Something doesn't seem consistent between A and B.
lasik advocate with flap melt
A. http://washingtoneye.com/oculoplastics/washingtoneyenewsletter.htm
Why doesn't this testimonial include these issues?
B. http://www.capriati.host.sk/news.htm
"August 8 - 9, 2002 - Third round and quarterfinal in LA. Jennifer
struggles to overcome Tamarine Tanasugarn (THA #28) in third round of
JPMorgan Chase Open in LA. After two hours eight minutes Jennifer won
6:3 6:7(3) 6:2. Playing under the lights was a big problem for
Jennifer because she had Lasik eye surgery two years ago. "I have a
bit of a halo and they say that sometimes after a while lights can
start to become really bright," she explained. In quarterfinals,
Jennifer met Ai Sugiyama (JPN #29) who shocked her with a good tennis
and Jen lost 3:6 3:6. This is the third consecutive quarterfinal loss
for Jennifer. Next week she will play at Canadian Open Rogers AT&T Cup
in Montreal. "
Dr. Leukoma
news:b0866067.03090...@posting.google.com:
Jennifer needs a well-fitted RGP lens for her night matches.
DrG
lasik advocate with flap melt
any of the others will work in the majority of cases after LASIK? I'm
reluctant to wear an RGP long term. I have tear film problems now and
I'm also concerned about losing more and more cornea over time. Are
contact lenses safer than nothing for the health of the cornea in
general (assuming I take extra, extra precautions)? Wouldn't a soft
lens be better for the cornea than an RGP? I've heard of a lot of
people having problems with RGPs where they can't wear them for
stretches of time while their eyes recover.
"Dr. Leukoma" <drgN...@leukoma.com> wrote in message news:<Xns93EB4860F3C...@63.240.76.16>...
Dr. Leukoma
> So you don't think a wavefront soft lens, focus night&Day, proclear or
> any of the others will work in the majority of cases after LASIK? I'm
> reluctant to wear an RGP long term. I have tear film problems now and
> I'm also concerned about losing more and more cornea over time. Are
> contact lenses safer than nothing for the health of the cornea in
> general (assuming I take extra, extra precautions)? Wouldn't a soft
> lens be better for the cornea than an RGP? I've heard of a lot of
> people having problems with RGPs where they can't wear them for
> stretches of time while their eyes recover.
You infer maybe too much from my posts. I have fit every contact lens
known to man - except for scleral lenses - following refractive surgery.
In some cases, a soft lens will work just fine. It really depends upon the
particular circumstances and needs of the patient. However, if I may
generalize a bit, soft lenses do not provide the visual quality of an RGP
lens for MOST post-refractive patients.
NO contact lens is safer than nothing following refractive surgery - UNLESS
the cornea is suffering from severe keratitis, in which case a soft lens
will help provide a moisture barrier and assist in the healing process.
ALSO a soft lens can help cushion an RGP lens. This is called
piggybacking.
For those patients who cannot tolerate an RGP lens for prolonged periods,
there is piggybacking. If this is unsuccessful, then there are severe
problems with the tear film. There are a handful of people for whom I
haven't found a solution. I believe that most of them are people who had
contact lens intolerance prior to LASIK.
Then there is the frontier of scleral lenses for the truly disfigured and
intolerant. Of course, you will need to remove them at regular intervals,
clean them, and re-insert them with fresh saline periodically throughout
the day.
DrG
lasik advocate with flap melt
the way there yet.
My primary focus right now is on cornea health rather than vision (I
think you'll understand given that flap melt can get progressively
worse over time and it didn't start to my knowledge until years
post-op).
You wrote,
>UNLESS the cornea is suffering from severe keratitis, in which case a
soft >lens will help provide a moisture barrier and assist in the
healing process.
From your answer, I'm assuming that RGPs don't provide any benefit to
cornea health in any circumstance- is that accurate? IF a soft lens
will help provide a moisture barrier that assists in healing, then
wouldn't this also be beneficial to the cornea vs. wearing nothing at
all? I would like to know the optimal thing to do for cornea health
without respect to vision. Then, I can focus on things that help
vision with respect to the potential adverse effects on cornea health.
