I have an on going problem since a second lasik operation 10 months ago. Virtually no prescription and very good topography data. Yet my wavefront result - the actual light dots gained are extremely poor in definition and intensity. The clinic had a very hard to time obtain a reading off one - the most varrying eye too. My sight has never felt close to being good and stable - even something right in front won't be defined or sharp in clarity or intensity and can varry. 2 factor - i use a zero power contact in one of my eyes to help stabalise the vision (even though it has only +0.5/0.5) and my dominate eye is pratically zero - yet "feels" very dull and not strong atall. I can also disrupt my clarity too easy with light finger rolls over eye lids over cornea. I have a general haze (plus light burst) to everything even at low pupil sizes. I have previously posted a question and had the response of the epithelium being loose. My doctor has looked at the surface with die and told of no vision defects. BUT is it possible for a large portion of epethelium to be loose and be physically seperated from the bowmans layer and show no signs under slip lamp? my email is . i can show my topography, wavefront dots/results etc (from all times along my history). My doctor is puzzled but I know something is unstable from what happens. Any help from a doctor seeing this before would be great. thanks David

David wrote:

I have an on going problem since a second lasik operation 10 months ago. Virtually no prescription and very good topography data. Yet my wavefront result - the actual light dots gained are extremely poor in definition and intensity. The clinic had a very hard to time obtain a reading off one - the most varrying eye too. My sight has never felt close to being good and stable - even something right in front won't be defined or sharp in clarity or intensity and can varry. 2 factor - i use a zero power contact in one of my eyes to help stabalise the vision (even though it has only +0.5/0.5) and my dominate eye is pratically zero - yet "feels" very dull and not strong atall. I can also disrupt my clarity too easy with light finger rolls over eye lids over cornea. I have a general haze (plus light burst) to everything even at low pupil sizes. I have previously posted a question and had the response of the epithelium being loose. My doctor has looked at the surface with die and told of no vision defects. BUT is it possible for a large portion of epethelium to be loose and be physically seperated from the bowmans layer and show no signs under slip lamp? my email is . i can show my topography, wavefront dots/results etc (from all times along my history). My doctor is puzzled but I know something is unstable from what happens. Any help from a doctor seeing this before would be great. thanks David"

David, I must confess I'm having trouble understanding your post. On the wavefront, what does it mean 'light dots gained'? Are you talking about your point spread function?

If the clinic had a hard time taking a reading from your eye it may be because you were making an indadequate tear film. This could explain your visual instability (variation in dryness during the day can produce variation in vision because the tear film is an essential component of your refraction).

Dry eye can also make your vision seem blurry and hazy. Does your vision suddenly improve, transiently when you put in eye drops?

You need to go see a 2nd opinion doctor and find out what's going on with your eyes. You need a good refraction, a slit lamp exam (ask if you have microstriae or striae - these are wrinkles in the flap - also ask specifically if you have signs of haze or epithelial ingrowth).

I'm curious to see your scans. I just might follow up with an e-mail to you to obtain copies. Too bad there is no way to post them here.

If your epithelium was loose the doctor would be able to tell this easily. Even if you had a complete epithelial erosion it would hurt like h*ll and then be over in a few days. Probably not the epithelium.

See a good 2nd opinion doc!

All my best!

What kind of light bursts are you seeing? If you are seeing lots of burst of light this could be due to a retinal problem. Have a retinal exam while you're seeing that 2nd opinion doc.

You may be having fluctuating vision due to corneal instability. What is your residual corneal thickness? Did you have thin corneas before surgery? It may also be helpful to have serial orbscans taken over a period of a few months.

The bottom line is that refractive surgery is really bad for your eyes. It is possible to acquire all sorts of damage - corneal nerve damage, corneal distortions, posterior vitreous detachment, retinal tears, optic nerve damage, recurrent epithelial erosions, difficulty focusing, over correction, under correction, refractive imbalance, pupil size/optical zone mismatch, decentration. It's a long list. This was just a partial list. Tell your friends how much trouble you're having and that refractive surgery is not safe and a 'snap'.

Those who remain silent pave the way for others to be damaged.

David,

I have sent you an email. If you would like to send me your information, I am at glenn dot hagele at usaeyes dot com.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

David,

Thank you for sending me all the data and images. Please remember that I am neither a physician nor a technician, so my reading of the diagnostic topographies and wavescans is limited.

Your doctor's diagnosis of microstriae seems consistent with the information you provided. While the topographies are relatively unremarkable, the wavescans show the results of the light scatter through the "Bowman's Crinkles" of microstriae.

