Thursday, September 29, 2011

LASIK Enhancements-Should I have One?

Question: I have a question about having a LASIK enhancement. I had LASIK 11 months ago. My original prescription was -3.50 in the right eye and -4.00 in the left eye. The procedure went very well but I had some dry eye and with Restasis is was okay. At the 6 month check-up I was 20/30 in my left 20/20 in my right eye and now after 11 months I am still 20/30 in my left. I just had a consultation with the LASIK Surgeon, who's reaction was "I can do a LASIK enhancement if it bothers you, but if you can tolerate it, my opinion is to just leave it be". I went through 2-3 years of my left eye being under corrected even with glasses, so it's annoying as all get out. I'm just not sure if it'll be worth it. I'm in a quandary. On one hand, I'm kind of miffed that I spent the money to see perfectly and am just slightly less clear in the left eye. On the other hand, it's not horrifically bad, just slightly less clear with like reading the digital clock and being able to see the speed limit signs. The one thing I'm scared about is the possible negative outcomes of an enhancement (over correction, epithelial in growth, halos) because the initial surgery went so well. It also seems that with every blink of the left eye, I get slightly different vision. I can be looking at the digital clock on the DVD player from the couch, cover my right eye, and hardly be able to make out the numbers. But other times it doesn't seem like there's very much of a difference. Can you offer me opinions PLEASE??


Answer: It sounds like you have a few things to think about.

First, is the notion that you "paid for perfect vision". If this is why you had LASIK it was an unrealistic expectation. LASIK is surgery. There is no guarantee of a so called "perfect" outcome. The use of Snellin Visual Acuity to measure "success" is not really appropriate. What is appropriate is asking yourself of you are better off being able to do virtually everything in your life without being dependent on eyeglasses or contacts to see at a distance? With the vision you have now it is a pretty sure bet you can do this. Further it is not normal to compare the two eyes-each eye heals slightly differently.

The second thing to think about is that you seem to have fluctuating vision with blinking that comes and goes-this is very often do to a continued dry eye or tear film problem that may be caused by LASIK or a mild inflammation or irregularity in the health or condition of your eyelid margins. You should fully investigate the cause with your LASIK Surgeon as this may simply require that you continue Restasis or have some treatment for your eyelid margins. If after this you still have 20/30-as you most likely will-then you should just accept it as this is an excellent outcome.

Important Note: The information presented on the See With LASIK Blog or provided in response to a request for information in the Ask LASIK Surgeons section on www.seewithlasik.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to LASIK. In particular a response to an inquiry made on the Ask LASIK Surgeons section of www.seewithlasik.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and LASIK surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Monday, September 19, 2011

Should I have LASIK?

Question: I am interested in LASIK but have a few concerns:


1) My vision has gotten progressively more near-sighted over the past several years. Small changes, but I started at about -2.00 in each eye in my early twenties, and now I am 28 and at -3.75. The changes seem to be slowing down, but it hasn't stopped. I heard that you should wait until vision is stable.

2) I have dry eyes. It is not usually severe, and much of the time it doesn't bother me. But, there are times when I have to use artificial tears (which don't seem to help much), and occasionally it gets pretty bad, and is extremely bothersome. I am confused about the information I've read about LASIK and dry eyes. Is the worsening of dry eye symptoms after LASIK permanent or temporary?

3) If I choose to get tear duct plugs, how much extra might that cost, and how effective are they? What are the downsides of getting them?

Answer: Your questions ascertaining your suitability for LASIK are excellent. First, if your vision has progressed from -2.00 to -3.75 during your early to late twenties it suggests that your nearsightedness is progressive rather than stable at this time. Over the past few years criteria for refractive stability have loosened up somewhat but a conservative approach might be to demonstrate that your prescription has not changed more than -.50 over a 12 month horizon. This would be a conservative approach to refractive stability and some LASIK Surgeons vary somewhat from this standard.

Regarding dry eyes, you certainly need to have a careful evaluation of yourr tear film as part of your LASIK consultation. Through this evaluation, the best LASIK Surgeons will be able to determine whether both the quality and quantity of the tear film will allow you to have the best possible results. If there is a deficiency in either it may be necessary to a) use artificial tears b) artificial tears + punctual plugs c) artificial tears + punctal plugs + Restasis prescription eye drops. Your LASIK Surgeon will want to treat ANY tear film deficiency PRIOR to your procedure. After LASIK it is very often the case that there is TRANSIENT dry eye whether or not you had a pre existing dry eye problem. Most often it is limited to less than 6 months after the LASIK Surgery procedure and will most likely treated with either punctal plugs and/or Restasis. If you should need punctal plugs the cost is usually covered by insurance. They along with Restasis are quite effective in dry eye treatment. Really there are no downsides to punctal plugs for dry eye should you require them.

