Central Serous Retinopathy (CSR) and Wavefornt...

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Central Serous Retinopathy (CSR) and Wavefornt...

Postby paulfog » Wed Oct 25, 2006 7:25 pm

Hi,

I am 42 years old, hyperopic in my left eye, +3.75 with a mild astigmatism. My other eye is fine--20/20. So, I was considering LASIK for my left eye only. This could be a very practical solution for my situation.

However, I have a condition which may or may not be an issue for LASIK surgery. I have Central Sirous Retinopathy (CSR). As a result, I have slight metamorphopsia--my retina has slight imperfections/aberrations where the Pigment Epithelial Detachments or "PED" episodes have occurred. The retinal specialist says LASIK itself is no problem if I am stable (no episode for 12 months), which is the case for me. He also says that the PED's where the episodes occurred may continue to improve slightly over time--as in months or years. Right now, though, there are still some slight distortions in the PED areas which I do notice--especially when looking at lines or a
grid of some sort.

So, this leads to my question. Because the retina is not affected by LASIK in a way that would complicate my CSR, the retinal specialist said it was fine to have it done. And, if it were regular LASIK, I would not be concerned. However, now that "Wavefront" technology has become the norm, I am wondering how that will affect my situation. Specifically, the High Order Aberration mapping that occurs during the wave front scan may take into consideration the imperfections on my retina and try to correct for them in the final procedure with the eximer laser. Although it is called "corneal mapping", the image is derived from all HOA's of the eye, as I understand it. So, in my case, if the PED's which create the distortion improve over time, then wouldn't my LASIK correction conversely go out of correction over time as well?

Please share your thoughts on this, if any. It is a deal breaker for me as to whether or not I have the procedure done.

Also, a few other questions:

1. I read that wave front technology could be used in making custom contact lenses. Is that true? Maybe this could be an alternative if the LASIK is not practical for my situation. However, I am still leaning towards having the LASIK procedure done as my preferred choice. How can I find out about custom contacts. Are they hard or soft?

2. Are there any good post-op statistics involving halos, glare, contrast sensitivity or night vision?

3. How about regression for hyperopia, like me, +3.75? What's the likelihood?

4. Any significant LASIK advancements coming up worth waiting for?

Sorry for all the questions!


Thanks so much!
Paul
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Re: Central Serous Retinopathy (CSR) and Wavefornt...

Postby LasikExpert » Thu Oct 26, 2006 7:14 pm

The retina is affected by Lasik, IntraLasik, and Epi-Lasik due to the use of a microkeratome. A microkeratome is a device used to create a flap of corneal tissue. It is affixed to the eye with suction. This suction greatly increases the intraocular pressure (IOP). A rise in IOP will place greater pressure on the retina and all interior tissue of the eye. This short-term IOP spike is not problematic for a healthy eye but is problematic for a person with a history of Central Serous Retinopathy (CSR) or any retina disorder.

In the American Journal of Ophthalmology. 2004 Dec;138(6):1069-71, you will find an article entitled "Bilateral serous macular detachment following laser in situ keratomileusis." by Singhvi A, Dutta M, Sharma N, Pal N, Vajpayee RB. of the Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

PURPOSE: To report a case of bilateral serous macular detachment following laser in situ keratomileusis (LASIK). DESIGN: Observational case report. METHODS: A 33-year-old man presented with sudden decrease of vision in both eyes 4 days following uncomplicated LASIK in both eyes for spherical equivalent of +5.00 diopters sph in the right eye and +7.00 diopters sph in the left eye. Detailed history with ocular and systemic examination, fluorescein angiography, and optical coherence tomography were done. Retinal examination had a documentation of retinal pigment epithelium atrophy in the macular region in both eyes pre-LASIK. RESULTS: A diagnosis of central serous chorioretinopathy (CSCR) was made in both eyes, with multifocal alterations in the retinal pigment epithelium and a pocket of serous retinal fluid in the macular region confirmed on OCT. Late venous phase of fluorescein angiogram demonstrated multiple hyperfluorescent foci of leakage, more in the right eye with areas of retinal pigment epithelium staining. CONCLUSIONS: Preexisting macular pathology, such as retinal pigment epithelium atrophy could be a new contraindication to LASIK for hypermetropia with possible development of CSCR, requiring a careful examination of the fundus pre-LASIK.


paulfog wrote:However, now that "Wavefront" technology has become the norm, I am wondering how that will affect my situation.


Not on the retinal health issue. Wavefront-guided ablation is simply an advanced method to map where the excimer laser will remove tissue. It is totally neutral on the issue of retinal involvement.


paulfog wrote:Although it is called "corneal mapping", the image is derived from all HOA's of the eye, as I understand it. So, in my case, if the PED's which create the distortion improve over time, then wouldn't my LASIK correction conversely go out of correction over time as well?


That is correct and is true with all types of refractive error correction. The difference is that it is much easier to change spectacles and contact lenses than Lasik.

paulfog wrote:1. I read that wave front technology could be used in making custom contact lenses. Is that true? Maybe this could be an alternative if the LASIK is not practical for my situation. However, I am still leaning towards having the LASIK procedure done as my preferred choice. How can I find out about custom contacts. Are they hard or soft?


The problem with making wavefront derived contact lenses is that contacts rotate on the eye. This would cause problematic changes in higher order aberration (HOA) corrections if the contacts were attempting to neutralize HOA. Wavefront diagnosis is being used to create spectacles and contact lenses, but only for the correction of sphere (myopia, hyperopia) and cylinder (astigmatism). At this point, wavefront is being used as an autorefractor to create an accurate prescription. I suspect this area will continue to develop, but there are significant limitations to what can be accomplished.

paulfog wrote:2. Are there any good post-op statistics involving halos, glare, contrast sensitivity or night vision?


The problem with postop stats of complications is that every person is unique and what applied to someone with a complication may not apply at all to someone considering surgery. Our organization's Quality Standards Advisory Committee has evaluated several studies and we have directly evaluated thousands of patient outcomes to determine that about 3% of refractive surgery patients (all types of corrections, patients, techniques) have some sort of unresolved complication at six monhts postop, and 0.5% have a serious complication that requires extensive maintenance or invasive procedure to manage or correct.

paulfog wrote:3. How about regression for hyperopia, like me, +3.75? What's the likelihood?


Absolutely expect regression. If you had refractive surgery (surface ablation like PRK, LASEK, or Epi-Lasik) then it would be reasonable for your doctor to overcorrect you into myopia (nearsighted, lshortsighted) vision to accommodate expected regression and to help with near vision for someone who is at an age that presbyopia (need for reading glasses or bifocals) will become an issue.

paulfog wrote:4. Any significant LASIK advancements coming up worth waiting for?


Nothing big is coming through the FDA pipeline or in development. A lot of small changes for narrow improvement in techniques, but nothing big.
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