I was just thinking about it just now. I know they remove the
epithelium in PRK, laser your cornea then let the epithelium regrow. If
the epithelium regrows thicker than usual, you regress and end a bit
myopic instead of plano. This is why they sometimes overcorrect you
slightly to allow for regression.

So why not do just the epithelium removal without any laser surgury if
your pescription is very mild or to reduce mild to moderate
pescriptions? I am not sure how much myopia or hyperopia could be
addressed with this method. Id say a diopter is easy with two or even
three diopters possible? This would be great for mild myopes, hyperopes
or to give monovision. Moderate myopes and hyperopes would reduce their
pescription and improve their uncorrected vision threefold, fourfold or
even more!

There may be chemicals that stimulate agressive growing of the
epithelium or to slow down the regrowth so it grows back thinner.
Average thickness is 50 microns. I dont know how much thinning you can
safely do, but I know orthoK can thin it up to 40-50% temporary in an
oblate 6mm zone. Removing the epithelium and letting it regrow would
result in a prolate zone that covers your entire cornea of 12mm.
Perhaps you can thin the epithelium to 35 microns or thicken it to 80+
microns. Its likley youll be able to treat more hyperopia than myopia.
Pupil size would be a nonissue. The risks would be small and no cornea
would be removed, just the epithelium which regrows back in a week or
less.

This will be a blessing for those with mild pescriptions and still
benefit those with moderate pescriptions. Its much safer than laser
surgury. Lasik will stay but itll be used for more severe pescriptions.
Someone with -1 diopters could likley end plano. A -2 may end plano or
if not then 20/25 or 20/30 which will vitrually eliminate glasses
dependancy anyway. A -3 could have his pescription reduced by half to
two thirds and his vision improved around five-fold! May end 20/40 to
20/70 most likley(compared to 20/200 to 20/300) Someone whos -4 may not
experience benefits to the extent low myopes will but he can still
reduce his pescription by a third to half. This will improve his 20/400
uncorrected vision around threefold and get him in the 20/100 to 20/150
range. More than -4 and the amount of improvement will be pretty small
and many may just consider lasik or prk instead for full improvement.
Hyperopes would likewise experience improvements.

Epithelium thinning or thickening can also be used to combat
anisometropia. I know this lady in real life who was -6 in one eye and
-3.5 in the other. Her worse eye was almost three times blurrier. With
glasses, she saw different sized images. She said she was getting
intralase laser in about 3 months to take care of the anisometropia and
of course ditch those akward glasses. Epithelium thinning in her -6 eye
could greatly reduce the anisometropia and it would only have to be
done in one eye. A great alternative if you dont mind still wearing
glasses and not willing to take the risk of lasik but you want to
minimize the anisometropia.

So.........is epithelium thinning/thickening done now or is it in
research as an alternative to refractive surgury?

He's moved into research

does nothing on this forum but bash Ace and serve as a biased
proponent for the lasik industry. Ace is a member of this forum and
he has every right to make conversation and give his opinion. I
have found that Ace generally discourages people from having
refractive surgery. I do not find this morally objectable. Perhaps
Ace is cutting into David's action.

Ace, I'm afraid your idea isn't feasible because the epithelium simply grows back the way it was. Orthokeratology simply pushes it away from the center and heaps it up in the mid-periphery, but the effects aren't long-lasting. Even the principle of corneaplasty was not to treat the epithelium, but to re-arrange the collagen in the stroma using an enzyme.

DrG

>Ace, I'm afraid your idea isn't feasible
>because the epithelium simply grows back
>the way it was. Orthokeratology
>simply pushes it away from the
>center and heaps it up in
>the mid-periphery, but the effects aren't
>long-lasting. Even the principle of
>corneaplasty was not to treat the
>epithelium, but to re-arrange the collagen
>in the stroma using an enzyme.
>

>DrG

corneaplasty may have failed to get FDA approval and it looks like further clinical trials were canceled. I am guessing they found too many problems/complications and decided it wasnt a better alternative than lasik. It sure sounds risky to play with enzymes that alter your stroma. Still orthoK is a blessing for athlates who want a much safer alternative to lasik.

I know that epithelium thinning and thickening is already underway in research. Take PRK for example. You could treat someone whos -5 to plano then he can regress to around -1 and epithelium thickening is often a reason. His epithelium post PRK is thicker than it was before he got PRK! All the researchers have to do is find a way to make this happen without actual laser surgury. Probably some yet to be discovered chemical to be administered by eyedrops that can stimulate the epithelium to regrow thicker after being removed and a bandage contact then use eyedrops several times a day. Likewise, something can be done to understimulate it so it regrows thinner. I am not a doctor/scientist so I dont know the reasoning nor science behind it but I just know and heard epithelium maniplation is possible.(and without laser surgury too!)

Ace, the behavior of the epithelium is ALWAYS under research. But, still your approach is not workable.

DrG