I am wondering if I am a candidate for Lasik. I had a botched RK
about six years ago on my left eye. I went from -7 to +7. I then had two
surgeries where they opened up some of the cuts and then sewed them up.
Now I am +.5 with a fixed astigmatism +222 axis 30. The pupil is 4mm size.
Corneal thickness is 560. I do alot of fine work through a bronchoscope
and have lost my depth perception. I see about 20/50 and cannot correct
to 20/20 with glasses in this eye.
My right eye is -7.75 +.5 x175. Pupil is 4 mm in a dim room.
Corneal thickness is 539.Steepness of 44. During a recent evaluation for
Lasik,
the ophthalmologist noticed gutae on both cornea. There were just a few.
Now I find out an uncle had Fuques.Would this be a problem with Lasik?
Thank you very much.
Greg Shay MD
Pediatric Pulmonology
Oakland, CA

Dr. Shay,

You certainly have a complciated history. Lets address the right eye first. LASIK has been found to be pretty effective following RK, although I have not performed LASIK on a patient who had previous RK who now is a -7.75. I would think that you could have LASIK, but I know the person I would want to see in San Francisco is Edward Manche, MD at Stanford, who lectures all over the world and may be able to better evaluate your eye. He has performed many thousands of LASIKs and lectures through out the U.S.'
As for your left eye- it sounds pretty complicated, and would be best for an experienced cornea specialist/LASIK surgeon to evaluate your eye

please let me know how things turn out

Best of luck

Bill Trattler, MD
Miami, FL

Greg:

The quick answer is "yes" you are a potential candidate for LASIK in the RK eye, but the more important question is "should it be done?"

While I have done LASIK in RK eyes, I only do this with well-done RKs and well-healed corneas. It sounds to me like you are NOT in this category: "botched RK", "two surgeries where they opened up some of the cuts and then sewed them up"and "cannot correct to 20/20 with glasses in this eye".

Also, if your refraction is +0.50 +2.22 x30 then your major problem is hyperopic astigmatism which is not approved for treatment in the US at this time.

Your problem with depth perception may be improved by considering LASIK in your non-RK eye and restoring some balance between the two eyes. Of course you must then be comfortable having someone operate on your GOOD eye. Think about this carefully and discuss it with your surgeon at length!

Your corneal thickness and steepness are not a problem. You probably have Fuchs' dystrophy based on the finding of gutattae and a family history. As long as your gutattae are more than 1+ (my grading system (trace <1/2 <1+ <2+ <3+ <4+) I would not be concerned.

Hope this helps!

Gary A. Varley, M.D.
Cincinnati Eye Institute

greg,

well, my friend, you have been through a lot with your vision. my advice is to stay away from any further surgery and attempt visual improvment with rigid gas permeable lenses.

first, your left eye is not correctable to 20/20, and has had an unpredictable response to previous rk surgery. that tells me to be careful, and be thankful for what's left.

your right eye, by numbers would be a good candidate for lasik, but when you throw in the fuch's dystrophy....yikes. why risk the best vision you have just for the convenience of no glasses.

i love operating, and think lasik is an incredible procedure, however, i'm wondering if your questions are put in to test the integrity of these physicians...i love happy patients more than i love operating, and i would not wan to see you have any further damage to your vision.

sorry for the harsh words; just my opinion!

debra tennen, md