Corneal Scars and LASIK

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Question: I Was Told That I Have a Scar on my Cornea and Glasses or Contacts Wouldn’t Help. Would Lasik Help?

Answer: It is likely that if you were told that you have a scar that the scar is not visible cosmetically and may not affect vision at all. In this case, there is really no need to treat the scar. It is like having a birth mark that nobody sees and doesn’t affect you.

LASIK would likely not eliminate the scar either since it creates a flap which is then replaced after the surgery. PRK could potentially treat the scar. In PRK, the corneal epithelium is removed and the underlying tissue is treated with a laser. Following treatment, a bandage contact lens is placed over the cornea and the epithelium grows back. A surface scar on the cornea can be eliminated via this procedure.

Unless the scar is large and central, it often has no impact on vision.

Minimum age for LASIK surgery

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The FDA has approved excimer lasers for use in LASIK for patients as young as 18 years of age. Surgeons could perform LASIK in patients younger than 18 but such a treatment would be considered off-label.

The concern for younger patients is that the glasses prescription has not yet stabilized and the person would later need a second or third treatment in order to achieve best corrected vision.

LASIK for recent onset of myopia

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Q: I’ve been nearsighted for about 1-1/2 years, is Lasik a permanent cure?

A: Your question reveals some information that indicates Lasik may not be an option…yet.

You say you are “suffering from near-sightedness for about a year”. It is unusual for an adult to experience late onset myopia (nearsighted, shortsighted) vision. Natural myopia commonly first presents in early adolescence. In the US, the patient must commonly be over age 18 to have Lasik.

Another concern is that you have experienced myopia for only a year and a half. A patient must have a stable refractive error before Lasik. For most doctors that means two years without a change in prescription. If you myopia presented a year and a half ago, then your vision is not stable.

Lasik permanently changes the focus of the eye by reshaping the cornea, but the eye will continue to change after Lasik at the same rate it did before Lasik. The “permanence” of Lasik depends on how much your eye is naturally changing.

Lasik can resolve the symptoms of myopia (poor distance vision), but does not resolve the actual cause of myopia. Myopia is commonly caused by the eye being longer than normal, causing focus of the light entering the eye to be in front of the retina (light sensitive membrane at the back of the eye that changes light into nerve signals). Lasik does not change the length of the eye, but reshapes the cornea (clear front) of the eye to change the point of focus within the eye. This is important to remember because myopia (primarily high myopia) can lead to other issues such as retinal detachment. Even though you may no longer see after Lasik like you are myopic, your eye remains myopic.

Only a comprehensive examination from a competent Lasik doctor will be able to determine if you are a good candidate for Lasik and if Lasik is right for you.

If your myopia is very low, you may find success with Orthokeratology. This is a process of reshaping the cornea with specially fitted hard contact lenses. When the contacts are removed, the reshaped cornea remains for a few to several hours. Sometimes you can sleep in the specially fitted contacts and the vision change will last the whole day.

Water in the eye

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Question: I had LASIK 3 weeks ago and while taking a shower a drop of water went into the eye, there is no discomfort but wondering if this is okay? or should i book an appointment with my optometrist?

Answer: Three weeks following surgery there is usually not an issue with getting a little water in the eye from the shower. Many LASIK centers typically allow patients to shower normally after just 1-2 weeks. Unless you vision is abnormal, there is pain, or some other sign that there might be something wrong, you can probably wait until your next appointment.

If this is causing you stress, however, it would be simple just to schedule a quick checkup. It might relieve your anxiety over this and give you greater peace of mind.

Another option would be to put a drop of the antibiotic in that eye. This is another frequently advised treatment even if water gets in the eye during the first day or two after LASIK.

Walnut Creek LASIK eye surgery patient with hyperopia

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Recently, we had a LASIK patient in our Walnut Creek LASIK facility who was over 50 and suffering from hypermetropia (also called hyperopia or far-sightedness) as well as presbyopia (the inability to see near objects due to aging). This Walnut Creek native was confused about the difference between hyperopia, far-sightedness, and presbyopia. This confusion is very common and I even had an optician ask for me to explain the difference to her as well so even professional eye care workers can struggle with these terms.

