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Home > Archive > Lasik Eyes Surgery > November 2005 > -6 to +3 approx After Lasek, Can this Happen?
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-6 to +3 approx After Lasek, Can this Happen?
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| maurice.oprey@xmli5.com 2005-11-13, 6:02 pm |
| My wife had Lasek Wavefront on her right eye in the UK and went from -6
to +3 (approx) after the treatment. She is now longsighted in one eye
(+3) and short sighted (-6.5) in the other (which hasn't as yet been
treated).
Unhappy with the Clinic who performed the treatment we asked for a
second opinion (although from a surgeon who also uses that Clinic's
facilities for private treatment). He said that this simply doesn't
happen in laser surgery (i.e. such a level of over correction) and
whilst he suggested a couple of names of other surgeons who may be abl
to re-treat was unable to explain why this had occured. My wife now has
only 90 micons of corneal tissue left in the right eye.
My questions are
1/. Does this happen? It obviously has to my wife.
2/. Why does it happen?
3/. Has anyone experience of having this successfuly retreated?
I would be very very grateful for any advice.
Regards
Maurice O'Prey
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| Andre Aubert 2005-11-13, 6:02 pm |
| I'm sorry to hear about your wife's results. I can't help you with your
questions, but I have been wondering about one thing that MIGHT be related.
What would happen if the laser thinks it is treating Lasik when it
really is treating Lasek? The distance from the laser to the point of
ablation would be different (and also the shape of the ablation; the eye
is "flat" after Lasik), so it would all be wrong.
Since Lasik is much more common than surface ablation (Lasek etc), it
could be possible that they "forgot" to set the laser to surface ablation?
I really don't know, but I have been wondering about this.
---
André Aubert
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| Ragnar 2005-11-13, 6:02 pm |
| That is not possible, particularly with Wavefront. The only way it
could happen is if someone intentionally sabotaged the laser system.
Also, having 90 microns left is also not possible. The LASEK flap
alone would be a bit thicker than that.
Go to a different OPHTHALMOLOGIST that isn't associated with that
clinic.
On 13 Nov 2005 00:45:44 -0800, "maurice.oprey@xmli5.com"
<maurice.oprey@xmli5.com> wrote:
>My wife had Lasek Wavefront on her right eye in the UK and went from -6
>to +3 (approx) after the treatment. She is now longsighted in one eye
>(+3) and short sighted (-6.5) in the other (which hasn't as yet been
>treated).
>
>Unhappy with the Clinic who performed the treatment we asked for a
>second opinion (although from a surgeon who also uses that Clinic's
>facilities for private treatment). He said that this simply doesn't
>happen in laser surgery (i.e. such a level of over correction) and
>whilst he suggested a couple of names of other surgeons who may be abl
>to re-treat was unable to explain why this had occured. My wife now has
>only 90 micons of corneal tissue left in the right eye.
>
>My questions are
>
>1/. Does this happen? It obviously has to my wife.
>
>2/. Why does it happen?
>
>3/. Has anyone experience of having this successfuly retreated?
>
>I would be very very grateful for any advice.
>
>Regards
>
>Maurice O'Prey
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| maurice.oprey@xmli5.com 2005-11-13, 6:02 pm |
| I should correct my post,
Firstly the opthamologist said that the 90 microns was in addition to
the 250 micron limit (his words) therefore she has 340 microns in the
right eye, with 90 micons left to effectively perform a retreatment
on..
Secondly, it is possible for this level of overcorrection to happen
because it has happened to my wife and quite frankly I do not need
anyone else telling that it is not possible! I'm sure you can
understand the frustration of hearing this particular statement!
Finally, if opthalmologists wish to be called opthalmologists then it
would help if the clinic referred to them as such, in my dealings they
were constantly referred to as Surgeons (possibly easier for us mere
mortals to understand and spell). And yes we will seek opinion from an
individual who is not connected with that clinic.
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| Glenn - USAEyes.org 2005-11-14, 12:59 am |
| There is virtually no difference in the laser treatment if the removal
of the tissue is on the surface (PRK, LASEK, Epi-LASIK) or under a
stromal flap (LASIK, IntraLASIK).
