I saw my surgeon yesterday, she thinks since my eyes were more hydrated than others, it caused the laser to take less tissue than planned and that is why I still have a refractive error in both eyes (-2.00). The refractive error is generally the same now in both eyes vs. prior to Lasik (L-8 R-9). Is this truly possible? That your eyes can be 'too' hydrated and cause less tissue than planned to be removed, hence leaving more tissue behind for an enhancement?

Thank you for your insights.

First - there is always a chance we can end up over or under corrected with any procedure. Since the laser was programmed properly, one explanation is that as the laser treated - the cornea was a little too hydrated. As the laser is removed corneal cells, if things are a little wetter, some of the energy is used up removed excess fluid.
On the other hand - when we get over-corrections - the theory in some cases is that things were a little dryer than normal.
That is why we carefully control the temperature and humidity in our laser operating suites.

I hope this helps answer your question

William Trattler, MD
Miami, FL

Thank you for responding to my question. You mentioned controlling the environment of the laser.....I would say that the room the surgery was performed in was cold (the center is in Savannah, GA). Could my problem be due to the laser environment itself, or would you say it indeed had to do with the amount of tears/hydration of my eyes at the time of the procedure? If I get an enhancement, this could then happen again? My being under-corrected or God forbid, over-corrected? In your professional practice, how many times have you seen a flap dislodged and how were they dislodged?

In my experience - enhancements work very well. And typically the treatment is much less than the original treatment, so the results are even tighter (remember that the higher the treatment, the higher the chance of being slightly off.) So again for my patients, their results with enhancements are typically very good.

As far as flap dislocations - fortunately they are uncommon. One of the doctors who I have lectured with reported that the US military at least 10 flap dislocations through 2003. But I do not have a more recent number. I would say that they are fortunately uncommon.

I hope this helps

Bill Trattler, MD
Miami, FL

Again, thank you for your response. I'd be interested to know if the number of dislocations in 2003 had anything to do with the increased operations tempo the Military is experiencing. Also, I am sure more Military members have had the surgery, to avoid the hassle of contacts/glasses in a combat environment. I was actually surprised to learn that the Military performed Lasik. I would think they would choose to lean towards Lasek or some other form of correction, because of the possibility of flap complications, etc.

It does indeed make sense that an enhancement could be 'tighter', and therefore achieve the best corrected vision possible. I was a -8L -9R, so that could explain some of my vision disturbance, since more treatment can lead to being slightly off, as you stated. Can a custom enhancement be performed to treat any other issues that aren't usually corrected with glasses?

Thank you, again, for your time, effort and for creating this forum.

The vast majority of refractive surgery cases are surface abaltion procedures (PRK and LASEK). I believe the number is close to 85 percent (as reported at the LASEK Congress in 2005).
The flap dislocations occured in varied parts of the world in all types of situations.
I don't quite understand your second part of your question.

Best regards

Bill Trattler, MD
Miami, FL