASEK vs LASIK: A review of indications and outcomes’, Ophthalmology, 125(8), pp. 1232–1243.
Available at: https://pubmed.ncbi.nlm.nih.gov/29887125/
Zarei-Ghanavati, S. and Randleman, J.B. (2021) ‘Corneal ectasia risk factors following refractive surgery’, Current Opinion in Ophthalmology, 32(4), pp. 298–305.
Available at: https://pubmed.ncbi.nlm.nih.gov/33927225/
Xu, Y., Yang, X. and Zhang, J. (2019) ‘Comparison of visual recovery between LASIK and surface ablation’, Medicine, 98(15), e15112.
Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472734/

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