I have had successful RK and 8 years later fairly successful lasik all in my dominant eye for distance. One feature of my eyes is that I have an atypical optic nerve opening/"deep cupping." Since the lasik, I have good daytime vision, nearly 20/20 some days but my visual acuity changes almost daily. Typically, when I squint,
my visual acuity improves. Question: Is there a reasonably good chance that a wavefront technology
enhancement can help my vision to stabilize and improve further?

Your optic nerves have no relation to your fluctuating vision. It sounds like you are describing a situation where your eye has residual refractive error, and if you wore glasses or contacts (as well as squint), the vision improves. If this is the case, you may want to consider a pair of glasses for driving at night or other activities.
If you have irregular astigmatism or other problems that do not improve with glasses, then either hard contacts or possibly wavefront may be helpful. It is impossible to know for sure without examining your eyes.

Best of luck

Bill Trattler, MD
Miami, FL

Thank you Dr. Trattler. As always, I really appreciate your help and all that you give to this
valuable website. Joe

If I understand you correctly, you had RK and years later had LASIK in same eye. Most likely you do have some residual astigmatism. At EmoryVision we are recommending people in this situation to wait for wavefront technology. We are hoping to have it available by this summer.

Dr. Corwin,
Please excuse my delay in responding. I certainly appreciate your letting me know this. I have heard some excellent things about the Emory program. I plan to contact your office to get more information about the possibility of having wavefront done this summer at your clinic. If possible, perhaps you could let me know the type of wavefront equipment you expect to have. Others reading this may also wish to know about it. Thank you again.
Joe

The subject of wavefront is fairly complex so I won't attempt to cover it here. However, simply put it is a way to extremely precisely determine the exact refractive power of the entire eye as opposed to an "average" which is what we use when determining an eyeglass prescription. It will enable us to customize the laser portion of the LASIK for you as opposed to what we do now i.e. everyone with the refraction -3.00 gets the exact same excimer laser treatment. For people with irregular astigmatism which is what many people have after RK, we feel it will give you a better visual result than current LASIK methods. Most of the laser companies are using developing slightly different technologies to achieve the same results (patent battles and all). At EmoryVision we are working closely with Nidek on their wavefront program. Independently with a group of researchers at Harvard we are working on a wavefront instrument which we hope can be used with any brand of laser. Interestingly most of the wavefront analysis is based on research originally done by astronomers to more clearly see details of individual stars many light years away.

Dr. Corwin,
Thank you explaining this. This information is very helpful. I imagine that others who are reading this site will find it useful as well. I do plan to contact your office and am hopeful that
you will find me a good candidate for treatment.
Best wishes,
Joe