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| Glenn - USAEyes.org 2005-11-14, 12:59 am |
| First of all, don't panic. There will be plenty of time for panic
later and from what you describe you wife should be able to have
successfully corrected vision even if not with additional surgery.
Of course overcorrection is possible, even with wavefront.
The 90 microns in addition to the 250 micron limit makes a lot more
sense. That would be enough to correct up to 7.50 diopters of
refractive error: much less than your wife is dealing with. The tissue
removal for hyperopic (farsighted, longsighted) vision correction is
primarily at the periphery of the cornea, whereas her treatment for
myopic (nearsighted, shortsighted) vision is primarily in the center
of the cornea. Additionally, the periphery of the cornea is normally
thicker. It would seem that your wife would be able to have hyperopic
correction if that is deemed appropriate.
There are many possible reasons for the overcorrection. I'm not at all
sure what happened, but here is some speculation both wild and
probable.
) The doctor screwed up. It is possible the doctor put in the wrong
information or put in information from a different patient. This
should have been able to be verified as the lasers keep such data.
) The laser screwed up. It is rare, but it is possible that the laser
did not perform as it was instructed. If the patients immediately
before and after also had problems or there is otherwise a history of
an errant laser, that would indicate the laser could be at fault. If
all the numbers put in and recorded are all correct, this is a
possibility.
) Laser mis-calibrated. It may also be that the laser was not
calibrated appropriately or was used too many times between
calibration. Again, this should all be available to be verified.
) The cornea was too dry. If the cornea became unusually dry during
the surgery the amount of tissue that will be removed with each pulse
increases. This could cause an overcorrection.
) Deliberate overcorrection. When a higher myope has surgery it is
common for the surgeon to slightly over correct to accommodate
expected regression. It could be that planned overcorrection for
regression was overestimated, or in combination with other issues made
your wife significantly hyperopic.
) Regression has not kicked in. It is common for higher myopes to
regress after surgery. It may be that regression has not occurred or
that normal regression will not occur.
) Corneal cell response. Your wife's cornea's reaction to the laser
may have been unusual. This is very rare, but some people's corneas
simply react in an unusual way.
) Meds or disease. Every once in a while medication (over the counter
and prescription), disease, chronic conditions, cause strange
reactions in the eyes. This could mean that the preoperative
measurements were not accurate because of a temporary condition, the
current vision is affected by a temporary condition, or the laser
ablated tissue differently because of the constitution of the cornea
being unusual due to meds/disease. Double check all meds taken from
first exam to today (don't forget birth control), and verify with the
doctor any chronic, viral, or similar conditions even if you don't
think they should have anything to do with your eyes.
) Pregnancy/Menopause/Lactation. If any of these conditions apply,
the hormone changes could easily cause 1.50 diopters of change. Don't
do anything until the temporary condition has naturally resolved.
) Steroid response. Some people respond differently to the steroids
used after surgery. If this is the case, your wife's vision may
actually end up where it should have been in the first place as the
effect of the steroids dissipates.
) Epithelium response. The epithelium is outermost layer of corneal
cells about 50 microns thick. If the epithelium has been disrupted by
the LASEK process enough to reduce it's thickness by even half, that
could account for all of your wife's current problem.
) SNAFU - Systems Normal Actual Fault Unknown. It may be that
everything was done as it should have been done but for a reason that
is not known and may never be known your wife was overcorrected. It is
rare that a cause cannot be found (for obvious reasons sometimes the
cause is found but not admitted or some folks really don't look all
that hard), but it may be that you will never know what actually
happened.
I do recommend that you do NOT do anything until either the exact
cause of the apparent overcorrection is determined and/or at least 3-6
months postop. Depending on exactly what is going on, your wife might
end up fine. If she does opt for additional surgery, expect the doctor
to deliberately under correct the second eye to accommodate for the
unexpected behavior of the first. It would be better to under correct
and require enhancement for residual myopia, than to overcorrect.
Where are you located?
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| Ragnar 2005-11-14, 12:59 am |
| Thanks for correcting that. She's got plenty of cornea left for an
enhancement.
