Don't fully understand swimming and lasik

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.

Don't fully understand swimming and lasik

Postby kschueleraugsburg » Sun Jul 29, 2007 10:37 pm

Hello Glenn, hello community:

I've done a lot of research and a lot of reading regarding lasik, also went to three different eye doctors/laser surgeons in U.S. and Germany to have my eyes checked. All three came uup with virtually the same numbers, and with virtually the same recommendation for treatment (Lasik, non-wavefront), and one suggested Intralase (the other two do not own Intralase equipment).

I am currently scheduled for treatment on August 9, and am in the process of triple- and quadruple checking every detail (maybe I should not bother that much??).

One thing is not totally clear to me, and maybe Glenn or other people on the board can help me with this.
The subject of flap healing, and thing like going swimming (pool or sea), even diving without goggles with eyes open. Also, flushing the eyes in case there is something in the eye (example: sand, small insect, ...).

Often time I hear that the flap never really really heals, on the other hand I hear that it is "relatively" secure shortly after the surgery. Apparently, Navy pilots can't have lasik because extreme conditions may move the flap out of position.

Other than the article on this webpage about flap healing, is there other information available, maybe with graphics what is going on? Is this process more like "gluing pieces together", or is it like healing bones where the formerly broken bone ends up stronger after the healing?

Your feedback, as usual, is greatly appreciated!

Best regards,
K
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Postby SteveR » Tue Jul 31, 2007 11:26 am

Hi kschueleraugsburg,

You're right to be concerned about the strength of LASIK flaps, they do heal relatively poorly, but I think you are perhaps being overly pessimistic in far as the amount of trauma required to dislocate a flap. And those dislocations that I have read about have all been have been satifactorarily repositioned afterwards. The flap heals with maximal strength reached at around 3.5 years I gather.

Below is some research I uncovered before I got bored:

http://www.journalofrefractivesurgery.c ... hing=11320
The human corneal stroma typically heals after LASIK in a limited and incomplete fashion; this results in a weak, central and paracentral hypocellular primitive stromal scar that averages 2.4% as strong as normal corneal stroma. Conversely, the LASIK flap wound margin heals by producing a 10-fold stronger, peripheral hypercellular fibrotic stromal scar that averages 28.1% as strong as normal corneal stromal, but displays marked variability. [J Refract Surg. 2005;21:433-445.]

-Or in plain English the edges of the flap heal best (but relatively poorly) and the rest of the flap hardly adheres back to the cornea at all. Also the flap takes away corneal thickness and adds little to the structural integrity of the eye.

http://abstracts.iovs.org/cgi/content/a ... /44/5/2681
Conclusions: Dislocations of the corneal flap created at the time of LASIK can occur many months after the primary procedure. These dislocations can occur with relatively minor trauma and during activities of normal daily life. Despite complications, all three patients recovered excellent uncorrected visual acuity.

There are various case studies of flap trauma and dislocations available on Pub Med http://www.ncbi.nlm.nih.gov/sites/entrez :
(I searched on LASIK trauma). From what I’ve seen even quite minor trauma (e.g. a finger poke) can cause flap dislocation many years after LASIK.

Examples from Pub Med:

    CONCLUSIONS: Trauma occurring several months or years after LASIK may cause flap injury. Adequate and prompt treatment usually is successful.
    http://www.ncbi.nlm.nih.gov/sites/entre ... itool=Entr ezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    http://www.ncbi.nlm.nih.gov/sites/entre ... tool=Entre zSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    We present a case of late traumatic flap dislocation 47 months after laser in situ keratomileusis (LASIK). This is the latest reported case of traumatic LASIK flap dislocation to date. The patient was examined 5 days after being struck in the face and found to have a flap dislocation. The flap was repositioned surgically, and postoperatively the patient had 20/20 visual acuity and no visual complaints.
    http://www.ncbi.nlm.nih.gov/sites/entre ... itool=Entr ezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    A case of traumatic flap displacement with a fingernail injury four years after LASIK is reported.
    http://www.ncbi.nlm.nih.gov/sites/entre ... itool=Entr ezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    Here’s some better news (in rabbits, done very soon after LASIK):

    Impact force was compared to that generated by mechanical trauma (fingers and a small tree branch) striking a force gauge. RESULTS: Of 43 eyes tested for injury, flaps could not be dislocated in 11 eyes (26%). There was no significant difference between eyes treated with flap only and those that also had ablation. When flaps were dislodged, the required force generally resulted in extensive intraocular injury.
    http://www.ncbi.nlm.nih.gov/sites/entre ... itool=Entr ezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum


I would actually prefer to see some research on low energy impacts that more realistically simulate a blow to the eye (men will be men), for example by a heavy and relatively low speed tangential force (across) the eye surface, wwith or without eye lid protection. Not that I'm overly keen on animal experiments. We'll have to see how cases develop over time, as LASIK goes big time. I have had LASIK myself btw. On the other hand LASIK preserves the bowman's layer, which LASEK doesn't, and I doubt nature gave us it for no reason (though I gather many carnivors do not have it, strangly enough).

