Julie asked:

Dear Dave, I am about to get an enhancement surgery since my eye changed to -1.0 after just 10 months. I got the flap cut with the laser. I see that this type of cut heels quickly and I know doctor will not be using the cutting laser again, so how is he going to lift the flap? I’m terrified and thinking that I will be better off wearing glasses again. What do you think?  Thank you

Hi Julie
We lift flaps manually, using a special instrument designed for lifting, which is usually a fairly simple process. It should be possible to lift a femtosecond flap at 10 months, but you wont know until it is tried. I had one patient that proved impossible to lift after 6 months, but that was unusual. You could opt for PRK enhancement with mitomycin, but I would opt normally to lift the flap first. You can discuss this with your surgeon before going ahead.
We are now hitting 100% for patients seeing 20/20 or better at my clinic, Focus, so enhancements are getting increasingly rare. If they do happen, it is usually for patients with very high myopia.
Best regards, Dave

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Trudi asked

Hello Dave,
I had my eyes lasered in Dec 2009. My prescription was SPH -4.50 & -5.00. My left eye (which had the worst prescription) is perfect! I have had enhancement surgery on my right though as a slight astigmatism remained. I had enhancement surgery (using the LASEK method this time round) 4 wks ago and the vision is not yet as good as it was after the first surgery, before the enhancement. I am beginning to think I should have lived with the result I had after the first surgery and been grateful. Do you think my eye will heal to at least what it was after the first surgery?

Also, I have regular post-op check-ups with various different opticians (dependant on who’s in on the day of my app) and each tells a different story about healing and drops. I have been told that keeping the eyes wet with blink drops is *very important* to aid healing. I have also been told by another optician that I only need to put drops in when my eye feels dry. What is your view?
Thanks.

Trudi, for the lubrication, I would recommend regular instillation rather than just when they feel dry. The nerves are lasered during the treatment and see the eye is somewhat insensitive for a while, so you may not be aware of some dryness and so not lubricate. Aim for 4-6 times a day over the next couple of months. I prefer the preservative free version (you can buy e.g. Blink or Refresh over the counter at Boots) which will be less irritant with regular usage over an extended period. These are the ones in individual droppers. One vial should last you a day, one drop in each eye every 3-4 hours.

For surface laser correction (PRK/LASEK) the full result can take months to fully settle and the vision is often a bit off at 4 weeks post-op. You should find it will settle more over the next 4-8 weeks.

This is a common question about laser eye surgery safety I get asked by patients:

What happens if my vision isn’t right after treatment?

Most people don’t realise that the effect of laser eye surgery, including LASIK, LASEK and PRK procedures, CAN be fully reversed.

Although this isn’t necessary because if the prescription for glasses hasn’t been fully corrected then a second treatment is easily performed to fix that and stay free from the need for glasses or contact lenses. If the effect of the laser correction is a bit too strong or too weak, we call this an over-correction or an under-correction respectively.

All over- and under-corrections can be treated easily. In fact, as I mentioned, the whole laser eye treatment can be reversed. The move over to the Ziemer blade free system (Z-LASIK) has dramatically reduced the need to re-do LASIK treatments.

Most clinics quote enhancement rates of around 5%.  BUT with Z-LASIK for short-sight I have only had to adjust one case in the last 200, so that’s a 0.5% rate. Without any hype or spin, that’s just very impressive and a great step forward.

To fully reverse the effect of e.g. a short-sighted laser eye treatment, we remove some tissue from the outer part of the cornea to put the corneal curvature back to where it started. So now an equal amount of tissue has been removed across the cornea and so the focus would be back where it started. Of course, the cornea is a little thinner than before, but still strong enough for its role.

It’s the accuracy of the dual laser approach that allows such a very low enhancement rate, which means 99.5% of short-sighted patients are on target and very happy with only one treatment and without the need for a top-up.