I am new to this board, and would appreciate any Wavefront Surgeon(s) opinions:

Background:
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I have the usual GASH complications most prevalent in my left eye (+1.25 sphere with about -.5 cyl). I have been diagnosed with central island, irregular astigmatism (high coma), now lens vacuole in the center of my optical zone. I have tried RGP macro/sclera lens with Dr.G., and it worked great at first (20/15 without much aberrations), but now cannot wear due to hazing of the lense. I am scheduled to have the Oculus Pentacam scan performed with another highly recommended O.D. here in Dallas to determine the underlining lasik complications.

Questions:
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1 - Assuming I have enough corneal, and stromal bed thickness to perform another enhancement, lets say Ladarvision Customcornea with an expert Surgeon, would a Lens Vacuole directly in optical center necessarily skew the wavefront system data ?

2 - Also, looking for a comparative analysis about the 3D imaging cornea/lasik diagnostic tools: Oculus Pentacam (5 micron resolution) vs. VHF Digital Ultrasound Eye Arc-Scanner Artemis (1-5 micron resolution) ? Is one better than the other ? Will the Pentacam give a definitive answer as to further ablation will help, or will I have to ultimately seek out the Artemis anyways ? Is 5 microns of more detail alot when it comes to diagnosis ?

Any comments ?

Thanks,

Stosh in Dallas

Welcome Stosh,

You have a better chance of getting a response from a surgeon if you post this question into the doctor's forum.

Best of luck to you!
BE

Do you understand that a lens vacuole is an early stage of cataract? As the eye ages, natural aberrations change and cataract development is just part of the process. Wavefront procedures based on inherently changing aberrations will untimately be undone at some point when you need cataract surgery.

A lens vacuole is not usually going to progress to a significant cataract quickly. However, a vacuole interferes much more with vision when it is "on axis".

While your question, "would a lens vacuole in optical center necessarily skew the wavefront system data?" seems like a good one, the element of time is not addressed. If the vacuole does not skew the data significantly at this time, it is the potential for the vacuole to "skew" your vision later that makes wavefront findings irrelevant.

Thank you for your timely response doctor.

Clarification please:
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You wrote, "Wavefront procedures based on inherently changing aberrations will ultimately be undone at some point when you need cataract surgery"

Question: For argument sake, lets say I get the further enhancement within the next 6 months, and cataract(s) soon development thereafter. Isn't common knowledge that one can just replace the lense of eye to remove the cataract(s) ? I guess I am confused on how the lense replacement directly affects HOA. What degree of change are we talking about here ? BTW, I possibly have enough corneal thickness for one more surgery, and I am in my upper 40s.

In short, if the vacuole skews my vision later (after wavefront), can't the current lense replacement technology correct it without affecting HOA ? Thank you in advance.

Stosh,

Unfortunately, surgeons have a more difficult time getting the implant (lens) to give the right correction for us post-LASIKers because we have reshaped corneas.

Also, HOAs come from corneal shape irregularities (such as from LASIK) as well as from irregularities within the cornea.

Good luck,

Lynne

Wavefront is measuring ALL the optical aberrations in the eye. The natural lens imparts its own aberrations, increasingly with cataract development. If the corneal curvature is altered utilizing waverfront technology, the lens aberrations are incorporated as well. Removing the lens (cataract surgery) removes those aberrations that were "corrected" by wavefront guided ablations. Following cataract surgery, the cornea is now "correcting" aberrations that are no longer there, so the value of the wavefront technology, and the increased accuracy marketed with it, is no longer valid.

The intraocular lens (implant) that replaces the cataractous, natural lens is designed to restore vision to what it was before the cataract developed and NOT to work in conjunction with wavefront ablations. It would be better to do the cataract surgery first and follow it with wavefront ablation, not the other way around.

"What degree of change are we talking about here?"

The significance of all this is not something anyone can calculate precisely since the wavefront findings cannot differentiate lens aberrations from corneal aberrations. Perhaps some subtraction methodology is being developed but I am not aware of it. Wavefront prior to cataract surgery and the potential for ensuing vision issues are relatively new territory that could manifest over time. You may be blazing territory for those to follow.

Thank you Dr.Hartzok for your detailed responses. It convinces me that I need to slam on the breaks for now as far as additional surgical options.

This message has been edited. Last edited by: Stosh,

Second thought......

Remember I wrote: "I have tried RGP macro/sclera lens with Dr.G., and it worked great at first (20/15 without much aberrations), but now cannot wear due to hazing of the lense."

Couldn't you conclude from the above description that my HOAs are mostly corneal, not lenticular; therefore, I might benefit by additional RS Wavefront retreatment before natural lense replacement ?

Any thoughts Dr. H, or other doctors monitoring this board ?

S-