Zembla Documentary on Lasik, Pain, and Suicidality

This Lasik documentary was created by investigative journalists in Holland. The language is mostly Dutch, with English subtitles. The documentary focuses on corneal neuropathic path after Lasik and the suicidality it creates. Dutch physician Dr. Michael Brouwer and other Lasik sufferers in Holland are interviewed, as is Dr. Edward Boshnick in the United States (see EyeFreedom.com). The investigators ask: Is the experience of pain after Lasik really uncommon? What are the consequences when it occurs? Also interviewed are Dr. David Barsook and Dr. Morris Waxler. Dr. Barsook is Director of the Pain and Imaging Neuroscience (P.A.I.N.) Group at Boston Children’s Hospital, MGH ,and McLean Hospital at Harvard University. Dr. Barsook maintains that corneal pain after Lasik follows an established model of neuropathic pain. Dr. Morris Waxler is the FDA's former chief research scientist on Lasik. Dr. Waxler maintains at his website HelpStopLasik.com that "The FDA does not want to admit that millions of people have now had a surgery that never should have been approved by its own rules. The FDA is now engaged in covering-up a scandal and an epidemic, and its own corrupt practices. This should be exposed, and LASIK should end." He revisits these conclusions in the video.

LASIK

The GVR Scleral Lens and Lasik

LASIK complications are the unanticipated events that can take place after the LASIK surgery is done. Many of these complications may not take place immediately after the surgery but can take place months or years later. These complications include but are not limited to:

  • 1. Severe Dry Eye (the most common complication affecting over a third of the entire post-LASIK population)
  • 2. Irregular, uneven or rough corneal surface.
  • 3. Blurred, distorted and unstable vision.
  • 4. Reduced vision indoors and at night.
  • 5. Glare, halos and starbursts and eye pain.
  • 6. Vitreous floaters and posterior vitreous detachment.
  • 7. Light sensitivity, ghost images and/or double vision.
  • 8. Complications with the surgically induced LASIK flap such as wrinkles, debris or cellular growth beneath the flap.
  • 9. Corneal ectasia which a bulging or protrusion of the corneal surface.
  • 10. Corneal epithelial erosion.
  • 11. Severe depression and in some instances thoughts of suicide.

Read more ...

post-Lasik Complications Patients Become Friends

This is a photo of me with my 2 patients who traveled great distances to visit our practice. Ahmed, on the left from Qatar and Jakob on the right who traveled from Copenhagen, Denmark. Both of these young men lost quality vision due to complications from LASIK surgery. By coincidence, Jakob and Ahmed stayed at the same hotel while in Miami and met in my office. They became friends with each other and spent time seeing the local sights together while here. It was a privilege to have taken part in their vision care and to have helped them both see clearly and comfortably once again. I am looking forward to them both having many years of clear, comfortable vision. Restoring quality vision in patients like Jakob and Ahmed is what gives my professional life meaning.

post-Lasik Corneal Neuropathy Treated with GVR Scleral Lens

This is a photo of me with my patient Jakob who recently visited our practice from Copenhagen, Denmark. Jakob suffers from post-LASIK corneal neuropathy. 4 years ago, Jakob underwent LASIK surgery. 1 year later unrelenting pain developed " beneath my eyes" according to Jakob. Jakob's eye pain was worse indoors and when he got tired, but was always there. Jakob never suffered any form of eye pain before undergoing LASIK surgery. Back home in Denmark, Jakob was dismissed by a number of physicians who told him that there was nothing wrong with his eyes. As Jakob's despair and depression deepened, he decided to look into scleral lens technology to give him relief from his eye pain. Last week, we fit Jakob with GVR Scleral lenses. With these lenses, Jakob no longer is experiencing any eye discomfort or pain. Besides seeing clearly, he is able to wear these lenses comfortably all day. According to Dr. Perry Rosenthal, professor of ophthalmology at Harvard University Medical School, the cornea is the most powerful pain generator in the human body. The density of corneal pain receptors has been estimated to be 40 times that of dental pulp. In my opinion, It was damage to the corneal nerves in Jakob's corneas that created Jakob's symptoms. The scleral lenses that Jakob is now wearing is vaulting over the compromised cornea and protecting it from the environment and the blinking action of the eyelids. The space between the back surface of the scleral lens and the front surface of the cornea is filled with unpreserved saline solution. In other words, Jakob's corneas are always in a liquid environment. I expect Jakob to be wearing his scleral lenses comfortably with clear vision and without any eye pain for many years to come.

OCT of Cornea

This is a cross-sectional OCT (Optical Coherence Tomography) image of a scleral lens over a cornea with "Hydrops" that underwent 4 separate LASIK procedures followed by a PRK procedure. These surgeries ultimately led to the destruction of the LASIK flap. In this image, the top 2 curved lines represent the front and back surfaces of the scleral lens. The thick curved gray structure is the cornea. Look carefully at the torn membrane on the left aspect of the back corneal surface. This membrane torn due to the pressures and forces within the eye against the weakened cornea. When this membrane tore, fluid from within the eye (aqueous) entered the cornea causing it to become cloudy. This entire scenario is called "Hydrops". Look carefully at the very top of this image. Note the curved gray white line along the corneal surface. This is the area where the LASIK flap once existed. What you see now is a form of scar tissue. This cornea is extremely distorted and dry. In addition, the ocular damage caused by these surgeries has made this eye very painful for this patient. This scleral lens has not only provided clear vision to this eye, but has also created an ocular environment where the eye is now moist and free of virtually all pain. Without the scleral lens this patient has less than 20/800 vision with this eye. With the scleral lens the patient is now able to see 20/30 with all day lens wear.