For a balanced view one would also need to contrast those cases I found above (which are by no means exhaustive, I just got bored there) with trauma to unLASIK'd eyes also of course. A finger poke might presumably be nasty to a normal eye for example, and LASIK’d eyes that have suffered no flap complication following trauma likely far exceed those cases seeing the day of light in the medical publications.

Regarding your other queries, swimming and the other activities you mention are usually okay a few weeks or so following surgery. But you'd have to check with your treating clinic with regard to their exact recommendations with regard to the time to wait before engaging in vigourous/unusual activities or being exposed to dusty/gritty environments. Diving from heights may be a new one for them, and it may be worth asking them about at consultation.
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Postby kschueleraugsburg » Tue Jul 31, 2007 9:35 pm

Hi SteveR:

Thanks for your reply, pretty detailed information. Did you do this research before or after you had LASIK?

Maybe I'm too concerned about this. Somehow I can't see how LASIK could be so successful if it carried severe complications in a large number of cases.

Still unsure about LASIK vs PRK. However, the recovery time with PRK seems to be very long and may require me to go off work for a substantial amount of time.
My problem is: I'm o.k. with the procedure, not overly concerned about results because I did extensive research. From everything that I know (about my prescription, topography, HOA, corneal thickness, pupil size, ...), I don't find red flags, and three eye doctors independently from each other suggested same treatment.
On the other hand I would feel more comfortable if there was a way to provide more strenght to the flap. As a engineer, I would suggest the flap be "spot welded" at the rim, but that may be unrealistic at least for now.

If you want to share more of your experience and research, I would greatly appreciate it.

Best regards,
K
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Postby LasikExpert » Tue Jul 31, 2007 9:45 pm

SteveR wrote:Diving from heights may be a new one for them, and it may be worth asking them about at consultation.


The thought of having my eyes open at the point of entry into the water had never occurred to me. I guess I'm just not that curious.

The lamellar flap used in Lasik has been around for about six decades. During that time a lot has been learned about the healing process and strength of the flap. The Lasik flap does heal, but the cornea is different after Lasik. This is one of the reasons PRK and its cousins LASEK and Epi-Lasik are regaining popularity among surgeons.

As an engineer I'm sure you understand elimination of weak points even if the probability of failure is miniscule. Although there is a slower vision recovery, you may want to consider the peace of mind you may gain by knowing that you will never have a Lasik flap related problem during surgery or thereafter.
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Postby houstonman » Tue Jul 31, 2007 10:07 pm

after months and months of research I knew I wanted to have lasik. I then went to 2 docs and after the tests they said im well suited to be a candidate. The day of the procedure I backed out because I heard read more and more on PRK and I have now decided that is what I want to go with. Pure laser with no cutting! I also plan to do alot of swimming and going out to Cancun next summer and I dont want to deal with 1 problem what so ever! I cant wait to have it done and look forward to it within the coming days
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Postby LasikExpert » Tue Jul 31, 2007 11:32 pm

We look forward to seeing you tell us about your experience in the "Just Had It" section!
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Postby SteveR » Wed Aug 01, 2007 8:30 am

Hi kschueleraugsburg,

Did you do this research before or after you had LASIK?


I’d been following developments in laser surgery for over a decade. In the early days my prescription (-8.00,-7.00) and pupil size ruled me out for PRK, and so I watched LASIK and LASEK, etc arrive on the scene and techniques improve generally (wavefront, tissue sparing algorithms, etc) . When intralase (femtosecond laser, used for creating the flap) came on stream and was suitably guinea-pigged (thanks guys) I decided to go for another consultation. I remained undecided, but glasses and contact vision wasn’t great and so laser treatment started to look worth it. I half-heartedly explored the surface techniques with the optometrist again, but he recommended against them in my case. After yet more consideration, one day I just went all out for it. I could have waited another decade to see if the tide would turn back to the surface techniques for prescriptions such as mine, but I had less knowledge about those improvements at the time (just 3 months ago). For me long-term outlook outweights short-term comfort, but the surface techniques just weren't an option if I was to heed the opthalmists advice. If I had to make the decision again now with hindsight? I would have laser treatment again, since what I have now is better than before treatment, but I can’t say whether I would choose a surface technique over LASIK, if the choice existed. I still don’t feel I know enough to decide.

Maybe I'm too concerned about this


Could well be!

I'm o.k. with the procedure, not overly concerned about results because I did extensive research.


Which makes you sound like a good candidate.
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