Need Your Advice - Enhancement or no for dry eye after LASIK

[Ccoughlin]

Hi,

I just had an in-depth meeting with my eye dr., whom I trust. He said that I have MGB, Blepharitus and low oil production, but that my osmolarity is good, as is my tear film. I've been desperately trying to figure out if I have blurriness (about 1.00, 4 clicks off) due to Dry Eye, or a messed prescription. He thinks it both - that I've had dry eye so long (6.5 months) that it's regressed my prescription from .25 to 1.00 in each eye. He thinks I should get an enhancement from LASIK once we get the dry eye under control. That really scares me - the thought of doing this again, but I don't think I'll have much of a choice. He did not recommend contacts, as they make dry eye worse, but whos to say that an enhancement will not start this roller coaster all over again. Maybe I should get a second opinion. Any thoughts/advice about this would be welcome. I have thicker gland material that is not coating the eye nicely, but it appears I've messed with my prescription.

I don't understand how this could happen - I thought the laser does all the work underneath the flap, so it's not disturbed. How could this change, and why might I need another enhancement? Again, would love your expertise on this. He thinks I'll have to wait until winter is over - - another annoying thing, wearing my glasses for another 5 months (we live in Minnesota!)

I'm disappointed by LASIK, to say the least, but trying to keep a decent attitude going forward.

[robster]

As someone who has been suffering from post-LASIK dry eye for over a year I would say a massive NO to the enhancement. The enhancement will only make any dry eye issues flare up again and if you have any nerve damage that will only be made worse by having an enhancement.

Not sure about the dry eye causing your regression as many people who have no dry eye issues have regression after LASIK. I have dry eye but my vision thankfully is still 20/20.

The laser does do all the work under the flap but in order to create the flap the laser has to make a cut in your corneal surface which causes nerve damage and can exasperate any underlying dry eye issues such as asymptomatic MGD. Also due to the nerves being severed when the flap is cut everyone has increased dryness after LASIK which is why all LASIK patients are given eye drops for the first few weeks after LASIK.

If your Dr thinks that dryness is partly to blame for your regression then surely he must realise that a further LASIK procedure will only cause more dry eye issues which following his logic would create more regression?

[Ccoughlin]

As someone who has been suffering from post-LASIK dry eye for over a year I would say a massive NO to the enhancement. The enhancement will only make any dry eye issues flare up again and if you have any nerve damage that will only be made worse by having an enhancement.

Not sure about the dry eye causing your regression as many people who have no dry eye issues have regression after LASIK. I have dry eye but my vision thankfully is still 20/20.

The laser does do all the work under the flap but in order to create the flap the laser has to make a cut in your corneal surface which causes nerve damage and can exasperate any underlying dry eye issues such as asymptomatic MGD. Also due to the nerves being severed when the flap is cut everyone has increased dryness after LASIK which is why all LASIK patients are given eye drops for the first few weeks after LASIK.

If your Dr thinks that dryness is partly to blame for your regression then surely he must realise that a further LASIK procedure will only cause more dry eye issues which following his logic would create more regression?

Robster,
Thanks for writing back. I'm inclined to agree, but it 's been 6 months, and I'm really sick of not being able to see more sharply since before I got this wretched surgery. So, should I get fitted for contacts in the meantime? I wish I had good vision, and just dealt with dry eye, but I appear to have both problems - regression & dry eye. It really sucks to be honest. I try not to get depressed about it. Believe me, another surgery also sounds pretty scary. I feel like I'm stuck between a rock & a hard place.....

[Guest]

I totally get how strong the desire is to stop wearing glasses... but having an enhancement is going to disturb your corneal nerves yet again, and what if it worsens your dryness? What if it worsens it so badly that you never recover? Trust me, if that happens, wearing glasses will seem like no big deal in comparison to suffering with long-term severely dry eyes.

