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Home > Archive > Lasik Eyes Surgery > October 2004 > Is PRK done after Lasik when enhancement needed?
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Is PRK done after Lasik when enhancement needed?
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| Bluesman 2004-10-07, 11:09 am |
| My enhancement is scheduled for 12/3 - Dr said he will determine best
course to go - whether it be lift the flap (it will be 14 months since
the 1st Lasik) cut a new one (I don't like that too much) or just
laser on the surface of the eye.
This "surface of the eye" deal is PRK or what?
BTW, I am hyperopic astig, right now +1.50...
Thoughts appreciated.
Bluesman
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| Richard 2004-10-07, 7:11 pm |
| hotblues20@netscape.net (Bluesman) wrote in
news:775aa28e.0410070655.6cebd253@posting.google.com:
> My enhancement is scheduled for 12/3 - Dr said he will determine best
> course to go - whether it be lift the flap (it will be 14 months since
> the 1st Lasik) cut a new one (I don't like that too much) or just
> laser on the surface of the eye.
>
> This "surface of the eye" deal is PRK or what?
>
> BTW, I am hyperopic astig, right now +1.50...
>
The laser the surface would be either PRK or LASEK I do believe. Can't
answer as to how accepted that is at this point, or what the expected
results from such a procedure might be. I am however interested in hearing
them, as that is what my surgeon is recomending for me should I desire to
have an enhancement done, due, in my case, to the fact that my corneas are
marginal in thickness in so far as allowing a LASIK enhancement to be
performed. For the time being, I have chosen not to go ahead. I should
add that he has no financial motive in recomending this course of action,
as my enhancement, should I do it, would be free of charge.
--
Richard
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| I have one suggestion. Have the surgeon decide if he's going to lift
the flap, make a new flap, or do a surface ablation before a surgery
is scheduled. If you show up for surgery and he changes his mind,
don't let him proceed. He should lift the flap. If he wants to do
anything else, get a 2nd opinion from another ophthalmologist. I
don't exactly know the reason why, but surface ablation is not done on
top of a flap (unless there is a defect on the surface such as a
scratch). Strangely enough, even PRK is enhanced with LASIK, not PRK.
I have yet to get a good explanation for that, but it's true.
On 7 Oct 2004 17:12:45 GMT, Richard <RichardRapier@netscape.net>
wrote:
>hotblues20@netscape.net (Bluesman) wrote in
>news:775aa28e.0410070655.6cebd253@posting.google.com:
>
>
>The laser the surface would be either PRK or LASEK I do believe. Can't
>answer as to how accepted that is at this point, or what the expected
>results from such a procedure might be. I am however interested in hearing
>them, as that is what my surgeon is recomending for me should I desire to
>have an enhancement done, due, in my case, to the fact that my corneas are
>marginal in thickness in so far as allowing a LASIK enhancement to be
>performed. For the time being, I have chosen not to go ahead. I should
>add that he has no financial motive in recomending this course of action,
>as my enhancement, should I do it, would be free of charge.
| |
|
| I mistakenly replied to Richard who war responding to you. Please
refer to the reply I made to him.
Basically, if your surgeon does anything but lift the flap, there is
something strange going on.
On 7 Oct 2004 07:55:34 -0700, hotblues20@netscape.net (Bluesman)
wrote:
>My enhancement is scheduled for 12/3 - Dr said he will determine best
>course to go - whether it be lift the flap (it will be 14 months since
>the 1st Lasik) cut a new one (I don't like that too much) or just
>laser on the surface of the eye.
>
>This "surface of the eye" deal is PRK or what?
>
>BTW, I am hyperopic astig, right now +1.50...
>
>Thoughts appreciated.
>
>
>
>Bluesman
| |
| Glenn - USAEyes.org 2004-10-07, 7:11 pm |
| Ugh!
Hyperopia correction is not as predictable or successful as myopic
correction. Hyperopic astigmatism is even more difficult to correct.
It sounds like your surgeon has most of his ducks in a row. What will
be most difficult is to determine the exact flap thickness at the area
of intended tissue ablation on top of the flap. You do not want to
ablate through the flap. This can cause poor vision and increase the
likelihood of epithelial ingrowth.
If the flap was created with a mechanical microkeratome (most common),
then the flap is thin at the outer edge, thick in the mid-periphery,
and thinner in the center. This might work to your advantage because
it is the mid periphery that would receive the most ablation. You
just don't want the ablation to encroach on the thin areas.