RK in 1980s, 3 Lasiks Beginning in 2001, Infectious Crystal Keratopathy

When this patient came to see me several weeks ago, I felt that the white deposits in the center of her cornea beneath the LASIK flap were from epithelial ingrowth since this eye suffered several episodes of this condition over the past few years. I referred this patient to the Bascom Palmer Eye Institute here in Miami for another opinion. Well, my diagnosis was incorrect. The condition that this eye is suffering from is "infectious crystal keratopathy", an extremely rare complication of refractive eye surgery. This eye underwent a number of separate Radial Keratotomy procedures in the 1980's followed by 3 separate LASIK procedures beginning in 2001. In this condition, crystals are deposited in the anterior portion of the cornea between the LASIK flap and the corneal surface. The infection related crystal deposits have a fine branchlike shape that develop over time and may be associated with inflammation. Fortified antibiotics were prescribed for this patient to use 4 times daily for the next few weeks at which time she will be seen again by the corneal specialists at Bascom Palmer. During my many years in practice I have seen thousands of patients suffering ocular trauma due to refractive eye surgeries including LASIK. This is the first time that I have ever seen an eye with "infectious crystal keratopathy".

Profile view of Eye with 15 Diopters of Myopia before Lasik. Now 20/30 with GVR Scleral Lens

Profile view of an eye that had -15 diopters of myopia before undergoing LASIK. Cornea is extremely thin. The vision is this eye is extremely distorted. Note how flat the corneal surface is. With a scleral lens this eye is capable of 20/30 vision without distortions.

Lasik in 2000 and 2003. Emergency Corneal Transplant due to Intacs, now 20/25 with GVR Scleral Lens

These are photos of the right and left eye of a patient that underwent LASIK surgery in 2000 and once again in 2003 in each eye. Shortly after the 2nd LASIK procedure, this patient developed ectasia in her left eye. Her corneal surgeon attempted to insert Intacs (corneal rings) into her left cornea intending to smooth out the corneal surface. During the Intacs surgery the cornea got damaged forcing this patient to undergo an emergency corneal transplant. About 8 years later ectasia developed in this patient's right eye. A different corneal surgeon in Central America suggested that Ferrara Rings be inserted in her right cornea. Ferrara rings are very similar to Intacs except that they do not have FDA approval in the United States. In addition, the separation of the Ferrara rings within the cornea is much closer than seen with Intacs and can interfere with night vision. Look carefully at the first photo. This shows the right cornea with the Ferrara rings. Note that these rings are along the pupillary border and are affecting this patient's night vision. The 2nd photo shows this patient's left cornea with the transplant. The white-gray ring circling the peripheral cornea is the junction between the host and donor cornea. Look carefully and you can see new blood vessel growth onto the donor cornea at 12:00 and 1:00. Rarely do these blood vessels traverse the host-donor interface. This condition will have to be monitored indefinitely This patient had not been able to tolerate any form of contact lens correction. In addition, eyeglasses did not provide her with functional vision. For the past 2 years this patient has been wearing scleral lenses which are allowing her to see clearly (20/25) in each eye with excellent comfort.

Lasik followed by Ectasia and Intacs and Ferrara Rings

This is a photo of my patient Ana and me. Ana first visited our office from Mexico 2 years ago. In 2000, Ana underwent LASIK surgery in both eyes. When her vision began to fail, Ana underwent a 2nd LASIK procedure in each eye in 2003. Shortly after undergoing her 2nd LASIK procedure, Ana developed ectasia in her left eye. In an attempt to smooth out the surface of the left cornea, Ana's surgeon attempted to insert Intacs (corneal rings) into her cornea. During the Intacs surgery, the cornea got damaged forcing Ana to have an emergency corneal transplant in her left eye. About 8 years later, ectasia developed in Ana's right cornea. Corneal ectasia is a condition that can develop years after refractive surgery such as LASIK is done. It is characterized by a thinning and protrusion of the corneal surface. A corneal surgeon in Mexico suggested that Ferrara Rings be inserted into her right cornea to reduce or eliminate her ectasia. Ferrara Rings are very similar to Intacs except that they do not have FDA approval for use in the US. In addition, the separation of the Ferrara Rings within the cornea is much closer than seen with Intacs and can interfere with night vision. Look carefully at the first ocular photo. This shows Ana's right cornea with the Ferrara Rings. Note that these rings are along the pupillary border and are affecting Ana's night vision. The 2nd ocular photo shows Ana's left corneal transplant. The white- gray ring circling the peripheral cornea is the junction between the host and donor cornea. Look carefully and you can see new blood vessel growth onto the donor cornea at 12:00 and at 1:00. Rarely do these blood vessels traverse the host-donor interface. This condition (neovascularization) will have to be monitored for an indefinite period of time. Before visiting our office 2 years ago, Ana was not able to tolerate any type of contact lens. In addition, eyeglasses did not allow her to have functional vision. For the past 2 years Ana has been wearing GVR Scleral lenses which are allowing her to see clearly (20/25 in each eye) and comfortably once again.

Lasik Ten Years ago, Followed by Ectasia. Treated with EyePrint Pro Scleral Lens

The photo below is of a patient having an impression made of the front surface of his eye so that he can have a custom made EyePrintPro scleral lens made. This patient underwent LASIK surgery about 10 years ago. Several years later he developed a condition known as post-LASIK corneal ectasia. This condition is characterized by a protruding, irregular dry cornea. This patient was unable to comfortably wear a conventional scleral lens and could not tolerate gas permeable contact lenses. In addition he did not have functional vision with eyeglasses. The EyePrintPro impression process captures precisely every detail of the entire ocular surface so that a scleral lens can be made using 3-D imaging technology. The Scleral lens made from this technology is very unique much like a finger print for each individual eye. Every "hill and valley" of his cornea is negatively imbedded into the back surface of the EyePrint Pro Scleral lens. This patient received his new EyePrintPro Scleral lenses this morning. His visual acuity is now 20/15. To quote this patient " I don't think that I have ever seen this clearly". The 2nd photo shows me with my patient after receiving his new scleral lenses. The last photo shows the EyePrintPro Scleral lens on his right eye. This unique lens replaces the irregular cornea as a optical surface. In addition, to address the dry eye issues that this patient has had to deal with, the space between the back surface of the lens and the front surface of the irregular cornea is filled with sterile saline solution. In other words, the front of the eye is always in a moist environment.

