The flap

If you are thinking about having Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL eye surgery, this is the forum to research your concerns or ask your questions.

The flap

Postby The Pezman » Thu Feb 08, 2007 2:29 am

So I did research on LASIK. Since my primary exposure was to LASIK doctors' websites and various Youtube videos detailing what an absolute miracle it was, I figured I'd give the other side a chance to speak.

The issues I found mostly had to do with malpractice and non FDA-approved devices. I had used this site to find the team of doctors I elected to use, and they gave me a comparatively cheap price ($4000) for both eyes with bladeless and custom wavefront operations. So I just don't see malpractice or FDA issues being an issue here, but the one claim the sites made which I couldn't really get over was this:

The flap doesn't heal.

Now obviously when you hear something like that you're going to wonder. They're literally tearing a hole in the protectice layer in front of your pupil. What do they do to seal it shut? Is it true (as the site claimed) that if any follow-up surgery is needed they can simply pull back the flap without having to cut it again? Will I be able to swim, play sports, or even get hit in the head without the worry that the flaps might be dislodged? Please answer these to the best of your ability.

Note: This post was edited to remove a clinic's name.
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Postby LasikExpert » Thu Feb 08, 2007 1:02 pm

The "Lasik flap never heals" claim is what I call lying the truth. The Lasik flap most certainly heals, but it does not heal like a cut on your arm. It is always going to be different. For some people, such as those involved in extreme activities, the difference may be important. For most the difference is of little consequence. You may want to read our article about Lasik flap healing.

Lasik flaps have been lifted for Lasik enhancement as much as 12 years after initial surgery. "Lifted" is really not the best term. It is more like surgically separating the cornea at the location of the original incision.

Trauma to the eye can cause a Lasik flap to become dislodged. If the flap itself is not damaged and care is provided quickly, the flap can often be repositioned and will heal again. If the flap is lost, a transplant with donor tissue may be performed. In some cases a transplant is not needed and vision is able to be restored without the Lasik flap. Like any trauma to the eye, the best method to respond and the probability of long-term problems will depend upon the unique circumstances of the incident.

Concern about the Lasik flap is why for years military special operations and fighter pilots had not been allowed to have Lasik. I think it is fair to say that being ejected from a fighter plane at high speeds is rather traumatic. Pilots were provided the surface ablation techniques PRK, LASEK, or Epi-Lasik as an alternative. This policy has recently changed as the Navy is now providing All-Laser Lasik to active fighter pilots. See US Navy pilots and Lasik.

You will be able to swim after Lasik, mountain climb after Lasik, and even get whacked upside the head after Lasik without it affecting the Lasik flap. If you expect to be in extreme environments often, you may want to consider PRK, LASEK, or Epi-Lasik instead of Lasik.
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Thanks very much

Postby The Pezman » Thu Feb 08, 2007 5:25 pm

That's quite informative. I'm not all that athletically active, but I do karate, work out, swim, and, of course, take showers. So odds are if it's good enough for fighter pilots, it's good enough for me.

What do they actually use to seal the flap back after it's done?

Also, I didn't realize I wasn't allowed to mention specific doctors or organizations here. Why is that?
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Postby LasikExpert » Thu Feb 08, 2007 6:23 pm

We do not allow the mention of specific doctors in this forum because the experience of one person, good or bad, does not necessarily indicate the expertise or medical ability of the provider. Elsewhere in our website we list Certified Lasik Doctors we have evaluated. We do not even allow their names in the forum, only in our official listing.

No adhesion of the flap is necessary. The eye gets much of its oxygen through the cornea. This creates a virtual suction. Moments after the flap is layed down it begins to become stable. This is one of the reasons why you can blink your eyes shortly after surgery without likelyhood of flap displacement. Within days the epithelial cells cover the flap edge and provide more solid adhesion. This process continues in the following weeks and months.
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Postby DryEye » Thu Feb 15, 2007 2:29 am

I recently read two articles on the military and their stance on lasik based on 10 year studies. One appeared in the Kansas City Times - Google News military lasik) the other was around the time Intralase was bought. Something about them going into a contract with Intralase for soldiers.
I had heard and read that they were more for PRK, especially for fighter pilots and special op guys, but that thinking may have changed based on the Intralase article & the Kansas City Times article?
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Postby LasikExpert » Thu Feb 15, 2007 5:49 pm

The US Navy is testing if Lasik with a femtosecond laser created flap (All-Laser Lasik) is appropriate for pilots. Restrictions away from Lasik and All-Laser Lask and toward surface ablations such as PRK, LASEK, and Epi-Lasik still generally apply.
Glenn Hagele
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USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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