It is not possible with wavefront to have that occur on the VISX
system... unless someone tampered with the laser system. Doctors
have been known to tamper with their laser systems.
Any surgeon that performs the LASIK procedure is whom you need to talk
to... and not the one that did your wife's procedure. In fact,
there are ophthalmologists who do little else than cataract surgery.
Unless they actually perform LASIK, they don't necessarily know what
they are talking about.
I think her problem will be easily fixed.
Why did she only have one eye done? Was that planned ahead of time?
That is very unusual.
On 13 Nov 2005 13:56:39 -0800, "maurice.oprey@xmli5.com"
<maurice.oprey@xmli5.com> wrote:
>I should correct my post,
>
>Firstly the opthamologist said that the 90 microns was in addition to
>the 250 micron limit (his words) therefore she has 340 microns in the
>right eye, with 90 micons left to effectively perform a retreatment
>on..
>
>Secondly, it is possible for this level of overcorrection to happen
>because it has happened to my wife and quite frankly I do not need
>anyone else telling that it is not possible! I'm sure you can
>understand the frustration of hearing this particular statement!
>
>Finally, if opthalmologists wish to be called opthalmologists then it
>would help if the clinic referred to them as such, in my dealings they
>were constantly referred to as Surgeons (possibly easier for us mere
>mortals to understand and spell). And yes we will seek opinion from an
>individual who is not connected with that clinic.
| |
| Ragnar 2005-11-14, 12:59 am |
| No difference? With surface ablation, about twice as much tissue is
ablated, and rouglhly half of that regenerates over the next 12 months
- requring a bit of initial overcorrection to compensate for the
significant degree of regression with surface ablation.
A good analogy with teeth would be that LASIK is like having a cavity
filled, whereas surface ablation is like having a root canal done.
On Mon, 14 Nov 2005 00:30:42 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>There is virtually no difference in the laser treatment if the removal
>of the tissue is on the surface (PRK, LASEK, Epi-LASIK) or under a
>stromal flap (LASIK, IntraLASIK).
>
>Glenn Hagele
>Executive Director
>USAEyes.org
>
>"Consider and Choose With Confidence"
>
>Email to glenn dot hagele at usaeyes dot org
>
>http://www.USAEyes.org
>http://www.ComplicatedEyes.org
>
>I am not a doctor.
| |
| Glenn - USAEyes.org 2005-11-14, 12:59 am |
| I've checked to verify my facts. There is no difference in the
ablation whether the treatment is PRK, LASEK, Epi-LASIK, LASIK, or
IntraLASIK. The only difference is that the epithelium is removed (and
sometimes replaced) with surface ablation but it is not removed with
LASIK or IntraLASIK.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| maurice.oprey@xmli5.com 2005-11-14, 11:02 am |
| Glenn
Thank you very much for the detailed and helpful reply. We are located
in the UK. The actual treatment took place on 13th Augst 2004 so it is
now approx 15 months post op. The advice my wife received, as a second
opinion, was
A) Consider a contact lens, at least for a while.(this she is going to
do)
B) If you are going to seek retreament go to someone who is experienced
in this (a couple of names in the UK were supplied)
Thanks
Maurice
| |
| maurice.oprey@xmli5.com 2005-11-14, 11:02 am |
| It was recommended from day one that she only have one eye done at a
time. Indeed I believe, at least for my wife's measurements, that this
is normal practice here in the UK.
| |
| Glenn - USAEyes.org 2005-11-14, 11:02 am |
| It sounds like your wife has already received valid advice and a
referral. Hyperopic correction is somewhat less predictable than
myopic (not that you would personally claim much predictability in
myopic correction), but the lopsided vision must be causing her
difficulties. Objects are probably different sizes from one eye to the
other and even with corrective lenses depth perception could be
negatively affected.
Proceed with care and caution, but I'd still like to know why this
happened in the first place.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| Ragnar 2005-11-14, 5:58 pm |
| I have a one word reply to this message...
ONLY?
On Mon, 14 Nov 2005 05:56:14 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>I've checked to verify my facts. There is no difference in the
>ablation whether the treatment is PRK, LASEK, Epi-LASIK, LASIK, or
>IntraLASIK. The only difference is that the epithelium is removed (and
>sometimes replaced) with surface ablation but it is not removed with
>LASIK or IntraLASIK.
