I just returned from seeing my surgeonI am 1 week post-enhancement. I have been having a problem with blurred vision. The doctor said that there were small stria in my line of vision that were probably causing my blurry vision and also some starbursts at night. I asked about suturing the cornea and he said that they are using a procedure where the flap is lifted and heat is used to basically iron out the stria. I have not read anything on this procedure and would like to know more about it. Please Comment on this procedure.
Also, he said that I am reading the 20/25 line on the acuity chart and that I would probably be very happy with my vision if it were not for the stria. Is this an accurate statement??

Dr. Eric Donnenfeld, one of the leaders in refractive surgery, posted his results with hyperthermia for removal of striae at the American Academy of Ophthalmology meeting this week. I have never tried this technique myself.
His article states: 18 patients with striae were treated with hyperthermia, and on average improved by 2 lines of vision. No patients reported a reduction in vision following the treatment.
I personally think hyperthermia is an interesting idea, but one that not that many people are currently using. I do not know if it is the most effective way to remove striae - but Dr. Donnenfeld in general is on the money with his research and techniques.
Flap suturing is a procedure that is used when flap striae have not been able to be removed with simpler techniques (such as flap lifts, flap stretching, hyperthermia to the flap, etc).
I hope this information is helpful
Bill Trattler, MD
Miami, FL

Is striae that has become essentially permanent something that can be addressed in the future with customer LASIK? Assuming the striae over time become an abberant feature of the cornea, would the new technology on the horizon be able to improve the vision by addressing it as if it's simply a corneal defect?

Striae are folds in the flap. New technologies are looking at laser treatments of the "corneal bed" and would not be able to fix the folds in the corneal flap.
I am not aware of any new treatments for corneal folds - but of course there may be some in the future.

Hope all is well

Bill Trattler, MD
Miami, FL

can be treated with PRK if they are superficial.

That was my next question. I was wondering if wavefront phased out PRK or if the technology applied to both procedures, after the flap completely heals (whenever that happens).

nancy: I absolutely disagree. Striae can not be treated with PRK. There has not been one report in any medical publication even suggesting that this would be possible.
Here are some of the reasons why. We know that when people end up over or under corrected with LASIK, that PRK can not be performed after LASIK for an enhancement. The reason is - scarring and hazing of the flap occurs very commonly. A number of reports have described this particular problem, so now no LASIK surgeon will perform PRK on a patient who had previous LASIK. (there is a procedure called epithelial PRK which has been shown to safely enhance up to one diopter of myopia or hyeropia - but this is different fromn regular PRK).
The next issue - is that the wrinkles/folds/striae often extend throughout the entire flap (from the epithelial surface all of the wau to where the laser was performed (the stroma). The striae often get transmitted into the stroma, so that the underlying stroma has folds. When the flap is lifted to remove striae, it is common to see folds in the underlying stroma. These folds need to be smoothed (the striae in the flap also need to be smoothed).

So I completely disagree that now or in the future - PRK will be an option for people with decreased vision due to flap folds/striae.

I hope this was helpful

Bill Trattler, MD
Miami, FL

Dr. Trattler,

Thanks for that explanation. Now I know which corneal specialist I won't be going back to!

I do believe that Nancy used the word "superficial" and PRK has been suggested to me also because my cornea is very thin after LASIK.

Dr. Trattler mentions that no doctors will do PRK over LASIK because of reports of haze, etc. Yet thousands of surgeons are hearing reports of LASIK-induced ectasia and they continue to do LASIK. There are reports of legal blindness after LASIK, lives being destroyed by various serious complications, etc. and the marketing of LASIK still marches forward.

Everything in life has risks, including LASIK. Perhaps LASIK marches forward, as you put it, because those who have had these serious complications fall within a minority--that 3%. Yes, it's horrible when you are the one it happens to, but hopefully anyone having surgery on their eyes has done their homework and made an informed decision.

There are many, many elective surgical procedures that have far greater risks that people, and the FDA, find to be within acceptable limits. It's a matter of how much it means to you, educating yourself, and finding the best doctor (not the best deal).

Carlene,

Congratulations. It sounds like you are one of the lucky majority. Many people do exhaustive research and pick the "best" surgeons and still end up with serious complications. Please don't blame it on the patients! The only surgeons who don't have complications are the ones who don't do surgery. I have a friend who now lives in the dark, on disability, because of LASIK. Do you think that of the over 20 surgeons she has seen, even one is trying to help her? Not one! They are too busy making money to take care of their casualties, or those of their peers.

I wasn't blaming the patient. I was just saying that doing everything you can to minimize the risk is the best you can do. There is still a risk. You would do well not to demonize the industry for things that are beyond their control as well.

A few comments. Doctors who perform LASIK in general are very concerned to provide the best care, and when there is a problem, work hard to fix the problem and get the patient seeing again. I am surprised to hear that your friend went to 20 doctors - and not one would help. I actually find that hard to believe - as if there is something to be done - I am sure many of the doctors would have offered options.
Since I do not know the specifics of your friends problems - I can just say that there are numerous types of fixes for almost any type of problem that might happen after LASIK. Most people who have LASIK have excellent outcomes. When a serious complication does occur - timely attention generally leads to a positive resolution. I will be happy to answr any specific questions about your friend and offer any thoughts/ideas for further treatments.
As for LASIK marketing - I personally think it is ridiculously over done. My office of 13 doctors (7 of who do refractive surgery) does not advertise for LASIK. But many other local doctors in the area do (and I only wish I could point out to all of the listeners of these radio ads why many of the things being said are "exagerations")
Any way - please feel free to have your friend post their question here

Best of luck

Bill Trattler, MD
Miami, FL

I agreed with you about the ads, Dr. Trattler. I just heard one today that was done by an actual radio personality I listen to all the time. He said the results are "instantaneous." My surgery was unbelievably average and I would never tell anyone it's instantaneous. Three hours later, maybe... So anyone who asks me about getting LASIK, I've taken to asking them how they've learned what they've learned about it. If they say an ad, I tell them not to do it--at least not at the clinic that did the ad. I've gotten THAT fed up with it.

Still, I am a LASIK advocate to people who are putting more thought into the procedure than the advertising.