Considering Enhancement

[babiesforme]

I had Custom Lasik (Ladarvision) done in Feb 2006. I don't remember my exact numbers but I do know I had moderate myopia maybe about -7 and was at the outer limits for the machine's capacity with my astigmatism (around -4) for both eyes. At that time, I was told I would probably need an enhancement due to my astigmatism.

Prior to LASIK, I wore hard, then gas perm contacts since I was 13 (I am 40 now) and had the unfortunate experience of wearing my glasses for 4 very long (and dangerous!) months immediately prior to the LASIK being done. I have been wearing corrective lenses since I was 4. I have been interested in RK since the late 80's (I didn't really qualify at the time) due to contact troubles from allergies and an active lifestyle. Glasses just didn't fit my lifestyle at all and I never had any success at finding any I could actually see through anyways.

Fortunately, I have had a relatively great experience post-LASIK. While it did take the usual several months to really settle down to stable vision, anything was better than my glasses! But as each follow-up exam took place, I noticed the frustration of the technician (and myself) to ever find that clear vision spot while reading the eye chart with one eye at a time. This is especially true with my left eye.

At my 1 yr exam in February, I was scheduled for the full-deal enhancement exam in March. This confirmed some ?striations on my left eye flap (I think he has said this all along but the pictures he showed me showed the problem he was talking about.) He also said I had enough astigmatism in both eyes that he could do an enhancement for both. He would try to do the Lasik; however, my flaps had sealed down so well that he might have to do PRK instead if he couldn't lift my flaps.

I changed my appt from April to June to do a little research and I'm glad I did! Here are my questions.

1. After reading the posts on this site, it looks like a flap can always be lifted, so why would he have to switch to PRK? I'm not so sure I am willing to do PRK and at this point I have only taken 2 days off from work. If my flaps have sealed so well, is it worth the risk to "unseal" them? (OK, that is a question only I can answer, since I don't even know the "numbers" of my astigmatism - sorry.)

2. I asked at 2 different appts and got 2 different answers - the initial being, give it time, the last at the last appt being I don't know. When I've kept track of my good and bad days, it seems I have about one GREAT vision day, 2 good vision days, and 4 so-so vision days per week. My eyes don't feel dry, though I do take multiple oral antihistamines and use Zaditor eye drops, but I am religious about using my Refresh gel drops twice a day and the moderate drops thruout the day whenever my vision is blurry. They don't seem to help past that initial couple minutes. I can't imagine astigmatism fluctuates on a daily basis at 15 months????

3. If I look thru one eye (either one), my vision is "warbled" (a product of the astigmatism) but if I look thru both of them, it is ok enough in general for the most part. Good in my little "study" 3 days a week and livable, but annoying 4 days. If it's "fixed", now my 4 days are good and my 3 days are ???? - worse, amazing??? Has anyone had this experience to share? My thoughts are to just do my left eye if I do go ahead with the enhancement, but that is my dominant eye (I do a lot of photography and that is the one I use). Is that the best path?

I'd love to be able to see down the aisle of the grocery store EVERY day, not just random days. And see those street signs in the dark, but as it is, I am so very fortunate to wake up every morning and see across my backyard! Before I couldn't see the clock on my nightstand unless it was RIGHT beside the bed. I don't want to risk messing anything up! And while I went to a dozen seminars in the past 12 years in this area and picked this specific doctor, suddenly he has me wondering....

Thanks a bunch for any advice. I've learned so much (and how much technical jargon I don't know!). I did a ton of research back in 2003- 2005 but don't remember this site. It has a wealth of info!

Diane

[LasikExpert]

1. After reading the posts on this site, it looks like a flap can always be lifted, so why would he have to switch to PRK? I'm not so sure I am willing to do PRK and at this point I have only taken 2 days off from work. If my flaps have sealed so well, is it worth the risk to "unseal" them? (OK, that is a question only I can answer, since I don't even know the "numbers" of my astigmatism - sorry.)

By doing PRK your surgeon will likely be able to resolve both the Lasik flap wrinkles (striae) and the residual refractive error.

Micro-striae can occur when the Lasik flap releases internal tensions between the Bowman's layer of the cornea and the surrounding stroma. Micro-striae are like appliqué sewn on a towel after a few washings. The terrycloth towel shrinks at a different rate than the appliqué and this causes a wrinkling effect.

The healing of the Lasik flap will likely have reduced the micro-striae a bit, however all those internal tension issues may reappear if the flap is lifted. You will go through the entire healing process again and the quality of vision may not improve. It could even get worse.

Since Micro-striae occurs at the Bowman's layer and Bowman's is usually fully ablated away during PRK, the choice of PRK on the Lasik flap may resolve two problems with one procedure.

2. I asked at 2 different appts and got 2 different answers - the initial being, give it time, the last at the last appt being I don't know. When I've kept track of my good and bad days, it seems I have about one GREAT vision day, 2 good vision days, and 4 so-so vision days per week. My eyes don't feel dry, though I do take multiple oral antihistamines and use Zaditor eye drops, but I am religious about using my Refresh gel drops twice a day and the moderate drops thruout the day whenever my vision is blurry. They don't seem to help past that initial couple minutes. I can't imagine astigmatism fluctuates on a daily basis at 15 months????

The usual treatment for micro-striae is to leave it alone and allow healing to resolve whatever can be resolved. The epithelium does a great job of filling in the tiny wrinkles, but can only do so much. Added artificial tears can make that final improvement and provide extra clarity. Your vision at its best would be the target for PRK on Lasik.

3a. If I look thru one eye (either one), my vision is "warbled" (a product of the astigmatism) but if I look thru both of them, it is ok enough in general for the most part. Good in my little "study" 3 days a week and livable, but annoying 4 days. If it's "fixed", now my 4 days are good and my 3 days are ???? - worse, amazing??? Has anyone had this experience to share?

The target will be that seven days will be good with both eyes and each eye individually. You will need to discuss the probabilities with your surgeon.

3b.My thoughts are to just do my left eye if I do go ahead with the enhancement, but that is my dominant eye (I do a lot of photography and that is the one I use). Is that the best path?

This is wise.

3c.I'd love to be able to see down the aisle of the grocery store EVERY day, not just random days. And see those street signs in the dark, but as it is, I am so very fortunate to wake up every morning and see across my backyard! Before I couldn't see the clock on my nightstand unless it was RIGHT beside the bed.

Since you are now age 40, you will be dealing with presbyopia and reading glasses. You will want to discuss with your doctor if a monovisioncorrection would be appropriate (possibly not due to your photography).

3d.I don't want to risk messing anything up! And while I went to a dozen seminars in the past 12 years in this area and picked this specific doctor, suddenly he has me wondering....

The fact that you are more concerned indicates that you are more informed.

Thanks a bunch for any advice. I've learned so much (and how much technical jargon I don't know!). I did a ton of research back in 2003- 2005 but don't remember this site. It has a wealth of info!

Hopefully we will be more impressive this time! We have a detailed Lasik glossary that may be helpful.