Is PRK done after Lasik when enhancement needed?

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

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

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

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.