If the flap was created with the Intralase femtosecond laser, the flap
would be of even thickness, so there would be little worry of hitting
a thin spot...unless the whole flap is too thin for additional
ablation.
Lifting the flap at 14 months should not be a problem. It has been
done at 12 years. Although the flap does heal, it does not heal like
a cut on your arm and can be separated at the location of the original
incision virtually forever.
I'm going to throw you a curve. I think you should seriously consider
Conductive Keratoplasty (CK) as an alternative to additional tissue
removal with PRK or LASIK.
Although primarily touted for NearVision CK monovision, CK was
originally approved for hyperopia correction and a skilled CK surgeon
is able to correct a significant amount of astigmatism with CK. CK
does regress at the rate of about .25 diopters per year, but it does
not require any tissue removal, can be done after LASIK, and
retreatments can accommodate regression.
It may be that your doctor does not provide CK, or finds the
regression rate problematic, but what you are facing could not under
any stretch of the imagination be considered an ideal situation. I
think it would be worth your time to consider all reasonable
alternatives. If contacts and glasses just don't do it for you, I
urge you to investigate CK as a viable alternative to LASIK or PRK on
the flap.
If you want a referral to a CK surgeon nearby, feel free to contact me
directly.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| Ragnar Suomi 2004-10-08, 10:08 pm |
| I missed the original message about hyperopic astigmatism. Glenn is
right in pointing out that correcting hyperopic astigmatism is
difficult. The reason for that is your visual acuity is based upon
the light that enters the central area of your cornea, not the out
ring of the cornea. In myopic LASIK, the central area is ablated to
flatten the cornea a bit. In this process, the astigmatism is also
greatly eliminated. In hyperopic lasik, the outer ring of the cornea
is ablated to steepen the cornea a bit - leaving the central area -
astigmatism and all - left virtually untouched.
There is a huge difference between myopic and hyperopic lasik. The
procedure and effects are opposites of one another in many ways.
On Thu, 07 Oct 2004 18:44:27 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>Ugh!
>
>Hyperopia correction is not as predictable or successful as myopic
>correction. Hyperopic astigmatism is even more difficult to correct.
>
>It sounds like your surgeon has most of his ducks in a row. What will
>be most difficult is to determine the exact flap thickness at the area
>of intended tissue ablation on top of the flap. You do not want to
>ablate through the flap. This can cause poor vision and increase the
>likelihood of epithelial ingrowth.
>
>If the flap was created with a mechanical microkeratome (most common),
>then the flap is thin at the outer edge, thick in the mid-periphery,
>and thinner in the center. This might work to your advantage because
>it is the mid periphery that would receive the most ablation. You
>just don't want the ablation to encroach on the thin areas.
>
>If the flap was created with the Intralase femtosecond laser, the flap
>would be of even thickness, so there would be little worry of hitting
>a thin spot...unless the whole flap is too thin for additional
>ablation.
>
>Lifting the flap at 14 months should not be a problem. It has been
>done at 12 years. Although the flap does heal, it does not heal like
>a cut on your arm and can be separated at the location of the original
>incision virtually forever.
>
>I'm going to throw you a curve. I think you should seriously consider
>Conductive Keratoplasty (CK) as an alternative to additional tissue
>removal with PRK or LASIK.
>
>Although primarily touted for NearVision CK monovision, CK was
>originally approved for hyperopia correction and a skilled CK surgeon
>is able to correct a significant amount of astigmatism with CK. CK
>does regress at the rate of about .25 diopters per year, but it does
>not require any tissue removal, can be done after LASIK, and
>retreatments can accommodate regression.
>
>It may be that your doctor does not provide CK, or finds the
>regression rate problematic, but what you are facing could not under
>any stretch of the imagination be considered an ideal situation. I
>think it would be worth your time to consider all reasonable
>alternatives. If contacts and glasses just don't do it for you, I
>urge you to investigate CK as a viable alternative to LASIK or PRK on
>the flap.
>
>If you want a referral to a CK surgeon nearby, feel free to contact me
>directly.
>
>Glenn Hagele
>Executive Director
>Council for Refractive Surgery Quality Assurance
>
>Email to glenn dot hagele at usaeyes dot org
>
>http://www.USAEyes.org
>http://www.ComplicatedEyes.org
>
>I am not a doctor.
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