Four Lasiks and Conductive Keratoplasty, now 20/20 in Each Eye with GVR Scleral Lens

This patient recently visited our office from Portugal. Over a 12 year period beginning in 2004 he underwent 4 separate LASIK surgeries and 1 conductive keratoplasty procedure (CK) all in his right eye. In 2004, he underwent LASIK surgery in his left eye. In conductive keratoplasty, a probe utilizing radio frequency energy is inserted into the corneal periphery in spots corresponding to the numbers on a clock. Each successive surgery made the vision in this patient's right eye worse than the preceding surgery. When this patient first entered our office his entering visual acuity was 20/40 in his right eye ( with distortions, shadows, starbursts etc.) and 20/25 in his left eye also with shadows. Over a 2 week period we fit both of this patient's eyes with GVR Scleral lenses. A number of lens changes needed to be made (over a 2 week period) to optimize the lens fit and eliminate the shadows he was seeing, especially in his right eye. With the lenses he went home with he was able to see clearly (20/20) in each eye. The shadows and distortions that he was seeing (mainly at night) were eliminated in his left eye and greatly reduced in his right eye. My feeling is that the greatly reduced higher order aberrations that this patient had been seeing in his right eye was caused for the most part by the natural lens within his right eye and not by the scleral lens. In any case, I am working with several lens technologies to address the remaining issues with the night time shadows that this patient is experiencing with his right eye. Overall, this patient is seeing significantly clearer and more comfortably now for the first time since undergoing his LASIK surgeries and the CK procedure. In the photo below I am standing next to this most interesting patient. Below this is a photo of this patient's right eye taken through a bio-microscope. A special dye is used to highlight details on the corneal surface. The bright green tinted curved line going around the corneal periphery is the first LASIK flap border. A fainter curved line several mm within the cornea is the 2nd LASIK flap border. Note the round spots appearing around this LASIK flap going around the corneal periphery like the numbers on a clock. These are the permanent spots created by the CK probe. It must be understood that there are no surgical or other invasive procedures that will undo the damage caused by the LASIK and CK procedures performed on this patient. Scleral lenses are the best non-invasive options that will allow this unique patient population to see clearly and comfortably once again.

Lasik, Pellucid Marginal Degeneration, X-Linking, Ectasia, now 20/25 with GVR Scleral Lens

This patient has a 14 year history of multiple vision and ocular complications dating from 2002 to 2015. Because she wanted to see clearer while taking photos and videos under water this patient had LASIK surgery in her right eye in 2002. After the surgery her vision was good except for halos and starbursts at night. After 5 years this patient noted that the vision in her right eye began to decrease. In 2011, she was diagnosed with Anterior Basement Membrane disease and early cataracts. For several months she tried unsuccessfully to wear soft contact lenses. Also around this time she began noticing double vision. In 2013 this patient visited a well respected ophthalmologist in Houston who told her that she had a corneal deformity known as Pellucid Marginal Degeneration (PMD). In late 2013, this patient had Collagen Cross-Linking (CXL) done on her right cornea and a "pocket" CXL done on her left cornea. (Pocket CXL involves the use of a Femtosecond laser to make a "pocket" in the cornea where the active chemical is placed). For a 6 month period following these procedures, this patient suffered inflammations and corneal erosions in both eyes requiring 17 office visits. Following these visits, this patient had no functional vision in her left eye for several months. Following the CXL procedures, the same surgeon removed "several small bumps" (patient quote) from her left cornea using a small scalpel. After this was done this patient tried once again, unsuccessfully to wear soft lenses. When I first saw this patient in October, 2015, I diagnosed her with post-LASIK corneal ectasia in her right eye. Her left cornea was very distorted due to the "pocket" CXL. In addition, the laser used on her left cornea created a significant haze. This was the reason that this patient noted double vision in her left eye. At her initial visit, this patient's visual acuity was 20/50 in her right eye (with distortions) and 20/80 in her left eye (also with distortions). Over the last few months we were able to fit this patient with GVR Scleral lenses which are providing her with clear (20/25 vision in each eye) stable vision for the first time in many years. In the lower left photo, note the grey-white haze in the center of the cornea. This was created by the Femtosecond laser. The lower photo to the right is a cross-section of this patient's cornea (with a scleral lens over it) taken with Ocular Coherence Tomography (OCT). The 2 top curved lines represent the front and back surfaces of the scleral lens. The large, curved grey structure is the patient's cornea. Look carefully and you will note a short white line to the left of center of the cornea. This is the "pocket" created by the laser. The space between the back surface of the scleral lens and the front surface of the cornea is filled with unpreserved saline solution. I expect this patient to see clearly and comfortably with her scleral lenses for many years to come. She will never need to undergo corneal transplant surgery.

Lasik, with HOAs and Deteriorating Vision, Vitrectomy, Cataract Surgery, now 20/20 in Each Eye

This patient, a psychologist and author, underwent LASIK surgery 16 years ago. Immediately after his surgery he experienced double vision along with blurred vision in his right eye. 3 months after his initial LASIK surgery, another LASIK procedure was done on both eyes which made the vision in his right eye worse and led to significant ocular pain due to the ocular surface in both eyes becoming dry. Over the years the vision in this patient's left eye continued to deteriorate. To treat his dry eyes he used on a daily basis a variety of eye drops, eye covering masks, and a humidifier in his bedroom. About 4 years ago, during a crying episode over the death of a pet, this patient rubbed his eyes and immediately noticed "massive sheets of floaters" (a quote from patient) in both eyes but more noticeable in his right eye. The floaters were so pronounced that he could no longer perform his daily activities. 30 months ago this patient underwent a procedure known as a "vitrectomy" to remove the floaters in his right eye. This procedure involves the removal of the main interior gel within the eye known as the vitreous and replacing it with saline solution. 1 year later cataract surgery was performed on this patient's right eye. This is because virtually every patient who undergoes vitrectomy surgery will develop a cataract within one year. We recently fit this patient with GVR Scleral lenses which are allowing this patient to see clearly and comfortably once again. With these lenses, this patient can see clearly (20/20 in each eye) with all day comfort and without any vision distortions such as halo's and glare. The dry eye issues which are so common in post-LASIK eyes have been successfully addressed with these lenses. This is because the scleral lenses vault over the corneas and keep this patient's eyes in a moist environment.

