Advanced Surface Ablation (ASA) is the modern iteration of the PRK laser vision correction procedure and is the preferred approach in certain subsets of patients. ASA utilizes the exact same high technology laser that is used with LASIK. Like LASIK, ASA can be used to treat nearsightedness, farsightedness and astigmatism. Using the ASA approach, we can incorporate CustomCornea wavefront treatments as well as enhance/update previous LASIK surgery.

Prior to the actual laser treatment, the epithelium (surface cells) of the cornea is gently loosened and removed. In nearsighted patients, the laser will flatten the curvature of the cornea. In farsighted patients, the laser steepens the cornea. For patients with astigmatism, the laser will contour or make the cornea more spherical in shape. Also called LASEK (laser epithelial keratomileusis), Epithelial LASIK or E-LASIK, ASA is most commonly chosen for patients with corneas that are too thin for LASIK, or in cases in which creating or lifting a LASIK flap carries an undesirable risk. This procedure is often preferred for patients in special requirement professions such as military aviation and special forces.

The most important advantage of ASA is the preservation of corneal structure which results from not creating a LASIK flap. The disadvantage of using an ASA approach is a longer recovery after the vision correction procedure; it can often take a week or more for ASA patients to achieve the same level of vision improvement a LASIK patient can attain after just a day or two of recovery. However, there is no difference in the ultimate result and excellent vision attained when comparing ASA and LASIK.



Am I a good candidate for ASA?

The best candidate for ASA is an informed patient. We strongly recommend all prospective patients learn about their vision correction options. You should be at least 18 years of age with a stable refraction, have a healthy eye with no eye disease or corneal condition, and have realistic expectations for your results. ASA can be a better choice than LASIK based on corneal thickness and structure, eyeglass prescription, or occupational requirements.

What should I ask my doctor?

It is important to discuss your surgical options with your surgeon. Piedmont Better Vision surgeons are Board Certified and skilled in all corneal procedures including refractive surgery. They will discuss all of your vision correction options with you. These include LASIK, Advanced Surface Ablation (ASA), Refractive Lens Exchange (Clear Lens Extraction), or other proven vision correction techniques. Based on your refractive error, pupil size and corneal thickness, they will evaluate what procedures or technologies will provide you with the best visual results.

You should discuss the following conditions with your doctor:

  • Diabetes
  • Severe allergies
  • A history of glaucoma
  • Previous ocular surgeries
  • Significant dry eye that is unresponsive to treatment

What can I expect in my preoperative exam?

Your initial exam is important to accurately measure your vision and determine if you are a candidate for vision correction surgery. The exam will last approximately two hours. It includes a comprehensive medical eye exam as well as two refractions, computerized corneal mapping, pupillometry, corneal thickness measurement, glaucoma testing, and a full medical and ophthalmic history. You will be dilated during the exam. It will make you sensitive to light and blur your near vision to a greater extent than your distance vision. Driving home after the exam will depend on your comfort level, but typically most patients are able to drive after the exam.

What can I expect during ASA surgery?

On the day of surgery, your doctor will measure and dilate your eyes for the procedure. Your eyes will be anesthetized with numbing eye drops. There are no needles or IVs. You will be comfortably positioned on a bed beneath the laser. A small device called a lid speculum is used to keep your eyelids open and exposed to the doctor. Your doctor and the technicians will perform a pilot-style checklist with each patient to ensure the equipment is working properly and programmed correctly with the intended correction.

The surgeon immerses the central cornea with a dilute alcohol solution for approximately 30 seconds. The solution loosens the edges of the epithelium from its underlying attachments. After rinsing the alcohol solution from the eye, the surgeon lifts the edge of the epithelial flap and gently folds it back out of the way. Then he or she uses an excimer laser, as in LASIK or PRK, to sculpt the corneal tissue underneath. The cold laser beam is used to remove tissue to reshape your cornea based on your desired correction. During the treatment, you will hear a clicking sound of the laser pulses. You will be asked to look towards a blinking fixation light; however, the tracking system will follow any eye movement and allow the laser to accurately place the treatment. The use of the laser is generally for one minute or less. Afterward, a non-powered, bandage-type contact lens is placed to improve comfort and healing during the first five to seven days. You will feel eye irritation to a varying degree during the first few days. The biggest difference between LASIK and ASA is the time it takes to recover vision after ASA, often up to one to two weeks.

Checklist for Surgery

  • Leave contact lenses out prior to surgery at least 3 days for soft lenses, 3 - 4 weeks for gas permeable lenses.
  • Wear loose comfortable clothing.
  • Do not wear make-up around your eyes for at least 3 days prior to surgery.
  • Do not wear any perfume, cologne or facial make-up on the day of surgery.
  • Do not take any sedatives or antihistamines on the day of surgery.
  • Read your Informed Consent and bring the unsigned copy on the day of surgery to be signed with the Coordinator.
  • Arrive at the scheduled time and plan to be at the Center for about 2 hours.
  • Plan to return to the center for your postoperative visit the following morning.

What can I expect after the procedure?

You may be sensitive to light and have a feeling that something is in your eyes. Sunglasses may make you more comfortable and are provided in your post-operative kit. You will experience discomfort. Your doctor will prescribe pain medication. Antibiotic, anti-inflammatory, and lubricating drops should be used in the first 7 days. The anti-inflammatory drops will be gradually tapered over the three weeks after surgery. Do not rub your eyes. If you notice any decrease in your vision, you should contact your doctor immediately.

Although the ultimate visual results after ASA are outstanding and equivalent to LASIK, the first few weeks can be somewhat unpredictable as far as the level of vision and comfort are concerned. For most patients, the recovery resembles LASIK quickly achieving a very useful level of vision and minimal discomfort. For others, however, the discomfort can be more prominent and a slower visual recovery can occur. For this reason, we advise that ASA patients carefully plan their postoperative period during a time that there will be minimal visual demands and occupational requirements. It is wise to delay travel until comfort and vision have reached suitable levels.

We will ask you to avoid immersion of your eyes in water for two to three weeks. This includes swimming and hot tubs. Otherwise, as your vision improves, you may resume your normal activities without major restriction.

What can I expect my results to be?

Your doctor will discuss your expectations and the chances of success for your individual case during the preoperative consultation. The technology selected by the surgeons at Piedmont Better Vision was chosen to improve the safety, predictability and visual results for patients.



Piedmont Better Vision