Enhancement after ALK

Post your questions and start your research in this forum if more than three months ago you had any type of surgery to reduce the need for glasses and contacts.

Enhancement after ALK

Postby BERNARDVANCE » Tue Mar 06, 2007 11:08 pm

I am currently 43 and had ALK in my left eye fifteen years ago. I was not happy with the result and therefore left my dominant right eye untouched. My pre-op refraction was -6.00 diopters in both eyes with no astigmatism and BCVA of 20/15 in both eyes. I am now +1.75 diopters in my left eye with some induced regular astigmatism, BCVA 20/25, UCVA 20/40. I had no glare or halos at night prior to surgery, but would now find it very difficult and dangerous to drive at night if I had to rely on just my left eye. I now wear a soft contact in my right eye and nothing in my left eye. What are my options for an enhancement? It seems to me that attempting to lift the flap after all these years and re-weakening my eye structure would be a bad idea. My primary goal for the enhancement is an improvement in my night vision and elimination of the overcorrection/induced astigmatism. I have heard of a very new system out of Italy called iVIS. I would like to have my right eye done at some point but am afraid that if the left eye problems are not addressed and I have night problems with my right, I will not be able to drive at night. Please help.
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Postby LasikExpert » Wed Mar 07, 2007 4:34 am

Automated Lamellar Keratectomy (ALK) is the process of using a mechanical microkeratome to remove a layer of the front of the cornea, set that "button" of corneal tissue aside, and then take another pass with the microkeratome across the exposed area to shave off a thin layer of cornea, which is discarded. Removing this thin layer would flatten the center of the cornea. The "button" would then be repositioned over the treatment area.

Later ALK allowed a portion of the "button" to remain attached, thereby making a flap of corneal tissue.

The first pass of ALK is almost exactly the first step of Lasik. Lasik is actually ALK (flap created with microkeratome) combined with PRK (laser to reshape the cornea). PRK is much more predictable at removing tissue than attempting to shave off a thin layer of cornea with a microkeratome.

Although the ALK/Lasik flap heals, it is not like a cut on your arm. There is always a difference. That may be to your advantage. A skilled surgeon would probably be able to lift the existing ALK flap and use a modern laser to reshape the cornea to reduce your current refractive error.

It is also probable that PRK on the ALK flap could be performed. As little as a couple of years ago this could not be done because of fear of corneal haze, however the use of Mitomycin C reduces the probability of corneal haze with PRK on the Lasik (in your case ALK) flap to almost nil.

You probably have many options available to you, but you would only know after a comprehensive evaluation from a competent surgeon.

I do not have enough information about the iVIS system to comment.
Glenn Hagele
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