Healing of LASIK flaps

| May 12, 2010 | Comments 10

LASIK flap healing

Here is a question on LASIK flap healing received this week:

Hi Dave,

I recently got custom lasik done on April 29 2010 with a microkeratome. I’m worried now because im reading all this stuff on how the flap never really heals. How easy is it to dislodge the flap? And How worried should i be and can they amputate the flap if it ever becomes dislodged?
thanks Dave

In reply, I said that yes, it is true that the flap interface does not heal strongly when cut deeper, as with most (blade) microkeratomes. It is possible to lift those thicker keratome flaps even years later. However, the flaps will not move with normal daily life activities, and are only at risk with direct significant trauma. There are case reports of flaps moving with direct injury, including an air bag, but these events are rare for most people so you don’t need to worry.
However, the better healing at the interface of thin flaps is one of the reasons for the introduction of femtosecond lasers, which is now available at 80% of UK clinics. I have written on this topic in more detail before, but am sure we will come back to it.

Filed Under: LASIK • Safety

About the Author: Mr. Dave Allamby FRCS FRCOphth is a leading London-based laser eye surgeon. You may have seen him on the This Morning TV show with Phillip Schofield and Fern Britton or read one of several articles in the national press, recently for treating Denise Van Outen, rock giant Rick Wakeman and broadcaster Paul Ross. David is Medical Director at Focus Laser Vision, known as a world-leading clinic in the treatment of presbyopia, or age related loss of close vision. Focus Laser Vision is also London's only clinic to offer next-generation Z-LASIK laser eye treatment for short sight, long sight or astigmatism.

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  1. love says:
    February 25, 2011 at 11:56 pm

    would rubbing my eyes dislodge the flap?

    Reply
  2. Sam says:
    May 24, 2010 at 12:44 am

    Hi,

    Are microkeratomes detectable years after surguery?

    Reply
    • Dave Allamby says:
      May 27, 2010 at 7:44 am

      Hi Sam
      Yes, under the microscope only though. If an ophthalmologist were to examine your eyes it is possible to detect the edge of the flap. Although you would normally have to be looking for it as it can easily be missed even on a microscopic exam.
      Best regards, Dave

      Reply
      • Tony says:
        April 9, 2011 at 4:56 pm

        Hi Dave, I had my consultation yesterday. I am a 53yr old Surveyor and I am very shortsighted. Bad enough that the Optical Express ‘Wavefront Lasik’ treatment would be £3600. I delayed their booking as I became very concerned about future problems with the corneal flap dislodging. I have no qualms with Optical Express at all but I must admit this possible ‘flap’ problem worries me deeply, that and the fact that my eyesight may deteriorate as I’m getting older.

        Thanks

        Tony

        Reply
        • Dave Allamby says:
          April 9, 2011 at 5:08 pm

          Hi Tony
          Can you let me know your prescription (approximately). Didi OE offer you distance vision correction only, or blended vision to correct both distance and near vision?
          Thanks, Dave

          Reply
          • Tony says:
            April 10, 2011 at 11:48 am

            Hi Dave, yes it was distance correction only. I haven’t any issues having reading glasses as well. My prescription is :

            Right
            SPH -6
            CYL -0.25
            Axis 10
            Near +1.50

            Left
            SPH -4.5
            CYL -3.0
            Axis 7
            Near +1.50

            I was told my reading glasses would just be the ‘off the shelf magnification’ ones.

            I am aware that any operation can have problems and I am sure the laser treatment will be OK with 20/20 vision. With being a surveyor I spend a lot of time peering through a theodolite and I was concerned that the adhesion qualities around the corneal flap may be compromised if one is not careful. I also didn’t one to incur extra costs should remedial work be required.

            Thanks again.

            Tony

          • Dave Allamby says:
            April 11, 2011 at 11:03 am

            Hi Tony
            The flap wont be an issue. A flap injury to cause a problem really needs to be a direct sharp trauma to the eyeball itself, which is actually a pretty rare event. Most eye trauma is blunt. Using a theodolite won’t be a problem.
            With best regards, Dave

          • Tony says:
            April 11, 2011 at 5:05 pm

            Thanks for that your reply Dave.

            One final question, as I stated earlier I am 53yrs old and have worn glasses since I was six or seven. What are the chances of my eyes deteriorating further due to my age?

            I can sense a 200 mile trip to London coming on ;-)

            Regards,

            Tony

          • Dave Allamby says:
            April 11, 2011 at 7:01 pm

            Hi Tony
            Your short-sight is be stable now, so any distance correction will be permanent. There can some small increase in myopia from the 70s onwards due to changes in density within the natural lens of the eye, perhaps as a precursor to cataract development (correcting that is now very straightforward as a walk-in, walk-out procedure).
            The loss of near (reading) vision slowly progresses until 60-65 years of age. At Focus, when we do a blended vision correction to also target reading vision, and the patient is short-sighted naturally, we can usually give a very long-lasting correction for far and near.
            Of course, you are always welcome to come to Focus. Which part of the country are you based?
            Best regards, Dave

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