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recurring corneal abrasion question

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Don

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Nov 2, 2005, 11:53:55 AM11/2/05
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I had Lasik surgery in 1996. In hindsite I probably wasn't a good
candidate because I have dry eyes. Ever since I had Lasik I've had an
on going problem with my eyes sticking to the back of my eyelids at
night time. If I simply wake up and open my eyelids it can and does
tear my cornea a bit. So my brain trained itself to rotate the eyes
around for a few minutes before opening my eyelids. Sunday I ripped my
left eye pretty good. Excruciating pain as usual. My surgeon
prescribed anti bacteria ointment and pain pills. One of my neighbors
suggested I see an optometrist friend of his. So I did. He is very
well aware of this problem and has seen in on numerous occasions. He
says all my Doctor is doing is treating the symptoms and not fixing
the problem. Bottom line is he wants to do something known as
Superficial Keratectomy. It is supposed to be a simple procedure that
takes about 1 to 2 minutes. He feels this will go a long way in
getting rid of my so called "sticky eye" problems. Of course I'm
researching this on google but wanted to get some opinions out here
also. I'm wondering why my surgeon has never gone this route and just
keeps telling me to squirt a glob of ointment in my eyes at night.
I've done this but it is a total pain in the ass to squirt what feels
like vaseline for the eye in your eyes at night. Thanks in advance for
any advice.

Don

Ragnar

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Nov 2, 2005, 1:00:07 PM11/2/05
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Sounds to me like your doctor is full of it.
It sounds like you may actually have the condition known as "dry eye"
which is not a result of LASIK.
Anyway... here is what I suggest you do.
First, get an over the counter eyedrop called SYSTANE. I bet that
works for you. If not, try any gel type eyedrip such as Genteal Gel.
If you still have a problem, talk to your optometrist about RESTASIS.
And I repeat, your condition has nothing to do with LASIK.

One other thing you might consider is getting a room humidifier, or
take two flaxseed oil capsules per day.

Don

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Nov 2, 2005, 1:15:20 PM11/2/05
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I already use Systane. Also .... I never had this issue ever prior to
Lasik so I don't buy your diagnosis. The optometrist I saw on Monday
said it was directly related to the Lasik surgery. He said my eyes
were probably already dry prior to the surgery and that I would not be
a good candidate today. But he also said the Lasik made it worse to
the point of having this problem of my eye sticking to the back of my
eyelid. Sorry but I don't think it was coincidence that right after my
Lasik surgery my eyes started sticking. I think there is a direct
relationship.

Don


On Wed, 02 Nov 2005 18:00:07 GMT, Ragnar <ragna...@yahoo.com>
wrote:

Glenn - USAEyes.org

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Nov 2, 2005, 3:00:57 PM11/2/05
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Your difficulties appear to relate directly to the reduction of
moisture under the eye lids during sleep. This is, simply put, dry
eye. Since dry eye is the cause, it is also what needs to be treated.

A symptom of dry eye is as you describe; an abrasion of the corneal
epithelium (outermost layer of cornea cells) when you open your eyes
in the morning. The abrasion requires the epithelium to regenerate
cells and heal every day, which is not a great way to treat your eyes
and can lead to poor vision quality.

The recommendation of superficial keratectomy (removing the epithelial
layer and allowing a new layer to cover the cornea) indicates that
your optometrist believes what is wrong is the epithelial layer not
holding to the underlying cornea. When you have "sticky eye" in the
morning, the epithelial layer is lifted. The problem I see with this
approach is that the dry eye will undoubtedly continue and will
disrupt the epithelium. Superficial keratectomy may not cause any
damage other than the discomfort and weeks of poor vision while your
epithelium heals, but may not provide much improvement.

Using a bland nighttime ointment, such as Refresh PM, will add the
lubrication that you apparently need. This too is treating the
symptoms, not the cause.

It seems clear that the cause of the dry eye, such as limited lipid
flow, low aqueous, poor mucin production, etc. is what needs to be
diagnosed and treated. Restasis has been shown to be very beneficial
in this regard, but what is needed most is a good evaluation of your
tearing function by someone who is knowledgeable.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Glenn - USAEyes.org

unread,
Nov 2, 2005, 3:06:15 PM11/2/05
to
This problem occurring after refractive surgery is undoubtedly not a
coincidence. LASIK can push people predisposed to dry eye over the
threshold to where dry eye symptoms raise their ugly head. LASIK
induced dry eye is normally temporary for someone with a healthy
tearing system, but can be just enough to trigger full blown dry eye
problems. As the cornea heals from surgery the tearing function may
return to preoperative levels. If not, the dry eye needs to be
treated.

