Everything You Need to Know About Advanced Surface Treatment (AST)

AST, or Advanced Surface Treatment, is a procedure that uses a cool-beam excimer laser to reshape the cornea on the very top surface of the eye. First, the surface cells of the eye, called the epithelium, are removed. No corneal flap is created. With WaveScan technology, Dr. Mai can customize the treatment for your eyes. After the laser is applied, a non-prescription “bandage” contact lens is placed over the treated area to protect the eye while the epithelium grows back.

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What Is Advanced Surface Treatment of the Cornea?

Advanced Surface Ablation is a commonly performed laser vision correction procedure designed to reduce or eliminate the need for glasses or contact lenses. It can correct myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (blurry vision due to an irregularly shaped cornea).

It differs from LASIK because it does not involve creating a corneal flap. Instead, the cornea’s self-healing surface layer, the epithelium, is removed, and then the excimer laser reshapes the cornea to correct the refractive error.

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Advanced Surface Ablation is usually recommended when the cornea is too thin for LASIK, or when creating a flap is not desirable — for example, in people whose jobs or hobbies carry a higher risk of eye injury. Many of these patients can now also be treated with SMILE, a newer keyhole, flapless laser vision correction procedure.

How Does Advanced Surface Treatment Work?

The entire procedure is painless, although you may feel some pressure on the eye at times. Similar to LASIK, it typically takes about 5–10 minutes per eye and roughly 30 minutes for the whole session.

After numbing eye drops are applied, you will be taken to the treatment room and asked to lie down on the bed. A lid speculum is placed to keep your eye open and prevent blinking.

The surgeon first removes the corneal epithelium, usually with the help of a diluted alcohol solution that loosens the epithelial attachments. The excimer laser is then used to precisely resculpt the cornea. Finally, a protective contact lens is placed on the eye to reduce postoperative discomfort and support healing.

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After Advanced Surface Treatment of the Cornea

Immediately after the procedure, you will be taken to your room to rest, where the surgeon will examine your eyes. You will be given antibiotic, steroid, and lubricating eye drops to support healing over the next few weeks, and you will continue using them at home as instructed. Oral pain medication will also be provided. You will need to arrange for someone to drive you home, and you should rest for the remainder of the day.

The main difference between Advanced Surface Ablation and LASIK or SMILE is the recovery period. After Advanced Surface Ablation, discomfort and light sensitivity are usually more noticeable and last longer—typically 3–5 days. Visual recovery is also slower and may take up to a month to stabilize. However, the final visual outcome is not inferior to LASIK or SMILE.

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Advantages of Advanced Surface Treatment of the Cornea

The most important advantages of Advanced Surface Treatment of the cornea include:

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