Lasik in 2007, Vision Worse with Retreatments, now 20/20 with GVR Scleral Lens

The patient standing next to me recently visited us from the Canary Islands seeking help in restoring vision to her right eye. In 2007, this patient underwent LASIK surgery in both eyes. When her vision began to fail she underwent another LASIK procedure in each eye in 2009. This 2nd procedure made the vision in her right eye worse. In 2010, this patient underwent photo refractive keratectomy (PRK) in her right eye in an attempt to restore the vision she lost from her previous surgeries. What resulted was additional vision loss and ocular pain. In early 2015, once again, in an attempt to improve the vision in her right eye this patient underwent a 4th surgery known as photo therapeutic keratectomy (PTK). The purpose of this last procedure was to smooth out the corneal irregularities and eliminate the corneal opacities created by her previous surgeries. What resulted from this last surgery was an additional reduction in her vision and a dramatic increase in her ocular pain. This patient visited 2 of the most respected eye institutions in Spain seeking help. The doctors at both University eye clinics told her that her only option was corneal transplant surgery. When this patient first visited us, the visual acuity in her right eye was 20/300 and 20/30 in her left eye. We recently fit both of this patient's eyes with GVR Scleral lenses. She is now seeing clearly (20/20 in each eye) and comfortably once again. The pain she was experiencing in her right eye is gone. The last time this patient had decent vision in her right eye was 8 years ago. In the lower left photo if you look carefully you can see the corneal scars created by her 4 surgeries. In the lower right photo under higher magnification you can see the dense elevated corneal scars. The corneal damage created by these eye surgeries prevented the outer corneal layer (the epithelium) from healing. Because of this the corneal nerve endings in the center of her cornea are exposed to the environment and the blinking action of her eyelids. The purpose of this scleral lens is to not only provide quality vision once again but to protect the cornea from the environment and to promote healing. This eye will never need to undergo corneal transplant surgery. One last point: this patient had suffered from depression and anxiety from her vision loss and the thought of needing a corneal transplant. This is now a thing of the past.

Lasik in 2000, Ectasia in 2007, now 20/20 with GVR Scleral Lens

This is a photo of a patient and his wife who visited us from Santiago, Chile. In 2000 this patient underwent LASIK surgery. For 5 years following his surgery he saw clearly. In 2005 this patient started losing his vision in a progressive manner over the following years. In 2007 he was diagnosed with post-LASIK corneal ectasia. Corneal ectasia is a protrusion and thinning of the front surface of the eye (the cornea). This results in a very irregular, distorted cornea and distorted vision which cannot be corrected with eyeglasses or conventional contact lenses. This patient visited a number of doctors in his country seeking help with his vision. Several years ago he was fit with "piggy back" lenses. This is a combination of soft lenses placed on the eyes first followed by gas permeable lenses worn over the soft lenses. For several years this patient wore this lens combination which was not only painful but in addition the lenses would often pop out of his eyes. When we first saw this patient about 2 weeks ago, he could barely open his eyes. Both of his corneas had significant scarring from his small gas permeable lenses. Without his lenses this patient's visual acuity was less than 20/800 in each eye. With the lenses he first wore into our office his visual acuity was 20/80. We fit this patient with GVR Scleral lenses which now provide him with 20/20 vision in his right eye and 20/30 vision in his left eye. The reduced visual acuity in this patient's left eye was due to the corneal scarring in this eye. This patient returned home today. He is now able to wear his new lenses comfortably with all day lens wear. In the lower left photo you can see the corneal scarring created by his previous lenses. The lower right photo shows the protrusion (ectasia) that was caused by his LASIK surgery. I feel that this patient will be able to wear his new scleral lenses comfortably and with clear vision for many years to come.

Bullous Keratopathy post-Lasik Treated with GVR Scleral Lens

This patient underwent LASIK surgery in both eyes in 1998. 2 years later when his vision began to fail he underwent a 2nd LASIK operation in 2000. In 2004 his left eye suffered a complete 360 degree retinal detachment which led to complete vision loss in this eye. In 2014 this patient's left eye became extremely painful. He visited a number of eye doctors earlier that year seeking relief from the pain. None of the medications given to him worked to help this patient. In November, 2014, this patient visited our office. We noted at this visit that the patient's left eye was extremely inflamed and that this eye was completely blind and without light perception. When we examined his left eye with a technology known as "optical coherence tomography" or OCT, it was apparent that the LASIK flap in this eye was separating from the underlying cornea. In addition, the outer layer of the cornea was coming "undone" a condition known as bullous keratopathy. In an effort to avoid the necessity of having this patient's left eye removed we fit his left eye with a GVR Scleral lens. The intention was to protect this seriously damaged eye from the environment and the blinking action of the eyelids. In addition, by covering the exposed corneal nerves with this lens we were hoping that this patient would not experience pain any longer. For the past 12 months, this patient has been wearing his scleral lens comfortably on a daily basis without any pain or discomfort. In the photo below left you can see this inflamed, cloudy blood vessel laden cornea. The "OCT" image below right shows a cross-section of the damaged cornea. The 2 curved lines at the top of the image represents the front and back surface of the GVR Scleral lens. The space between the back surface of the lens and the front surface of the cornea is filled with saline solution. The curved convex images on the corneal surface represent the outer layer (the corneal epithelium) of the cornea separating from the underlying cornea much like wall paper coming off of a wall. The horizontal split within the cornea is the LASIK flap separating from the underlying corneal stroma. This patient visited us last week for his semi-annual examination. He has been very happy with his scleral lens as without it he suffers from unbearable pain.