CatmanX

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Nov 2, 2005, 2:47:36 PM11/2/05
to
For goodness sake Glenn and Cliff, stop giving advice on things you
don't know about.

This is a recurrent corneal erosion, NOT dry eye. The problem is with
the adhesion of the basal epithelial cells to the basement membrane. It
is most likely unrelated to Lasik and can be caused by numerous things
such as epithelial dystrophies and foreign bodies, particularly organic
matter such as gardening mishaps.

Treatment options are:

1) gel/parafin lubricants such as lacrilube prior to sleep. These leave
a layer between the cornea and lid to hopefully stop adhesion. Drops
are no good as you need something that will still br there in the
morning.

2) Bandage contact lens. This is beneficial after the act to relieve
soreness, but is better used overnight to create a barrier between lid
and cornea. Needs to be used for lengthy periods, nightly for 4-6
months or more.

3) PTK - this is what the optom you saw was talking about. The 'T'
stands for therapeutic. It is PRK, but instead of making a refractive
change, a small layer off the surface is ablated. The ablatd surface
generally has better adhesion than the existing basement membrane.

4) Stromal puncture - the surgeon uses a needle to make small puncture
marks at the area that is causing problems. Not entirely sure what it
is supposed to do, possibly rough up the area, but it is relatively
effective and roughly the same benefit and success rate as PTK.

Hope this helps a bit.

dr grant

Glenn - USAEyes.org

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Nov 2, 2005, 5:03:03 PM11/2/05
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Thanks Doc for the details, but in my defense I personally have this
exact same problem on occasion and it has been diagnosed as dry eye,
not a recurrent corneal erosion.

serebel

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Nov 2, 2005, 9:04:23 PM11/2/05
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Glenn and Grant have given you some food for thought. Something to
bring to your doc's attention. Which ever condition you have should be
treatable.

SErebel

Ragnar

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Nov 3, 2005, 5:07:56 AM11/3/05
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most optometrists don't know diddly about dry eye...

and if you had dryness problems before lasik, you should not have had
the surgery.
and 1996 would make you one of the very first LASIK patients.

CatmanX

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Nov 3, 2005, 5:36:39 AM11/3/05
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Glenn, this ain't dry eye. It is what is classified as a morning
syndrome. The problem is one where the adhesions (semidesmosomes if you
want to impress your docs) are not connecting to the basement membrane.
With overnight oedema from lid closure and reduction in tears causes
sticking to the back of the lid. When you open your eye, the epithelium
is not strong enough to stay in place.

RCE usually goes eventually, but it can take 12 months to happen (as it
did in my case). It can go for weeks and months, then occur suddenly.

Treatment needs to be aimed at resolving the underlying issue not
superficial glossing over the surface.

In your case Glenn, if it is a small erosion, it can be resolved in as
little as 0.5hr, so by the time you see your doc, there is no trace of
it, but you do not get the feeling of a needle in your eye on lid
opening from dry eye.

Cheers,

dr grant

Ragnar

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Nov 3, 2005, 6:07:44 AM11/3/05
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You don't really know what you are talking about either...

1) on the gels... they are INTENDED for only use during sleep,
however, from personal experience I have found that the gel "melts"
sufficiently to provide clear vision and great lubrication - which is
nice during the first 2 months post op.

2) bandage contact lens is really only relevant to PRK or non-LASIK.
although they can be used in lasik too.. they can have some benefit
with lasik. They are nececessary for PRK

3) PTK is probably what the guy was referring to. And I do not
think that is a viable solution for his problem.

4) Stromal puncture? you started off chiding about talking about
things not known about, then you freely admit that you don't know what
stromal puncture is about. We could have gone without hearing about
stromal puncture which is a voodoo technique.

On 2 Nov 2005 11:47:36 -0800, "CatmanX" <gra...@connexus.net.au>
wrote:

RT

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Nov 3, 2005, 7:49:00 AM11/3/05
to
Don:

This thread should be ample proof to you to never seek a diagnosis over
the internet. You will get as many opinions as there are people willing
to answer.

Please make an appointment ASAP with an OPHTHALMOLOGIST, not an
optometrist. You need to see a medical specialist. Please let us know
what happens so that we can all learn something.

Best of luck!

--
~RT

Don

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Nov 3, 2005, 10:53:27 AM11/3/05
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Wow I never thought my question would generate so many diagnoses from
so many folks. I have a call into an ophthalmologist in Denver who
supposedly knows this issue quite well with other Lasik patients. I
will let you know what she says once she sees me.

