Eyes: What can happen if Bowman's layer of the cornea is lost during laser surgery?

[Iamgr8]

I am 300 degrees of myopia with astigmatism. I am extremely sick of wearing glasses. I have decided to do laser surgery. While researching I found out Lasik is more damaging to cornea since it cuts a flap in cornea and makes the cornea much weaker which may result in corneal ectasia which is a blinding complication and has no cure. Its really scary so I looked into PRK surgery. Its a better surgery as it is not an incisional surgery but the recovery is long. Although every corneal surgery makes the cornea weak but PRK or its new modern form lasek / epi-lasik / epi-lasek don't make the cornea as weak as lasik does. So post operative cornea is likely to remain more stable in long term but one major drawback of PRK is it removes a very superficial thin layer  Bowman's layer permanently. This is a big concern.

Will it make the cornea more prone to get ectasia if the layer is lost?

This layer is not found in many animals like dogs, cats etc but humans have this layer.

I will take a risk thats why I am opting for the surgery but will it be better to have PRK or its better to have lasik for more stronger cornea and for less risk of ectasia? I am a good candidate for both but I want the safest surgery.

Can anyone tell me what is the actual function of Bowman's layer of cornea?

[Houman Vosoghi, MD]

Bowman's layer has to do with corneal healing and if it is violated traumatically it leads to a higher likelihood of scarring.  Ablating it should not increase your chance of ectasia.  The only theoretical downside to PRK in that regard may be a higher propensity to corneal abrasions.  I don't know of any real life experience that backs up that theory given millions of people have had PRK without too much trouble.  Lasik has its own set of complications with the flap.  If I had to choose, I would probably go with PRK but have chosen not to risk my vision at all.

HV