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.

I'm assuming you did NOT have these problems before LASIK. If eyeglasses fully correct the quality of your night vision, then you have a residual refractive error (ie nearsightedness, farsightedness, and/or astigmatism), and you could consider more treatment with either "traditional" or "wavefront" laser vision correction. Correction could be LASIK if you have sufficient corneal thickness under your flap, or it could be a surface ablation such as PRK. Both work well. Wavefront might be better, but it typically ablates more cornea, and depending on your thickness, may or may not be an option. It also typically costs more.

If eyeglasses DON'T correct the night side effects, then a traditional retreatment would NOT correct them either. Wavefront LASIK or PRK would be the only option, and would probably help. There is a chance it would solve the troubles you are having, but there is also the possibility of only a partial improvement (or rarely, no improvment). Treating high order optical aberrations such as spherical aberration, coma and trefoil with wavefront guided LASIK is good but not always perfect.

Other nonsurgical options include eyedrops such as Alphagan P at dusk to slightly reduce the size of your pupils, to reduce these night side effects.

And of course, a full eye exam should be done to make sure you don't have anything else going on, such as corneal scarring, epithelial ingrowth, a decentered original ablation, cataracts or even glaucoma, all of which can cause the night effects you describe.

Contacts can distort the shape of the cornea, and the measurements used to program the laser for LASIK. It is generally recommended that soft contacts should be out at least a week, and with newer wavefront treatments which are higher resolution, even two weeks. Rigid gas permeable (RGP) and hard contacts should be out at least 3 weeks, and some practitioners advise one month for every 10 years of wear.

Contacts can not only change the preoperative measurements and hence the predictability of your surgery, they can also alter the shape of the cornea and make it unclear for your surgeon if your corneal is normal or not. Contact lens induced corneal warpage is a situation diagnosed on topography, or corneal mapping, and this condition can mimic a condition called inferior corneal steepening, or forme-fruste keratoconus. With these conditions, LASIK may pose increased risk, and a procedure such as PRK may be safer.

So, one day is usually not enough. It will increase your risk of needing a touchup, and, depending on your corneal topography, you may be getting LASIK when you ought to have PRK (unlikely but possible).

Hope this helps.

You might be a candidate for LASIK, you might not. It really depends on the characteristics and health of your eyes. Primarily, your corneal thickness must be sufficient to allow this amount of correction (higher prescription dictate more corneal tissue removal). The thickness of your cornea can be measured at an exam. The shape, or topography of your cornea is also important. If you have an unusually shaped cornea, LASIK may not be a good option.

If this is the case, sometimes PRK (surface ablation) would be an option, and sometimes a lens-based procedure such as an ICL or Refractive Lens Exchange (RLE) would be best. If your corneas are flat, LASIK would flatten them even more, which could lead to quality-of-vision problems postop. In this case, a non-corneal procedure such as an ICL or RLE would be preferred.

If you do have LASIK, a wavefront ("custom") treatment would be helpful to reduce your risk of night side effects such as halos and glare. These side effects are more common in patients who start out with extreme prescriptions, so anything that can be done to mitigate this risk is helpful.

The general health of your eyes is important as well. If you have cataracts (clouding of the lens inside the eye), usually an RLE procedure is a better option than LASIK. I don't know how old you are, but cataracts generally develop in your 60s, but in extremely nearsighted patients, they tend to develop about 10 years sooner.

In short, a thorough examination with a refractive surgery specialist (a surgeon who offers ALL types of refractive surgery) would be your best bet to determine which procedure (if any) might be best for you.

Hope this helps.

Yes, but the preop anesthetic costs an additional $1700... seriously though, these low-price offers are laden with fine print, and require purchase of many "extras" such as postop care. It costs more than this to do surgery, so any clinic offering these deals will not be around long. The field of refractive surgery (LASIK) is littered with the carcasses of defunct discount surgery centers which have disappeared and left patients without any aftercare. In some cases, centers have required prepayments to secure a low price, then have shut their doors and kept all these prepayments.

In LASIK, as in life, you get what you pay for.

Regarding the Nidek laser, it is an older machine but tends to give very good results. It gets a bad rap from surgeons who have never used it. Those who have, know it's a great machine and gives great results (for the right prescriptions). There is no royalty paid to the manufacturer for Nidek use, so surgeons who offer this laser are generally able to discount the price to the patient a bit (a few hundred dollars per eye). Plenty of great surgeons offer the Nidek. I use it to this day, along with the "latest and greatest" lasers such as the Allegretto Wavelight and the Bausch & Lomb Zyoptix.

Hyperopic (or farsighted) LASIK surgery can be done for corrections up to +6 diopters with most advanced lasers. It IS FDA approved for these high corrections. However, most experienced surgeons have seen best results up to +4D or so, with results between +4 and +6D being good but not as good.

For higher corrections, there is a higher risk of night glare/halos, increased risk of subtle loss of best corrected visual acuity, and a higher risk of needing a touchup surgery. Also, for people over 40, high plus corrections do not typically allow us to do monovision, since we might have to program the laser for even more that 6D to create some nearsightedness in the reading eye.

If over 40, and +5.50D, you may have LASIK. But, you may be better suited for a procedure like Refractive Lens Exchange (RLE).