Amjad Khokhar, MD

I am sorry to here that you are having difficulty with your vision after lasik surgery.  It is very common for one eye to be corrected better than the other eye.  I tell all patients this in advance to expect this.  Just like one of our arms is longer than the other arm.  Our body is not symmetric.  One eye will usually be a little stronger or dominant compared to the other.

That being said, it is important for you to be satisfied with you vision as you complete your daily activities.  It sounds like your not there yet.  It is surprising to many patient to know how much dryness can affect your vision.  If you are being troubled with dryness, which is expected after LASIK, then that should be optimally controlled before considering any type of second surgery.  In fact, it can often be difficult to plan any additional surgery when struggling with dryness of the eyes.




The drops can be cumbersome.  There are many alternatives, none our perfect, to reduce your dependency on drops.  You may already be using Xiidra and/or Restasis.  You may have already have punctal plugs placed.  Using thicker drops can sometime reduce the number of drops your have to apply especially is you can place some ointment in you eyes at night.  Omega 3 Fatty Acids can help.  Sometime changes to work behavior especially is you spend hours staring at a computer need to be considered.  Also, if the cause of you dryness is not purely decreased tear production after LASIK but also evaporative tear loss from blepharitis or meibonitis, then that need to be addressed as well in somewhat different approach.




But you have to manage this dryness as your first priority.

A +5 prescription is a challenging prescription to handle with LASIK, though it can be done.  The candidate needs to be aware of the normal postoperative course.  Specifically, initially many surgeon will slightly over treat knowing that some regression will take place in the months after the surgery.  Also, I tell patients with this prescription to expect fluctuations for months or even during the first year as the cornea stabilizes.

I imagine that your vision is amazing better (probably life-changing) compared to before as you needed glasses to do anything.  Probably your just wondering what to expect as far of your distance vision goes.  I would say expect fluctuation that will decrease in magnitude as the months go by.  At this point, no reason for you not to expect you will achieve vision to your satisfaction.

And of course you know that.  Many things can cause the difficulties you described but the 2 most common would be some refraction and the other cataracts.  By refraction I mean some of the prescription you treated with ASA may have returned.  Both of these issues are addressable.  Enhancement can be done for the former and cataract surgery can done for the later.  Cataract are the natural normal clouding of the crystalline lens that is inside our eye as we get older.  We all have to have cataract surgery, provided we get to enjoy a long life.  Hope this helps.  But in summary, I think you have much to look forward to as it is likely this issue can be treated.

I imagine that you are asking this question due to concerns of not having safe amount of residual corneal thickness.  It's a very specific question with an answer that is not specific.  There are many factors that play into how much cornea tissue is used.  

First, the creation of corneal flap uses roughly around 110 microns of tissue.  This tissue is replaced and heals very quickly; however, it does not contribute at much to corneal stability.

Secondly, the treatment by the excimer laser (the laser that corrects the shape of the cornea) "uses" some corneal tissue.  How much...2 major factors are the prescription and the treatment diameter (Optical Zone). There are other factors such a blend zones, etc, but we'll ignore that for now.  Since there is not much variation in optical zone diameters in the US, the prescription is going to determine how much tissue is used.

In general, the more nearsightedness you have, the  more tissue is used up.  Surgeons never violate the bottom 250 microns of cornea ...however sometimes we will treat even someone with a thick thick cornea just due to how it is shaped.  Other factors include total level of prescription, race, corneal shape.

So in summary, the more nearsighted you are, the more cornea is used up.  If not enough tissue is available or if this is a concern, alternative procedures of surface ablation, visian implantable collamer lens, and refractive lens exchanges can be considered.

I am assuming you mean without contact lenses.  
In the United States, the answer is NO.  There is no procedure that is FDA approved for this purpose.
I remember reading about a laser being developed Stroma Medical for this purpose.  I was wondering if you could enroll in a clinical trial.  However, I reviewed there website and it appears they do not have FDA approval for clinical trials in the US at this time or are not pursuing clinical trials in the US at this time.

Keep this company in your radar.  I imagine in the next 5 years are so, it may be possible.