PRK in 1996 and 1998

[GeneralPatientInquiry]

On June 28, 1996, Dr. G of Denver CO performed PRK on my left eye. Prior to the surgery my left eye prescription was -5.75 -1.00 x 159. This ablation is decentered resulting in significant visual problems in my left eye. The problems include multiple ghost images, starbursts and loss of contrast sensitivity. The current post-surgery prescription is 2.50 -3.00 170 though my glasses are 2.00 -2.00 170. I see Dr. W (Optometrist) in Denver and I have consulted with Dr. P and Dr. L in Denver, on possible enhancements to improve the vision in my left eye. Dr. P & Dr. L have mentioned CCAP as a possibility for correcting the decentration but they do not have experience with CCAP and correcting decentered ablations. I would like to consult with one or more doctors who are experienced with correcting decentered ablations. Thanks for your assistance.



p.s. I also had PRK on my right eye on February 27, 1998 by Dr. K in Denver. The pre-op prescription was -4.25 -2.25 008. The current post-op prescription is 1.00 -0.75 010. The vision in the right eye is reasonable but not great.

[LasikExpert]

CCAP is an interesting process designed to reduce irregularities at the corneal surface. This may or may not be an appropriate surgical technique to correct your left eye's decentration.

The CCAP process is to apply a liquid material over the cornea that will fill in the valleys of the irregularities. The applied material can be removed by an excimer laser at about the same rate as corneal tissue. After the material has filled in all the low spots, an even application of excimer energy is applied to the entire area. In theory, the high spots consisting of corneal tissue are removed with the low spots being "protected" by the liquid material. Additional excimer energy is applied until all high spots are removed all the way down to the bottom of the low spots.

Of course, nothing screws up a perfectly good theory faster than reality. The reality is that CCAP can often provide improvement in an irregular surface, but does not always result in a smooth surface.

Decentration is quite different than an irregular surface. It would appear from your description that the surface of your cornea is probably smooth, but lopsided. Remember that astigmatism means that the surface of the cornea is not spherical like the top of a ball, but elliptical like the back of a spoon. This is what decentration of an excimer ablation can do. This explains your high astigmatism reflected in your eyeglass prescription. If the surface of your cornea is smooth, but is decentered, then CCAP may not be the best response.

My recommendation would be to be evaluated with a wavefront diagnostic by a surgeon who uses a wavefront-guided excimer laser. The wavefront diagnostic will determine if a wavefront-guided ablation would be likely to resolve the visual effects caused by the decentration. If you want a referral to a surgeon who has a bit of experience in Complex Wavefront Retreatments (CWR), I can recommend someone in Kansas City.

If CCAP is still indicated after you have been evaluated with a wavefront diagnostic, then I will glady recommend a doctor considered in ophthalmic circles as one of the best with CCAP.