Seven months after LASEK surgery, my eyes are both overcorrected by ~ 2 diopters and the ablation zone is too small for my 7 mm pupils. In daylight, my vision is acceptable, but for the hyperopia. At night, the glare/halos/starbursts are bad. Alphagan helps. After talking to two surgeons, I am presented with two surgical treatment options:

(1) Retreatment with the exact same equipment (VISX S4, wavefront). After shooting a number of PreVue lenses, one provides much improved center vision.

(2) Retreatment with the latest Allegretto wavefront and topography guided laser (in Canada or Germany).

Option (1) has been described to me as "safer" in that it changes fewer variables compared to the initial surgery (same laser, same doctor, same humidity, etc.). However, it would not enlarge the optical zone and thus do nothing for the night vision problems.

Option (2) is what I can't evaluate at all. Topo-lasek seems to be quite successful in enlarging optical zones and reducing HOAs (which are presently ~ 12%) based on reading MEDLINE abstracts, but I am not a doctor.

Here are my questions to the members of this board (which has been a great resource):

(i) What are your experiences with Topo-guided treatments?
(ii) Is the "better do it again with the same laser" argument sound?
(iii) Is there a difference between having the surgery done in Canada or Germany in terms of quality of medical treatment? (A huge generalization, I know).
(iv) Does anyone know a specialist who could, as an independent third party who would not perform either surgery, evaluate the treatment plans?

Best regards, Sam

Combination wavefront and topography treatments are new. They look promising but so far there is no great body of evidence that demonstrates they will work for most people. Approach them with caution.

The best article I’ve seen this year on combo treatments is:

http://www.revophth.com/index.asp?page=1_869.htm

Most systems are only at the beginning stages of merging the data from both the wavefront and the topography. It look like it will be another several years before there is enough data on this new technology to evaluate the real risk.