I had Lasik enhancement surgery in January of 2005. Before my first lasik, I was -9 and -10. I have been reading about ectasia and it being prevelent in high miopic eyes after Lasik. My doctor told me I had enough cornea left for the enchancement procedure. It is one and a half years post enhancement and I find myself scared to death that this may happen to me. I know the minumum cornea thickness is supposed to be at least 250, but my left eye is only a little more than that, about 255 or 260. My right eye is about 270. I am just terrified that my eyes will get ectasia. Are there any signs or symptoms of this happening. My eyes have been stable since and I have good vision, except for alot of floaters. I do have ghosting in my left eye, ever since the enhancement, but it seems to be better when I put in eyedrops. If my eye was going to get this would it have already happened my now? This is just frightening for me to think about. I went in May for a check up and he said the vision and eye health were fine. Please help.

Kay

I would really prefer a doctor address your concerns.

The fact that your vision has remained stable for 1 1/2 years post-op is a good sign. Your pre-op topography was very likely normal. The 250 micron residual cornea bed is a guideline. Some doctors prefer to leave more but even if the residual stromal bed falls somewhat below the 250 microns, that still doesn't mean you will develop ectasia.

Thankfully, ectasia is rare. Looking at the members in my support group, the main reason for ectasia after LASIK is suspicious pre-op topography (forme fruste keratoconus and early pellucid). Thicker than expected flaps (measured by the artemis or by confocal microscopy), is another cause. The puzzling ectasia cases in the group were younger patients who had normal pre-op topographies but developed ectasia even with an adequate residual stromal bed. This raises suspicion that perhaps the topographies would not have been normal pre-ops if the patient had been older when they were taken.

Pre-op pachymetry under 500 microns appears to be another possible cause for the development of ectasia after LASIK.

Again, ectasia is rare. I hope this helps.

Communicate with me privately if you like.

Gail Keziah

Thank you very much for your reply. That makes me feel a little better. I know my doctor is a good doctor and is well recommended in my area. I felt confident that he would not have performed the surgery if he thought something would happen, but when I read about how it still happens to some people it just really frightenend me. Maybe I need to quit reading about stuff like that!
Thanks,
Kay

There is nothing to be gained by obsessing over a potential complication whose likelihood in your case is vanishingly small, Kay. Gail has given you an excellent and informed synopsis of the results of years of clinical research into the etiology of post-LASIK ectasia. Although very serious when it does occur, ectasia is also very rare, with a rate of occurrence of less than 1 in 5,000 cases of bilateral LASIK. So, if (1) your pre-op topographies were normal (no evidence of FFK, PMD or other markers for keratoconus), (2) you were at least 30 years old at the time of your surgery, and (3) your residual stromal beds after LASIK were at least 250 um, then your chances of developing late-onset post-LASIK ectasia are too small to worry about. Better to worry about something that might actually happen -- like, say, being hit by lightning, or abducted by aliens*, for instance. My advice is to enjoy your new vision, and stay away from anti-LASIK horror sites. They masquerade as support sites, but their main agenda is to frighten and terrify anyone who is contemplating or has had LASIK by citing horror stories and distorting the truth about the procedure. Of course, complications can and do occur with LASIK, and some of them are serious, but the vast overwhelmingly majority of LASIK patients end up with a good result and consider having had LASIK one of the best decisions they ever made.

Bryce Carlson

* Hey, I said aliens, not space aliens ;)

''There is nothing to be gained by obsessing over a potential
complication whose likelihood in your case is vanishingly small,
Kay.''

I agree with this completely.

I will also agree that Kay does not seem to be at risk for
developing ectasia if her pre-op topographies were normal,
especially since her vision has remained stable. However, many
surgeons now consider 300 microns to be the safe limit to
prevent ectasia.

''My advice is to enjoy your new vision, and stay away from anti-
LASIK horror sites.''

Increased floaters and ghost images do not sound enjoyable to
me. The chance of being struck by lightning is estimated to be 1
in 700,000. The chance that you could have a devastating LASIK
outcome is much greater. It seems that most of the information
about lasik available on the Internet is heavily biased one way or
the other. In fact, most information is actually total fluff
provided by laser centers. It is important for anyone considering
LASIK to hear both sides of the story. If you've already had a
good outcome then I suppose ignorance is bliss.

Thanks to all of your replies. That last reply about the new minimum being 300 scares me, but I guess there is no point in worrying about something that's already been done. I'm not sure if the chance of ectasia happening is more down the line (long term) or if it would have happened by now. Anyway, I'm sure I'm not the only one whose had that much taken off their corneas!
Thanks,
Kay

In a normal healthy cornea a post-op residual stromal bed (RSB) of 250 um is sufficient to avert ectasia. However, in a cornea with weakened collagen it may well not be sufficient. Normally, such compromised corneas (with FFK, sub-clinical PMD, etc.) are detected on topography in the pre-op screening process, and such patients are advised not to have LASIK. However, in young patients (under ~30 years of age) the usual markers for such sub-clinical corneal disease may (rarely) not yet have presented, and such patients may appear to be good candidates for LASIK yet (rarely) go on to develop post-op ectasia. The solution to avert these rare "surprise" cases of ectasia is to either raise the minimum age for LASIK to ~30, or increase the minimum RSB to ~300 um. The former solution is the better one, but the latter one is better than nothing. Also, of course, many surgeons leave an RSB of significantly more than 250 um so, if necessary, they can perform an enhancement without having to resort to surface laser. Personally, I advise anyone who asks to wait until they are at least 30 years old to have LASIK and to make sure they are left with an RSB of at least 270 um. It is important to keep in mind that although LASIK is a medically safe and effective procedure, it is not perfect and risk-free. There are risks with LASIK, and some of them are serious, but there are benefits as well, and some of them are wonderful.