Hyperopia occurs when the eye focuses naturally behind the retina due to a flatter than normal cornea or a shorter than normal eye (or both). When the individual is young, he or she can accommodate (move the focus forward onto the retina by using the ciliary muscle) to make the image clear. As a person grows older, the ability to accommodate diminishes and the individual will see worse up close and eventually worse at a distance as well (the rate of this change depends on the magnitude of the prescription). LASIK laser vision correction can effectively treat hyperopia.

Presbyopia is caused by the loss of focusing power with age. An individual with presbyopia might have good distance vision but unable to read up close. LASIK can help some people through a process known as monovision. One eye is focused at distance to see clearly. The other eye is focused at a closer distance for reading and computer work. For most people they adapt to this condition can their brain naturally chooses to see through the clearer eye. Normally our brain takes the image of the world that we see with both eyes and filters it to provide us with an accurate visual assessment of the world. With monovision, our brain does the same thing, it takes the images of the two eyes and filters them to provide the best vision at both distance and near.

The Walnut Creek LASIK patient is now very happy with the vision obtained, which allows her to see adequately at both near and far without having to wear glasses. The vision is not perfect but it is much better than it was before and most importantly, she is glad that she chose to have LASIK eye surgery.

Will Lasik Work in my Case?

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Question: I’ve tried glasses but never contacts. Glasses for me do almost nothing but give me a headache. My vision improves only marginally to the point I don’t know much of a difference with or without. When I have both eyes open I see fine, but when I close my right eye everything is blurry. Just wondering if Lasik would make a noticeable difference. I’d rather not spend the money if it won’t considering what it costs to have done.

Answer: It sounds as if you might have significant anisometropia (a difference in prescription between the two eyes). This might be a good reason to have LASIK eye surgery but you should see an eye care specialist for a better evaluation.

1. Glasses for me do almost nothing but give me a headache.

Perhaps your glasses prescription is wrong. If you have high astigmatism a small error in your prescription (as little as a few degrees) would easily eliminate the advantage of the prescription. If the glasses were decentered, the prescription was incorrect, or the prescription was remarkably different between the two eyes (even if it was correct), you could easily experience headaches. LASIK might help with all three of these.

2. My vision improves only marginally to the point I don’t know much of a difference with or without.

If you have high astigmatism and did not wear glasses as a child you might have a level of amblyopia (an inability to see well that occurs in the brain due to a lack of clear visual stimulus as a child). You might also have keratoconus or some other optical disorder which creates aberrations which are not correctable with glasses. Keratoconus is not correctable with LASIK but some other higher order aberrations are.

3. When I have both eyes open I see fine, but when I close my right eye everything is blurry.

This sounds like you have anisometropia (and possibly amblyopia as well) and your brain is repressing the image in your left eye when both eyes are open. Glasses might be clearing up the left eye partially but causing you more discomfort as it becomes more difficult to repress the blur in that eye.

I would suggest a more in-depth eye examination in which you explain these problems and make certain you receive a satisfactory answer. LASIK might be helpful to you. It also might not be a good choice depending on your condition. If you are better of repressing the left eye, LASIK could force you to use it and cause significant discomfort. If you have keratoconus, LASIK would definitely be a bad choice. On the other hand, if your discomfort is caused by anisometropia (and a resulting difference in image sizes), LASIK would be better than glasses. Also, if your discomfort is caused by an improper prescription, LASIK might be better but only if the LASIK surgery was more accurate than the glasses, which can never be guaranteed 100%.

Each LASIK case is unique and each case requires an in-depth and complete examination to determine if LASIK is right in your case. Specific measurements must be taken and specialized medical equipment must be used to determine the best choice. The eye care professional will then be able to counsel with you about your specific vision needs.

