Hi everyone! I'm not great at short stories...so please bear with me :) If you make it to the end of my post, thanks for taking the time to read it!
First, some background:
I'm 29 years old...I had Lasik done 1.5 months ago...the day after surgery, my eyes were 20/15...I could even make out a couple of letters on the 20/10 line...but at my 7 day post-op appt., I had regressed...this was confirmed at my 1 mo. post-op appt....fortunately, I am still able to be corrected to 20/20 vision easily (that thing they use to figure out what strength your glasses prescription is could focus my vision perfectly). My surgeon said that if at 3 mo., my vision has not improved, that I can consider getting an enhancement...however, he said it is best not to rush, as he has had some pt's who appear to require an enhancement at 3mo, no longer require it by 6 mo. I am leaning towards getting an enhancement if required....I figure if I have already permanently weakened my cornea by getting Lasik, then I want the benefit of being able to do EVERYTHING without glasses/contacts. If I still require glasses (not including reading glasses when I'm older), then that will be disapointing.

My prescription prior to Lasik was
RE: SPH -5.25
LE: SPH -5.25, CYL +0.25, AXIS 085

Question:
1) Any of you out there have your vision start out perfect one day post-op...then regress to the point where you legally need glasses to drive (altho are ok without them for everything else), and then luck out by improving to the point where you no longer legally require glasses to drive?
2) Any of you out there, with results similar to mine 1.5 mo. post-op, end up going through with an enhancement? Did it leave you free from glasses/contacts for everything? (including driving)
3) What # of enhancement procedures is considered being "experienced" at lifting flaps for enhancements? One of the many reasons I chose my surgeon was that he had done thousands of Lasik procedures...since he has done so many first time treatments, this may correlate with a high number of enhancement procedures over time (ie. practice makes perfect and all)...then again, maybe not...so when I ask him how often he lifts flaps in his practice, I would like to know what frequency would be considered "experienced".

For the surgeons that respond to posts on these boards:
1)Do you generally find it "easy" to lift flaps 6mo. or so post op, once you have experience with doing so?
2)If I decide that I am going to get an enhancement, I plan to make an appointment with an ophthamologist that does NOT do Lasik procedures...I will want him to take a look at my eyes to make sure that everything looks normal and healthy prior to going ahead with an enhancement procedure. Are there any specific exams/tests or questions that you feel I should ask him about?
3) What is the current theory on the long-term effects of lifting the flap for an enhancement? Assuming that my surgeon does an excellent job of it, how much worse off will my cornea be after going thru a second trauma like that? (ie. after the healing is complete, is it likely that the healing will be as good as if I had only had the first procedure and then stopped? or will it not heal as well because it has now been traumatized a second time?)

Does anyone have any links to videos of enhancement procedures being done? specifically, the actual lifting of the flap...

Great questions. First - enhancements are even easier than primary LASIK, because we do not need to make a cut - just lift the flap. Then once the flap is lifted, the rest of the procedure is identical to primary LASIK. I would generally recommend that patients stick with their primary surgeon when they end up needing an enhancement, since they will know you situation the best.
As well....starting off 20/15 and then regressing can occur. Sometimes, your vision can recover if you are agresive with treatment of any underlying dry eye. Ask your doctor whether Restasis, Oral Omega 3 Fatty Acid supplements, low dose steroids, or preservative free lubricating drops would be helpful.
I hope this helps

Bill Trattler, MD
Miami, FL

Thanks so much for the response! It is reassuring to hear that performing an enhancement is "easier" for the surgeon than the original surgery!
In regards to my lubricating drops regimen: I've been using Systane once per hour while at work (altho I had 1 or 2 really good days where I only seemed to need drops every 2 hours or so)...when I am home, I use Tears Naturale Free (preservative-free) once per hour or so....at bedtime I've been using Liposic (opth. gel)since my 1 mo. appt. My eyes feel quite comfortable overall with this regimen...at the slightest hint of a dry feeling, I use the drops (ie. about once per hr.)

Question:
1)Aside from potential irritation from the preservatives (which I don't seem to be experiencing so far...), is there any other advantage to switching to using ONLY preserv.-free drops? If using preserv.-free vs. multi-use bottles is likely to further aid in my healing, then I would be willing to switch...

2) regarding "low-dose steroids": are you referring to ophthalmic drops? or oral tabs?
If this is any help, to the naked eye, my eyes do not appear inflamed (no redness at all), and my surgeon hasn't mentioned noticing any complications...at my 1mo. appt. he seemed quite pleased with the healing of the flap so far (aside from the regression of course)...in what specific situation were you thinking that steroids could be beneficial? (I realize that situation may not apply to me...but was just wondering...)

3) In regard to omega-3 fatty acid supplements, is there a specific amount (dose) that is considered therapeutic? or has that not been studied yet?