Bryce Carlson

Thanks Bryce. I will take your earlier advice and quit reading lasik horror sites. There really is no use in obsessing over it. My doctor did tell me when I had my enhancement that he would get my eyes as close as he could to 20/20 safely, but would not put them in danger and that I probably would not be able to do another enhancement. I do think he knows what he's doing, he is well recommended in my area. I wish I knew if there was a timetable as to when I would know for sure that my eyes will not get ectasia. I'm sure it is a good sign that my vision is still stable after a year and a half. Thanks for your replies.

Kara

Many cases of ectasia present within the first year after surgery; however, the mean time to diagnosis is about 1.4 years post op, and ectasia has rarely been diagnosed as late as four years after LASIK. Keep in mind that ectasia is very rare, with an occurrence of only about 1 in 5,000 bilateral surgeries.

Bryce Carlson

I'm just wondering...I've had a slight ghosting in my left eye since my lasik enhancement a year and a half ago. I only see it when there is low light and I'm looking at a dark background with white letters or in other conditions similar to that. It hasn't gotten any better within the last year, but it hasn't gotten worse either. Should I be worried about that or is that just an astigmatism? When I went for a check up in May my doctor didn't mention any signs of ectasia or anything, although I'm not sure if they can see signs by looking into your eyes. Thanks.

Many post-LASIK patients complain of slight to moderate ghosting, especially in dim light (when their pupils are dilated). It is generally caused by mild irregular astigmatism at the mid-periphery of the ablation zone. Sometimes, this ghosting fades out over time as the epithelium remodels; sometimes it doesn't. Generally, it has no significance other than being a mild annoyance. Now, you really need to get over this ectasia obsession, Kay. If you can't let it go based on the information I and others have already given you, then I suggest you go back to your LASIK surgeon, explain to him about your ectasia fears, and ask to have an Orbscan II or similar scan performed to measure your corneal posterior float. If that test comes back normal then you can put your fears of ectasia to rest for good. Orbscan II, in particular, sometimes gives false positives for elevated posterior float in post LASIK's, but when it comes back normal in a patient such as you (well over a year post-enhancement) then it really is normal, and ectasia can be ruled out with high confidence.

Bryce Carlson

''Many post-LASIK patients complain of slight to moderate
ghosting, especially in dim light (when their pupils are dilated). It is
generally caused by mild irregular astigmatism at the mid-
periphery of the ablation zone. Sometimes, this ghosting fades out
over time as the epithelium remodels; sometimes it doesn't.
Generally, it has no significance other than being a mild
annoyance.''

Only someone who is in some way affiliated with the LASIK industry
would consider ghost imaging to be a ''mild annoyance''. Did you
see ghost images with glasses Kay?

Had Lasik 9 years ago..very pleased very happy. Distance vision started bothering me...dr suggested contacts, glasses. Was not a candidate for LASIK enhancement. Dr research had PRK 12 days ago...NOT happy at all, vision is extremely blurry within 15 feet and I'm afraid my close up vision may have been sacrificed. Been crying every day. Hope it gets better. Wish I would have just left it alone and popped a contact in.

Why are you so concerned about compromised mid-range and close-up vision only 12 days post-PRK, Debra? As you should know (from your surgeon or from your own proper due diligence) PRK takes much longer to settle down then LASIK. Generally, you can expect a minimum of 6 weeks for the epithelium to heal and fully remodel, and with PRK some regression almost always occurs, so surgeons generally overcorrect the intended Rx somewhat (which is probably why you have compromised mid-range and close-up vision now). Wait until you are about 2 months post op, Debra; by then you should have a good idea of what your final result will be.

Bryce Carlson

P.S. In reply to Trevor, I am not affiliated with the refractive surgery (or medical) industry in any way.

Bryce,thanks for your support. Actually, my surgeon only told me that I may need reading glasses some time in the future (doesn't everybody eventually?)
When I originally got LASIK 8 1/2 years ago, it was as if a whole world opened up to me...I could now DO things. Since this surgery which is now 17 days out ALL I can focus on is what I can't focus on within 15-20 feet, which is everything, my face is blurry, looking inside a drawer, purse, sitting at this computer is all blurry..Maybe I'm hitting the panic button too soon, but this is really upsetting me and I hope I haven't sacrificed my everyday vision (within 15-25 feet which used to be clear and crisp)for the ability to see a bunny eating grass very clearly 100 feet away! I can't get my surgeon to give me a straight answer. I'm in pharmaceuticals and it sounds like you are in the medical profession, I'd like to pick your brain more, if possible. My direct email is . Thanks!

Happy to help, Debra. As I mentioned, with PRK surgeons generally overcorrect the intended Rx, somewhat, in anticipation of the regression that almost inevitably accompanies the cornea's rather robust healing response to surface laser. So, compromised mid-range and close-up vision in a middle-aged formerly myopic adult is to be expected so soon after surgery. It will almost certainly get better, likely, much better. If you are into your forties or older, however, you may end up needing reading glasses for really close-up work due to presbyopia -- just as all middle-aged people with normal emmetropic vision do. In a couple of months you will have a much better idea of what your final result will be.

Bryce Carlson