vision progressively worse and back of corena problem

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vision progressively worse and back of corena problem

Postby GeneralPatientInquiry » Sun Jun 04, 2006 3:21 pm

I had lasik 4 months ago. My vision prior to surgery was 6.5 in left and 7.0 in right eye and had been stable for over 10 years.
Since my surgery my vision is progressively gotten worse and it's now at 1.25(left eye) and 1.5 (R eye). My Dr. sent me for an orbscan to check the depth of my cornea because he was concerned with the change in my vision. The test result show that I have a steepen back of the cornea and my Dr. informed me that he cannot due an adjustment because he fears my vision may get worse. Now I'm concerned that my vision may get worse then before. Is there anything that can be done to correct this? Could this have been avoided with more tests prior to Lasik surgery?
Maria, New Jersey
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Postby LasikExpert » Sun Jun 04, 2006 3:24 pm

Maria,

First of all, don't panic. There will be plenty of time to panic later, and it won't do you any good now. You need your wits about you to make rational decisions about what to do next. If what you describe is what I think it is, then you will be able to have your vision stabilized in due time.

The progressing myopia can indicate normal regression, however a steepening of the back of the cornea indicates either keratoconus or ectasia.

Keratoconus is a progressive disease of the eye that causes the cornea to bulge forward due to weakening of the corneal tissue. Keratoconus normally causes a bulging at the bottom of your cornea and creates significant astigmatism. Your prescription does not indicate astigmatism. Keratoconus is not caused by LASIK, but can be exacerbated by LASIK. Keratoconus is sometimes not able to be diagnosed prior to surgery.

Ectasia is a more uniform central bulging forward of the cornea that can occur after refractive surgery. Ectasia is normally caused by too much thinning of the cornea during surgery and does not require disease like keratoconus. Ectasia does not normally occur if the eye is healthy and at least 250 microns of corneal tissue remain untouched.

There are several new ways to accommodate keratoconus and ectasia that have a very high probability of restoring your vision and the strength of your eyes, but first an accurate diagnosis is required. You may have a diseased cornea, a cornea that is now too thin, or just normal regression that often occurs after Lasik; especially to people who were very nearsighted.

I recommend that you ask your current doctor for a referral to a corneal specialist for an evaluation. You didn't say if the doctor who did the Orbscan was a corneal specialist or not. This will provide the best information about the health of your eyes. But before you do this, I have some odd questions.

Are you pregnant? Are you going through menopause? Are you taking hormone replacement therapy? Are you taking any medications for thyroid or hormone imbalance? Each of these can cause changes in the eye that would look very much like posterior corneal steeping and obviously have nothing to do with corneal disease or surgery.

Of course you want to know if your surgeon screwed up. To be honest, I doubt I will be able to determine that for you via Internet. What I do recommend is to try to keep a cooperative relationship with your doctor. It sounds like his response in the face of trouble has been right on target. It may be that he did everything right, but you ended up with a poor result. That can happen. It's rare, but it does happen.

If at any time you feel you need the opinion of a different surgeon and would like my assistance with a referral, just let me know. After you have had a second opinion from a corneal specialist, write me again and we can go over the details of what has been learned.

Visit:
Keratoconus and Ectasia Treatment
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Postby GeneralPatientInquiry » Sun Jun 04, 2006 3:37 pm

Glenn,
Thank you so much. You've been very helpful. My answers to your "odd"
questions is no to all of them. I did tell my doctor that I wanted a second opinion and he is sending me copies of my records. I would appreciate a name of a specialist where I could get the second opinion. I agreed with my doctor that he would keep me under observation and check my vision periodically. He suggested that once my vision stabilizes he may be able to perform PRK. Not sure what that is? At this point he doesn't recommend I do anything but wait and see.
Thanks,
Maria
This post is a reprint of a previously requested inquiry received by USAEyes.org via email.
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Postby LasikExpert » Mon Jun 05, 2006 5:48 am

Maria,

Are you willing/able to make a trip to Manhattan for a second opinion? This is where the doctor to whom I would like to refer you practices.

If your problem is not related to a weak cornea, then additional surgery to correct the final refractive error may be appropriate. PRK is photorefractive keratectomy. PRK is nearly identical to LASIK, but in LASIK the tissue is removed under a flap and with PRK the tissue is removed on the outer surface of the eye. PRK over LASIK is appropriate in some cases, but there are many factors that need to be evaluated first.

Number one on your agenda is to determine if the regression you are experiencing is just run of the mill regression, or if the cornea is now too weak and cannot have any additional refractive surgery. You may need additional surgery, but it may be surgery to stabilize your cornea, not surgery to change your refractive error.

BTW, it's time to contact your medical insurance. While major medical insurance will not normally cover LASIK, it will often cover the costs related to care for LASIK-induced complications. If you are in an HMO, contact your primary care provider (PCP) general doctor and discuss the situation. If you are in a PPO, then you can go to any doctor and a portion will be paid by the insurance. A larger portion if the doctor is in the PPO panel, a smaller one if not. If you are one of the dozen people left in the US with traditional unencumbered indemnity medical insurance, you can go to anyone you want with no restrictions.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


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