I am 55 and had relatively successful Lasik surgery 5 months ago, which corrected my myoptic vision of between -6 and -7 diopters. I am now at about -.75 diopters of undercorrection after tests done the past two month's post op visits. Before seriously considering enhancement in a month or two, my doctor suggested using -.75 corrective glasses to test if this amount of correction would reduce my night driving starbursts and poor vision in low indoor artificial lighting. The use of the glasses changed my vision from "acceptable" to crisp clear vision. I love the additional correction for safe driving, general enjoyment of the outdoors, panoramic vistas and much clearer indoor tennis depth perception.

At this week's visit, I said that I wanted to consider enhancement. My doctor suggested I do a much safer "superficial Lasik" rather than relifting the flap and possibly experiencing the usual host of Lasik risks. This minor superficial procedure will Lasik flatten the outer epithelium surface rather than carve further the stroma layer normally reshaped in standard Lasik procedures. I would wear a contact lense bandage for one day after. He indicates the only drawback is a higher chance of regression as the epithelium heals and possibly regrows to counter the Lasik corrective flattening.

Is this superficial procedure in general use for enhancements or is this experimental? Are there are any stats on the long-term (beyond a year) success? Any reason this should not be considered as a "safe enhancement" procedure or viable option to a relift and standard Lasik enhancement?

I have used superficial lasers for a number of patients, and for a few, they have been happy for over 2 years. I have also had some patients that did not respond completely to the superficial laser treatment.
The advantage of this technique is that is is very safe compared to lifting a flap. If it ends up being successful, you will have avoided risks such as epithelial ingrowth, flap striae (wrinkles), etc. As well, there is less risk of an over-correction with this technique.
I personally recommend this technique to my patients who have less than 1 diopter or residual myopia or hyperopia and want an enhancement.

I hope this helps

Best of luck

Bill Trattler, MD
Miami, FL

Dr. Trattler -- Thank you for your prompt reply. It is somewhat encouraging since my doctor has only done this to about half-dozen of recent patients though he has done thousands of traditional lasiks and considered one of the top surgeons in the Chicago area.

If the success is only partial, can superficial be safely done again in a few years if there continues to be regression after this procedure? Will its success be known in days to weeks after or does it take months to know if the correction stabilizes? Tx.

This sounds alot like zapping the flap, which I understand to be verboten due to the likelihood of haze formation.

Perhaps I misunderstood. If this is something else, I may be interested. Please explain more if possible.

Frank,
I have discussed this issue with a number of doctors across the US. Basically, there are a number of doctors who have begun enhancing patients with LASEK (which is laser on the surface of the flap) rather than lifting the flap. This is a helpful treatment option in cases such as:

1. Patient needs an enhancement and has recurrent erosion syndrome
2. Patient needs a hyperopic enhancement and the flap is currently not wide enough (so a new flap would have to be cut)
3. Patient needs an enhancement but there is not enough room under the flap - as with a case where the residual stroma is in the 250 micron range already
4. Patient needs an enhancement and developed severe dry eye after LASIK which has finally improved. Lifting the flap may exacerbate the dry eye problem.

There is one paper from 2000 by Carones in the Journal called Ophthalmology where a high rate of haze occurred in patients enhanced with PRK. However, the laser was an older style model.

There are now numerous ways to prevent haze, It helps that the cause of haze has been found to b UV radiation exposure. I prefer the use of oral vitamin C 1000mg for 2 months after surgery to prevent haze. Other doctors will use mitomycin C for a minute or so during surgery. As well, we advise our patients to avoid UV exposure.
I am currently compiling data on cases from a group of doctors, and hope to report this information in one of the ophthalmology journals during the next 6 months or so.

I hope this helps

Bill Trattler, MD
Miami, FL

I just read your note about superficial laser (PRK?) as an enhancement method...I am very interested in this as I had LASIK in 2001 and have a great left eye, but dry right eye that's undercorrected...I wear a -1.00 contact lens...I had severe dry right eye for two years and it's finally getting better...I wish to have an enhancement but fear recurring dryness and would like this superficial laser treatment...my doctor advised against PRK because of haze..can I come to you for treatment???...Thank you