I had Lasik surgery on my right eye 7 months ago. Immediately following the surgery, I developed a central island. Prior to surgery I was a -7.0. I was treated with the Summit laser.

I am happy to say that the island has now completely resolved. I am left, however, with -1.25 of nearsigntedness in the right eye.

My surgeon would now like to do an enhancement. I have a few questions:

1. What are the chances that I will develop another central island?

2. I have heard that the Summit laser is more likely to cause central islands. I discussed this with my surgeon and he feels that the Summit laser is excellent and I shouldn't have any problems. Should I still be concerned about the Summit?

3. Is 7 months to long to wait to have an enhancement? Is it too risky at this point?

Thanks!!

maggie,

i routinely use the summit laser and have excellent results. if the new correction definitely gives a noticeable improvement in your vision, i would go for it. 7 months is a perfect time for re treatment, as long as the vision is no longer fluctuating. there are even reports of lifting a flap as long as 5 years after surgery.

the most important key to retreatment is that you agree and want the improvement in your vision.also, make sure that the doctor demonstrates for you the change in your near vision after the retreatment.

good luck

debra tennen, md
los angeles, ca

A Dr. Horn at http://www.chicagolasercenter.com/cgi-bin/lasik.pl has said publicly that the Summit laser is more frequently implicated in central islands than the Visx Star S2 or tracking lasers.

Additionally, doctors using Summit are in the minority these days. I wouldn't have a surgery done on one.

You mentioned in a response post to an individual concerning LASIK surgery that you use the Summit machine in your practice. Do you use Visx at all? If not, why Summit and not Visx?

As an individual considering LASIK surgery and a Certified Financial Planner (CFP), I have to wonder why the stock of Visx has outpaced that of Summit! Thank you for your response.

Mark Carruthers

VISX stock has sky rocketed because (from what the Motley Fool and others have said) they have about 80% of the U.S. market. VISX and Summit collect a royalty fee of $260 per eye, so VISX is collecting more revenue - making their stock jump over the last 6 months.
Summit Stock has also more than doubled since January, especially since they have combined with autonomous (another laser company).
I personally use only the VISX, which is an extremely versatile machine. However, as Dr.Tennen has pointed out previously, the Summit laser also provides excellent results. I have not heard that central islands with LASIK are more of a problem with Summit than the VISX. In fact, an ophthalmologist who lives in New York City had LASIK performed on his eyes 4 months ago - with the Summit.
I think the most important aspect with LASIK surgery is to find an excellent surgeon in your city who you feel comfortable with and who is experienced. Every surgeon will use different equipment (lasers, microkeratomes, etc) and even vary their techniques slightly. The key is to find a surgeon who you feel comfortable with.
I hope some of the doctors on this board who use the Summit laser can comment specifically on their laser preference. I know I have been thrilled with how well the VISX works (and my wife who was previously -6.50 in both eyes can confirm the excellence of the VISX machine. Since she had laser surgery with the VISX in January 1998 she has had 20/15 vision inb both eyes)

Best of luck

Bill Trattler, MD
Miami, FL

I agree with Dr. Trattler's comments. I have used both and currently use the VISX laser. However, when I was using the Summit, I was very pleased with it's performance. I would like to comment on the issue of experience. While there is definately a learning curve for this surgery, I personally feel that the learning curve is a short and limited one. From a technical point of view, I think cataract surgery is much more challenging from a technical surgeon's point of view than is LASIK. Quite frankly, it is quite easy to do, assuming no complications during surgery. There are occasional comments on this board regarding finding a surgeon with lots of experience. I don't think that is as important as finding one who you are comfortable with. 95% of the success of this operation is due to the preoperative counseling and postoperative counseling given to patients. As evidenced by the extensive requests by patients on this board for "counseling", I think it is important to find a doctor who will guide you through the process and answers your questions to your satisfaction. I remember one messages posted that said they were going to have surgery by Dr.X because the day he was there he was doing 50 of them. Quite, frankly, I don't think that is as important as the issues noted above.

i have been using the summit laser since acting as the medical director for the ucla laser vision centers, in 1996, when the decision at several major universities was to buy summit lasers. the statistical results between summit and visx are directly comparable, and not significantly different. as i have repeatedly said, i achieve excellent results with my laser- a summit apex plus- i feel this is because i understand how to use the machine, and do not have twenty different surgeons using the equipment.

