Comments on: SAFETY NOTE: Does the LASIK flap ever heal?

By: Dave Allamby

Dave Allamby — Tue, 10 Apr 2012 22:25:29 +0000

hi Olly. Your eyes are still settling and much too soon to say how the final vision will be. If though it was good on day one, it will often end up very good. Flap dislocation is very rare and should not be worried about. Certainly a LASEK touch up is possible but you will most likely be fine.
Regards
David

By: Olly

Olly — Sun, 08 Apr 2012 18:35:13 +0000

Hi Dr. Allamby,
I have just had intralase lasik with wavefront (4 days ago) and am slightly concerned that the day after the procedure I could see slightly better then I can now.
Is this normal? hopefully I am just over worrying! In some ways I wish I had had lasek, as I am now worried about flap dislocation with my career in the building trade. I don’t think I could stomach another ‘touch up’ procedure wiith lasik as t would worry me disturbing the flap again, Is it possible to have lasek if it is necessary?

Many thanks,
Olly

By: David

David — Sat, 17 Mar 2012 02:20:04 +0000

Hello Dave, I have a question to ask.

I had lasik on Feb 28th. Today its day 18.

I had Lasik and the flap was created with the blade and my prescription was 3.50 astigmatism and 1.5 myopi on both eyes.

I am having night vision issues, mostly regarding to starbursts and glares. Both occur even under daylight but are minor (sun reflecting on cars and glare when looking at windows/doors). When I watch TV and there are white subtitles on a back background they are ‘shadowed’. Is there any chance that this will diminish over time?

Another question… since day 16 I have noticed that the starbursts/glare on my right eye are getting worse, I went to my doc and he said that my eyes were overreacting to the procedure and he could find minor scars that are probably causing these problems(the new and the old regarding night vision).
He said that if the scar grows until the 30 day appointment we will need to discuss other options, but he didn’t sound happy about that. What can be done if it gets worse?

Another question, when is it ‘safe’ to rub my eyes? On day 15 I woke up rubbing my eyes which got me really worried, but on the appointment with the doc he said everything but the scars were ok…

Thanks a lot, your site is very helpful, I wish I could have read it before the surgery…

By: Dave Allamby

Dave Allamby — Thu, 15 Mar 2012 15:51:48 +0000

hi Myopic. You have good corneal thickness at 557 and 560, slightly above average, so that is in your favour. However, the risk for a weakened cornea is more linked to the appearance on a combined set of corneal image scans, such as a Pentacam scanner provides. These scanners also provide statistical analysis of your risk for weakness, such as keratoconus. This is more important, to have a Pentacam or similar quality scan, rather than Intralase vs blade.
Regards, David

By: Myopic

Myopic — Tue, 06 Mar 2012 04:08:25 +0000

I have -3.00 (both eyes) myopia with -1.00 astigmatism in left eye. Corneal thickness: 557(Right) & 560(Left). Is my cornea too thin for having traditional Lasik? No intralase option in my area. Will I suffer serious complication like corneal ectasia in future due to less corneal thickness after Lasik? Please Dr. I need honest answer. Its a matter of eyes. I am very tensed.

By: Lisa

Lisa — Wed, 29 Feb 2012 17:54:51 +0000

Hi Dr. Allamby,

I just found this site and am so appreciative of you taking time to carefully answers all of our questions. I am planning to have LASIK surgery in the next week and some of the reports and site I have seen online have got me scared to let anyone touch my precious eyes. I read through all of your posts and great knowledge, yet I still have a stream of questions that I plan to cover with my eye clinic here in Tallahassee, Florida but I wanted to shoot several of these your way as well. Hope you will help, thanks so much in advance.

1. does LASIK require lifelong post-op vigliance by patient and doctor?

2. do steroids help or eliminate the common side effects of halos, dry eye, poor night vision, and light sensitivity?

3. one advantage of wearing glasses is that I can always rub my eye when it itches, or when I awake…will I be able to still do that after LASIK?

4. I read that the LASIK flap creates a permanent portal in the cornea for microorganisms to penetrate, causing lifelong increased risk of sight-threatening corneal infections…this scares me a lot!

5. can steroid drops used after LASIK hasten the onset of cataracts?

6. the FDA website says having LASIK on both eyes at the same time is riskier than having two separate surgies, do you agree?

7. does my occupation as an accountant, staring at small numbers on a computer screen most 8 hours each day mean I may not be a good candidate for LASIK?

8. what is a floater?

9. should I take the day of and day after surgery off from my accounting job?

10. is blood floating in the eye common after LASIK?

11. what if I get sand in my eye (beach volleyball) or an eyelash in my eye after LASIK, can I touch my eyeball or flush my eye with water to get out the sand or eyelash? (that is what I currently do, performing the former usually).

Thank you Doctor for indulging my questions.

By: Marlene

Marlene — Sat, 11 Feb 2012 00:37:41 +0000

Dear Dr. Allamby, I am hoping you have some insight for a post-op symptom I have developed. 8 days ago I had intralase lasik on both eyes, with a correction on OD of -7.00D and -1.00D and OS -6.75D and -0.75D. I had a corneal thickness of about 600um and a flap of 110 was created. Maxidex steroid was used (one drop every 2 hours for first 24hours and then 4 times per day x5 days; Vigamox antibiotic 4 times per day x5 days, and Bion Tears continously). At 4 days post-op I began to experience a strange sensation with my right eye. I have a cold sensation on my eye, but more so on my eyelid and close to my brow, and in the inner corner near my nose. Its a constant feeling of cold or a cool draft in that area. I am wondering what may cause this sensation, what is it due to (maybe nerve damage, a problem with the tear ducts and glands, use of the steroid??) It seems to be less in the morning when I wake up but progresses throughout the day, being worst in afternoons and evenings. Sometimes it even alternates to a burning/stinging sensation. Is this a normal symptom? Will is pass with time? Is it permanent? I could use your expert knowledge with this matter. I have not even been able to fully enjoy my new vision due to this frustration..

Looking forward to your reply,
Marlene

By: Lucy

Lucy — Tue, 31 Jan 2012 05:03:39 +0000

Dr. Allamby, it’s me Lucy again. I forgot to mention previously that I seem to have what I think might be floaters while looking at my white computer screen, and sometimes little stars for very short periods of time when I get up or sit quickly. I know this has something to do with retina. I recently had a dilated exam for pre-lasik, and my opthamologist didn’t say anything was wrong. What could this be, is it normal (maybe because I’m -8)? and do these pre-op symptoms pose any threats for Lasik surgery?

Thanks for your knowledge and expertise!

Lucy

By: Lucy

Lucy — Mon, 30 Jan 2012 22:09:19 +0000

Thanks David! I will contact my surgeon for further clarification about my particular case.
Regards,
Lucy

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

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

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

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

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

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