I had my original Lasik procedure done on Sept. 7, 2005....I am currently using preservative-free artificial tears once per hour during the day...and an eye gel at bedtime.
My surgeon said that at the end of December, he could perform my enhancement procedure if I wish (my prescription has been stable for the past 2 months).
I mentioned to him that I was concerned about whether or not my dry eye symptoms after an enhancement would be worse than those immediately after the original procedure, since I would now be going into it with pre-existing dry eyes...he said he thinks that it should be the same as after the original procedure. I assume this means that I will simply be re-setting my healing clock so to speak...dryness and all...
Although I am happy with my surgeon, I think second opinions can't hurt...so am curious what the doctors on this board think...(just in case Restasis would be a suggestion, I'm from Canada and we don't have that here).

Just wondering if any of the Dr's have any comments/opinions on this...I don't intend to use your answers to go back to my surgeon and criticize his judgement or anything...but I figure if you guys agree with his assessment, then that gives me added peace of mind about this issue...and if you guys disagree, then it gives me extra information to mull over
Thanks in advance for any replies
:)

S.Sorry to hear that you may have to have an enhancement.I am not a Dr. so I can't answer your questions but I am curious to ask about the enhancement.Can you share the before/after stats for your vision?While this is not a medical opinion,I would think maybe allowing more healing time before an enhancement would be beneficial.You are just crossing the 3 months to 100 day mark since surgery and might benefit from waiting a bit.Let's ask others to jump in and hopefully get more informed opinions.Good luck.
charles

what was your pescription before lasik and whats it now? If its low enough, you will have very little dependancy on glasses

To answer your question Charles:
My pre-op rx was -5.00 in each eye (no astigmatism)
1 day post-op I was able to see 20/15 in each eye...it was fantastic!!...but over the first week I regressed a fair bit... :( This continued very gradually over the next while...but stabilized by my 1 mo. post-op appt.
Since my 1 mo. post-op appt., my rx has remained unchanged at -0.75 (left) and -1.5 (right)...still no astigmatism. At my 1 mo. appt. my surgeon was hopeful that my rx would turn around and improve...but I presume that since it has now remained completely the same over the last 2 months, he does not think it is likely that it will "bounce back", hence has said I can have the enhancement.

Although I am now able to function for MOST things without glasses, I still require them to meet the requirements for driving...It is my understanding that people's vision can change continously as they age...if my distance vision were to get even a tiny bit worse over the years, then I would be back to glasses for EVERYTHING... I would be terribly disapointed if that happens...soooo...I figure that if I have the enhancement, any subsequent regression after THAT procedure should be much less than after my first one...so hopefully I will then be able to enjoy many years without glasses for ANYTHING as a benefit from Lasik. (I'm only 29 years old now...so I don't expect to need reading glasses for many years hehe)

I'm still hopeing one of the Dr's will have a chance to answer my question :)

Dr. Trattler....since you deal a lot with dry eye patients...what has been your experience with patients similar to me? I've already scheduled my enhancement procedure for Jan 25...but figure the more I know about what to expect, the better :)

Dry eye needs to be under control before having an enhancement. Options for treatment includes:
Punctal plugs
Low dose topical steroids
Moisture goggles
Restasis (I know you can not get this in Canada, but it is something I would recommend if you were here in the US)
etc.

Best regards

Bill

I hope this doesn't sound silly, but define "under control"....
By using the artificial tears etc. as I mentioned in my original post, my eyes don't bother me at all...no burning, no redness or any other symptoms....so I suppose one could consider my dry eyes to be "under control" (contrast that to NOT using the drops, where I would definitly be experiencing irritation and redness etc...that would definitly NOT be under control hehe)....Is that what you meant by "under control"?

I would assume that is what you mean...but just double checking....
Again..I hope this doesn't sound like a ridiculous question hehe

Under control means that the dry eyes are not affecting your vision. So your doctor needs to examine you and determine the severity of your dryness. If everything is doing well, then you can consider additional surgery. But if your eyes still show signs of dryness - then you need to get the dryness under control - to a point where they are no longer affecting the eyes and affecting the quality of vision.

I hope I answered your question

Bill Trattler, MD
Miami, FL

"Since my 1 mo. post-op appt., my rx has remained unchanged at -0.75 (left) and -1.5 (right)...still no astigmatism."

If you decide to get an enhancement, do only one eye at a time starting with the -1.5. I would leave the -.75 alone as its too close to perfect and can overcorrect(famous quote) Its your -1.5 eye that probably doesnt meet the 20/40 required to drive. The -.75 should also help keep you out of reading glasses some time past 40 too.

Thank-you for the clarification Dr. Trattler.
I think all is well then...my dry eye is not affecting my vision, and as long as I use the moisturizing drops regularly my eyes feel fine.
:)
I think it's great to be able to ask questions of the doctors here...sometimes I forget to ask things at my appointment...or just want a second opinion for peace of mind...it's soooo helpful that you guys donate your time here!! I'd like to send a HUGE THANK-YOU to you guys!

In reply to Ace's point, I am going to go ahead with the enhancement to both eyes...I trust in the abilities of my surgeon...plus, even with the few second opinions I've asked for on this board, the answers have been very consistent with what my own surgeon has discussed with me....he has done thousands of these procedures...plus, his "aim" was good after the first procedure (20/15 the day after surgery)...so I think my odds are very good that I will be satisfied with the results of my enhancement. I considered leaving things alone, but since I am only 29, although my vision is quite stable, my eyes may get a little bit more myopic over the next decade or so anyways...so I think that the closer I am NOW to 20/20 the less chance of my needing ANY glasses at all (up until I need reading glasses in my 40's that is). I won't be able to get any further enhancements after this due to the limit on how much corneal tissue must remain...so I would rather enhance it now when the flap can be relifted as opposed to waiting a few years to see what happens, and then requiring a new flap to be cut. But everyone is different...my aim going into this was to get rid of my need for glasses COMPLETELY (except for reading glasses later on of course)...others may be happy with simply reducing that need.

Anyhow, thanks for the replies guys...I'll keep you all posted on how things go.
:)

just an update...
1 day post-enhancement (both eyes) I was able to read 20/15 on the eye chart.
My only adverse effects from the procedure (besides dry eye) were MAJOR foreign-body sensation in my left eye on the first day (that's gone now though), and I am still experiencing eye-strain...but I am confident that this will go away within a week or two, since I had the exact same thing after my original Lasik procedure.
My surgeon re-lifted the flap...and for me, this made the enhancement a breeze since there was no need for the suction ring (I really hated that part the first time hehe)...also, since no suction ring, my eyes areen't red and scratcy-feeling like after my original procedure.