Important Note: The information presented on the See With LASIK Blog or provided in response to a request for information in the Ask LASIK Surgeons section on seewithlasik.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to LASIK. In particular a response to an inquiry made on the Ask LASIK Surgeons section of seewithlasik.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and LASIK surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Wednesday, September 14, 2011

LASIK Surgery with Diabetes?

Question: I have a question about having LASIK surgery if I have diabetes. I am a type one diabetic, would I be a good candidate for LASIK eye surgery?

Answer: Type I Diabetes is not an absolute contraindication for having LASIK Eye Surgery but there are several considerations to be aware of.. Type I Diabetes is uusually diagnosed in children and young adults. As with anyone having LASIK or any type of Laser Eye Surgery for Laser Vision Correction your prescription must be stable. Typically refractive stability should be demonstrated over 1-2 years AND for anyone with Diabetes it would be important to make sure that there was refractive stability through the range of blood glucose levels experienced by the patient. That is, the patient should have pretty tightly controlled blood glucose levels.that do not cause any visual fluctuations. A thorough evaluation of the retina should document the presence and extent of any Diabetic Retinopathy so as not to confuse the visual results and outcomes of LASIK with any vision limitations caused by the retina. A careful evaluation of the cornea is done as part of any LASIK evaluation but specific observation of the corneal basement membrane is important in Diabetic patients as sometimes they have less than optimum basement membrane health and this might warrant recommendation of a different Laser Eye Surgery procedure for vision correction. MANY Diabetic patients elect to have LASIK and do so quite successfully. The key is to find the best LASIK Surgeon in your area and schedule a consultation. They will confer with your Internist or Endocrinologist to make sure that you get the best possible result.

Important Note: The information presented on the See With LASIK Blog or provided in response to a request for information in the Ask LASIK Surgeons section on seewithlasik.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to LASIK. In particular a response to an inquiry made on the Ask LASIK Surgeons section of seewithlasik.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and LASIK surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Gene for Nearsightedness Identified by Israeli Researchers

In an article appearing online in the American Journal of Human Genetics a Ben-Gurion University of the Negev research group led by Professor Ohad Birk has identified a gene whose defect specifically causes myopia or nearsightedness. "We are finally beginning to understand at a molecular level why nearsightedness occurs," Professor Birk relayed. The discovery was a group effort at BGU's Morris Kahn Laboratory of Human Genetics at the National Institute for Biotechnology in the Negev and the Dayan Clinical Genetics Wing at Soroka University Medical Center.

Nearsightedness is the most common human eye disorder and is mostly a hereditary trait. Aside from being a significant public health concern, nearsightedness also leads to a higher incidence of other secondary eye disorders, such as retinal detachment, macular degeneration, as well as early onset glaucoma and cataracts. Despite decades of intensive research, the specific genes whose defects lead to nearsightedness have remained elusive. The defective gene was identified in a thorough study of severe early-onset myopia that is common in a specific Bedouin tribe in southern Israel. The gene encodes an enzyme that is essential for the final modification of collagen in the eye. In the absence of the active form of this enzyme, aberrant collagen is formed, causing the human eyeball to be longer than normal. As a consequence, light beams entering the eyeball focus in front of the retina rather than on the retina itself and myopia emerges.

Astigmatism and NFL Football-What's In Common?

What do an official NFL Football and Astigmatism have in common? The Baltimore Ravens......The Washington Redskins.......The New England Patriots all certainly demonstrated laser vision precision in passing this week. But, the common feature is really that the shape of a football is very much like the shape of a cornea and an eye that has astigmatism! Fortunately today we can correct that football like shape with eyeglasses, contact lenses and LASIK Eye Surgery-and for those patients who have astigmatism and need Cataract Surgery we can even correct their astigmatism with astigmatism correcting toric lens implants. If you have an astigmatism and might wish to become less dependent or even free from the hassle of eyeglasses or contacts think about LASIK to achieve your personal vision correction goals.

Friday, September 9, 2011

LASIK with Retinal Hole Problem

Question: I am interested in LASIK but I may have a retinal problem. Three years ago my eye doctor found a hole in my retina in my left eye. I have not had any problems with floaters, flashes of light or anything like that. The hole has also not changed in the three years since it has been discovered. Would I be a possible candidate for LASIK eye surgery?


Answer: Depending on the characteristics of the retinal hole and its stability you may or may not be a candidate for LASIK. If the hole is due to thinning from an elongated eye and is well attached at its margins without any associated tears or areas of "traction", it is very possible that you would be cleared to have LASIK. If the hole looks unstable in any way and might lead to a further tear or retinal detachment you would be excluded from having LASIK. The most appropriate next step is for you to find the best LASIK Surgeon in your area and schedule an examination and consultation. From the examination the LASIK Surgeon will be able to determine whether you are a suitable candidate. If there is any question about the integrity and stability of your retina, he or she will refer you to a retinal specialist to help determine any risk.

