Comments for Laser Eye Surgery Blog | LASIK-Truth.com

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Dave Allamby

Dave Allamby — Mon, 30 Jan 2012 13:42:38 +0000

hi Lucy, You are fortunate to have thick corneas, so that your -8.00 is treatable with LASIK. That is the way I would recommend to go. The chance of needing an enhancement does increase with prescription size, but is an easier proposition with LASIK compared to PRK. It also varies a lot between different clinics and surgeons, so best to ask your doctor what his rate is. My rate for myopia enhancement is only around 1 in 300 (0.3%), but some others might be 5% or higher. You have done the right thing by choosing the best surgeon you can. The decision is made around 3 months post-op, so you would have time to get that done before you move at 5 months.
The incidence of night vision issues is linked to two main factors – do you have them pre-op (you do) and the size of the correction (you are in the high correction group). So you should expect that you will still have some starbursts etc after LASIK, as you do before. They will be more noticeable for the first few weeks, then will usually start to settle to similar to pre-op levels, but there is a small chance that it could be more than pre.
For the ‘scarier’ risks you mention, through screening should help remove the chance for eg. keratoconus. You doctor can advise in your specific case based on the corneal scans. I would recommend a dilated eye exam 4 weeks post-LASIK to re-assess your retina. However, the clinical studies do not find a link between LASIK and increased chance of retinal detachment. But for high myopes, I personally like to dilate post op and confirm the retina (which is thinned in high myopia) is still OK.

Best regards, David

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Lucy

Lucy — Mon, 30 Jan 2012 06:06:00 +0000

Hi there, first of all this is an excellent site!

I am having LASIK this week (with one of the best surgeons in Toronto, Canada – with Intralase) and I am overly anxious about all possible complications. I am near-sighted with myopia of -8 in both eyes, and at first I was torn between PRK and Lasik only because of my fear of the flap (which thanks to your site I learned that it actually does heal! I was afraid that I would have the cut in the cornea for the rest of my life.) I am a candidate for Lasik because I have very thick corneas (over 600)… Which I learned is a good thing should I need an enhancement, although I am hoping I will not need one. What are the chances someone highly myopic like me will need an enhancement? I am concerned because I plan to move to another country in 5 months and will not be close to my surgeon any longer. When would i know if I need it?

However, because I am highly myopic, I am still very paranoid for complications such as light sensitivity, night vision problems (halos, glare, double vision, starbursts – I have some starburts now PRE-surgery with my glasses!) Do these usually subside with time after Lasik?

Then the scarier risks like Keratoconus, ectasia, and possible retinal detachment caused by the pressure device! Am I paranoid for nothing? Would my surgeon know if i am at risk for any of these after thorough examination and measuring?

I have not slept since I read my consent form! Please help!

Lucy

Comment on Part 7: LASIK vs PRK/LASEK? Which laser procedure is best? by Dave Allamby

Dave Allamby — Tue, 17 Jan 2012 16:07:55 +0000

hi Steven, There is a very small, but not zero, risk of the flap being moved late on. Needs sharp direct trauma, which is possible in the contact martial arts you mentioned – finger tips/nails. It is quite reasonable to opt for PRK in this situation. It’s very hard to quantify the risk though. Regards, Dave

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Dave Allamby

Dave Allamby — Tue, 17 Jan 2012 16:05:02 +0000

Hi Varshan, you are better to target the keratocytes and potential haze with MMC in your case, rather than vitamin C. MMC will slow the re-epitheliazation by about a day. Your pupils are of normal size. The relevance of pupil size to night vision symptoms is still being debated. E.g. the recent presentation this month by Schallhorn:

“Large pupils not at greater risk”
mail.google.com/mail/?shva=1#inbox/134cea26ec90ea92
Patients with large low-light pupils are not at greater risk for quality of vision or quality of life symptoms at 1 month post-op laser vision correction, despite persistent rumors to the contrary, reported retired Navy Capt. Steve C. Schallhorn, M.D., former director of Cornea Service & Refractive Surgery, Naval Medical Center, San Diego; and professor of ophthalmology, University of California, San Francisco.
Best regards
Dave

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Varshan

Varshan — Tue, 17 Jan 2012 13:59:05 +0000

Thanks so much for your reply Doctor. Just to get your opinion on a few points you missed out:

1. What’s your experience with corneal scarring and what’s my statistical risk of developing a) scarring and b) significant haze.

