I have a bunch of questions on microstriae and would greatly appreciate any feedback.

Background info:
I had Lasik surgery on April 6, 2000. My preop prescription was:
OD -2.25 -.75 x 075 20/20
OS -1.50 -1.50 x 100 20/20
My right eye turned out pretty good: 20/25. My left eye has microstriae on one side of my eye that are distorting my vision. Habitual distance va is 20/40- and best corrected va is 20/30-. My surgeon tried to remove the striae on June 8th.

He scraped of the surface cells over the striae. Then he lifted the portion of the flap with striae and put hypotonic solution under and on top of the flap. Then he made many even stroked across this area towards the outside of my eye with a sponge(?). He did this hypotonic solution/sponging technique four times before quitting. He had me wear a bandage lens for 2 days.

No wrinkled were visible the first two days. I believe this is because the abrasion caused by scraping of surface cells obscured view of the wrinkles. One week after this surgery the striae were visible but less pronounced then before. I see no noticeable improvement in my vision.

My Questions:
1. Given that striae become more difficult to remove with time, how long should I wait before having more surgery to try removing them?
2. What techniques are there other than the technique my surgeon used for removing old striae?
3. What techniques have you found to work best for older wrinkles?
4. I got a second opinion from a Lasik surgeon, and he believes an irregular astigmatism caused by microstriae is distorting my vision and did not believe an enhancement would help. My surgeon is in favor of an enhancement after my eye stabilizes. In fact he did not agree to try removing the striae until I got the second opinion from his friend. Is there a way of knowing for sure whether the microstriae are preventing me from seeing 20/20, or whether an enhancement could help by giving my farther correction?
5. How important is experience for successful removal of striae? From what I've read my surgeon used appropriate techniques. He has performed many Lasik surgeries, although he admitted he had little experience with old wrinkles.
6. My surgeon could not see the microstriae while he was working to remove them, so he could not tell while doing the procedure whether it was working. Is this common? Does it take very specific lighting and instruments to see striae and are these conditions that may not exist in an operating room?
7. If you were me, what would you ask your surgeon?

I realize I have asked a lot of questions - maybe too many for a bulletin board. Even if you respond just to one Q I will greatly appreciate it. Thanks.

Paula

Old stiae are, indeed, difficult to remove. I have very little experience with them because I always try to remove them asap after they are discovered if they are visually significant. I would perhaps try another round of lifting the flap with hypotonic saline, etc. Perhaps some more extensive "stretching" after the flap is replaced. Striae are impossible to see using the laser microscope. You can only see them using a "slit lamp", the light your doctor uses to look at your eye in his/her office. I have one right next to my laser so after we're done, the patient just sits in the next chair and I look at the flap. You are correct in noting that removing the front layer of the cornea (epithelium) during flap lifting would, indeed, make identification of striae more challenging. Good luck and let us know how things turn out.
Steven Ofner, M.D.
Eugene, Oregon
http://www.eugeneeyecare.com

Striae management is certainly a challenge, and experience certainly counts. It sounds like your surgeon, who may be fantastic, is not an expert at striae management. You therefore have a few options.
The first is to search out and find a surgeon in your area who is experienced at removing striae. A consulatation with this doctor may prove helpful.
A second option is to stick with your doctor. However, the last thing you want to do is have more laser treatment while you have striae - because it is the striae that are causing the visual distortion. Laser will not eliminate the distortion, and in fact may induce furthe irregulaties
the key is - remove the striae (if this is what is causing your visual distortion problem. The longer you wait, the more difficult the removal of striae is - but there are reports of eliminating striae numerous months after LASIK.
As for techniques - the general technique described by you is often effective - but again experience counts. Sterile hypotonic water to hydrate the flap is one method that can be used alone or in combination with other techniques. As well - lifting and stretching the entire flap is also effective (I have never heard of lifting only a portion of the flap - and I would think that this would be less effective than lifting the entire flap).
If these methods fail - one very effective technique is suturing the flap. This is generally done only after other methods fail - but it can eliminate striae and folds that are numerous months old.

I hope this information is helpful.

Bill Trattler, MD
Miami, FL

Paula,
You can consider seeing Dr. Lomas, who is in Renton, Washington, and is one of our panel members. He is experienced at treating striae

His office number is:

I hope this is helpful

Bill Trattler, MD
Miami,FL