Comments on: SAFETY NOTE: Does the LASIK flap ever heal? http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/ Your personal on-call laser eye surgeon Wed, 08 Feb 2012 21:33:01 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Dave Allamby http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3487 Dave Allamby Mon, 30 Jan 2012 13:42:38 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3487 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 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

]]> By: Lucy http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3486 Lucy Mon, 30 Jan 2012 06:06:00 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3486 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 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

]]> By: Dave Allamby http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3410 Dave Allamby Tue, 17 Jan 2012 16:05:02 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3410 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” https://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 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

]]> By: Varshan http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3408 Varshan Tue, 17 Jan 2012 13:59:05 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3408 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 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

]]> By: Dave Allamby http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3406 Dave Allamby Tue, 17 Jan 2012 09:47:46 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3406 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 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

]]> By: Dave Allamby http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3405 Dave Allamby Tue, 17 Jan 2012 09:18:20 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3405 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 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

]]> By: Varshan http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3400 Varshan Mon, 16 Jan 2012 20:24:04 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3400 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. 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.

]]> By: brian http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3397 brian Mon, 16 Jan 2012 14:20:51 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3397 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 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

]]> By: Dave Allamby http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3369 Dave Allamby Sat, 14 Jan 2012 16:40:11 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3369 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 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

]]> By: Brian G http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3365 Brian G Fri, 13 Jan 2012 19:06:13 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3365 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 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

]]> By: Dave Allamby http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3326 Dave Allamby Mon, 09 Jan 2012 17:17:54 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3326 Hi Kieran. Can take 3 months to fully settle so still time. Of course, -8.00 with astigmatism is a very large prescription, so -0.50 is not greatly off, esp if the other eye is even better. Wait until the 3 month point and discuss with your treating surgeon. You have to balance the risks of an enhancement (flap lift plus excimer) agains the benefit gained from a monocular -0.50 when binocular vision is (presumably) very good. Again, all to be discussed with your surgeon. Regards, Dave Hi Kieran. Can take 3 months to fully settle so still time. Of course, -8.00 with astigmatism is a very large prescription, so -0.50 is not greatly off, esp if the other eye is even better. Wait until the 3 month point and discuss with your treating surgeon. You have to balance the risks of an enhancement (flap lift plus excimer) agains the benefit gained from a monocular -0.50 when binocular vision is (presumably) very good. Again, all to be discussed with your surgeon.
Regards, Dave

]]> By: Dave Allamby http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3319 Dave Allamby Sun, 08 Jan 2012 23:31:47 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3319 Hi Kieran, Its quite soon at 4 weeks following LASIK for such a high prescription and it may all settle over the next two months. Wait and see, and then discuss with your treating surgeon for more advice at the post-op 3 month mark. An enhancement procedure may be offered if the benefits outweigh the risks, assuming there is sufficient tissue remaining to carry out an extra ablation. Best regards Dave Hi Kieran, Its quite soon at 4 weeks following LASIK for such a high prescription and it may all settle over the next two months. Wait and see, and then discuss with your treating surgeon for more advice at the post-op 3 month mark. An enhancement procedure may be offered if the benefits outweigh the risks, assuming there is sufficient tissue remaining to carry out an extra ablation.

Best regards
Dave

]]> By: Kieran http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3318 Kieran Sun, 08 Jan 2012 22:22:34 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3318 Hi Dave I had lasik done four weeks ago and I was -8 in both eyes with some astigmatism. I can function without glasses now but ideally I would like the vision to be sharper and at my one month checkup I was told there was still a -50 left. Is my eye sight likely to improve further and if not what options di I have in the future. Hi Dave
I had lasik done four weeks ago and I was -8 in both eyes with some astigmatism. I can function without glasses now but ideally I would like the vision to be sharper and at my one month checkup I was told there was still a -50 left. Is my eye sight likely to improve further and if not what options di I have in the future.

]]> By: Dave Allamby http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3311 Dave Allamby Sun, 08 Jan 2012 11:42:02 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3311 hi RJ, Any pain is not linked to striae so no need to lift the flap. Much more likely linked to dryness as your surgeons says - follow the advice for treating that. Flaxseed oil supplements can help, taking 2-4g of oil as capsules with food for 6 months. Takes around 2 months to see the benefit. Regards, Dave hi RJ, Any pain is not linked to striae so no need to lift the flap. Much more likely linked to dryness as your surgeons says – follow the advice for treating that. Flaxseed oil supplements can help, taking 2-4g of oil as capsules with food for 6 months. Takes around 2 months to see the benefit. Regards, Dave

]]> By: RJ http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/comment-page-1/#comment-3296 RJ Fri, 06 Jan 2012 17:35:16 +0000 http://lasik-truth.com/lasik-laser-eye-surgery/safety-note-does-the-lasik-flap-ever-heal-2/#comment-3296 Hi, i had Lasik 6 months ago and i now see perfect 20/20. However i have a slight straie in my right eye and there is an annoying pain in that eye. Would relifting the flap and having it cleaned and ironed out help reduce the pain. Or is it not worth the risk? My Surgeon claims the pain is dryness but it feels like their is debri under my cornea that needs to be cleaned out. Hi, i had Lasik 6 months ago and i now see perfect 20/20. However i have a slight straie in my right eye and there is an annoying pain in that eye. Would relifting the flap and having it cleaned and ironed out help reduce the pain. Or is it not worth the risk? My Surgeon claims the pain is dryness but it feels like their is debri under my cornea that needs to be cleaned out.

]]>