Need Straight Answers: Diagnosed with EBMD after Lasik

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Need Straight Answers: Diagnosed with EBMD after Lasik

Postby unluckyson » Fri Jan 14, 2011 7:44 pm

This is a bit long-winded, so if you want to get right to the point just skip to the last paragraph and the numbered questions.

After two separate consultations at different clinics, both of which deemed me as an excellent candidate Lasik, I went ahead with the operation.

I had the flap created using the latest 150 kHz femtosecond laser (iLasik) and had the custom wavefront guided correction using the Allegretto eximer laser. I flew to another city so that I could have the procedure done by one of the most experienced and well-respected refractive eye surgeons in the world at a clinic with the most advanced technology available.

Both during and immediately after the procedure, the doctor and his staff kept reassuring me that the surgery was going perfectly. After it was done, the doctor said that the surgery went flawlessly and sent me on my way home.

I went home relieved that the surgery had went well. When I woke up the following morning I still couldn't see at all and began to get a little concerned.

My follow-up visit the next day was done by a different doctor than the one who had performed the surgery. She informed me that I had a minor complication called Epithelial Basement Membrane Dystrophy. When my eyebrows raised up and I had the WTF?!?! expression on my face she asked me "oh? the doctor didn't explain this to you last night?".... I was shocked. She said that my EBMD wasn't a severe case and that after a few days the haze/blur would clear up and I would start to see clearly.

It is now a little over one week after surgery and my vision has indeed improved from near-blindness during the first 3 days to just blurry and hazy vision. In my one-week follow up visit I was able to make out the letters at 20/40 but they were extremely blurry and I was barely able to make them out. I tried asking questions but I felt like the doctor was just dismissing my concerns, telling me that everything was ok and that my eyes "looked like a million bucks" and trying to rush me out of his office.

My eyes are still very bloodshot. I can read signs at a distance and drive fine, but my vision is still significantly blurry. The doctors at this institute kept reassuring me that this complication is minor and to just give it time to heal and that my vision will eventually become crisp and clear and that I will most likely improve to 20/20 vision. I'm willing to be patient and I want to take the doctors at their word, but the paranoid person in me wants a second opinion. Basically, my concerns can be summarized in the following questions:

1. Will this complication affect the final results of the procedure? Can I indeed expect to improve to 20/20 once I'm fully healed as the doctors keep telling me? or does EBMD typically result in unfavorable outcomes?

2. Does EBMD typically result in weaker flap adhesion? Being involved in many diffferent full contact sports I need to be re-assured that the flap will be just as strong as if I didn't have EBMD

3. How long should I expect the healing to take? I realize that everyone heals at their own pace, but I'm unable to take an indefinite vacation from work. My vision does seem to be improving every day but only by very very tiny, miniscule margins. How long does it typically take for the bluriness/haze to go away completely (if at all?) in Lasik patients with minor EBMD? It is possible that this blur/haze could be permanent?

The doctors keep telling me that everything is fine, and to just be patient and give it some time. They tell me that my blurry/hazy vision will eventually clear and that I should improve to 20/20 or better. However, I prefer to have the cold hard and honest answers so I know what to prepare myself for, rather than getting false reassurances.

Thanks for any input.
unluckyson
 
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Re: Need Straight Answers: Diagnosed with EBMD after Lasik

Postby LasikExpert » Sun Jan 16, 2011 6:48 am

unluckyson wrote:She informed me that I had a minor complication called Epithelial Basement Membrane Dystrophy.

The epithelium is the thin soft outermost layer of cells on the cornea. If you touch your cornea with your finger, you are touching your epithelium. The basement membrane is the bottom layer of the epithelium. The basement membrane works to help hold the epithelium layer to the lower layer of the cornea. EBMD, also known at map-dot-fingerprint corneal dystrophy, means that the epithelium is irregular and/or having difficulty holding on to the underlying corneal layers. Mild EBMD may present as you descirbe, with poor quality vision and a bit of a haze appearance at all distances.

Any kind of surgery or management of the cornea can exacerbate preexisting EBMD. Asymptomatic patients may become symptomatic. Symptomatic patients may progress into vision disrupting and painful recurrent corneal erosions. Since you were obviously asymptomatic prior to your Lasik it does not seem at all likely that you will progress much beyond what you have now.

unluckyson wrote:My eyes are still very bloodshot.

Depending upon exaclty what you mean by "bloodshot", the symptom may or may not relate to EBMD. It seems likely that enlarged blood vessels are your eyes' general wound response.

unluckyson wrote:I can read signs at a distance and drive fine, but my vision is still significantly blurry.

