Safety and effectiveness of a LASEK/epiLASEK Enhancement Procedure
Dr. Chynn recently answered Sakiko’s (a prospective enhancement patient) questions regarding LASEK’s safety and effectiveness.
We are now contemplating having EpiLASIK or LASEK done at your clinic next time we visitNew York, in order to correct the under-performance of the LASIK surgery done at Singapore National Eye Center.
Below are my questions:
1. I have read that EpiLASIK or LASEK carries a certain risk of cornea scarring andmitomycin-C effects as a result of the treatment of this, ‘in high-myopic patientst’. AsI am now around -2 (I can’t remember what the exact vision we determined I now have atyour clinic), is that considered to be ‘high-myopic’ and am I therefore at risk if Iproceed with the second operation? If so, what percentage would you estimate? Can thislead to blindness or other permanent damage? Are there other potential side effects toconsider?
Your residual Rx is quite low; only in the low myopia category now. If you were a primary treatment, you would not get MMC, as your risk of scarring would be very low. You would get MMC because you are a re-treatment, and the risk of scarring is higher in all re-treatments compared to primary surgery, no matter what the Rx. However, I would not say your risk of scarring is high–probably about 5%, which would mean you would have about a 95% of not scarring. These are really very good and acceptable odds. This means the chance that you would see better after your enhancement is about 95%, the chance same about 2.5%, and the chance worse about 2.5%, since even if you scar a bit your vision will not be worse than it is now, since it is not now that great. Again, a very positive risk-benefit ratio!:)
2. If I choose not to have further treatment, can I wear contact lenses without riskingdamage to my eyes, and what lenses should I in this case wear?
You can wear contacts, but this is really kind of silly, since you did the surgery to get rid of them, and I can get rid of the need for this with over a 95% success rate.
3. If I again choose no further treatment, how far (in a worst case scenario) can my eyedeterioration become, in your view?
Your vision now is as bad as it is likely to get, pretty much.
4. What are the chances of EpiLASIK or LASEK surgery going wrong and causing damage, andif so what damage, and can this damage be corrected? And is there a chance of thisprocedure having a similar effect as the LASIK, i.e. post-surgery eyesight deterioration?If this happens, can I have (a third!!) surgery to correct the previous two?
See odds above. If you scar, we can re-laser you to remove the scar, usually. But I think the chance that you would need a 3rd procedure is about 2.5%, which is really very low, so not what we should really be dwelling on now, since it probably is not going to happen. I would focus on what you should to to PREVENT scarring if I were you instead (take Vitamin C, wear sunglasses w UV protection postop, etc.).
5. Are there any conditions / diseases that I may get in years to come that have beenrendered untreatable as a result of these procedures (cataracts, etc)?
No, you may develop cataracts in 1-2 decades or whatever, but they are still treatable, it is a different part of your eye (the lens inside your eye not your cornea).
6. I’m afraid I have forgotten which treatment you recommended; EpiLASIK or LASEK? Andwhat is the difference between the two?
If you had prior LASIK you cannot get epi-LASEK as there is a small risk of getting your flap back up using the machine. Using my own hands, I can actually be a bit more delicate and controlled than with the epi-Keratome, so my risk of getting your old flap up with a LASEK is almost 0. Therefore, you would have a CustumVue LASEK over your prior LASIK, just like about a hundred patients. If you call my office they can email a few of these patients who had LASEK over a prior LASIK and cc you on the email, so you can chat w them. Unfortunately, you have to call us at your nighttime so you speak to my front desk, as they work way better attending to calls than to emails:)
7. How sensitive are my eyes by now (suregery was March 26th last year)? How much shouldI panic for minor skirmishes, a bump, a scratch, etc?
Safer than after your 1st procedure as we are not cutting a new flap, nor lifting your old flap up.
I would be most grateful for your advise. I do not ask for, or expect, free
consultations, so if you could very kindly attach payment details in your reply, I willimmediately remit the consultation fee. The last question is: do I win a prize for beingthe most irritating patient in the history of eye care?
I am actually willing to spend time with and meet with and email complicated patients who have had prior LASIK, as I love helping them see better. It’s the most rewarding thing I now do (fix prior surgery problems). You can post this on the following sites: Yelp, Citysearch, MySpace, Facebook. That will be fine, Nils. And no, you are NOT CLOSE to being my most annoying patient!:)
Thank you so very much for your kind attention. As you understand, I am still concerned.
No problem, enhancement patients are naturally concerned, which is 100% understandable. Don’t worry, I CAN fix you!:)
yours,