10 Days Post Lasik but Vision is not perfect in my Left Eye?

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Question: its been 10 days of my i lasik in both eyes i had high power – 5.00 in both eyes but now after lasik although i can see 20/20 from my right eye but in left eye i see blurred i had a big clot on up of my left eye which is touching the iris may be thats the reason for the blurdness kindly advise the surgeon says it takes 3 months to stablize vision but i heard next day u can see perfect as in case of my right eye or may be clot is the reason

Answer: While many patients see 20/20 on the next day after LASIK, it is also common for many patients to require additional time (days or weeks or even months) before the best vision is achieved. Studies show that vision continues to improve following LASIK vision correction for up to a year after the procedure. LASIK does not always achieve perfect vision immediately and in fact perfect vision is not guaranteed nor should it be expected. LASIK is very successful and 98-99% of people are happy that they chose to have the procedure.

There are many reasons for the blurred vision. If the full refractive correction was not achieved with the initial surgery, a follow-up touch-up procedure is occasionally required. Sometimes dryness can prevent the best vision until it resolves which can take 3 months or longer. Inflammation can also delay your best vision and may require prolonged use of eye drops to help it resolve.

You mentioned a clot that is located in left eye. This might be a broken blood vessel that occurred during the surgery, similar to a bruise on your skin. This would be called a subconjunctival hemorrhage and might take several weeks to resolve. If it is located entirely on the white portion of your eye it should not interfere with vision. These are a common finding following LASIK surgery and are temporary. They do not result in long-term complications.

Do Lower Prescriptions Have Better Results with Lasik?

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Question: Is It True That Lower Prescriptions Have Better Results with Lasik?

I had Lasik about a year ago and have had almost no complications and been overall happy with the result. But I’ve been surfing the web and what I found worried me, terrible reviews and regrets about having the procedure done. I had a low prescription and did it mainly because contacts really bothered me and hated the way I looked with glasses. Is it true that you have better results with lower prescriptions like mine? Or will I suffer regression and chronic dry eyes in the future?

Answer:
LASIK eye surgery treats myopia (near-sightedness) by flattening the cornea which causes the light to focus correctly onto the retina. The laser flattens the cornea by evaporating corneal tissue thereby thinning the cornea.

The higher the near-sighted prescription, the more the cornea must be flattened and the more corneal tissue is required. This results in more corneal tissue being required for higher prescriptions than for lower prescriptions. As a result, lower prescriptions are more predictable and have less side effects after having LASIK surgery.

Of course, higher prescriptions have much more to gain from LASIK surgery. People with high prescriptions often cannot function effectively without glasses or contact lenses. They are more likely to overwear their contact lenses and are at a much greater disadvantage if their glasses are lost or broken.

Overall, LASIK has a very high rating of satisfaction. Even people who are not completely satisfied with LASIK most often report that they would still have the procedure done if given the choice over again.

How much would LASIK cost me?

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Q: How Much Can I Expect LASIK Surgery for -3.75 D to Cost on the Average? (WaveFront)

A: It is a common misunderstanding that the cost of LASIK depends on the prescription. While some low cost centers might connect the price of LASIK eye surgery to your prescription, the most common reason for this is that they are using an older laser, older technology, and outdated laser vision correction treatment methods for this low cost option.

They do not provide custom wavefront all-laser LASIK using the newest upgraded laser technology for these low price options. Most often they try to bait-and-switch patients by dangling low prices (such as $600 per eye) and then convince patients that due to astigmatism, moderate myopia, and higher order aberrations they will need to upgrade the costs or they might sacrifice safety. This scare tactic seems a bit dishonest in my mind.

LASIK is not an inexpensive procedure. Generally you should expect at least $2000 per eye if not more. The best surgeons and the best technology generally cost around $2500 per eye or more. If your price is a fraction of this (as are sometimes advertised in various markets), then there is a chance that your surgeon is cutting corners and providing a less safe and less accurate treatment.