Lasik in 2006 Followed by Failing Vision, now 20/15 with GVR Scleral Lens

This young woman underwent LASIK surgery in 2006 at a world famous eye institution. 2 years later when she noticed that her vision was failing she returned to the same doctors and had the LASIK redone in both eyes. Several years later her vision once again began to fail. This time, however, the doctors at this institution declined to do any additional procedures as her corneas were too thin for another LASIK surgery. Over the following years this woman visited a number of eye doctors seeking help in restoring her vision. Eye glasses did not provide her with functional vision. She was also unable to tolerate any rigid or soft contact lenses. Last month this young woman visited our office for the first time. After examining her we determined that the reason she was unable to see clearly was that both of her corneas were extremely distorted. Her visual acuity with her eyeglasses was 20/80 in one eye and 20/50 in her other eye. In addition, she told us that her vision would change at different times of the day. Several weeks ago we fit this patient with GVR Scleral lenses. Now her corrected vision with these unique lenses is 20/15 in each eye. Her vision is stable and she is able to wear her lenses comfortably all day. I will be monitoring her carefully over the next few months to make sure that her corneas remain stable and that her improved vision remains the same. I don't expect any changes in her vision and I feel that she will be able to wear these lenses comfortably for many years to come.

Lasik with Retreatment, Followed by Ectasia, now 20/20 with GVR Scleral Lens

This patient underwent LASIK surgery in 2003. Shortly afterward, she noticed that her vision was failing. In 2004 this patient had a repeat LASIK procedure done on both eyes in an attempt to restore the vision she had lost. This patient's vision began to deteriorate once again in 2005. Over the following years she visited a number of eye doctors who fit her with a variety of soft lens designs which did not correct her vision and only added to her dry eye symptoms. In 2011, an eye doctor in her home city diagnosed her with post-LASIK corneal ectasia and referred her to our office. When she first visited our office her visual acuity was 20/200 in each eye. Eye glasses were not an option as they created optical distortions too great for her to tolerate.In 2011, we fit this patient with GVR Scleral lenses. These lenses provided her with clear (20/20), comfortable vision in each eye with all day lens wear. Over the last 4 years I have examined this patient every year to make sure that her eyes remained healthy and her corneas remain stable. This patient came in today for her yearly examination. Her eyes have remained stable as has her vision. This patient will not need to undergo any additional surgical or non-surgical procedures. I expect her corneas and her vision to remain stable for many years into the future.

Lasik in 2000, Ectasia Left Eye Nine Years Later, now 20/40 with GVR Scleral Lens

This patient underwent LASIK surgery in both eyes in 2000. 9 years later he noted that the vision in his left eye began to deteriorate. Over the years he visited several eye doctors who were unable to diagnose his problem or help improve his vision. An eye doctor in our community referred this patient to us last year. At his initial visit his visual acuity was 20/25 in his right eye and 20/800 in his left eye. We diagnosed his left eye with a condition known as post-LASIK corneal ectasia. This condition is characterized by a protrusion or bulging of the cornea. This condition can occur months to years after the LASIK surgery was done. This patient's left eye was fit with a GVR lens which is allowing his left eye to see clearly (20/40) and comfortably. I expect that the visual acuity in this patient's left eye to improve over the coming months as his visual system adjusts to the newly improved vision. As long as this patient wears the lens in his left eye, he will never need to undergo corneal transplant surgery.

Lasik in 2002, Epithelial Ingrowth, Neovascularization, now seeing 20/20 with GVR Scleral Lens

This patient underwent LASIK surgery on both eyes in 2002. A 2nd LASIK surgery was done on her left eye several months after the first procedure. In 2005, this patient's vision in her left eye deteriorated to the point where eyeglasses and contact lenses were not able to help her obtain functional vision. When this patient first visited our practice we diagnosed corneal ectasia in both of her corneas. This condition is a relatively uncommon event seen in post-LASIK corneas years after the surgery was performed. It is characterized by a very distorted, irregular corneal surface. In addition, in the superior portion of her left cornea I noticed a gray arcuate haze above which were blood vessels extending onto the cornea from outside the cornea. These 2 conditions can be seen in the lower photo. The gray haze is a condition called epithelial ingrowth. This is due to the cells on the corneal surface getting underneath the LASIK flap. This is not a normal situation and must be monitored to make sure that these cells do not multiply, otherwise the LASIK flap must be lifted and the underlying epithelial cells cleaned out. The blood vessel growth visible in the superior cornea is known as "neo-vascularization." This too must be monitored to make sure that an unstable situation does not come about. In 2008, we fit both eyes with GVR Scleral lenses which have allowed this patient to see clearly (20/20) and comfortably with all day lens wear. Over the last 7 years, the epithelial ingrowth and the neo-vascularization of her left cornea have remained stable. This patient's eyes will not need to undergo any additional invasive procedures and I expect that she will be able to wear her lenses comfortably for many more years to come, however, yearly monitoring of her corneas are necessary.

RK Followed by Lasik, Followed by Deteriorating Vision

The patient seen in this photo with me, visited our office for the first time from Guatemala 10 years ago. In the 1980's this patient underwent 2 separate Radial Keratotomy procedures in both eyes. Over the following years his vision began to deteriorate to the point where he was not able to obtain functional vision with eyeglasses or any type of contact lens. Because of this, in 2001 and 2002 he underwent 2 separate LASIK procedures in his right eye and 1 LASIK procedure in his left eye in 2001. Needless to say, over the following years his vision and ocular comfort continued to deteriorate. Several corneal surgeons suggested that he undergo corneal transplant surgery in his right eye since the right eye was significantly more compromised that his left eye. In 2006 we fit this patient's right eye with a GVR Scleral lens which provided this eye with clear, undistorted 20/20 vision. Prior to visiting us, the best corrected vision that he was able to achieve with his right eye was less than 20/200. Because this patient's left eye was significantly less distorted he was able to achieve acceptable vision with a disposable soft lens. This patient visited our office today for his yearly eye health and scleral lens examination. Both of his corneas are stable, clear and healthy. In the ocular photo to the right can be seen several small blood vessels growing onto the corneal surface along the RK incisions (which still remain open). This is not a healthy situation as the cornea is the only tissue in our body without any blood vessels. However, this condition has remained stable for the last 10 years but still needs to be monitored on a yearly basis. The photo to the right shows the GVR Scleral lens over this patient's right cornea. Look carefully and you can see the straight, gray, scarred RK incisions radiating inward from the periphery of the cornea. The LASIK flap incision going around the corneal periphery is difficult to see in this photo. This patient will never need to undergo corneal transplant surgery. 