I had an enhancement because I trusted my surgeon - he said it would not effect any dryness I had - and now here I am 7 years later, wearing goggles, spending SIX THOUSAND dollars per year on drops and prescriptions to keep my eyes at a level where I can work and function. I'm sure the enhancement didn't help my dryness situation one bit.

Anyhow, I totally sympathize.. it is a huge bummer when LASIK doesn't give the promised 20/20 vision... good luck!!!!

[oneblurryeye]

Hi, Ccoughlin, I know your post was from more than a year ago, but I'm facing the same exact situation you were in and I'm just wondering what you decided to do and how it worked out for you?

I had LASIK almost 4 months ago and have both dry eye and an under correction in my right eye and they are recommending an enhancement.

This whole LASIK thing has been a total nightmare. (My left eye is perfectly fine, clear, barely dry at all, but my right eye has been a mess.) I can get a correction with a soft contact lens, but wearing it exacerbates the dry eye. Glasses give me bad headaches, I've never been able to wear them. That's partly why I had the LASIK in the first place b/c with age and allergies my contacts were becoming less tolerable and I couldn't stand the glasses and headaches.

Anyway, like you said, I feel like one or the other would be tolerable, but the blurry vision combined with the discomfort in the dry eye is a constant distraction and frustration. I also have a slightly messed up flap b/c I had a wrinkle in it to start with so refloating the flap might actually make my dry eye better (in theory). But I keep going in circles about whether or not to do the enhancement b/c of the risk of things being even worse.

[Guest]

I know I'm not Ccoughlin hehe, but honestly, I'd avoid an enhancement like the plague. Your eyes are dry at least in part due to the fact that during surgery they cut your corneal nerves (which are responsible for telling your lacrimal glands and oil-producing glands to produce tears and oil respectively). Those nerves are trying to grow back and re-enervate the flap, they are hopefully going to regain their full function again, and then if you have an enhancement, you put a stop to that, and re-start them at zero again.

Makes me think of when you have a scab, it starts to heal, and you pick at it - you end up with more scarring and it doesn't heal quite right. In my mind, your eyes obviously haven't responded normally to LASIK as it is (you're 4 mo. out and have noticeable dryness), so why stress them out more by re-severing those nerves?

(Ok... I know why you want to do it... that's why I had the enhancement myself in January 2006... my surgeon insisted it wouldn't leave me any worse off as far as dryness goes... but in hindsight, I wonder if my dryness wouldn't be as severe as it is today if I had skipped the enhancement... It's been over 8 years now, and no signs of my eyes ever being normal again... be sure to consider that possibility.)

[littlemermaid]

having an enhancement is going to disturb your corneal nerves yet again

'The Role of Corneal Innervation in LASIK-Induced Neuropathic Dry Eye' Cecilia Chao, Blanka Golebiowski, Fiona Stapleton. The Ocular Surface - January 2014 (Vol. 12, Issue 1, Pages 32-45, DOI: 10.1016/j.jtos.2013.09.001) New paper supporting SAAG's experience http://www.theocularsurfacejournal.c...129-8/fulltext

'Almost half the patients who undergo laser in situ keratomileusis (LASIK) experience dry eye following the procedure. However, the etiology of LASIK-induced dry eye is unclear. The purpose of this review is to examine and summarize the current evidence for the etiology of LASIK-induced dry eye, with a focus on ocular surface sensitivity and corneal innervation. Evidence suggests that the alteration of corneal nerves after LASIK is the most likely cause of the subjective symptoms of LASIK-induced dry eye, even though corneal sensitivity and the clinical indicators of dry eye return to apparently normal values within a year due to the partial recovery of the corneal nerve plexus. The hypothesis is explored that dry eye symptoms following LASIK may result from abnormal sensation due to LASIK-induced corneal neuropathy. Other factors, such as alterations in conjunctival goblet cell density, might also contribute to the symptoms and signs of LASIK-induced dry eye. Inter-relationships between nerve morphology, tear neuropeptide levels and dry eye require further investigation. A better understanding of this phenomenon may result in improved management of post-LASIK dry eye.'