If I'm not asking this in the best way, then I'll keep trying to word
it better.
"Dr. Leukoma" <drgN...@leukoma.com> wrote in message news:<Xns93EBD7B23E4...@216.148.227.77>...
Dr. Leukoma
"lasik advocate with flap melt" <kpat...@hotmail.com> wrote in message
news:b0866067.03090...@posting.google.com...
> Thank you and thanks again. Yes, that helps a lot, but I'm not all
> the way there yet.
>
> My primary focus right now is on cornea health rather than vision (I
> think you'll understand given that flap melt can get progressively
> worse over time and it didn't start to my knowledge until years
> post-op).
>
> You wrote,
> >UNLESS the cornea is suffering from severe keratitis, in which case a
> soft >lens will help provide a moisture barrier and assist in the
> healing process.
>
> From your answer, I'm assuming that RGPs don't provide any benefit to
> cornea health in any circumstance- is that accurate? IF a soft lens
> will help provide a moisture barrier that assists in healing, then
> wouldn't this also be beneficial to the cornea vs. wearing nothing at
> all? I would like to know the optimal thing to do for cornea health
> without respect to vision. Then, I can focus on things that help
> vision with respect to the potential adverse effects on cornea health.
Depends. An RGP is not recognized as providing any corneal health benefit
over not wearing any lens at all, but may be better that some soft lenses
with respect to corneal swelling from hypoxia. As far as I know, there are
no RGP bandage lenses, only soft bandage lenses, and these typically must be
used with plenty of lubrication, otherwise they might create more dryness in
an otherwise dry eye.
lasik advocate with flap melt
for the sake of this discussion, but with punctal plugs), then what
would be the best thing for cornea health? Nothing?
I already know the answer depends so if it depends on A, B, C, D, then
please list them and which option is best in each case. I'm not
asking for medical advice- I'm asking for information I can take to my
Doctor to stimulate further discussion.
Regardless, which soft lens contact material would be the best for
cornea health?
I'm assuming a macrolens or a scleral lens isn't a good option since
you indicated RGPs are not better than nothing at all, but which of
these would be better for eye health?
In another thread, you wrote
For lack of a good technical explanation, I would just say "increased
friction" with the smaller diameter RGP. With a larger lens - a
Macrolens,
for example - the lids glide smoothly over the edges, with only the
surface
friction which is reduced with increased mucus production of the dry
eye.
In a tear deficient situation, Macrolenses tend to suffer from lack of
tear
exchange, or at least it would appear so from the fluorescein pattern
under
the slit-lamp. After awhile, the patient reports foggy or hazy
vision, but
rarely discomfort until the lens is removed. If the epithelium has
been
compromised, then the eye can be uncomfortable.
I don't equate a low water soft lens with low tear exchange. I equate
a
low water hydrogel lens with poor oxygen permeability. This is not
true
for a silicone hydrogel lens, whose oxygen permeability is actually
inversely related to the amount of water. Their low water content
also
gives them better dimensional stability in the dry eye, as they tend
to
shrink less and remain mobile with the blink.
Very recently - within the past year or so - research is showing that
the
rate of mitosis in the epithelium markedly slows under the influence
of the
contact lens, more so in the case of low Dk lenses, and it takes
awhile to
recover. Perhaps this is somehow related to long-term intolerance in
some
way, but that is only pure speculation at this point. Nobody really
knows
at this point. This work is being done right here in the Big D at our
own
UT Southwestern Medical Center.
"Dr. Leukoma" <gre...@ix.netcom.com> wrote in message news:<Q5M5b.8672$tw6....@newsread4.news.pas.earthlink.net>...
Dr. Leukoma
> Assuming, the only problem was severe dry eyes (no tear film at all
> for the sake of this discussion, but with punctal plugs), then what
> would be the best thing for cornea health? Nothing?
>
> I already know the answer depends so if it depends on A, B, C, D, then
> please list them and which option is best in each case. I'm not
> asking for medical advice- I'm asking for information I can take to my
> Doctor to stimulate further discussion.
