I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients
with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable lens
polymer ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. With certain
patients wearing this lens under extended wear conditions can be considered.
WHAT IS LASIK?
LASIK surgery involves the use os a blade (microkeratome) or laser to make a thinly hinged corneal flap. The corneal flap is pulled back to expose the underlying corneal tissue so that the excimer laser can reshape the patient’s cornea. The flap is then repositioned onto the underlying cornea. This surgery is used on patients who are nearsighted, farsighted or have astigmatism. Although most patients will experience significant improvement in their vision within a few hours after the LASIK is performed, LASIK complications can occur immediately or weeks, months or even years later.
WHAT ARE SOME OF THE COMPLICATIONS THAT LASIK SURGERY CAN CREATE?
There are many complications that can be directly and indirectly attributed to refractive surgeries in general and to LASIK surgery in particular.
These complications include:
- Over correction or under correction of the visual error
- Induced astigmatism due to a surgically created distorted cornea
- Issues with the LASIK flap ( ripples along the flap surface, debris under the flap etc.)
- Loss of vision which cannot be corrected with eyeglasses or conventional contact lenses
- Halos, double vision, glare and corneal haze
- Poor vision at night and in low light environments
- Chronic dry eyes, burning and ocular pain (corneal neuropathy)
- Post LASIK corneal ectasia which can occur many years after the LASIK surgery was done.
- Epithelial ingrowth (epithelial cells that exist on the corneal surface and getting underneath the corneal flap and then begin to grow
- Corneal Ectasia – Learn More
HOW ARE LASIK COMPLICATIONS TREATED?
The great majority of post-LASIK patients that we see suffer from chronic dry eyes, corneal ectasia and compromised vision due to “higher order aberrations”( glare, halos, double vision, starbursts). While some of these patients will have marginally functional vision with eyeglasses or conventional contact lenses, many will not. We can correct these LASIK induced complications with scleral lenses which we design with special computers using proprietary software.
A well designed and properly fit scleral lens will not touch the compromised corneal tissue but will vault over the cornea and come to rest on the white portion of the eye known as the sclera. The space between the back surface of the scleral lens and the front surface of the cornea is filled with sterile unpreserved saline solution. In other words, the ocular surface of the eye is always in a moist environment. Vision is often 20/20 or better and ocular comfort with the lenses is almost always excellent. A well designed scleral lens replaces the distorted compromised cornea as an optical surface. It’s like giving the patient a new cornea without surgery.
The purpose of a well designed and fit scleral lens is three-fold:
1. To protect the dry, irritated cornea from the environment and the blinking action of the eyelids.
2. To allowed the compromised corneal tissue to heal
3. To provide excellent vision while at the same time to create a comfortable nurturing environment for the ocular surface.
IS SCLERAL LENS TECHNOLOGY ONLY USED FOR PATIENTS WHO HAVE SUFFERED VISION LOSS DUE TO LASIK SURGERY?
Not at all. We use scleral lens to restore quality vision to patients who have lost vision due to a multitude of conditions and diseases. These include:
- Chronic dry eye due to disease, trauma, surgeries and the side effects of many medications.
- Conditions such as keratoconus, pellucid marginal degeneration, and highly irregular corneas.’
- Many surgeries including, Radial Keratotomy (RK), PRK (photorefractive keratectomy), corneal transplant surgery, and many corneal dystrophies and degenerations.
- Patients who cannot wear small hard lenses do very well with scleral lenses as do patients with very high prescriptions that cannot be corrected with conventional contact lenses or eyeglasses.
LASIK COMPLICATIONS AND SCLERAL LENSES
The most common LASIK induced complication is dry eye. The reason for this is that during LASIK surgery, most of the corneal nerves are severed. In addition, other common complications resulting from LASIK surgery include halos, glare, double vision and reduced night vision. Many patients become severely depressed after finding it impossible to deal with their loss of vision and ocular comfort. Some patients have told me that they have had suicidal thoughts due to these complications.
WHAT ARE THE SYMPTOMS OF DRY EYE?
Some of the symptoms of LASIK induced dry eye include a constant scratchy sensation similar to having sand in the eye. Other symptoms include a constant burning sensation requiring the constant application of lubricating eye drops. In addition, because the tear film covering the cornea is compromised, many patients will experience off and on blurred vision. Some patients will tell me that every time that they blink, it feels like sandpaper of rubbing against their eyes. Many patients report difficulty sleeping due to a condition known as “recurrent epithelial erosion”. This is a condition where areas along the surface of the cornea begin a cycle or periods of erosion followed by periods of healing within short periods of time. When corneal erosion takes place, the resulting pain could be very intense. Often, the ocular pain can be so debilitating that the quality of the patient’s life is severely impacted.
WHY ARE SCLERAL LENSES INDICATED FOR DRY EYE DISEASE?
Scleral lenses work in three ways to help this patient population: 1. protecting the traumatized, irregular, dry cornea from the environment and the blinking action of the eyelids. 2. promote healing and restoration of the ocular surface and thereby eliminating ocular pain and 3. restoring quality vision. Scleral lenses are inserted filled with preservative free saline solution.
These lenses vault over the compromised cornea and are supported by the white portion (the sclera) of the eye. The space between the back surface of the scleral lens and the front surface of the cornea is filled with saline solution. In other words, the ocular surface of the eye is always in a moist environment. In addition to scleral lenses being medically indicated for chronic dry eye, these unique lenses are also indicated for conditions associated with neuropathic ocular pain.
A QUESTION OFTEN ASKED BY POST-LASIK PATIENTS
A question commonly asked by patients who have suffered vision loss due to LASIK is: Since undergoing LASIK surgery I am suffering from glare, halos and starbursts in low light environments. Can you help me?
The two most likely reasons why patients like this are experiencing halos, glare, and starbursts after having undergone LASIK surgery are:
1. The patient’s pupils may be very large possibly 7 mm or larger in diameter.
2. The treatment zone created by the laser may be either too small or off center in relation to the location of the patient’s pupil
Once again, the best way to restore quality vision to this patient is to provide him (her) with custom designed scleral lenses.
A well designed and fit scleral lens will act as a new optical surface replacing the irregular cornea as an optical surface.
When properly fit, this patient will not longer experience the higher order aberrations such as halos and glare.
This is a photo of an eye that underwent LASIK surgery several years prior to the time that this photo was taken. The 2 arrows on the right are pointing to the LASIK flap. A special dye was used to highlight the defects along the corneal surface. The dark areas in the center represent areas along the corneal surface that are devoid of moisture. In addition to the corneal surface being dry. This patient has very poor vision which cannot be corrected with eyeglasses or conventional contact lenses. We fit this eye with a highly oxygen permeable scleral lens which is providing this patient with clear (20/20) comfortable vision for the first time in many years. In addition, the scleral lens is keeping the ocular surface in a moist environment.
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