Lasik in 1999, Ectasia following Retreatment, Now Seeing Clearly with GVR Scleral Lens

The young woman in this photo underwent LASIK surgery in both eyes in 1999. In 2004, she underwent a 2nd LASIK procedure in here right eye, commonly known as an enhancement. Several years after her 2nd LASIK surgery, she developed corneal ectasia in both eyes. The multiple LASIK surgeries resulted in significant vision loss in both eyes which could not be corrected with eye glasses or any type of contact lens. Corneal ectasia develops when the weakened post-surgical cornea becomes very irregular and areas along the corneal surface protrude or "bulge" much like a keratoconic cornea. For a number of years, this patient was unable to see clearly with eyeglasses. In 2010, this patient underwent Collagen Cross Linking in an effort to strengthen her corneas. In 2011, she visited our office where she was fit with GVR Scleral lenses. These lenses provided this patient with clear vision and all day comfort. Last month this patient returned for a comprehensive examination. At this visit new lenses were provided to this patient which are still allowing her to see clearly and comfortably with all day lens wear. In the lower photograph you will notice 2 circular lines going around the right cornea (which was stained with a dye and photographed using a special filter). These are the 2 LASIK flaps created by the 2 LASIK surgeries.

Lasik in 2003, Ectasia, Intacs, Ferrera Rings, Eye Pain, Now Seeing Clearly with GVR Scleral Lens

This patient visited us from Mexico after suffering debilitating vision loss from LASIK and additional ocular surgeries. In 2003 this woman had LASIK surgery in both eyes. In 2005 she underwent a 2nd LASIK procedure in her right eye. Several years later she developed post-LASIK ectasia in her left eye. In 2007, Intacs surgery was attempted in her left eye but the surgery was not successful so a penetrating keratoplasty (corneal transplant) was done instead. In 2012 this patient's right eye developed post-LASIK ectasia. After visiting several world famous eye institutions, this patient visited us for the first time in 2013. At that time we fit both eyes with GVR Scleral lenses which provided her with clear (20/20), comfortable and stable vision for the first time in many years. While her vision remained clear and stable for 18 months, in November, 2014, she visited a corneal specialist in Mexico who told her that the ectasia in her right eye had progressed and that she needed Intacs surgery in order for her to avoid corneal transplant surgery. Instead of placing Intacs plastic rings into her right cornea, this doctor inserted Ferrara rings into the center of her right cornea. Ferrara rings are plastic semicircular inserts that do not have FDA approval for use in the United States. The Ferrara rings surgery created additional distortions to her right eye and left her with constant pain in this eye. Last week we refit this patient's right eye with a GVR Scleral lens. She is now seeing clearly and comfortably once again in both eyes. In addition, the pain in her right eye is no longer there. It has been my experience that most patients who have suffered from post-LASIK ectasia do not do well after undergoing either Intacs or Ferrara ring surgery. In the lower left photo shown here is an image of this patient's right cornea. A special dye was used to highlight the lower Ferrara ring and the LASIK flap border. The lower "horse-shoe" image is the inferior Ferrara ring. It is located very close to the corneal surface which is one reason why she is experiencing eye pain. The lower center photo shows the Ferrara rings circling around the pupillary border. At night, when this patient's pupil is most dilated, she notes distortions around lights. The lower right photo shows the GCR Scleral lens over her left corneal transplant. As long as she wears her scleral lenses, this patient will have clear, stable vision. She will never need to undergo a corneal transplant in her right eye.

Lasik in 2000, Followed Later by Eye Pain and Retinal Detachment, Fitted with Scleral Lens to Protect Cornea

This patient underwent LASIK surgery on both eyes in 2000. In 2002 he had a 2nd LASIK procedure done on both eyes. In 2004 his left eye suffered a 360 degree retinal detachment which resulted in a complete loss of vision which was not correctable with any additional medical procedures. In early 2014 his left eye gradually became increasingly more painful. In November, 2014 the pain in his left eye became unbearable. For the following 4 or 5 months this patient visited a number of doctors seeking relief from the ocular pain in his left eye. One month ago his left eye was fit with a Prokera lens, which is derived from fetal tissue. The purpose of this lens is to allow a healing process to take place and eliminate pain. While the Prokera lens provided temporary relief, this lens was only able to partially heal the cornea. Please view the 3 images pictured below of this patient's left eye. The first image to the left is a cross-sectional image of the patient's left cornea with a scleral lens over it. Note the curved horizontal space going through the upper portion of the cornea. This is the LASIK flap separating from the underlying cornea. The 2 curved lines at the top of this image represent the outer and inner surfaces of the scleral lens. Look carefully and you will note the 2 curved "speed bump"- like lines on the surface of the cornea. This is the outer layer (the epithelium) of the cornea becoming "unglued" or separating from the underlying cornea. The center photo is a digital image of the same cornea using a special dye to better visualize the front surface. The various geometric patterns represent areas of the outer corneal layer separating from the underlying cornea. The lower right photo shows the same irregular "rough" corneal surface. Besides being a blind eye, the entire cornea is severely compromised. The purpose of fitting this eye with a GVR Scleral lens is to protect the cornea from the environment and the blinking action of the eyelids and to keep the cornea in a moist environment. It is our expectation the the scleral lens will allow the outer corneal layer (the epithelium) to "reseat" itself and prevent the further unravelling of this delicate corneal layer. The purpose of all this effort is to eliminate the necessity of removing this eye (enucleation), help the eye regain it's health and to eliminate the pain this patient has been experiencing for so many months. It is not possible for this eye to regain any type of vision.

