I am a 41 year old Family Physician and had lasik performed 6 mo ago with fantastic results. My sister, unfortunately, had O.U. lasik on Jan 4, 2000 and has distorted vision secondary to complications from striae. She was initially -12.5 O.D. and -11.5 O.S. She is now +.75 O.U. and seeing about 20/70 O.U. Her surgeon in Lincoln, NE has suggested lifting the flaps now and using "some sort of solution" (my sister didn't know the name of it) in hopes of getting a smoother flap. Is this a resonable approach? What are her options at this point? Are the development of stria a "surgeon dependent" phenomena? Should I suggest to her that she be seen at a research center or eye institute (I am most familiar with Philips in Minneapolis)? I would appreciate any insight you might have for my sister's sake. Thanks!

Wrinkles or striae are more common in higher levels of myopia, but the risk of having them is in general pretty low. You can say they are surgeon dependent - in that some surgeons may be better at preventing them than others. A research institute does not necessarily mean that they are bettter at LASIK, although Dr. Chu (formally of Phillips eye institute) is an excellent surgeon and has lots of experience.
To remove wrinkles, the approaches vary, but in general the flap is lifted and H20 (water without sodium) is placed on the undersurface of the flap - which causes the flap to swell. This can help elimiante the wrinkles. Some doctors will also scrape off the epithelial surface in case the epithelium has locked in the wrinkles.
Approaches vary, and your best bet is to give the doctor a call and find out their expereince

I hoep this helps

Bill Trattler, MD
Miami, FL

I think he was referring to "hypotonic" solution.
I've had striae since my lasik in Sept. 99. I have been referred to Dr. Robert Maloney by many sources, and saw him two days ago. He is very confident that he can remove my striae. I've been chomping at the bit with my surgeon, because he won't do anything for me--wants me to wait six months to see if the wrinkles go away on their own. From everything I've read, they don't, and mine haven't.

This is for Ratty -

Did you have any luck with Dr. Robert Maloney?

Wrinkles do not go away on their own, they only get more permanent. Not only does the flap have memory, but the wrinkles are imprinted on the stromal bed of the cornea like sheet wrinkles on your body. Removing them, especially this late seems like it would be quite a feat.

I have striae in my left eye and we decided against trying to correct it because it was discovered at my one-month exam, and my uncorrected vision in that eye was 20/25. I was told by my surgeon, my OD, and Dr. Trattler that the chances of getting the striae out and making it stay out were slim, and disturbing them might actually decreased my vision in that eye if it didn't work. If my vision had fallen to 20/40 or below, then the risk would be more in line with the potential benefit. So, talk it over with the doctor carefully. (Should I be assuming Dr. Maloney is not the doctor who performed your LASIK?)

Knowing what I know now about striae, I'm really surprised that your surgeon didn't jump on it immediately. I would almost call the inaction by the dreaded "M" word. It's one thing if they weren't found right away, it's another if there were found but ignored. To be fair, I had light striae in my right eye as well and it did resolve itself some time between my one-month and three-month exams. But I was told it was amazingly rare.

Dr. Maloney was not my original surgeon. Multiple attempts to remove the wrinkles have been unsuccessful.

I'm sorry to hear that. How badly is your vision compromised? If the hypotonic procedure doesn't work, you might ask Dr. Maloney about a hyperthermal technique I've heard mentioned. That is where they almost literally iron out the striae with heat. It's investigational, but if the striae really interferes it seems there's not so much to lose unless they all want money. (I'd be sending the bills to the original surgeon.)

Did you ever have your flap sutured? Suturing can be very effective at removing flap striae/wrinkles - although the procedure is more effective the more recent the surgery

Bill Trattler, MD
Miami, FL

I didn't have that done. I was told that there was a risk of inducing more astigmatism. It's probably been too long now. I don't feel like being a guinea pig anymore and risking the thermal collagenoplasty while it's still so new.