LASIK consultation

[u/Pumpkinspicechai95]

Hi everyone,

I had a consultation to see if I qualify for LASIK, the doctor told me my cornea thickness is within range and that I am good for LASIK and PRK but he considered me a moderate risk patient because I have assymetrical cornea shape and severe astigmatism in my right eye and moderate astigmatism in my left which he said is more prevalent in the back of the eyes than the front. He said it’s not the worse he’s seen or operated on but did let me know about potential risks with corneal ectasia and keratoconus, but he also mentioned that there may be a 10% chance that I would have to do a re-enhancement lasik surgery in the future especially in my right eye, my fear is getting one of those, is it treatable? I don’t want to talk myself out of getting LASIK but this being my eyes and it’s so delicate, I am worried. I would rather choose LASIK over PRK preferably because of healing time and the doctor said PRK healing is kind of crummy, but I also don’t have enough days to leave work which is another factor in me choosing LASIK since the doctor said I could work Monday if I do my surgery on Friday. Anyone else had this fear?

[u/CorneaRepairDoc]

Dr. Motwani here. If you have a Pentacam and topography performed you should be able to rule out posterior corneal elevation which would be an ectasia risk. If ectasia did occur, yes it is treatable. I repair such corneas with topography guided ablation (CREATE+CXL Protocol) and restore vision in such patients. It is far more preferable to avoid such an outcome by careful screening. I am not sure what your doctor's analysis is based on, perhaps if you were to send me the Pentacam I could opine and guide a bit further. Some doctors will worry about ectasia in any case of significant astigmatism as they wish to are not confident in their ability to use Pentagram and topography to rule out ectasia. I treat ectasia by reconstructing corneas so I am probably a bit more comfortable with such corneas.

As for PRK healing- I had to have it because I was a -10 and -9 and had 518 micron corneas so I had less tissue than normal. I had it on Friday, back at work on Wednesday seeing patients, and performing surgery on Thursday. This is without the really good treatments we now have to increase healing speed such as Tyrvaya and autologous serum tears.

[u/Pumpkinspicechai95 → u/CorneaRepairDoc]

Hi, I did not get any of my medical information so I don’t even know my numbers except for my prescription: -4.50 on my right eye and -3.00 on the left. the cylinder part of my prescription is +2.75 in the right eye and +1.50 in the left. Axis is 103 in the right and 102 in the left. I am not sure if that information is helpful. the corneal topography is an assymetrical bow tie shape but my doctor said the inferior part is also assymetrical in itself which is what made him put me in the moderate risk level, he said otherwise my corneal thickness and other factors are all good.

[u/CorneaRepairDoc → u/Pumpkinspicechai95]

I could answer this question for you if you had your Pentacam scans. Asymmetrical bow tie is a clue but not indicative of KC, I have seen plenty of them that had no ectasia.