as for central islands, they are in fact a very rare occurence at this time. early on in our prk experience, when these islands were first seen, visx added a correction for islands into the laser computer program. also changes were made about whether to use suction to suck away the plume of tissue being emanated by the laser energy. because summit was approved by the fda, changes could not be made without approval, and we surgeons began compensating for the islands on our own. the computer changes have since been made on the summit unit as well. islands are therefore extremely rare on either machine.

as someone else mentioned, i would feel more comfortable with a doctor who has given good pre and post operative conseling than with the doctor doing fifty cases in a day. i would want someone who is being mindful and thoughtful of each specific case.

okay- enough for one day!

debra tennen md

Dr. Tennen,

Thanks for your comments about central islands and the Summit laser. You mentioned that central islands are very rare. I had my surgery done by an experienced LASIK surgeon and ended up with central islands in both eyes. (The surgery was done bilaterally and with the Summit laser).

Needless to say, it has been a very distressing situation. Could there have been anything specific about my corneas that predisposed me to central islands? Would I most likely have had the same result with a different laser?

maggie-

no one know for sure if the it's the cornea or the laser or the combination that presidposes patients to this problem.

the good news is that they tend to resolve in the majority of patients- although it may take a year, so be patient. and if no resolution occurs, there are treatments to use the laser to flatten out the island and smooth the surface.

good luck

debra tennen md

Dr. Tannen: What do you mean by lifting the flap after 5 years? Does this mean that the flap does not reattach itself permanently? I'm interested in waterskiing again and I'm concerned with the flap coming loose as a result of water spray or a hard fall. Please elaborate...

Randall,
Over the course of many weeks after LASIK, the flap seals very tightly. However, eye surgeons can surgically find the previous plane between the flap and the normal cornea. Therefore, eye surgeons can lift the flap after many months to even many years after LASIK.
With a severe eye injury, it is possible that you could injure the flap many months to years after LASIK. But the injury would have to be very violent and just in the right spot, as the flap adheres tightly.

I hope this helps answer your question about LASIK
enhancements and flap adherance

Bill Trattler, MD
Miami, FL

Maggie, I am not a doctor, and I would value the statements made above by doctors if I were you.

But, this is a bulletin board, so I'll throw in my 2 cents. When I researched LASIK prior to my surgery, I found that the Summit is not as respected as the Visx or Nidek lasers. This may very well be because the majority of the doctors use the Visx (which of course translates into more patients operated on by a Visx laser). I personally chose a doctor who uses the Nidek EC5000, which seems to be a newer model, at least in the U.S, and it seemed to produce great results. The perception I found was the Summit was an "older model", the Visx the "newer model", and Nidek the "new and improved model". Again, not a scientific analysis, but I spent A LOT of time on my research.

With the above being said, I agree with what has already been written: the choice of a surgeon should be a priority. Find one who you trust and who is respected.

Also, if I was at -1.25 I would have an enhancement. My eyes were -1.75 and -2.25 before surgery. I am 20/16 after, and a walking commercial for the procedure and my surgeon. Good luck, keep researching and make an informed decision.

Kurt,
I would definitely disagree with you - in particular your comment that the Nidek is the new and improved model. As a VISX laser owner, I have found the VISX machine to be extremely versatile. In particular, VISX continues to make quarterly to semi-annual changes in the software, which has continually improved the overall results with this machine.
The latest upgrade has allowed the surgeon to select a tratment diameter of up to 6.5 mm (compared to 6.0 mm previously). This mild change to the software has been shown to decrease the risk of developing halos and other night time effects after LASIK.

Bill Trattler, MD
Miami, FL

Dr. Trattler, as I stated in my post, I am not a doctor and the opinions of experienced surgeons such as yourself should be valued more than my 2 cents' worth.

I know people who have had surgery via the Visx laser and they are happy with the results, just as I am with my Nidek results. I have also been told by surgeons that the Visx has had continual improvements, whereas I was told that the Summit had not had as many improvements.

I value your opinion and respect the amount of time and effort you put into this bulletin board and other posts I have seen attributed to you.