I have had lasik on both eyes about one year ago. The pre-0p refraction was about -16.os,with about 2 diopters of astigmatism, and about -13.d od with about 1.5d of astigmatism. An enhancement was done in june os, october od, and my final refractive error is about -3.00 os, and probably -1.50 od. ( I say probably, because as I am still regressing, I have not arranged my final refraction yet). My initial K's were around 43d ou.As I am 44 years of age, I am seeing quite well with my presbyopic eyes for near, without correction. I require glasses for driving and tv. If things stay stable I will be very happy with what I have. My question is, if I regress more is a 3rd enhancement out of the question, and what sort of pachymetry readings are necessary to enable a safe retreat?

I would wait. Given how high your initial correction was, there may not
be enough tissue left to perform another lasik enhancement. It sounds as if
your eyes are still fluctuating a little anyway, and so you have to wait for
the refractions to stabilize. As a general rule, we recommend leaving at
least 250 microns of cornea after the lasering (NOT counting the flap).
Given that a -3.00 diopter correction requires about 45 microns of ablation
depth for a 6.5mm zone of laser, you would have to have at least 295 microns
of cornea stromal tissue PLUS your flap (which can be between 110-180
microns). This means you would need a total corneal pachymetry before
another enhancement of about 475 microns to be safe. Moreover, your corneas
started at 43 diopters and my guess is they are much flatter now. This is
also an important point as we usually recommend a final corneal curvature of
36 Diopters or more to prevent optical aberrations. My suggestion is not to
do anything more, use your eyes to read and your glasses to drive and tv.
You said a mouthful when you said "you are very happy with things if they
stay stable." You have been made so much better by your surgeon, sometimes
knowing when to stop is important too.

Vincent deLuise MD FACS
Waterbury, CT

>I have had lasik on both eyes
>about one year ago. The pre-0p
>refraction was about -16.os,with about 2
>diopters of astigmatism, and about -13.d
>od with about 1.5d of astigmatism.
>An enhancement was done in june
>os, october od, and my final
>refractive error is about -3.00 os,
>and probably -1.50 od. ( I
>say probably, because as I am
>still regressing, I have not arranged
>my final refraction yet). My initial
>K's were around 43d ou.As I
>am 44 years of age, I
>am seeing quite well with my
>presbyopic eyes for near, without correction.
>I require glasses for driving and
>tv. If things stay stable I
>will be very happy with what
>I have. My question is, if
>I regress more is a 3rd
>enhancement out of the question, and
>what sort of pachymetry readings are
>necessary to enable a safe retreat?
>

Dr, deLuise, thank you for your quick reply. Yes I agree I should be happy with the enormous difference in life style afforded by the treatments. My physician in Montreal also feels that we should leave well enough alone. I am only trying to assertain my options, if any, should I regress to the point that I am 100% dependant on glasses.I am contact lens intolerant. Is the Intac procedure an alternative after lasik? Where can I go to on the net to find out about Intac? I was an ophthalmic assistant, so I won't be daunted by any technobabble.