Lasik 2003, Ectasia 2011, Seeing Clearly and Comfortably with GVR Scleral Lens

This is a photo of our student doctor Tina Cheung with a patient who underwent LASIK surgery in 2003. Several years after her LASIK surgery, this patient's vision began deteriorating. Her vision at night and indoors was very poor. Eyeglasses and contact lenses were not able to improve her vision. In 2011 this patient was diagnosed with post-LASIK ectasia. Last month we fit this patient with GVR Scleral lenses. She is now able to see clearly and comfortably indoors and at night both at distance and at near. She is also able to wear her GVR lenses all of her waking hours. The photo below was taken through a special microscope after a dye was instilled in her eye. The bright green circular line represents the LASIK flap. By the way, Tina Cheung graduates as an eye doctor later this month and will be taking care of patients in the San Francisco area.

Lasik 2006, Deteriorating Vision due to Ectasia in 2009, now 20/20 with GVR Scleral Lens

This patient had LASIK surgery done in 2006. For 3 years his vision was clear and stable. In 2009 his vision started to deteriorate rather suddenly. When he returned to his surgeon he was told that he had developed post-LASIK ectasia. Post-LASIK ectasia is a protrusion or distortion of the corneal surface. In an effort to stabilize and improve his vision he underwent Collagen Cross-linking in 2011. This is an in office procedure that strengthens the cornea and hopefully will improve the corneal surface. In 2013, this patient traveled to another country to have PRK laser surgery done. The intent of this surgery was to smooth out the cornea and improve this patient's vision. Shortly after undergoing PRK surgery, we fit this patient with GVR Scleral lenses which have provided him with clear, comfortable, stable vision with all day lens wear. For the last 2 years his vision has remained the same and he is seeing 20/20 in each eye with his scleral lenses.

Lasik in 2000, Ectasia Suddenly Eight Years Later

This is a profile photo of a cornea that underwent LASIK surgery in 2000. The "beer belly" shape is due to a condition known as post-LASIK corneal ectasia. The bulging out of the cornea took place 8 years after this eye underwent LASIK surgery. For 8 years this eye was able to provide very good vision. The ectasia took place in a rather sudden manner over a period of 4 weeks. Besides loosing significant vision, the ripple effect of this condition created other ocular issues. For the past 6 years this patient has been wearing GVR Scleral lenses which have restored a significant amount of quality vision once again. This eye will have to be watched very carefully with periodic examinations for the rest of this patient's life to make sure that the ocular health is maintained so that corneal transplant surgery will not need to be done.

Lasik in 2002, Ectasia in 2008, Hydrops in 2012

This patient underwent LASIK refractive eye surgery in 2002. In 2008 his vision began deteriorating rapidly due to the onset of ectasia which is a bulging or protrusion of the front surface of the eye, the cornea. To correct his vision we fit this patient with GVR Scleral lenses which allowed him to see clearly and comfortably once again. In 2012, due to the pressure within his eyes against his weakened corneas, the back layer of both corneas tore which then allowed fluid (aqueous) from within his eyes to enter his corneas which caused both corneas to have a foggy, milking appearance. This condition is called "hydrops" which caused additional vision and ocular issues. Medical treatment was initiated which after a period of several months did away with most of the "fog" in both corneas. We refit both eyes with redesigned GVR lenses which are now allowing him to function visually once again. If medical treatment was not initiated in a rapid manner, this patient would have needed to undergo corneal transplant surgery.

Lasik Patient with Large Pupils Seeing Clearly with GVR Scleral Lens

This patient underwent LASIK surgery in 2012. Soon after he noticed that his vision was not clear but "soft" and not sharp. He also noticed reduced vision indoors and at night. When he returned to his LASIK surgeon he was told that he was reading the 20/20 line and that there was nothing wrong with his vision. When he visited our office recently, we noted that he had 8mm pupils which I feel should have disqualified him from being considered for LASIK. In addition, the LASIK treatment zone was decentered which increased the visual distortions he was encountering, especially indoors and in the evening. We provided GVR Scleral lenses to this patient recently. He is now seeing clearly (20/20) in each eye comfortably with all day wear.

Nationally Ranked Tennis Player with Declining Lasik Vision now 20/20 with GVR Scleral Lens

This patient underwent LASIK surgery in 2001. 18 months following his LASIK surgery, his vision started to decline. Eyeglasses and contact lenses over the following years failed to provide comfort and quality vision. Collagen Cross-Linking and Intacs surgery was done in 2009. Later that same year conductive keratoplasty (CK) was done on both eyes. What makes this case and this patient so interesting is that in 1999, he was a nationally ranked tennis player in the under 35 age group. In 1999 he won the the amateur court tennis doubles championship. Several years after undergoing LASIK this patient was forced to give up driving. However, he still participated in national tennis tournaments often taking a cab to the event and still winning many tournaments. When asked how could he perform even though he had a problem seeing the ball, he responded that his body could feel where the ball was. This patient has developed post-LASIK corneal ectasia. When he first came into our office his visual acuity with eyeglasses was an unstable 20/50. We fit him with GVR Scleral lenses which are providing him with 20/20 vision in each eye with all day comfort and stable vision at night, indoors and in bright daylight.

Lasik in 2002, Vision Good for 4 Years, Then Ectasia. Treated with GVR Scleral Lens

This patient underwent LASIK in 2002 in Brazil. His vision remained good for about 4 years after which his vision started to gradually decline. When he returned to his doctor he was told that he had keratoconus. He eventually underwent Collagen Cross-Linking which he felt made his vision worse. For many years he was unable to maintain clear stable vision with either contact lenses or eyeglasses. Earlier this year we diagnosed this patient with post-LASIK ectasia. In addition, he has a condition known as epithelial ingrowth where cells from the outer corneal layer get beneath the LASIK flap where they do not belong. We fit this patient with GVR Scleral lenses which are now providing him with clear, stable, comfortable vision with all day wear in different light conditions. He will need to be monitored periodically to make sure that the epithelial ingrowth does not progress.

