I had Lasik 2 years ago for very high myopia. I went for an enhancement on my left eye last week. My surgeon thought he could lift the flap for the enhancement even though it had been 2 years since the original procedure. After trying to lift the flap he found that I had healed so well that he wasn't able to do it. He sent me home to heal and said he would then cut a new flap and do the enhancement. My question is how long should I wait to go back for him to cut a new flap and do the enhancement? I'd really appreciate to hear from any of the doctors. Thanks much.

The top doctor at Emory Vision in Atlanta has said that he can easily lift flaps and has done so up to 7 years post lasik and that there is seldom a need to cut new flaps. It is possible that your doctor is inexperienced in lifting new techniques. Ask him. If he is going to cut a new flap the old flap should have healed at least 3-6 months.

Also make sure that your regression is not a symptom of ectasia. The safe residual base was at one time considered to be 200 microns but was then changed to 250 microns to definitely prevent ectasia. With reports of a handful of people having ectasia with a remaining bed of 400 microns and no signs of keratoconus prior to lasik, many doctors are rethinking the 250 residual bed and now making the minimum residual base at least 300 or 350 microns. Ask your doctor to review the posterior float provided by the orbscans to make sure you do not have a higher risk of ectasia.

I would agree that many experts feel that a flap can be lifted many years after the surgery. But the technique to lifting the flap is not simple, and thus I am sure that many doctors who have not had to perform many enhancements can have difficulty in lifting a 2 year old flap (for example).
The concern is that at the American Academy of Ophthalmology meeting, studies have been presented that show that the risk of a serious visual problem is much higher when cutting a flap. This is because recutting the flap can occasionally result in accidently slicing a sliver of the bottom of the flap. This can lead to significant irregular astigmatism. Lifting the flap does not have this additional risk.
If your surgeon is very experienced and you truly have a very well-healed flap, then you should difinitely weigh the risks versus the benefits of an enhancement - as there are serious risks (these also include infections, inflammation, over-correction, etc). So please discuss all of this information with your own doctor.

best of luck

Bill Trattler, MD
Miami, FL