For those who keep saying this has nothing to do with Lasik all I can
say is for 43 years I never had my eyelids stick to my eye.
Immediately after Lasik (June of 97 not 96 as I first reported) till
today this has been a problem. So telling me this isn't related to
Lasik is a very hard sell here. You draw your own conclusions.

By the way about a year ago Denver local ABC TV station did a report
on people just like me who have this sticking issue after Lasik
surgery. They had no shortage of people who were experiencing exactly
what I have been through. Another reason that telling me this isn't
related to Lasik is a hard sell. I still have a weak 20/20 in both
eyes. This part I absolutely love. So in no way am I putting down
Lasik procedures. I'm just trying to get to the bottom of a problem.

Thanks to everyone for your advice/opinions. I'll let you know what
the Doc has to say once she sees me. In the meantime I'm wearing a
patch contact lense in my left eye while this thing heals. I thought a
contact lense would be the last thing on earth I'd want in that eye
while it was so irritated but I must admit it has helped a lot with
the pain. More to come.

Don

Glenn - USAEyes.org

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Nov 3, 2005, 5:53:04 PM11/3/05
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You've got that right, RT. Only an examination from a competent doctor
can tell a patient what is really going on, but at least Don will be
better informed when he talks with his doctor.

Ragnar

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Nov 4, 2005, 5:41:17 PM11/4/05
to
RT has been right on the money quite ofen lately.


The only think I would add is that it's ofen not so easy t get a free
consultation wth an ophthalmologist.

RT

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Nov 4, 2005, 5:59:10 PM11/4/05
to
In article <389mm1dfkkqa2dojv...@4ax.com>,
Ragnar <ragna...@yahoo.com> wrote:

> RT has been right on the money quite ofen lately.
>

thank you. I only post things I believe to be true.

> The only think I would add is that it's ofen not so easy t get a free
> consultation wth an ophthalmologist.

Nothing worth anything in life is free.

--
~RT

CatmanX

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Nov 5, 2005, 2:21:30 PM11/5/05
to
Still the ignorant twit cliffy?

1) Gels or petroleum based products are better than drops as they last
longer on the eye. You need some lubricant to be there in the morning
and drops will never do that.

2) A bandage CL has nothing to do with PRK vs Lasik, it is a means of
prevention of adhesion, and a good one at that. If you had learnt
anything over the years, you may have realised that we can use the same
item for many different purposes. In the case of a bandage CL, it can
be used to prevent adhesion of epithelium to the lid, as well as post
erosion to reduce pain.

3) PTK is what the original OD was talking about and if this is an
erosion, is a perfectly viable treatment option.

4) Stromal puncture has been used as a treatment option for RCE for
decades with high success rates. WHile I may not know the precise
mechanism as to why it works, it does, and has been successfully
treating RCE for years by ophthalmologists. You may try looking up a
textbook some time. Like Lasik, corneal grafting and cataract implants,
it is another voodoo technique used by ophthalmology.

drgrant

Ragnar

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Nov 6, 2005, 10:18:16 AM11/6/05
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yes.. you had several good posts... up until that off the wall swipe
earlier today.

Ragnar

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Nov 6, 2005, 10:32:14 AM11/6/05
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You still have a reading comprehension problem Mr.Mason...

1: I Pointed out that the gels were intended for night use only, but
I find them useful for daytime use also.

2. You are 100% wrong about this. You surprise me.

3. PTK is fine.. however, you are not qualified to even mention it.
Since you are posting as a doctor (which you aren't) you must have
the qualifications to speak about such things.
When one gives out information under the guise of being a doctor, they
are liable for what they say. One person here even points out on
every message that he is NOT a doctor.

4. So you, someone who is not even a doctor, is the expert on stromal
puncture. I just hope that nobody is duped by you..

On 5 Nov 2005 11:21:30 -0800, "CatmanX" <gra...@connexus.net.au>
wrote:

CatmanX

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Nov 6, 2005, 2:48:44 PM11/6/05
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Some points to cover:

2) 100% wrong about what? A bandage lens is just that, a bandage. It
can be used for many things. PRK used the lens to reduce post-operative
pain. With RCE it is used in exactly the same way, except that the
whole epithelium has not been removed. They are also used for abrasions
which are large and painful. They are used overnight for RCE patients
to prevent the erosion. If I am wrong, so are 1000's of OD's and MD's
across your country. Maybe you should ring them all and tell them they
are wrong too?

