San Jose LASIK doctors
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Gary Kawesch, MD
San Jose Ophthalmologist
606 Saratoga Avenue, San Jose |
24 answers | |
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Craig S. Bindi, MD
San Jose Ophthalmologist
606 Saratoga Avenue, San Jose |
Recent Answers
I was diagnosed with keratitis a couple of months ago that has since cleared up, but left a small scar on my right eye. I've read mixed opinions on whether I'd be an ideal candidate for lasik, ranging from "less than ideal" to "disqualified". Does having corneal scarring automatically disqualify me from the operation? If not, what is the safest operation for someone under these conditions?
There are several issues which need to be considered here. First, what is the exact cause of the scar? An injury? An infection? If an infection, was it contact-lens related, or was it HSV keratitis (a viral, herpetic keratitis)? If HSV, you should be aware that corneal refractive surgery can re-activate the virus and lead to more keratitis. Doesn't mean it can't be done, you just need to be aware of this risk. Also, LASIK is generally preferred versus PRK in this situation, in that it may be less commonly associated with a re-activation of the virus. Also, certain medications are often used pre and post-operatively to reduce the risk of this re-activation.
The location and depth of the scar within the cornea is also important. If the scar is near the center of the cornea, and affecting vision, often a surface treatment such as PRK is preferred over LASIK since it can remove some or all of the scar. It depends on how deep within the cornea the scar is, superficial scars are most completely removed. Deeper scars may be lessened, and vision improved, but may not be completely eliminated with PRK. With LASIK, the scar will often not be removed much at all, unless it is very deep in the cornea.
With LASIK, there are two ways to create a flap--using a blade (microkeratome), or using a femtosecond laser such as IntraLase or Ziemer's device. The laser created flaps typically should NOT be used in the presence of a superficial scar, since the laser beam may be scattered by the scar and an incomplete flap may result. A blade-based keratome is typically better used in this situation.
I've treated MANY patients with corneal scars with both PRK and LASIK, and have had great success.
Yes, this is possible IF corneal thickness permits. Also, I would recommend a contact lens trial of monovision first, to make sure that you like that type of vision (about 90% of patients like monovision). It would not be good to do monovision surgically with a second procedure, then find you don't like it, and have a third procedure.
Had custom lasik 4 wks ago and am experiencing terrible dry eye, light sensitivity, and daytime glare. Is dry eye causing this? The light sensitivity occurs with all types of lighting including sunlight. I am not only experiencing daytime glare but also some nightime glare as well, small halos and glare off headlights. Are these caused by abberations or dry eye?
Your light sensitivity (known as "photophobia" by doctors) may be caused by dryness. It might also be caused by microscopic swelling in the cornea, known as corneal edema, or by inflammation in the cornea or rarely after LASIK inside the eye itself. Photophobia is more common with femtosecond-laser created flaps ("all-laser LASIK" using the IntraLase or similar lasers) than it is with blade-created flaps. Femtosecond laser-associated Transient Light Sensitivity (TLS) is relatively common and is thought to be due to inflammation within the cornea. TLS is generally self-limited and resolves on its own, but may be treated with a longer course of steroid anti-inflammatory eyedrops.
Your surgeon should be able to determine the cause of your photophobia and recommend the proper treatment course.