2. Your take on how Vitamin C may impact re-epithelialization and fibroblast proliferation.

3. My scotopic pupils were 6.7mm each and I’d like to again stress that significant haze or night-time complications are important to me as I’m only having this surgery so I can give myself the best chance possible of achieving the dream of being a pilot.

And again considering all these things you suggest I avoid the Intralase/iFS + B&L and go for the Wavelight?

Thanks so much again, this is a gem of a website.
Varshan

Comment on Part 7: LASIK vs PRK/LASEK? Which laser procedure is best? by Steven Kapur

Steven Kapur — Tue, 17 Jan 2012 13:39:34 +0000

Hi Dave again,

Thank you for all your responses. I’ve been finding this blog very informative and useful.

One further question I have is how suitable is LASIK for combat sports such as Brazilian Jiu Jitsu and Muay Thai? I am currently not at a level were I am ready to spar but don’t want to rule it out in the future.

I have read various forums stating that people have had LASIK and still spar regularly as it would take quite a heavy blow to dislodge any flap. However they have to give the flap the maximum healing time of 3 months before resuming sparring. I am now in the situation were I am ready to book my surgery but still unsure due to the sports I participate in. I am also aware that the police now use LASIK as well.

Warm Regards,

Kunal

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Dave Allamby

Dave Allamby — Tue, 17 Jan 2012 09:47:46 +0000

hi Varshan, Of your options, I would certainly choose the WaveLight Eye-Q for surface laser, with mitomycin C. MMC is important considering the size of your prescription and latitude/UV exposure. There is very good follow up data looking at multiple aspects of corneal health post PRK, with and without MMC, which confirm no difference between the eyes up to 5 years post. This is very different to what Sato did in Japan in the 1950s, cutting into the posterior surface of the cornea, and you can’t fairly compare that with the worldwide research and application of the use of MMC. The Sato procedure would have led to rapid and major measurable changes in the posterior corneal health. You will be more likely to drop vision from haze than from the MMC.
Regards, Dave

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Dave Allamby

Dave Allamby — Tue, 17 Jan 2012 09:18:20 +0000

Brian, my pleasure. You won’t need to have the strong pressure feeling to flatten the eye next time, as your doctor can relift the existing flap, so you should find it easier if you need an enhancement.
Regards, Dave

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Varshan

Varshan — Mon, 16 Jan 2012 20:24:04 +0000

Dan, the healing has to do not only with the thickness but also with the fact that a keratome cuts like a splicer with graded edges and an FS laser cuts with rectangular edges, straight down.

Hello Dr.Allamby!

I’m an aspiring commercial pilot currently contemplating either an ASA or an FS lasik. After quite a lot of reading Azar’s, Vinciguerra’s, Pallikaris’ and Dr.Leo Bores’ books, I thought I’d come to the conclusion that I wanted to be flap-free but since then it seems like my flap dislocation worries have grown more than they ought to in my head, but saying I still do not want a flap and choose Epi-Lasik, what’s my risk of corneal scarring and/or grade 1+ haze(wearing sunglasses) considering I live close to the equator(Chennai, India.)? Also my surgeon isn’t keen on Vitamin C prophylaxis. My PPR was -5.10 OS and -4.5 OD with a -0.25 cylinder in both eyes.

2. ASA and MM-C are fairly new when compared to PRK so do you think there’s going to be unforeseen changes in the future considering Sato’s patients only developed bullous keratopathy a decade after surgery!

3. If I choose to have LASIK my preferred surgeon will use a Bausch & Lomb Technolas 217z laser with the Intralase system, and if I were to have ASA I would prefer to go to another surgeon, and he uses the Wavelight Allegretto Eye-Q. I’ve read the B&L is quite tissue-hungry and the eye tracker is impractically slow, but in your experience and word from colleagues do you suggest I steer particularly clear of the B&L laser for some reason? These are the only 2 Lasers available in my geographical vicinity and the guy who uses the Wavelight doesn’t have an FS laser.

