Ophthalmology & Optometry/treatment for microstriae

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Question
QUESTION: Hi,
  I have had LASIK 4 yrs back,which left me with microstriae. I was told they could smoothover with time. But I still have microstriae in both eyes. I have 20/20 vision in both eyes currently. however I have glare,and other higher order aberrations. I recently visited a Dr for retreatment and he recommended lifting the flap and suturing to treat microstriae first and then see treating higher order aberrations. Is it safe to treat microstriae after 4 yrs with lift and suturing? Is striae going to come back later? what are the complications from it? thanks.

ANSWER: It’s a judgement call.

Personally I would be very hesitant to lift, smooth, and suture a flap  to correct microstriae in an eye with 20/20 vision 4 years after the original procedure. It might make you worse.
There are significant risks associated with lifting and suturing: epithelial ingrowth, induced astigmatism... there is also no guarantee of eliminating microstriae.

Is the current quality of vision intolerable? Keep in mind, even 20/20 is not “perfect.”


---------- FOLLOW-UP ----------

QUESTION: Yes, my current vision is not that good in low light situations and during night.

I have HOA's as follows from recent abberometry readings
OS -  HOA's in the ranges of RMS error(micron) = 0.97, High order=40.2%, actuity map RMS error of 2.41 micron
OD - HOA's  RMS error(micron) = 0.79, high order = 38%, actuity map RMS error of 2.39 micron

When I went to an optometrist he prescribed me glasses with prescription -
   Sphere  Cylinder     Axis
R   -0.25D   -0.50D    152deg
L       -    -1.00D    13 deg
With glasses blurriness clears up a bit, still glare & other HOAs are there.

Is it a good idea to go for enhancement(with out flap lift) for above parameters? thanks for your response.

Answer
It certainly appears you would be symptomatic based on your wavefront data.

Given your willingness to accept the additional risks of further treatment, and all else being acceptable particularly corneal thickness, I would consider lifting the flap OS, adding an additional -0.90 D of correction, smoothing the microstriae, and replacing the flap with fibrin glue and a bandage contact lens. I would be hesitant to suture which could cause astigmatism and is more appropriate for the treatment of macrostriae.

If you did well, I would treat OD 3 months later.

Good luck

Ophthalmology & Optometry

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Scott W. Tunis MD FACS

Expertise

Laser Vision Correction procedures - LASIK, PRK, PTK. Cataract surgery with intraocular lens implantation, corneal transplantation, Rejuven*eyes conjunctival whitening surgery, general eye surgery and medical diseases of the eye.

Experience

• Board Certified Ophthalmologist • One of the Carolina’s most experienced LASIK Surgeons with 15 years LASIK experience and more than 15,000 LASIK procedures performed • 27 years Cataract Surgery experience with more than 20,000 Cataract procedures performed • Corneal Transplant Surgery since 1983 • US Patent Holder in Intraocular Lens Implant Technology; US Patent 5549614 and US Patent 5556400 • Was involved in FDA studies for Myopic LASIK • Past Chief of Ophthalmology, Holy Cross Hospital, Fort Lauderdale, FL • Past Chief of Ophthalmology, New Hanover Regional Medical Center, Wilmington, NC

Organizations
• Board Certified, American Board of Ophthalmology 1987 • Fellow, American Academy of Ophthalmology • Member, American Society of Cataract and Refractive Surgery

Publications
Ocular Surgery News, Premier Surgeon, Ring Magazine

Education/Credentials
• Amherst College BA 1977 • University of Virginia School of Medicine MD 1981 • Medical University of South Carolina Residency in Ophthalmology 1985 • Fellow, American College of Surgeons

Awards and Honors
• Consumer’s Research Council, America’s Top Ophthalmologists 2004-2011 • PS250 Premier Surgeon - One of the Top 250 Leading Innovators in the Field of Premium IOL Surgery

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