3) You state PTK is not viable, now say it is fine???? Make up your
mind....if you can find it. As much as I may not perform the process, I
do need to know about it and its viability. The success of PTK is
around 70-80% effective - not bad for a treatment you said was not
viable.

4) Stromal puncture has a success rate of ~70% also. Generally, the
difference in choosing PTK vs stromal puncture is the preference of the
doctor. Some do one, some do the other. Those with ready access to a
laser generally do that, those without use stromal puncture in their
rooms with a fine guage needle.

Once again my little friend, you are spouting rubbish and making
yourself look stupid. I am giving advice based on the symptoms
described by Don, especially on knowing that the pain occurs on OPENING
his eyes in the morning. He states that if he rolls his eyes before
opening then he is OK. This smacks of RCE as we will often tell RCE
patients to roll their eyes around before opening them in the morning
(not always easy to remember). As a licenced optometrist, this is the
thing I do every day, so yes, I am qualified to give this advice.

I also gave options that may be viable for treatment. Don is not my
patient and I do not expect that he will do as I say, but at least he
knows what the choices may be and what to discuss with his doctor.

I am sorry for your peteulant diatribe that again has hijacked the
thread and gone off topic, which should remain as to what to do about
Don's condition. As seen in this thread, Glenn has a similar thing,
which may also be RCE as well, but you wouldn't know that as you wish
to try to flame me once again, but can you at least learn what you are
talking about before you start raving as I am giving standard text-book
advice, and had you read the text-books, you would know this. You may
like to start with Clinical Ophthalmology by Jack Kanski, a nice
general ophthalmology text, well written and lots of nice pictures.

dr grant

Ragnar

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Nov 6, 2005, 6:10:51 PM11/6/05
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If anybody paid any attention to you, I would continue to battle with
you over this. But they aren't.
I would suggest anybody reading this to read this thread and see how
dr grant (who is not a doctor) keeps twisting words and misquoting
etc. That has been his style for years.

On 6 Nov 2005 11:48:44 -0800, "CatmanX" <gra...@connexus.net.au>
wrote:

CatmanX

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Nov 7, 2005, 3:46:53 PM11/7/05
to
Given up again cliff?

This is probably becaude you got done again with a structured arguement
vs your flaming and contradiction. If you would like, I will post the
text, which by the way, I actually looked up my Kanski text yesterday
while looking up something on another topic (retinopathy of prematurity
if you are interested). Guess what the 4 points in treatment were?
Funny, they were in exactly the same order as I wrote off the top of my
head at 4.00am one morning.

I do not need to twist your words, you do a good enough job of that
yourself.

dr grant

Ragnar

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Nov 8, 2005, 12:32:49 AM11/8/05
to
I didn't give up anthing. I have covered this over and over. The
only one who can't seem to get it through his thick skull is you. I
have no interest in being your teacher.


On 7 Nov 2005 12:46:53 -0800, "CatmanX" <gra...@connexus.net.au>
wrote:

CatmanX

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Nov 8, 2005, 1:40:25 PM11/8/05
to
I am waiting to learn something. If you read the posts here, I have
been the one teaching something. You have done nothing but contradict
yourself and gainsay everyrhing I have said.

Like I said, if you want to teach me something, get a textbook, read it
and quote something of value.

dr grant

Ragnar

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Nov 9, 2005, 11:37:28 AM11/9/05
to
I am not aware of you teaching anything. You constantly misrepresent
other people's posts though.

You are another one that is not worthy of a reply.
And by the way folks, his name is Mr. Grant Mason, not Dr. Grant. If
he were a doctor, which he is not, he would be Dr. Mason


On 8 Nov 2005 10:40:25 -0800, "CatmanX" <gra...@connexus.net.au>
wrote:

CatmanX

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Nov 9, 2005, 2:42:12 PM11/9/05
to
blah, blah, blah.........

Having read my posts, you now know how to treat RCE in a heirachical
order. That is teaching you something.

dr grant

Ragnar

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Nov 9, 2005, 7:57:45 PM11/9/05
to
I think you are delusional if you think I actually read your garbage
posts.
By the way, it's never a good idea to use words that you don't know
how to spell. It's hierarchical not hEIrachical.


On 9 Nov 2005 11:42:12 -0800, "CatmanX" <gra...@connexus.net.au>
wrote:

ycdbsoya

unread,
Nov 10, 2005, 10:58:25 AM11/10/05
to
You're proving to be an idiot again rather early today,

Rags, you read his posts, enough to respond with a spelling correction.
Really, are you retarded or something? You've reached credibility rock
bottom and you keep on digging.

