8 years after Lasik contemplating PRK-help??

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8 years after Lasik contemplating PRK-help??

Postby Jessica_Rohr » Sat Dec 29, 2007 3:12 am

At 21 I had Lasik and am now 29. I wore hard contact lenses for about 7 years prior to Lasik and stopped wearing them for about 6 months prior to the surgery. We were waiting for the shape of my eye to stabalize (I had an astigmatism). I don't know if we jumped the gun or if I was too young and my eyes were still changing. My vision was so bad pre-op I couldn't even see the alarm clock without glasses. Afterwards, my vision was never perfect but such an improvement compared to what I was used to, I thought. But, they did send me to get glasses after my post op. I used to would only wear them at night to drive, but now I have noticed my vision is worse and I can not see street signs in daylight or the TV without glasses. I have always had halos and worse vision in low lighting with some blurring. I went for a consult for an enhancement but the doc recommended PRK since she didn't think she could "lift" the same flap after so many years and didn't want to risk cutting a "doughnut" out of the old flap. I can't seem to find any research on anyone that has had PRK after Lasik. I don't want to run the risk of loss of best corrected visual acuity (BCVA).

Do you think my vision is just changing normally with age and it is not associated with the previous surgery?
Is PRK really the best option? If not what is?
Having these minor complications already; how much does this increase my chance of future complications if I have PRK?
Can any of my halos and blurriness be corrected with PRK?
Is there a greater risk to having PRK after Lasik than on a virgin eye?
Is the risk too great to chance trying surgery again?
Being 10 years away from 40 should I consider monovision?
How many times can you have laser eye surgery, since each time more tissue gets removed-or what is the recommended cut off?

After reading some of the horror stories I'm not sure what to do-although I know most of the outcomes are favorable.
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Re: 8 years after Lasik contemplating PRK-help??

Postby LasikExpert » Sat Dec 29, 2007 7:32 am

Jessica_Rohr wrote:I have always had halos and worse vision in low lighting with some blurring.


If the blurring and/or halos resolve with the use of glasses, then the problem is only simple refractive error (eye prescription). This would be a good sign. If the halos remain the same even with glasses, then your situation may be a bit more challenging.

Jessica_Rohr wrote:I went for a consult for an enhancement but the doc recommended PRK since she didn't think she could "lift" the same flap after so many years and didn't want to risk cutting a "doughnut" out of the old flap.


If the flap is a bit too thin or if it has healed really well, it can be difficult to lift the existing flap. PRK on the Lasik flap may be appropriate for low prescriptions.

Jessica_Rohr wrote:I can't seem to find any research on anyone that has had PRK after Lasik.


The use of Mitomycin C during PRK on the Lasik flap has all but eliminated the risk of the cornea (clear front) of the eye becoming cloudy. PRK on the Lasik flap is becoming more popular. Most of the research is in the medical journals, not lay articles. You may want to read this abstract in PubMed.

Jessica_Rohr wrote:I don't want to run the risk of loss of best corrected visual acuity (BCVA).


All surgery has the risk of an undesired outcome. You need to consider enhancement surgery with the same risk-to-benefit analysis you used for your first surgery.

Jessica_Rohr wrote:Do you think my vision is just changing normally with age and it is not associated with the previous surgery?


It is difficult to know with the limited information, but it is likely a combination of natural change and regression of effect.

Jessica_Rohr wrote:Is PRK really the best option? If not what is?


PRK on the Lasik flap may be an appropriate option and has some advantages over lifting the existing flap, but whether or not it is truly appropriate will only be determined after a comprehensive evaluation by a competent doctor.

Jessica_Rohr wrote:Having these minor complications already; how much does this increase my chance of future complications if I have PRK?


Depending upon the exact situation with your eyes, it is possible that enhancement with current technology will improve your quality of vision as well as reduce your need for glasses. This is not true in every case and there is always risk, but you need to discuss this in detail with your doctor.

Jessica_Rohr wrote:Can any of my halos and blurriness be corrected with PRK?


It is possible, yes. Much depends upon the exact nature of the cause. You may want to read about Lasik pupil size issues.

Jessica_Rohr wrote:Is there a greater risk to having PRK after Lasik than on a virgin eye?


Of course. Your eye is different after Lasik and those differences can be important. Whether or not the difference elevates your probability of a problem to an unacceptable level needs to be determined.

Jessica_Rohr wrote:Is the risk too great to chance trying surgery again?


Risk is relative. You, and only you, can decide if the potential benefit is worth the probable risk.

Jessica_Rohr wrote:Being 10 years away from 40 should I consider monovision?


You can try monovision with contact lenses first, and then decide if this is someting you want.

Jessica_Rohr wrote:How many times can you have laser eye surgery, since each time more tissue gets removed-or what is the recommended cut off?


In theory the surgery can be repeated as many times as necessary, provided at least 250 microns of corneal tissue remains untouched (more is always better) for Lasik enhancement. PRK on Lasik would be limited by Lasik flap thickness issues.

Jessica_Rohr wrote:After reading some of the horror stories I'm not sure what to do-although I know most of the outcomes are favorable.


There is nothing wrong with waiting, but it also seems wise to get a comprehensive evaluation and consider all your options.
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