>
>Glenn Hagele
>Executive Director
>USAEyes.org
>
>"Consider and Choose With Confidence"
>
>Email to glenn dot hagele at usaeyes dot org
>
>http://www.USAEyes.org
>http://www.ComplicatedEyes.org
>
>I am not a doctor.
| |
| Maurice O'Prey 2005-11-14, 5:58 pm |
| >>but I'd still like to know why this
happened in the first place.
So would I....
Thank you for your time Glenn
Maurice
| |
| Glenn - USAEyes.org 2005-11-14, 5:58 pm |
| Yea, as far as the ablation pattern is concerned.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| Ragnar 2005-11-14, 5:58 pm |
| That might be normal practice at the clinic your wife went to. It is
possible that the clinic she went to has had a history of bad outcomes
and they don't dare do more than one eye at a time.
Maybe there is something about her eyes that was unusual?
I have seen people with oblong irises and one with a triangular pupil.
On 13 Nov 2005 23:52:44 -0800, "maurice.oprey@xmli5.com"
<maurice.oprey@xmli5.com> wrote:
>It was recommended from day one that she only have one eye done at a
>time. Indeed I believe, at least for my wife's measurements, that this
>is normal practice here in the UK.
| |
| Bryce Carlson 2005-11-16, 5:58 pm |
| In general, that is not quite true, Glenn. Because surface laser induces a
much stronger healing response than does intra-lamellar laser (LASIK), there
tends to be somewhat greater regression with surface laser than with LASIK;
therefore, surface laser ablations are generally about 10% deeper than LASIK
ablations to compensate for this.
Bryce
"Glenn - USAEyes.org" wrote in message news:
> I've checked to verify my facts. There is no difference in the
> ablation whether the treatment is PRK, LASEK, Epi-LASIK, LASIK, or
> IntraLASIK. The only difference is that the epithelium is removed (and
> sometimes replaced) with surface ablation but it is not removed with
> LASIK or IntraLASIK.
>
> Glenn Hagele
>
| |
| Ragnar 2005-11-16, 5:58 pm |
| Bryce is so smart!
On Wed, 16 Nov 2005 19:17:48 GMT, "Bryce Carlson"
<brycarlson@verizon.net> wrote:
>In general, that is not quite true, Glenn. Because surface laser induces a
>much stronger healing response than does intra-lamellar laser (LASIK), there
>tends to be somewhat greater regression with surface laser than with LASIK;
>therefore, surface laser ablations are generally about 10% deeper than LASIK
>ablations to compensate for this.
>
>Bryce
>
>
>"Glenn - USAEyes.org" wrote in message news:
>
| |
| Glenn - USAEyes.org 2005-11-16, 5:58 pm |
| This would be the surgeon's offset...correct?
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| Bryce Carlson 2005-11-18, 5:59 pm |
| Yeah, this is a surgeon-selectable offset, Glenn. Bryce
"Glenn - USAEyes.org" <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message
news:6rbnn1p9jv1uerv40tsl89b03o9iqea1bg@4ax.com...
> This would be the surgeon's offset...correct?
>
> Glenn Hagele
> Executive Director
> USAEyes.org
>
> "Consider and Choose With Confidence"
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.
| |
| Glenn - USAEyes.org 2005-11-19, 1:02 am |
| Thanks. That is where I missed it. I was looking at the laser data and
not thinking about the surgeon's variable. Good catch.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
|
| How do you prospective patients out there feel about the screw-ups and
all of the guessing going on in refractive surgery? Kind of rekindles
your affection for your glasses and contact lenses, doesn't it?
Maurice, get the optical report for your wife's surgery. Find out how
much tissue was actually ablated during her surgery. Have a 2nd opinion
doctor estimate what would be needed for her correction and determine
if too much tissue was removed. By pachemetry, not calculation. It's
really important to figure out what happened with the first eye if she
ever considers treatment of the 2nd eye. It would be nice to learn a
lesson from the first eye so that the overcorrection disaster doesn't
happen twice.
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