Unfortunately lots of company here I see. I had Lasik 1997 with dye eye of course and significant higher order abberations. Had flap lifted and resmoothed, no help and subsequent wave front "enhancement", little help. Hard lenses corrected vision COMPLETELY but the suction was astounding and I could not get them out. Tried macrolens with trouble. Just hate having anything in my eyes and the really don't tear much. On to Izon glass some help. Where to from here?? I am in my mid 50s. I don't see any discussion about pixel technology, where are we with that? Also here's an optics question. If one has Izon glasses and they don't help much presumably because of inadequete technology, could one rescan THROUGH the first iteration lens and thus modify the next perscription?? Just a question since it seems it would be possible fix some of the higher order aberations with more sophistocated optics or is this a pipe dream?? Thanks for any insight.

This was my reply on a recent post. It should answer your question.

"The benefit from wavefront-generated glasses requires (1) looking through the optical center of the spectacle lens at all times AND (2) maintaining the exact (as measured) vertex distance (the distance between the back surface of the lens and cornea). If you look off center or if your glasses are out of adjustment, the wavefront advantage is lost. There may be some benefit in the asphericity of the lenses. But shaping a lens surface to micron tolerances makes little sense when the simple act of smiling can alter the position of your glasses on your face by 1000 microns. The tolerance of cutting (edging) a pair of spectacle lenses to fit into a frame is about one-half millimeter (500 microns). Measuring the distance between the eyes is to one-half millimeter."

As I said, there may be some benefit in the asphericity of the lenses but the extremely fine elements of measuring HOAs is lost.

Think about your post. The BEST vision you had was with rigid lenses which corrected your vision "completely". Pretty low tech solution optically. Most RS-induced HOAs are on the corneal surface. The RGP covers these HOAs with an optically-correct anterior surface. Find a doctor who can design the lenses without the suction (which indicates a significantly steep fit and/or too large an optic zone).

I've been on this BB a long time. There are lots of high tech solutions offered and yet a low tech device solves the problem. The fit mechanics of rigid lenses are not easy but the optics are relatively simple. Dryness IS a problem with many LASIK patients. Dryness can also get in the way of good vision and wavefront readings. We all hope that some easy solution is just around the corner.

Dr. Hartzok, Thank you for your kind reply. OK, so "low tech" solution appears to be best solution but how in my mid 50s can I wear contacts when the reason I had the Lasik is that I can't stand anything in my eye and don't envision putting eye drops in every few hours during the day. I realize this is somewhat rhetorical but I guess it comes down to rgp lens are the best solution. When you say you hope a solution to dryness may be just around the corner, can you speculate as to the form that might take? Tried cyclosporine drops. Anyway solution to dryness might allow successful rpg fitting, without it I think the exercise is hopeless. Thank you again.

The suction effect you noted with your RGPs indicates a poor fit. The intolerance was more likely due to the fit than to the dryness.

Post-LASIK dryness is, in many cases, not so dry as to prohibit lens wearing. The symptoms of a tight fit are often dryness so dryness gets blamed for a fit problem.

Again Thank you for your help. OK I am resigned to beginning the arduous task of fitting rps. In your experience what might work the best. I have read on this board about Synergeyes but have now idea what approaches to take. Please advise. Thank you.

This has been discussed at length so you may want to spend time in the archives. The key thing is not to think of this as a brand issue. Think of it as a custom fit issue. If you had a very small amount of LASIK, something off the shelf might work but if you had a higher Rx, no off the shelf brand is going to come close to working. You need a fitter who understands the post-LASIK cornea and who understands what it takes to align the posterior of the RGP to your cornea. Your previous lenses created a lot of suction. That was not the result of the "brand" of contact lens. If you had a size 10 foot and the only shoes you could find were all size 8, comparing brands at that point wouldn't matter; you're going to get a bad fit no matter. Most post-LASIK eyes require custom curves - not off the shelf. Your fitter has to know this. The idea is to fit the lens to the cornea and not expect the cornea to fit to the lens.

It all depends on how much the natural cornea was changed by the procedure. Personally I think doctors who are experienced with ortho-k fitting should be able to make the connection to post-LASIK fitting. This is not always the case but it is a starting point. Part of our goal at VSRN is to identify fitters in proximity to the patient but I don't have a name for your location. I will try to identify someone close to you.

In the meantime, call doctors in your vicinity, explain your situation, find out how much RGP experience he/she has with post-LASIK corneal fitting. If they simply suggest a "brand", you may want to move on and expand your search.