2 mo post op, couple of questions

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2 mo post op, couple of questions

Postby grumpyteach » Thu Oct 25, 2007 5:30 am

HI everyone,
My eyesight was initially -7.50 with -2 of astigmatism, 150 and 20...so yeah, pretty bad! My doc initially said there was a lot of work to be done, so I may need an enhancement.

I had my op Sept 3rd, great results as far as the health of the eye goes, which is great. I was very worried about corneal bulging, but my doc showed me the topography of my eye and he says there's no sign of it at all...

Now my eyesight seems to have settled, but I am -1.00 and -2.00 (with no astigmatism, hooray!). I am fine with having an enhancement, which I suppose will happen around mid-Jan. I don't feel like my eyesight is deteriorating, but my question is what are the chances of getting corneal bulging at this stage? Also, am I likely to end up OVERcorrected if I have an enhancement? My doc explained he 'errs on the side of caution' and since I had pretty bad myopia, said he preferred to undercorrect and do an enhancement than end up overcorrecting.

My doc has done over 5000 corrective eye surgeries and has an excellent reputation, but I worry that my eyes will do whatever they want no matter how good the doctor is!!!
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Re: 2 mo post op, couple of questions

Postby LasikExpert » Thu Oct 25, 2007 7:52 pm

grumpyteach wrote:I was very worried about corneal bulging, but my doc showed me the topography of my eye and he says there's no sign of it at all...


We hear a lot of concern from patients about "corneal bulging", which is corneal ectasia, but the reality is that it is a very, very rare Lasik complication. It seems some of the anti-surgery websites like to use ectasia in an attempt to scare people and influence their decsion about whether or not to have Lasik.

The process of Lasik reshapes the cornea by removing tissue. About five decades of practical knowledge has shown that if at least 250 microns of tissue remains untouched, a healthy cornea will remain stable. More is always better. There have been a handful of people that have had unexplained ectasia, but that is out of multiple millions of patients. There are also people who have less than 250 microns of untouched tissue and did not develop ectasia.

The greater concern, but yet still a very rare occurrence, is undiagnosed keratoconus. Keratoconus is a naturally occurring disease of the cornea that causes weakness and thinning. Obviously, anything like Lasik that thins the cornea would not be wise in the presence of keratoconus.

Both keratoconus and ectasia can be treated or managed with the use of rigid gas permeable (RGP) contact lenses, Intacs, or for extreme cases, corneal transplant.

Before Lasik surgery doctors are able to use diagnostic tests to help determine if keratoconus is present and measure the thickness of the cornea. With some margin for error, the amount of untouched corneal tissue is able to be calculated before surgery. Many doctors will even test corneal thickness underneath the Lasik flap, just as an added measure of safety.

Ectasia and undiagnosed keratoconus can happen, but with proper preoperative care the probability is relatively remote. Yet another reason why picking your Lasik doctor is so important.

grumpyteach wrote:Also, am I likely to end up OVERcorrected if I have an enhancement?


You have some important advantages for your Lasik enhancement surgery. A new Lasik flap will not be required. The existing flap will be lifted. Your doctor knows better how your corneas will respond to the laser energy. This can make treatment even more accurate.

grumpyteach wrote: My doc explained he 'errs on the side of caution' and since I had pretty bad myopia, said he preferred to undercorrect and do an enhancement than end up overcorrecting.


Deliberate overcorrection is an accepted technique for someone with high refractive error, but there is always the risk the patient will not regress enough. Your doctor's method is probably a bit more conservative.
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Postby DryEye » Thu Oct 25, 2007 10:28 pm

So, the two conditions mentioned above are the major concerns with enhancements? Does PRK over the flap avoid these scenarios better than a straight lasik enhancement (in terms of what is does to the overall structure of cornea)?
I have read here and informed cell ingrowth can occur (w/lasik enhancement), but is manageable.
If I got some microstriae from the initial procedure - is that underneath the flap or on top of the flap?
I plan on going to a top lasik doc for a followup in the spring when it is more humid for a possible enhancement on my right eye.
He was not my original surgeon, but after not getting a good result and proper information on what was/is causing my visual problems I found this new surgeon out of state.
He is well regarded within the industry as a top refractive surgeon and a part of this site I believe, so I imagine I am getting the best odds in terms of surgeon experience and knowledge.
Thanks
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Postby LasikExpert » Thu Oct 25, 2007 11:58 pm

DryEye wrote:Does PRK over the flap avoid these scenarios better than a straight lasik enhancement (in terms of what is does to the overall structure of cornea)?


The Lasik flap provides some structural strength to the cornea, but it is very small. Studies have shown it to be less than 3%, so lifting the flap and replacing it is not going to make much difference in this regard.

If the flap is very secure, a flap lift can cause corneal edema (swelling) that can provide poor vision quality until healing is complete.

PRK on the Lasik flap (with Mitomycin C) would virtually eliminate the possibility of a complication with the flap.

DryEye wrote:I have read here and informed cell ingrowth can occur (w/lasik enhancement), but is manageable.


Several studies have shown that epithelial ingrowth is more likely to occur with Lasik enhancement than with initial Lasik, but as you mention it is manageable.

DryEye wrote:If I got some microstriae from the initial procedure - is that underneath the flap or on top of the flap?


Microstriae are within the flap itself.
Glenn Hagele
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USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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