Gary Kawesch, MD (retired)

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.

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.

Six months out, your cornea should be healed and your vision stable.  There are a number of reasons your vision could be blurry.  It is possible that you have some residual refractive error (nearsightedness, farsightedness or astigmatism), and you may benefit from a touch-up or enhancement.  Other possible reasons include dry eye, which can blur the vision, or more rare complications such as flap wrinkles or striae, epithelial ingrowth, and even unrelated problems such as cataract or retinal disorders.

It would be best for you to see your surgeon, have him/her assess your current situation, and choose the proper solution.

Dryness after LASIK is extremely common, and it can blur the vision.  This blur can be either intermittent or contstant.  Fortunately, as the eyes heal, the dryness typically resolves, but it can persist for several weeks to months, and in some cases, it can be permanent. 

While waiting for it to improve, frequent use of artificial tears during the day, and even nighttime lubricating ointment, can be of great help.  For more severe cases of dryness, the medication Restasis can be useful to stimulate tear production, and punctum plug insertion into the tear ducts can also help reduce dryness by slowing the outflow of natural tears from the eyes.