I had Custom Wavefront LASEK surgery done 3 months ago (VISX S4). My original Rx was about -7.5 with 1 diopter astigmatism in both eyes. The post-op treatment consisted mainly of steroids (Predforte, Lotemax). The healing process was slow. It took me about 2 weeks to be able to read anything.

Now both eyes are significantly overcorrected, one by +1.5 (L) and the other by +2.75 (R) diopters. I have significant ghosting in the right eye and some ghosting in the left eye. The ghosting varies with focus, that is, if I focus intently on an object, the ghosting shadow (almost) merges with the object. At night, I have starbursts and glare in both eyes. The cornea surface of both eyes appears to be somewhat uneven; while the treatment area is uniformly "blue" on the topography scans, there are islands of "light blue" in both eyes, crossing right through the center of the pupil. To induce regression, I have been taking Acular and now Xibrom for about 1 month, so far without noticeable effect.

My doctor recommends retreating the right eye, but I have lost confidence in his recommendations, because he was unable (or unwilling) to explain how the overcorrection came about. (His answer, literally, was "I have no idea.")

Is anyone familiar with treatment options, including further laser surgery, at this point? Can someone recommend a specialist for LASEK complications prefereably in the Manhattan/New York/Northern New Jersey area?

Thank you very much, Sam

Hello, Sam.

Your surgeon was probably unable to explain the over-correction as opposed to being unwilling. There are a number of potential factors not discernible on hindsight. A detailed history might help: your age, contact lens history, pre- and post-operative topographies. If you have color copies of your topographies, you can place them directly into a post.

Surgical re-treatment in your case means placing a hyperopic ablation over the initial myopic ablation. This may be a little early at three months. In the meantime, have you been prescribed glasses to handle the overcorrection? An obvious question becomes how correctable and clear is your vision WITH glasses.

Thank you for your reply, Dr. Hartzok. My vision with glasses is indeed somewhat better - in particular near vision. For example, without glasses white characters on a black background at a distance of about 15 inches have a strongly visible, partly overlapping ghost to the upper right. With glasses, those ghosts are significantly less noticeable. Other problems, however, remain unaffected by the glasses, for example, a general lack of crisp optical resolution. Characters, if viewed at a distance of about 20 inches, tend to blur into each other. (And, of course, wearing +2.75 and +1.5 glasses distorts the vision uncomfortably and is really useful only for reading.)

Assuming that at least some of my problems are the result of corneal irregularities, which my surgeon confirmed, are there further surgical options? Is it -- generally speaking -- possible to correct "island shaped" irregularities in the process of placing the hyperopic ablation over the initial myopic one? If that doesn't work, is topography-guided laser surgery to only tackle the "islands" an option?

Wavefront ablations were to be the ultimate in laser vision correction procedures and yet problems remain.

I can't speculate on the possibility that a second procedure will resolve the aberrations. The aberrations would be modified and should provide some benefit. One has to ask why "island shaped" irregularities formed. If they are very central in the cornea, the hyperopic correction may need to be a little deeper. Eliminating those irregular areas will hopefully remove the distortion. There is, however, concern for the optical dynamics of the hyperopic ablation, as hyperopic ablations tend to be smaller. The secondary procedure should eliminate the over-correction.

Don't presume that a third surgery is some kind of charm. On a surface procedure like you had, we're dealing with regeneration of the epithelium and the healing response of the anterior stroma. There is no guarantee that the epithelium will remodel without optical aberration and/or that the anterior stroma won't develop haze. Laser surgery is traumatic to these tissues. People heal differently and each eye is facing unique circumstances.

One aspect of healing that never gets mentioned is superior eyelid pressure. When the natural corneal shape is altered, the relationship to the upper lid is modified as well. Patients with even a small chalazion develop distortion in a virgin cornea. It may not seem like much, but the variation in the altered lid pressure across the post-ablation corneal surface could create irregular thickening as it reforms. Analyzing that with topography and or wavefront for further correction will not eliminate that factor since the impact can not be known precisely. Just another factor that is impossible to calculate.