PRK Surgery Issues & Touch-up Re-surgery

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PRK Surgery Issues & Touch-up Re-surgery

Postby PRKpatient » Wed Jun 27, 2007 5:17 am

I had PRK Wavefront surgery with Alcon's Customcornea back in Feb 07. Prior to surgery I was wearing -6.0 (left), -6.5 (right) diopter bifocal contacts. Not sure I'm saying those measures correctly, but I was very nearsighted and doing a monovision/bifocal combo correction with contacts. The target for my PRK was standard 20/20 vision without monovision and anticipating the use of cheaters for reading.

5 months after PRK and my eyes have settled in around +1.5 diopters (farsighted) with a little astigmatism in the left. I'm using 1.5 cheaters for normal distance vision (looks good) and 2.5 cheaters for reading. At my first post-op vision test, my eyes measured in around +3 diopters. I'm currently waiting for another pre-op dialated screening and rescheduling for touch up PRK surgery.

I understand that I was overcorrected with anticipation of regression with an initial target of ~ 20% overcorrection (1.2 or 1.3 diopters) So in retrospect, it seems that I did regress as expected, but the overcorrection was too much by a factor > 2.

A couple of questions:

1. What is the typical overcorrection for PRK patients with my correction range and is my +3 initial reading within an expected statistical range?

2. Now that I'm planning for a touch-up the other direction, are there any new concerns/risks I should be aware of?
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Postby LasikExpert » Wed Jun 27, 2007 5:27 am

PRKpatient wrote:1. What is the typical overcorrection for PRK patients with my correction range and is my +3 initial reading within an expected statistical range?


Considering your preoperative refractive error, your doctor's initial target of about 1.25 diopter overcorrection was probably pretty close to what most doctors would use. Perhaps 1.25 diopters was a little agressive, bu the 3.00 overcorrection was obviously not desired.

PRKpatient wrote:2. Now that I'm planning for a touch-up the other direction, are there any new concerns/risks I should be aware of?


Hyperopic correction is more challenging than myopic correction, but you have the advantage that the doctor has a better understanding of how your cornea responds to the laser energy and you need less correction.
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Postby PRKpatient » Thu Jun 28, 2007 4:12 am

Thanks Glenn,

A few more follow up questions:

1. How is the the over correction added in Alcon's CustomCornea process? Specifically, who enters the over-correction target value and is the parameter specified as a percentage of total correction (e.g 20%) or as an actual diopter offset (e.g 1.2)?

2. Do you think my 3.0 over correction was an unintended mistake?

3. Is it possible that my excess over correction was do to my postop behavior? For example, not following post-op eye drop recommendations consistently or going back to work too soon (for computer work) even though it was very difficult and straining on my eyes.
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Postby LasikExpert » Thu Jun 28, 2007 7:48 pm

PRKpatient wrote:1. How is the the over correction added in Alcon's CustomCornea process? Specifically, who enters the over-correction target value and is the parameter specified as a percentage of total correction (e.g 20%) or as an actual diopter offset (e.g 1.2)?


That is a more technical question than I can answer fully. It is my understanding that the surgeon can program in an "offset" to the proposed correction.

PRKpatient wrote:2. Do you think my 3.0 over correction was an unintended mistake?


Certainly unintended, but I would not be so bold as to say it is a mistake. Different corneas respond differently and it is sometimes hard to predict. It is possible everything was programmed and performed correctly, but you did not get the desired outcome. That happens in surgery.

PRKpatient wrote:3. Is it possible that my excess over correction was do to my postop behavior? For example, not following post-op eye drop recommendations consistently or going back to work too soon (for computer work) even though it was very difficult and straining on my eyes.


The medication can control healing response to some degree, so not using it correctly may have made a difference. Going to work too soon could cause irritation, but does not seem likely to contribute to the overcorrected state. It does not seem likely that bad postop behavior would cause all that overcorrection.

What you have is a combination of too much tissue removed and too little regression. There are many variables that control both, but not all variables can be controlled.
Glenn Hagele
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Postby PRKpatient » Fri Jun 29, 2007 12:32 am

Much appreciated Glenn,

My compliments on your website. It's been very helpful to me. It will be a while but I'll report back in after the next correction.
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