Lasik in 2000, Followed by Deteriorating Vision, now 20/20 with GVR Scleral Lens

This patient is a world renown professional photographer who underwent LASIK surgery in 2000. Several years later she began experiencing blurred vision which became progressively more pronounced as the years went by. Over the years she visited a number of doctors who prescribed different soft contact lenses for her to use. All of these lenses provided her with unstable fluctuating vision. When asked how she was able to take such beautiful photos she responded that it was a struggle but she managed to do it. Last year we diagnosed her with post-LASIK corneal ectasia and fitted her with GVR Scleral lenses. Since receiving her lenses she has had stable, clear vision with all day comfort. Her corrected visual acuity is 20/20 in each eye at distance and also up close. She can now see all of her camera settings and also do photo editing on her computer. Her vision is now stable in all lighting environments.

Lasik in 2002 with Severe Dry Eyes, now 20/20 with GVR Scleral Lens

This patient underwent LASIK surgery in 2002. For 2 years his vision was clear and sharp even though he suffered from severe dry eyes. In 2004 his vision started to deteriorate slowly until 2010 when he was diagnosed with post-LASIK ectasia. Multiple eyeglasses and contact lenses were prescribed but the end result was blurred, distorted vision which could not be corrected with conventional lens technologies. In 2013 he was fit with GVR Scleral lenses which are providing him with clear (20/20), comfortable vision without visual distortions and all day comfort.

Point Spread Function With and Without Scleral Lenses

Below are 2 sets (or slides) of topographical ring and "point spread function images" (PSF) of the same pair of eyes of a patient that underwent both RK and LASIK surgery.

Although you can see the distorted ring images on the photos (slide) on top, what is most interesting are the "point spread function images" (PSF) that can be seen in the upper portions of both sets of images. Look carefully at both the upper and lower sets of PSF images. These images show how a very small beam of light "spreads" after passing through a pair post-surgical (LASIK) corneas and on the same corneas with scleral lenses (lower set of slides). The very small red dot represents a fine beam of light. In the upper set of images, note the white-grey "web-like" patterns around the red beam of light. This represents how light is "spread out" when passing through a distorted post-LASIK cornea. Note how the left PSF image (the image on the right side of the slide) is significantly more distorted than the right PSF image. This is because the left cornea is more distorted than the right cornea. This is why eyeglasses and soft contact lenses cannot provide the post-LASIK distorted cornea with clear, crisp vision. Note the PSF images of same pair of eyes with scleral lenses on the lower set of slides. Note that the small beam of light has virtually no distortion after passing through the scleral lenses. Also note that the ring images in the lower half of the bottom set of slides are perfectly round. Note how the topographical rings in the lower half of the upper set of slides are significantly distorted. Scleral lenses in effect replace the cornea as an optical surface.

Two separate Lasiks, 1 PRK, and 1 PTK

This patient is successfully wearing a GVR Scleral lens after having undergo 2 separate LASIK surgeries, 1 PRK and 1 TPK. Additional complications arose which forced the amputation of the corneal flap.

Article on post-Lasik Corneal Neuropathic Pain

Conclusion: Patients with persistent dry eye symptoms out of proportion to clinical signs after LASIK have a syndrome that may best be classified as corneal neuralgia. In vivo confocal microscopy can be informative as to the neuropathic basis of this condition. In keeping with current understanding of complex regional pain syndrome, early multimodal treatment directed toward reducing peripheral nociceptive signaling is warranted to avoid subsequent centralization and persistence of pain. Distinguishing this syndrome from typical post-LASIK dry eye remains a challenge.

Click Here To Read Article

Lasik Flap Separating from Cornea

This patient made an appointment to see me in an effort to get relief from the constant pain he has been experiencing with this eye for several years. He visited a number of eye doctors and several world famous eye institutions seeking help. Not one doctor or clinic was able to diagnose the LASIK flap becoming “unglued” from the underlying cornea.

In addition, the very outer layer of his cornea has a condition called “bullous keratopathy”. This is characterized by the outer epithelial layer of the cornea separating from the underlying corneal structures. This eye underwent 2 LASIK procedures about 10 years ago. Several years later a complete retinal detachment took place. This is now a blind eye, not even light perception. This patient was given a special scleral lens called the “Prokera” lens which utilizes stem cell technology to permit the eye to heal. After the lens is worn for 5 continuous days, this eye is expected to look better at which time we will provide this patient with a GVR Scleral lens to further promote healing and alleviate ocular pain. Sadly, it is not possible for this eye to regain any form of useful vision.


Scleral Lenses For The Treatment Of Post-Refractive Surgical Complications And Anterior Segment Anomalies

by Eiman Atia, Senior Optometry Student at the New England College Of Optometry
Stephanie Sturgis, Senior Optometry Student at the Pennsylvania College Of Optometry

Scleral lens technology has been around since 1888 and was first developed in Germany. However, the concept was first put on paper in the 15th century by Leonardo Da Vinci. They were the first contact lens to be developed but today they remain a highly under-utilized medical device. There are many anterior segment conditions that warrant usage of a scleral lens such as keratoconus, pellucid marginal degeneration, other atypical cones, dry eyes and Steven Johnson Syndrome. People who develop these conditions may be led to believe that the only option to address these issues is through invasive surgery. Some of these surgeries include LASIK, RK, ALK, CK, PRK, Intacs, and other types of corneal transplants. Of course with every surgery there are risks and complications and sometimes these surgeries do not always have the desired outcome. This paper will explore these procedures and their post-surgical complications that may indicate usage of scleral lenses.

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Conventional Lenses Slide Off This Flat Lasik Cornea

The flatter the cornea, the harder it is to fit with conventional lenses. In the picture below, the cornea is so flat that only a scleral lens will restore vision. A soft lens simply assumes the shape of the irregular cornea. Conventional rigid lenses slide off.

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EyePrint Pro

EyePrintPro technology creates a scleral lens based on a mold of the cornea. The molding is accurate to 1 or 2 microns and fits perfectly because it exactly mirrors the irregularities of the individual corneal surface. The technology is well suited for post-Lasik, Keratoconus, RK, eye injury, and corneal transplant patients. Read More in this PDF about EyePrintPro Scleral Lens Technology