I have an article published in this month's Journal of Refractive Surgery titled: Traumatic Dislocation of LASIK Flaps 4 and 9 Years After Surgery. With the help of UMDNJ ophthalmology resident, H. Jane Kim, we published two cases of traumatic flap dislocation following LASIK. One of the cases occurred 9 years following LASIK, making it the longest reported case medical literature. In this case the flap dislocated when my patient was struck in his eye with a dog's paw. After treatment both of my patients vision improved to 20/20.
This article brings up an important point, there is a potential to dislocate the LASIK flap if one is hit at the right angle, years after LASIK surgery. This is one of the reasons I advocate treating those patients who are involved in activities (boxers, special forces, etc) that may preclude them to get hit in the eye with surface treatments such as LASEK. This procedure creates no flap, and thus minimizes future risk.
Today was an exciting day here at EyeCare 20/20. We were fortunate to host the olympic Bronze Medal USA Bobsled team of Erin Pac and Elana Meyers. They were in town for two reasons.
First, they were here to let the public get a look at their Bronze Medals, sign autographed pictures, and talk about their Olympic experiences. About 100 people came in to take advantage of this unique opportunity. I posted photos of the event on our Flickr site.
Second, Elana was in town to join Erin as a member of the LASIK for the Gold team. Before an athlete can qualify for LASIK for the Gold, we have them get some preliminary testing at home so that I can review the results. If everything looks OK, they are scheduled to come to New Jersey for additional testing and undergo LASIK surgery. Unfortunately, this additional testing showed that Elana was not a good LASIK candidate, and the surgery was canceled. I think I was as disappointed as Elana!
This brings me to an important point: I truly believe you can tell how good a LASIK surgeon is NOT by the difficult cases he claims to perform, but by those cases he doesn't do. Most of the complications I see on consultation could have been avoided by never doing the surgery! The key to excellent results is in preoperative screening and avoiding those patients who are not good candidates for the procedure!
One of the many questions I face from prospective patients inquiring about LASIK is "When is it safe to get hit in the eye?" The answer may be never! If the eye is hit at just that right angle with just the right force, there is a chance that the LASIK flap can be moved. Case in point: I reported the 2 latest cases in medical literature of LASIK flaps moving up to 9 years after the original surgery. The results were presented at last years American Society of Cataract and Refractive Surgery's Annual Meeting in San Francisco. The title of this presentation was: Late Onset Dehiscence of LASIK Flap.
So, when a prospective patient tells me they are actively involved in activities that may lead to an eye injury such as:
I will try to convince them to opt for LASEK, a surface treatment that involves no flap. If one gets hit in the eye following this procedure, there is no increased risk of injury.
Doug Miller is moving towards a career as a professional Ultimate fighter. He discusses his results with LASEK with me here.
OSN Supersite, reporting from the Hawaiian Eye Meeting today an article titled: Early U.S. cross-linking study results positive for treating keratoconus, ectasia.
Marguerite B. McDonald, MD, presented early results of the prospective, block-randomized clinical trial of 292 eyes with either keratoconus or post-LASIK or post-PRK ectasia. Maximum keratometric value, best corrected visual acuity, uncorrected visual acuity and manifest refraction are being measured in the study.
"The interim conclusions look pretty good," Dr. McDonald said. "It halts the progression of keratoconus and ectasia after LASIK."
"We think it will become the standard of care for the treatment of corneal ectatic disease," Dr. McDonald said.
This is certainly exciting news. Ectasia is one of the most difficult complications of LASIK surgery. It is a condition in which the cornea assumes a conical shape due to weakness, thinning, and anterior bowing of the corneal surface in patients following LASIK. These patients may have a progressive corneal thinning and bulging.
The key to preventing post LASIK ectasia is proper screening of patients prior to surgery. Several risk factors exist including:
Current treatment regiments for ectasia include:Cross-linking of the cornea is a new curative approach to re-increase the mechanical stability of corneal tissue that is progressively decreasing as a result of a corneal disease such as ectasia, keratoconus, or pellucid marginal degeneration. The procedure of corneal cross linking was developed from 1993 until 1997 by Prof. Theo Seiler and Prof. Eberhard Spoerl at the University of Dresden. The first patients were treated in 1998. Today corneal cross-linking is performed in more than 300 centers around the world. In many centers it has the potential to become the standard treatment for ectasia and keratokonus thus preventing the need for corneal transplant. It is currently undergoing clinical trials here in the US. I am anxiously awaiting its approval.
Lisa Velasquez was very disappointed when she came in for her free LASIK screening last month after I told her she was not a good candidate for the procedure. With a -11.0 diopter prescription, I determined that there was not enough corneal tissue to safely perform LASIK on her. I went on to explain that I could treat this amount of nearsightedness by implanting an ICL into her eye.
The Visian ICL (Implantable Collamer Lens) is a Phakic intraocular lens. It is an alternative to laser eye surgery, and is similar to the intraocular lenses (IOLs) used in cataract surgery but does not permanently alter the structure of the eye. No corneal tissue is removed as in LASIK and other laser eye surgery procedures. The ICL resembles a traditional contact lens and is surgically placed behind the iris, in front of one's natural lens. Unlike the intraocular lenses used in cataract surgery, ICLs do not replace the eye's natural lens, but work with it, to correct moderate to large amounts of myopia (nearsightedness). Though phakic IOLs are intended to be permanent implants, they can be removed if complications arise or if the patient's vision changes.The insertion of the Visian ICL™ Implantable Collamer® Lens is made through a small incision in the surface of the cornea. The Visian ICL™ is folded, requiring a smaller incision than other implantable lenses. Once inserted, the lens unfolds to its full size. No sutures are required in the procedure. The procedure takes about 10 minutes, and is performed on an out patient basis. One eye is treated at a time, a week or two apart. Visual acuity is remarkably good, even 1 day after the procedure.
Lisa had her surgery last week on her right eye, and "has never seen better!" She is anxiously awaiting surgery on her left eye.
My office received a call today from a patient who was in for a LASIK screening last year. She is now ready to proceed with LASIK. She did have one question: could she get the LASIK now, even if she was taking Accutane for acne? The answer: "No!" I told her she may proceed with LASIK after she is off the Accutane for 6 months.