CatmanX

unread,
Nov 10, 2005, 3:02:14 PM11/10/05
to
cliff doesn't like that someone can see through his rubbish. He gets
annoyed that I know a little about eyes and know he doesn't so we end
in this continuing banter where cliff tries his best to put me down.
The problem is, like with most schizophrenics, he changes his mond and
contradicts himself to try to denounce me, like saying PTK isn't a
valid procedure, then saying it is, or picking on spelling rather than
having an arguement and putting a string of points together.

next he will tell me that I have been killfiled for years so it is
impossible for him to read my posts. Now there's some logic.

dr grant

Ragnar

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Nov 10, 2005, 9:25:03 PM11/10/05
to
coming from you, that is a compliment.
Go post some more messages to show everyone what a clown you are
Frank.


On 10 Nov 2005 07:58:25 -0800, "ycdbsoya" <the_bo...@hotmail.com>
wrote:

Ragnar

unread,
Nov 10, 2005, 9:31:07 PM11/10/05
to
Anybody of any intelligence can discern for themselves who is credible
and who is not.
I will agree with you on your statement that you know a little about
eyes.

It's amusing that there are doctors who post who don't let it be known
that they are doctors - and there are also people who are NOT doctors
such as Mr. Grant Mason aka "Dr. Grant" posting under the false
identity of being a doctor.

On 10 Nov 2005 12:02:14 -0800, "CatmanX" <gra...@connexus.net.au>
wrote:

CatmanX

unread,
Nov 10, 2005, 10:42:51 PM11/10/05
to
blah, blah, blah...........................

you're still yabberring cliffy, but we are waiting for you to say
something.

This was a thread on recurrent erosion, why don't you add something to
the topic???

dr grant

bourk...@gmail.com

unread,
Nov 11, 2005, 6:48:00 AM11/11/05
to

Ragnar

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Nov 11, 2005, 9:30:46 AM11/11/05
to
Your optometrist does not know what he is talking about. He is not
required to know about surgical procedures since he does not perform
them, however, he should not be giving you misinformation.
Furthermore, it sounds as if your optometrist has failed to treat your
problem, and is blaming the situation on your LASIK. If you really
have dry eye, you should have tried Restatis.

Go to an ophthalmologist.

Don

unread,
Nov 28, 2005, 11:38:39 AM11/28/05
to
Well I finally saw one of Denver's top corneal ophthalmologist. She
did a thorough evaluation of both my eyes and said that even in 1996 I
was not a good candidate for Lasik surgery because of the dry eye
issue. She went on to say that letting an optometrist do the
keratectomy procedure that he wanted to do would have been a mistake
and should only be used as a last resort. And that if we ever end up
doing something like that I should let a surgeon do it not a guy who
examines eyes. I'm sure that will piss some folks off but I tend to
agree with her. The bottom line is she put me back on Muro 128 (I
think that's the name of it) ointment and stressed that if I use this
regularly over a period of about 6 months all this could go away. She
also asked that the next time I get an abrasion to come immediately to
her office so she can look at it and map it out.

The bottom line is that I was quite impressed with her. Much more so
than any other ophthalmologist or optometrist I've been to. I was also
impressed that she never once asked the names of the guy who did my
Lasik or the guy who wanted to do the keratectomy on the first visit
ever.

For those of you who say my sticky eye issue has nothing to do with
Lasik she would disagree. She says the Lasik took a dry eye problem
and made it worse which led to the recurring corneal abrasion. She
also says she has seen this a lot and that a Denver TV station did an
entire story on it last year.

Don't think I wake up every morning screaming in pain. I don't. I
still have 20/20 vision at the ripe old age of 51 which says that part
of the Lasik worked quite well. The abrasion stuff happens about once
or twice a year. But the pain associated with that is horrific as many
of you may know. It's like a paper cut on your cornea. Ouch!

I hope this post doesn't create too much Monday morning quarter
backing. I just wanted to follow up and let you know what I found out.
Thanks for all the advice.

Don

Glenn - USAEyes.org

unread,
Nov 28, 2005, 5:59:22 PM11/28/05
to
Thanks for the follow up. It is good to hear that you have found a
good doctor. Corneal specialists tend to be no-nonsense kinds of
people. I'm not surprised about her not asking the identity of your
previous doctors. What mattered most was the current condition of your
eyes and how she could help you in the future.

serebel

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Nov 28, 2005, 10:10:47 PM11/28/05
to
Don,

I hope this regimen works for you, sounds like you found a good doc.

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