>
> Regardless, which soft lens contact material would be the best for
> cornea health?
>
> I'm assuming a macrolens or a scleral lens isn't a good option since
> you indicated RGPs are not better than nothing at all, but which of
> these would be better for eye health?
>
There are examples of scleral lenses being beneficial because they do not
come into contact with the cornea, whereas regular and Macro RGPs do.
My favorite lens for bandage is Proclear Compatible.
Rather than me list every conceivable option, why don't you publish the
particulars of your case, and I'll comment.
DrG
Eric 10Dpt
>for the sake of this discussion, but with punctal plugs), then what
>would be the best thing for cornea health? Nothing?
>
>I already know the answer depends so if it depends on A, B, C, D, then
>please list them and which option is best in each case. I'm not
>asking for medical advice- I'm asking for information I can take to my
>Doctor to stimulate further discussion.
>
>Regardless, which soft lens contact material would be the best for
>cornea health?
>
>I'm assuming a macrolens or a scleral lens isn't a good option since
>you indicated RGPs are not better than nothing at all, but which of
>these would be better for eye health?
Michael,
I am not an expert. I think the best thing for severe dry eyes is to get the
dry eyes treated and NOT wear any contact lens. Several people have told me
that rgp lenses cause less damage to drier eyes. The problem is comfort which
decreases a lot when you try to wear rgps with bad tear film. Which soft lens
material would be best for cornea health is a difficult question. Maybe silicon
hydrogels. Given that dry eyes don't have much tear exchange, oxygen supply
through the lens becomes even more important. I think that the water content of
the lens plays an important role in transporting water soluble nutrients
through the lens material. This would imply that a high water content material
provides more water soluble nutrients to the cornea. Silicon hydrogels have low
water content. So, will the low water content pose a problem over the years?
The older low water content soft lenses caused problems. But they were probably
due to low oxygen supply to the cornea. Now that we have silicon hydrogel
lenses with low water content and high oxygen permeability we will see whether
low water content causes problems when lenses are worn for many years or not.
Dr. Leukoma
news:20030905042751...@mb-m04.aol.com:
Eric, the use of a soft lens in the case of corneal trauma or disease is
well-known and understood. This is termed a therapeutic use of the lens.
In this manner, soft lenses are used following PRK and LASEK, and sometimes
following LASIK to hold the flap in place. While I profess not to
completely understand the line of Mr. Patterson's query, I think that he is
collecting information on the therapeutic use of the contact lens.
DrG
Eric 10Dpt
>well-known and understood. This is termed a therapeutic use of the lens.
>In this manner, soft lenses are used following PRK and LASEK, and sometimes
>following LASIK to hold the flap in place. While I profess not to
>completely understand the line of Mr. Patterson's query, I think that he is
>collecting information on the therapeutic use of the contact lens.
>
>DrG
>
OK. I misunderstood Michael's query. I think that soft lenses may be the best
therapeutic lenses or maybe scleral lenses which don't even touch the cornea.
But scleral lenses are too expenive for therapeutic use. I wonder if scleral
lenses would be good for the healing of the epithelium after Prk.
lasik advocate with flap melt
cornea health? Obviously my flap (like everyone elses) has NOT healed
because it never will. I'm well over 2 years post-op now. What's the
best for my cornea health? Silicone hydrogel lenses? Nothing?
"Dr. Leukoma" <d...@leukoma.com> wrote in message news:<Xns93ED6216C...@207.217.77.203>...
Dr. Leukoma
you. Given this state of affairs, I cannot answer the question as phrased.
I have fit post-LASIK patients with both soft and RGP lenses. Some have
worn Proclears, some have worn Purevision, and some doctors prefer Focus
Night and Day. It all depends on what needs to be accomplished. When you
refer to a flap melt, this can range from a slight melting at the edge, to
something more significant. Some patients have had to make to without a
flap altogether. After two years, you should have epithelium over the area
of the melt.
DrG
kpat...@hotmail.com (lasik advocate with flap melt) wrote in
news:b0866067.03090...@posting.google.com: