FAQ: Lasik and Scleral Lenses

I was told that I have corneal ectasia which resulted from LASIK surgeon. My doctor suggested that I have Collagen Cross Linking done. Do you think that this would be advisable?

I have found Collagen Cross Linking to be ineffective for patients who have suffered vision loss due to LASIK induced corneal ectasia. Collagen Cross Linking was first introduced as a way to control or even reduce the progression or keratoconus. Collagen Cross Linking may be an effective technology to treat keratoconus when it is in a progressive state. This usually applies to young patients. I have found that patients with corneal ectasia will have an unstable cornea for a very short period of time, possibly a few days to a few weeks after the onset of the ectasia. After this brief period the cornea will be stable making Collagen Cross Linking an ineffective and meaningless procedure.

I had Lasik last year. I can see clearly outdoors in bright light but when I get indoors in a low light environment, my vision gets very blurry. The same is true when I am out at night. Why does this happen?

What you are experiencing is due to either a very large pupil in a low light environment or to a small or decentered treatment zone. For example, your pupil diameter may be 3 mm outdoors in the daylight but may expand to 8 mm in a dimly lit room or outdoors at night. If the diameter of the treatment zone created by the LASIK surgery is 6 mm, for example, or if this treatment zone is decentered you will experience visual disturbances such as halos, glare and even double vision. My suggestion is not to get involved with any additional surgeries (enhancements) to correct this. With each additional surgery, unanticipated additional visual and ocular problems can occur. In my opinion, scleral lenses are the best non-surgical option to correct this. Please understand that a well fit scleral lens in not only comfortable but will replace your cornea as an optical surface allowing you to see clearly in all lighting environments.

Dr. Boshnick; I lost a great deal of vision due to LASIK surgery. I don’t want to go back into contact lenses again to see clearly. I am looking for a surgical procedure, maybe some sort of laser to fix or repair my eyes. If this is possible, what type of laser surgery will repair the damage that LASIK surgery created? Can anything be done to help me? I am desperate.

Over the years I have received questions and pleas for help on this order from many patients. There just are not any surgical procedures either with or without lasers that will repair your damaged corneas to their pre-surgical condition. Also, there are no surgical procedures either with or without the use of lasers that will restore your vision to the pre-surgical state. Any surgical procedure will involve the removal of corneal tissue. This is unavoidable. These life altering surgically induced complications cannot be fixed. Any surgical attempt to do so will only increase the risk of additional complications.

There are many LASIK surgeons advertising on the internet laser surgeries that will repair your damaged corneas. Procedures with names such as “All LASIK Laser” or “Custom Contoured Ablation” or “Wavefront Guided LASIK” and so on. More than a few of these LASIK surgeons are advertising “new” technologies that will repair your vision after a “botched” LASIK surgery. Once again, I am writing these words after many decades of experience in treating thousands of hurt patients permanently damaged from a variety of refractive surgical procedures such as LASIK, Radial Keratotomy, PRK, ALK, CK and so on.

The questioner states that he/she does not want to go back to contact lenses. I can understand this comment. After all, a great deal of money was spent in eliminating the need for contact lenses. The lenses that I recommend for almost all of my post-LASIK patients are gas permeable scleral lenses, specifically GVR Scleral lenses since these are the lenses we design with the use of special computers and proprietary software. Scleral lenses are not contact lenses in the strict sense of the word, since there is no “contact’ with the cornea. These lenses vault over the compromised corneal tissue and rest on the white portion of the eye known as the sclera. The comfort of these lenses is the same as with a soft lens. Because the lenses do not move they cannot pop out of your eye. There is a liquid reservoir between the back surface of the lens and the front surface of the cornea. Optically, these lenses replace the cornea as an optical surface. The irregular damaged cornea will not affect your vision any longer. These special lenses will allow you to see almost exactly how you saw before undergoing LASIK. Almost all of our patients wearing the GVR Scleral lens are able to wear their lenses all of their waking hours.

One final word: Recently, several of my post-LASIK patients asked me about two refractive surgeries. One is called ICL (Implantable Contact Lens) and the other is called RLE (Refractive Lens Exchange). These surgical procedures involve either removal of the natural lens in the eye or the implantation of a special contact lens inside the eye. Vision loss due to post-LASIK complications is due to damage to the cornea. These two refractive surgeries will do nothing to address these issues. Therefore the resultant vision after these two procedures will not be any better than before and possibly worse.

The Wavefront Scleral Lens

The corneal irregularities created by refractive surgeries, such as LASIK and RK, are responsible for ghosting, halos, starbursting, and loss of contrast sensitivity. These "higher order aberrations" may exist on both the anterior and posterior. With aberrometry, the defects of the entire optical system can now be corrected by a scleral lens.

The Wavefront Scleral Lens

Autologous Serum for Dry Eyes

Dry eye conditions are among the most challenging conditions faced by refractive surgery patients. With autologous serum, blood is spun down to plasma, forming an eye drop that helps rehabilitate the cornea.

Learn More about Autologous Serum

Dr. Boshnick on CBS This Morning

See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK

Optimum Infinite Gas Permeable Material

I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable material ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. Now for the first time, with certain patients, wearing a scleral lens made with the Infinite material under extended wear conditions can be considered.

SMAP 3D Scleral Lens Design

NEW: Powerpoint presentation on SMAP 3D

Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure the ocular curvatures outside the cornea. The SMAP allows us to do this. Read More

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Blurred Vision, Burning Eyes: This Is a Lasik Success?

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

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