Dr. Hartzok, in your opinion, how well do RGPs work for restoring visual clarity in patients with central microstriae? Do you fit many quadraplugged patients with lenses?

IMO, it depends on the lens design. I typically fit the ablation zone with no vault. The lens is designed to "settle in" to the ablated area and this can smooth out some flap irregularities. I think that microstriae are not as visually disabling as others presume. There are many factors that affect post-LASIK vision and it is not necessarily the ones that are visible under the microscope that cause the greatest problems.

In some patients, plugs can increase tear volume excessively, causing RGPs to float too much. In these cases, the lens periphery must be a little tighter to stabilize the fit and reduce the excess tear volume under the lens. Too much tear volume can be as much of a problem as too little.