Ectasia and Topographies

[Whiteshepherd]

I have a question and maybe you guys will know this. When I first had lasik the left eye got blurry after about a year or so. The left eye was then diagnosed with ectasia back in 2008. There was never any mention of ectasia on the right eye but the vision in that eye went bad about two years ago. But the right eye has a cataract in it. Each and every doctor that has examined my eyes says the lasik doctor botched my surgery and the eyes look bad. The left eye went down to a calculated 248 stromal bed after the lasik and that eye clearly has really bad ectasia and distortion. The right eye was not as bad with a calculated residual bed of 301. My question is that I am told by some doctors that you can't see ectasia with a slit lamp and that the topography is always needed but why would the doctors say my eyes are warped and were messed up if they can't see damage from lasik? The right eye had a flap tear and I am wondering if that could cause the look of ectasia too? my specialist last week finally mentioned some ectasia in the right eye but I have always wondered what they were talking about when they said the right eye was stable? Any ideas? The doctor did use a thick flap on the lasik even though he knew I was highly myopic. Just really curious about what they are actually seeing when viewing my eyes.

Brad

[andytraill]

Have they checked your total corneal thickness since (not the calculated preop residual)? How bad is your vision?

[Bigbird]

Sometimes they can see the distortion without a topo (depending on the severity of the ectasia). But I think the topo would be the most reliable

[longhoc]

We've had talks given by clinicians (both ophthalmologists who might perform LASIK and similar procedures -- and optometrists who sometimes have to try and get lenses to fit post-LASIK ectasic corneas) and what seems to be emerging is that while topography is a useful aid in determining contra-indications for LASIK (including irregular corneas and -- especially -- a diagnosis of Keratoconus) it most definitely isn't fool-proof. Slit Lamp examinations are also a useful tool and it might be wise to use this in addition to relying on the topography.

However, both of these can still miss factors which would lead both clinician and patient to not have the procedure performed. A particular risk is sub-clinical Keratoconus. This, as the description would suggest, is a cornea which has the Keratoconus disease process but not manifesting itself in a detectable way. Similarly, when you've got an irregular cornea either through, say, LASIK-induced ectasia or Keratoconus, it's not as simple as just reviewing the topography or the slit-lamp examination. They front of the eye is comprised of several layers. It's possible that the front layer (or layers) are okay, but something towards the back isn't right. If this happens, your topography can look just fine but you're getting internal refractions happening inside the front-of-the-eye layers somewhere which is causing low vision.

It's easy when you end up with a side effect from a treatment to try and rationalise the (on occasions) life-changing impact of that outcome by thinking "someone should have been able to tell...". Indeed, sometimes they should. But sometimes, and I know it's a cliché, these things just happen...

[Whiteshepherd]

My left eye now shows a corneal thickness in the center of 470 with over 600 on the outer edges. That eye has the confirmed ectasia. The right eye I don't know yet on the thickness but the only mention of ectasia by the specialist was afew weeks ago even though the optometrists have told me that the lasik doctor butchered my eyes years ago.

Here in the US it seems that there is a white line where the doctors don't want to tell that another doctor messed up. The doctors at Wilmer Eye Institute told me years ago that ectasia is made when the surgeon cuts the flap too deep. So a few weeks ago I had the lasik doctors records reviewed and sure enough the flaps were deep rather than thin and the right eye had a torn flap during the lasik. The right eye is the only eye that I can read with on signs or a book etc. When I tell epople I can't read they think I am talking about a book and I am talking about license plates and street signs. But I wonder which contacts are going to give me the best vision and be safe for my eyes. Intacs were recommended but the specialist was honest in that he mentioned that inly about one third of patients gain anything from them and the other one third gain nothing and the last third have to have them removed. So each and every day is not fun but I do hope to have a toric implant when I have cataracts surgery on the right eye and hope that eye remains stable. Are optometrists really able to see ectasia or messed up corneas from the slit lamp exam? Could a torn flap really never heal and cause a larger ectasia even though that is my best eye? Now they are trying to find some glasses for me to wear for a few weeks on the right eye to get a refraction but so far we are having no luck. The worst thing here is that nobody wants to admit they messed up even though ectasia was reported in the middle nineties. I appreciate your comments on the other layers because maybe that is what happened with the right eye. Thanks

Brad

[John Chalmers]

I think I have Lasik ectasia. My symptoms are difference to the normal. My vision changes during sleep and during the next day I go more myopic. I’ve seen about 6 specialists and nobody seems to know what’s happening. I drive to work in glasses and drive home in a difference pair my vision can change by a couple of diopters from morning till evening with a mixture of astigmatisms thrown in