I've been considering retreatments and other options from the start- over 4 years. I never wanted to live with this handicap.

Now I'm focusing on a surface treatment (PRK over lasik). LASEK might be safer if the epi was in good shape, but mine's so bad I'd prefer to start over by removing it all.

I have narrowed it down to 3 specific questions (others are not knowable) to make a decision which way to go, but I can't get an answer to them. I don't know is an acceptable answer- the problem is I can't get any answer at all. Not from the manufacturer or the doctors. That would be fine if they're willing to take all the risk (they can take care of my kids afterwards).

Have I overlooked any important factors aside from the other risks?

1. Does the Alcon or the Allegretto have better registration (the difference in centering the intended treatment between when they take the measurements and when they put me under the laser and use the measurements).

2. Can the Allegretto be programmed to leave me nearsighted (the Alcon can be set to +.75D so there's virtually no chance of becoming farsighted and a chance of -1D nearsighted).

3. Does the Allegretto have better eye tracking ability (the ability to keep up with movements of the eyes, not just sampling the movements).

4. What is the absolute safest technique and device (PRK with allegretto topo or wavefront, 400hz eye tracker?). How much additional risk is there with the next safest.

5. What are the chances the dry eye gets worse (Doctors seem to think it will get better or stay the same based on very few case experiences- only Doc who will talk to me did 3 PRKs over lasik).

"... based on very few case experiences- only Doc who will talk to me did 3 PRKs over lasik)."

Uncertainty makes such questions unanswerable. If poor initial outcomes cannot be reliably predicted, how predictable can a procedure be on a previously ablated cornea? Unless the problem can be precisely known and evaluated, how can any re-treatment be specific enough to address the need?

What type of problem is the patient attempting to resolve? He/she has highly specific questions but it just may be that no additional laser treatment is going to resolve the problem. Pupils? Original ablation depth and centration?

From patient in response to DaveOD:

What type of problem is the patient attempting to resolve?

This is in my questions- dry eye and HOAs (lots of spherical and coma) plus a "ridge". Epithelial problems (intermittent PEK)- also crustiness on the eyelids that effects vision.

He has highly specific questions but it just may be that no additional laser treatment is going to resolve the problem. Pupils?

Measured at 5.5 to 7.4, but no-one (despite my pleas) measured me dark adapted so just assume it's 7.5 for the sake of the discussion.


Original ablation depth and centration?

I was -5 with ~1 to 1.5 of astig which implies a depth of ~60um. No one has told me my depth of ablation. All doctors have said it's reasonably centered, but the level of coma is equivalent to someone else with a 2mm decentration- I haven't received any explanation of how a centered ablation can have that much coma. Any guesses?"

quote:

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I was -5 with ~1 to 1.5 of astig which implies a depth of ~60um. No one has told me my depth of ablation. All doctors have said it's reasonably centered, but the level of coma is equivalent to someone else with a 2mm decentration- I haven't received any explanation of how a centered ablation can have that much coma. Any guesses?"

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Your ablation depth should be on your operative report. Have you asked for copies of your records? A current topography will show if your ablation is decentered. Just because a refractive surgeon says it's "reasonably centered" doesn't mean it's reasonable centered. If you have a post-op topography, scan it and post it here so we can take a look.

I saw the records of a "successful" LASIK patients recently who was treated on a VISX with an eye tracker and his ablation was decentered in one eye -- Funny, all of his post-op exams have a note that he was complaining about the vision in that eye. Imagine that.