Your second doctor’s suggestion of lifting the flap, stretching it slightly, and suturing it is a very aggressive response, but may be the best response. Removing all of the epithelium is even more aggressive, but may be wise for several reasons. If all the epithelial cells are removed, the likelihood of epithelial ingrowth under the LASIK flap is very small. After a stretch and suture, you don’t want cells growing under the flap. Also, the epithelium is really amazing at filling in the imperfections that can be caused by striae. An entire new layer that is correcting the stretched flap may be better than relying on the old layer of cells.

Considering the difference in vision with a contact lens, the smoothing effect of the proposed procedure does seem reasonable.

You can expect some serious discomfort, outright pain, and a slew of medications…but considering your current vision that may be a small price to pay for a high probability of improvement. You may want to read http://www.complicatedeyes.org/striae.htm

Let us know what you decide and how it goes.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

have you been checked if you have cateracts? also check for glucumia, macular degradation and retina troubles. I wish you a speedy diagnosis and improvement

Every LASIK patient has Bowman's crinkles. Some have microstriae that is severe.

Unless your 2nd opinion doctor sees striae so severe through the slit lamp that he's reasonably sure that's your problem it is unwise to go for a flap lift, stretching and suturing.

An artemis scan would tell you for certain what's going on with your flap. I would get one, no matter how far I had to travel... before I'd be willing to proceed with more surgery.

You could have very thin corneas, a flap with a wavy cut, who knows what's going on? The Artemis will tell you better than the wavescan or point spread function. These scans will tell you there is a problem, not where it's coming from. It would be a shame to stretch your cornea if the flap is of variable thickness and that's your problem. Or if your problem is uneven lasering under your flap and your doctor treats your flap... also not good.

Many are made worse by retreatments. Get as much information as you can about your condition before you make a move.

Thanks Glenn and Eve for your responses. Well this is odd. There is an irregularity in the centre causing this. But the striae the doctor wanted to suture out are nothing now. But another VERY good complications doctor can spot like a "mosaic" pattern of flap irregularity which might be due to improper flap and stromal bed mismatchment. And this is what could have created the surface irregularities which were easy to spot 1/2 year ago..but since smoothed on surface. It is very hard to explain my symptoms and they are not directly related to abberations. Much more of a fine degradation of light that manifests in a nasty way. And it is very strange how a zero contact when my pupils are tiny even do SO much for the effect. Does anyone think that these compress irregularities under the surface in someway...as there is nothing to smooth surface wise now!
Eve - no probs with decentration, pupil size/optical zone treated ok, no significant striae in optical zone. Yes I know of ultrasound to look at the flap irregularities underneath very closely - Only one place in UK I know of and he is extremely expensive and a very long wait to see! I might well have this doctor with a HUGE amount of experience do this relift/smoothing/sweeling and try and clear this mosaic irregular effect..with the worse eye that has the biggest improvement from a bandage lens.
Carry on this post...I'll update all for sure.

David,

An optometrist I work with has used reverse geometry rigid contact lenses to effectively force out micro-striae from the center of the cornea toward the periphery. I know of only one case study, but it is a remarkable result.

It does not seem likely that the soft contact lens is actually resolving the striae - and the return of vision symptoms would seem to confirm this - but that the contact lens is creating a smooth outer surface that contributes to good vision quality. It is possible that there is some compression of the cornea that improves the flap interface, but this does not seem very likely.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

Actually, the following article describes two patients who were successfully treated for microstriae with contact lenses:

"Corneal remodeling by hard contact lenses to manage microstriae after laser in situ keratomileusis. J Cataract Refract Surg 2002 Nov;28(11):2050-3
Araki-Sasaki K; Tsumura T; Kinoshita T; Shimamoto T; Yoshida M; Kodaka R; Mano T
Tane Memorial Eye Hospital, Osaka, Japan."

Unfortunately, I have found that larger and deeper striae do not respond as well.

DrG
Greg Gemoules, O.D.
Coppell, Texas

Glenn/ Dr. G,

I too have a problem with micro-striae that a flap lift and smoothing did not fully resolve. I am told that my micro-striae are relatively small but they are creating some very annoying glare that is particularly noticeable at night. At this point I am interest in pursuing the least invasive option and would like to try an RGP lens. The "reverese geometry" lens mentioned that may even cure(?) the problem sounds particularly exiting.

Can either of you recommend an optometrist in the Los Angeles area that has expertise in this issue. Glenn, could you provide the name of your colleague in Sacramento? Thanks to the both of you for participating in this post.