Post-lasik Ectasia

I have just been diagnosed with ectasia in both eyes, 6 years after my LASIK procedure. Devastated as expected but vision distortions are not too severe (and currently only noticeable in the right eye) but will need to have collagen cross-linking to stop the deterioration. Has anyone had a similar experience, or could direct me to some personal accounts? I'm also curious about ways of correcting the higher-order aberrations after the CXL. My ophthalmologist mentioned using glasses, or a hybrid contact lens, she doesn't think that I need scleral lenses. Thank you for your advice!

Original Post

Also, is there a support group in London? And, is it possible to determine whether there has been negligence re the original LASIK (i.e. the surgeons/assistants missing some indication that I was not a suitable candidate)? I have requested all the original scans (which they have sent to me as hard copies) but it's difficult to decipher since I am not an expert. I understand the key metrics are corneal thickness, pupil size when dilated and history of keratoconus (which I do not have). 

You can download any scans you have to me personally and privately if you wish to you use our private forums option. Any additional information (pre-op Rx, etc.) would also be helpful.

Higher order aberrations that reach the surface level of the cornea can be addressed with contact lenses. HOAs at the posterior corneal surface and or within the stroma are not addressable by contact lenses.

CXL can strengthen the fibrils within the stroma to protect against further curvature changes buy will not specifically address HOAs.

Regarding negligence ...

When PRK / LASIK was introduced to patients there was a limit as to how thin the residual cornea could be based on rabbit studies. That thickness was 200 microns. In clinical practice it became obvious that 200 microns was not a safe minimum and that number was moved upward to 250 microns.  These "safe limits" pre-suppose that all human corneas behave similarly. Is it possible for someone with 200 microns of residual corneal thickness to be free from developing ectasia? Yes. Is it possible for someone with 250 microns of residual corneal thickness to develop ectasia? Yes. So how can a "safe minimum" be established? It is impossible to answer that question exactly because we cannot differentiate any one patient's individual characteristics to know. But one thing we can look at is the posterior corneal surface. Patients prone to ectasia (thinning) may exhibit forme fruste keratoconus in advance of any detectable vision loss and in advance of any topographical irregularities (true ectasia). Some of these patient's may go on to develop true (and easily diagnosable) keratoconus while others may just have sub-clinical vision issues. However, if a patient can be shown to have forme fruste keratoconus then LASIK is contraindicated. This is why it is critical to perform an Orbscan or Pentacam in advance of LASIK. 

Anneinlondon, 

Dr. Hartzok has explained very well your situation but I feel obligated to add one other item with respect to your comment;

"but will need to have collagen cross-linking to stop the deterioration."

There have been no studies to show that collagen cross linking will stop the deterioration when dealing with post-Lasik ectasia, and in fact there have been numerous anecdotal reports from patients that collagen cross-linking made their vision and overall general situation worse.

Do not just accept, because it "makes sense" or that the surgeon recommended it, that you will receive any short or long term benefit from collagen cross linking. Bear in mind you can find yourself significantly worse off than, 

"vision distortions are not too severe (and currently only noticeable in the right eye)"

Sincerely,

Dr. Maller

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