Dear Dr. Hartzok or Barbara:

Hi, first of all I would like to thank you for your support and information to every single one of us VSRN members, we appreciate your kindness and time. I have three questions to different matters that maybe you could answer.

First, about the information Dr. Hartzok provided recently about a certain type of lens taken out of the market for the moment, is it the intra-ocular lens that it has been used to correct myopia, or is it something else? (forgive me if it is a dumb question but I don’t handle some words or initials in English and the article was confusing to me).

My second question is about my personal condition. As I have said before I had PRK a year and a half ago with a 1 sec TBUT, my eyes were so dry at the time because of the long term use of contacts. I never experienced before surgery excessive burning during the day or pain in the middle of the night as I experience after that unforgettable day. The doctor who preformed the surgery said that it was not possible since he never cut the cornea as he does in lasik, so the tearing cells were intact. What could be the reason of the constant excessive dryness after PRK in my particular case? Could the lack of moisture during surgery have affected the "tearing cells" or something like that?

Third and last: At night, even with alphagan and pilo, the lights become a large line when I blink; I understand these are "arcing lights", why don't they disappear when my pupil is contracted?

Hi, Star-Mom.

Phakic IOLs, all brands, were recently pulled from the market in France due to significant endothelial cell loss. These are lenses implanted into the anterior chamber (behind the cornea, in front of the iris) and used to correct myopia.

LASIK severs the nerves when the flap is created but a laser then ablates the corneal tissue, which burns the severed ends of the nerves. PRK ablates the surface of the cornea and simultaneously burns the nerve ends as well. There are no "tearing cells" in the cornea. It is assumed that the creation of the flap (LASIK) damages more nerves than ablation alone (PRK) but PRK still damages nerves. The sensation of dryness (and discomfort) in some ablation patients exceeds the apparent loss of tear volume. An eye predisposed to dryness symptoms is at greater risk for post-surgical dryness.

Large pupils permit light to enter the eye that passes through the non-ablated cornea, light that is out of focus and/or distorted. However, the center of your cornea can still be optically irregular. Ablation and the subsequent healing of the corneal surface are subject to irregularities that can cause the visual effects you describe in spite of the pupils being constricted alphagan or pilo.

Hi Star-mom,

Pupil constricting drops did not help me at all. My 7+ mm pupils are much larger than my 3.4 mm ablation zone. Although I was unable to wear RGPs due to some unexplained and ever-present foreign body sensation in the left eye and severe dry eye in both eyes, my vision cleared up enormously while I was wearing the lenses Dr. Hartzok designed for me.

Dry eye after refractive surgery is one of the most common complaints we hear. PRK doesn't seem to cause as many problems, but for those who do have a problem, the symptoms between them and Lasik patients are similar. There are many factors that cause dry eye. Managing it is possible, but requires a specialist who will look at the entire health and eye picture to determine the causes, and only then decide upon a course of treatment.

Dr. Steven Maskin in Tampa and Dr. Scheffer Tseng in Miami are among the very few specialists who understand and know how to treat dry eye. Maskin has a new book out, Reversing Dry Eye Syndrome, that's easy to read and gives practical solutions to treating dry eye, also offers tips on how to find and work with a doctor.