This is very consistent with EBMD, but is consistent with other possible problems related to Lasik too, including simple inflammation.

unluckyson wrote:The doctors at this institute kept reassuring me that this complication is minor and to just give it time to heal and that my vision will eventually become crisp and clear and that I will most likely improve to 20/20 vision.

I have come to the conclusion that a "complication" is noly "minor" when it is someone else's, but your doctors' prognosis and your reported symptoms do seem to be consistent.

unluckyson wrote: I'm willing to be patient and I want to take the doctors at their word, but the paranoid person in me wants a second opinion.

A second opinion can provide a lot of peace of mind, even if it is unnecessary. I would suggest a corneal specialist and ask your Lasik surgeon for a recommendation. They would be working together on your treatment and your Lasik doctor has all the preop information that can be helpful.

unluckyson wrote:1. Will this complication affect the final results of the procedure?

Possibly, but not likely from what you and your doctors have said.

unluckyson wrote:Can I indeed expect to improve to 20/20 once I'm fully healed as the doctors keep telling me? or

You can reasonably expect to improve clarity as the EBMD resolves, but whether or not your vision will be 20/20 depends on the success of the surgery, not so much on the success of the EBMD healing.

unluckyson wrote:does EBMD typically result in unfavorable outcomes?

When the patient was asymptomatic preop the probability of full resolution is relatively high.

unluckyson wrote:Does EBMD typically result in weaker flap adhesion?

The Lasik flap is about 100 microns below the area of the cornea that is affected by the EBMD. One has little to do with the healing of the other.

unluckyson wrote:Being involved in many diffferent full contact sports I need to be re-assured that the flap will be just as strong as if I didn't have EBMD

The Lasik fully heals, but it does not heal like a scratch on your arm. It is always different. See our article about Lasik flap healing. If this is EBMD you had it before Lasik so your relative risk was the same before Lasik as it is now.

unluckyson wrote:How long should I expect the healing to take?

Three to eight weeks from your surgery.

unluckyson wrote:I realize that everyone heals at their own pace, but I'm unable to take an indefinite vacation from work. My vision does seem to be improving every day but only by very very tiny, miniscule margins. How long does it typically take for the bluriness/haze to go away completely (if at all?) in Lasik patients with minor EBMD? It is possible that this blur/haze could be permanent?

You will have "functional fuzzy" for the first several days and the improvement progresses about as fast as you have described.

unluckyson wrote:The doctors keep telling me that everything is fine, and to just be patient and give it some time. They tell me that my blurry/hazy vision will eventually clear and that I should improve to 20/20 or better. However, I prefer to have the cold hard and honest answers so I know what to prepare myself for, rather than getting false reassurances.

Most likley what the doctors have told you is exaclty the cold hard and honest response. Your vision is not great, it will slowly improve as your eye heals, and the EBMD will not likely change the final result of your Lasik. Whether or not it will be 20/20 is truly a different question that you will know in several weeks.
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Re: Need Straight Answers: Diagnosed with EBMD after Lasik

Postby unluckyson » Sun Jan 16, 2011 4:23 pm

^ Thank you very much for the info. If only the doctors at the institute took the time to explain things to me in that much detail, they would have saved me from a lot of stress and anxiety!

The most releiving bit of information is that I now know to give it 3-8 weeks to fully heal. When the doctor from the next-day follow up visit said "give it a few days and the haze will clear" I got the impression that the haze would clear completely within a few days. None of the staff bothered to tell me that complete healing would take 3-8 weeks. This is why I was concerned when there was still haze after a little over a week. Had they just straight up told me to expect to have hazy vision for several weeks then I would have known exactly what to expect and wouldn't have been feeling so uneasy.

I'll wait for 3 months from the surgery date then schedule a checkup to see how my vision is. I'm in my late 20's now, may consider PTK if the EBMD becomes a problem later in life (40's+) or a combined PTK/PRK if my vision regresses.
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Re: Need Straight Answers: Diagnosed with EBMD after Lasik

Postby LasikExpert » Sun Jan 16, 2011 9:49 pm

unluckyson wrote:I got the impression that the haze would clear completely within a few days.

It is possible for mild EBMD to resolve enough within 2-3 days that the patient does not see haze, however I tend to present worst-case scenarios. I find it better to over prepare a patient than panic a patient on the fourth day.

unluckyson wrote:I'll wait for 3 months from the surgery date then schedule a checkup to see how my vision is. I'm in my late 20's now, may consider PTK if the EBMD becomes a problem later in life (40's+) or a combined PTK/PRK if my vision regresses.

Good plan, but if you have any sudden changes be sure to report them to your doctor's office. Also, use only preservative-free artificial tears. The mild toxin used as a preservative in multi-use bottles can irritate the epithelium that is distressed due to EBMD.
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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