It’s also been a challenge for me to try and peer past all the marketing, honestly, nonsense that tries to create irrational exuberance for a certain procedure so I’m hoping you can give me an unbiased opinion.
Thankyou so much in advance,
Varshan.

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by brian

brian — Mon, 16 Jan 2012 14:20:51 +0000

Yes, this is what I meant, blurry at distance.
don’t know why but i am scared like he** may be because I know what I went trough the first time. having the thing in my eye to flatten it.
But look forward in other part. I am definitely not going back to glasses for distant vision. I will keep you posted (later in May-June 2012)

Thanks for your reply.
Brian

Comment on Part 7: LASIK vs PRK/LASEK? Which laser procedure is best? by Dave Allamby

Dave Allamby — Sat, 14 Jan 2012 17:05:13 +0000

hi Irene
Tear break up time (TBUT) is normally 10 seconds or longer, so yours is too quick at 6 seconds to offer laser eye surgery. Leaving the contacts out for longer before having them tested again is necessary to get a truer measure of the the health of the corneal surface. Not sure about the Ultralase comment as it seems back to front. Having a double digit TBUT is a good thing, not the reverse, so you may have misunderstood that comment? TBUT needs to be longer to provide continuous moisture on the corneal surface between blinks. Laser eye surgery will reduce the tear film further and increase the risk of dryness problems.
You can continue with 2000mg as it will build up with time. This may or may not extend the TBUT to a point where it is safe for LASIK. So you have two issues that need addressing before laser eye surgery is safe for you: the stability of your prescription, and the quality of your tear film.
Best regards, David

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Dave Allamby

Dave Allamby — Sat, 14 Jan 2012 16:40:11 +0000

hi Brian, I am guessing you mean regressed to minus one? With blurry distance vision but good near vision? If it is -1.00 then it will not fix itself by now and an enhancement will be needed. Don’t worry about the flap moving in everyday life, it doesn’t happen.
Thanks, Dave

Comment on SAFETY NOTE: Does the LASIK flap ever heal? by Brian G

Brian G — Fri, 13 Jan 2012 19:06:13 +0000

Hi, I am in Canada and went in QC last October ( 21, 2011) to have Intralase. My vision was myopia with -6.25 with sligh ast. -.25 ( i did not know that before going there)…

My question is: My vision regressed to +1.00, see blurry at far and can not really focus, I am going to see my optometrist for a follow up in February. Will i need enhancement or my vision *or cornea* will fix by themself?

I had all laser surgery and hoping in all my life, that the flap will not fly in the air when riding in bike or going to take a plunge in the water.

Thanks

Comment on Part 7: LASIK vs PRK/LASEK? Which laser procedure is best? by Irene

Irene — Fri, 13 Jan 2012 18:17:52 +0000

Hi David,
Hope you don’t mind me getting involved in this thread, but I have been advised I have some dryness in my eyes but I think it’s mainly from contact lens wear. When I went to UL (my Contacts were out for24 hours) they advised my tear break up was 6 seconds (I’m not sure what that means?) and that they are only concerned about dryness when it gets into double digits for tear break up. Is this right?
I have been taking flaxseed oil 2 x 1000mg aday for about 6 weeks as advised on the label but I notice you advised Ness to take 4 x 1000mg a day. I have found my eyes have improved with the flaxseed oil but occasionaly still wake up with some dryness (I still wear contact lenses the majority of the time so I do appreciate that isn’t helping but I have switched to Acuvue Moist Dailies which have been great and my eyes are fine when my contacts are in, the dryness is when I don’t have contacts in).
So as I want to have laser eye surgery with yourselves when my eyesight has stabilised, should I take 2x 1000mg per day or 4x 1000mg a day?
Many thanks- I really appreciate all the advice you have given to help me with such an important decision.
Irene

Comment on Night Vision Problems by Dave Allamby

Dave Allamby — Thu, 12 Jan 2012 09:31:46 +0000

hi Vishal, C-TEN is basically just PRK, another variant of surface laser treatment. There can be various reasons for starbursts, and they can be seen in the post-operative period. Typically they do improve with time so you might stick with your surgeon if things are getting better overall. However, if you see no improvement by 4 months, and if your surgeon cannot offer a solution or explanation, you might now wish to seek a second opinion. Thanks Dave