Important Note: The information presented on the See With LASIK Blog or provided in response to a request for information in the Ask LASIK Surgeons section on www.seewithlasik.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to LASIK. In particular a response to an inquiry made on the Ask LASIK Surgeons section of www.seewithlasik.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and LASIK surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Thursday, September 8, 2011

Joining the Military after LASIK

Question: I am interested in having LASIK but I am joining the military. Do you know if LASIK is allowed if I was to be joining the military?


Answer: The types if environments and tasks military personnel are exposed to can make the wearing of eyeglasses and contact lenses somewhat of a challenge. LASIK can be a good alternative for military personnel exposed to dusty or muddy environments as well as eliminate any concern about losing glasses or contacts in combat conditions. The Army, Navy, Marines and Air Force all accept personnel who have had LASIK but there may be some restrictions in the types of training and services that are allowable for certain military service members who have already had LASIK.

Some things to consider are that the Navy and Marines will routinely grant a waiver for pilots or student naval aviators to fly after PRK, assuming preoperative standards are met, no complications in the healing process were encountered and passing their standard vision tests. Candidates who have had PRK can get a blanket waiver for the Special Forces Qualification, Combat Diving Qualification and Military Free Fall courses. PRK and LASIK are both waived for Airborne, Air Assault and Ranger schools. However, those who have had LASIK must enroll in an observational study, if a slot is available, to undergo training in Special Forces qualification. LASIK is disqualifying/non-waiverable for several United States Army Special Operations Command (USASOC) schools (HALO, SCUBA, SERE) according to Army Regulation 40-501. THE BEST THING TO DO IS CHECK FOR THE CURRENT REGULATIONS, REQUIREMENTS AND WAIVERS WITH A RECRUITER AND/OR COMMANDING OFFICER AS THEY ARE REGULARLY MODIFIED.

Important Note: The information presented on the See With LASIK Blog or provided in response to a request for information in the Ask LASIK Surgeons section on www.seewithlasik.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to LASIK. In particular a response to an inquiry made on the Ask LASIK Surgeons section of www.seewithlasik.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and LASIK surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Tuesday, September 6, 2011

LASIK Surgery with Nystagmus and Astigmatism

Question: I have a question about having LASIK Surgery if I am albino and have astigmatism and nystagmus. With nystagmus is there any possibility of having LASIK?


Answer: In addition to the lack of pigment in the Iris and the Retina, ocular albinism is often associated with nystagmus and astigmatism. Nystagmus is an involuntary eye movement which can be present in differing patterns of movement. Depending on the type and severity of the nystagmus it is quite possible to have LASIK Surgery for vision correction. Today, most excimer lasers used for Laser Vision Correction use scanning and tracking technology to follow the position of the eye and deliver the laser treatment to exactly the correct location on the cornea. Scanning and tracking systems actually measure the position of the eye hundreds of times per second and adjust the energy delivery to the right position, thus can actually compensate for the involuntary eye movements of nystagmus in many cases. Your next step is to schedule a consultation with the best LASIK Surgeon on your area and have a thorough examination to see if you would be suitable candidate.

Important Note: The information presented on the See With LASIK Blog or provided in response to a request for information in the Ask LASIK Surgeons section on www.seewithlasik.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to LASIK. In particular a response to an inquiry made on the Ask LASIK Surgeons section of www.seewithlasik.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and LASIK surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Friday, September 2, 2011

Corneal Erosion, Contact Lenses and Safety

Contact Lenses are often trivialized with regard to safety as a result of their overall commercialization. However, according to researchers reporting in Contact Lens & The Anterior Eye-The Journal of the British Contact Lens Association, contact lens wear continues to be the highest single risk factor for microbial keratitis, particularly when worn in the extended wear modality. For microbial keratitis to occur, the presence of bacteria along with a break in the corneal surface is required. A break can occur from any form of corneal erosion both with and without contact lens wear. However the risk of infection is greater during contact lens wear as the lens can provide a source of bacteria.The causes of corneal erosion with contact lens wear are not completely understood but may be related to certain risk factors such as such as extended wear. Researchers are working to allow the appropriate diagnosis and effective treatment as well as the development of preventative strategies so as to further enhance contact lens wearer safety.


Dry Eye Patients Lose Work Productivity

Dry Eye patients lose productivity at work according to a study published in Current Medical Research & Opinion. A cross sectional dry eye study was administered to more than 9,000 patients who were employed and had self reported and physician diagnosed dry eye symptoms. The researchers said the loss of productivity was more pronounced among individuals who work in an office environment where the make portion of the work day is spent using a computer or reading. This is consistent with the fact that if you take patients with dry eyes and place them in activities such as computer work where the blink rate is decreased by 50% or more you actually make the problem worse and even more symptomatic for patients.