Lasik Flap detaching

I am posting the OCT image below of a scleral lens over an eye that underwent LASIK surgery about 15 years prior to the time that this image was taken. It shows a LASIK flap becoming “undone” or separating from the underlying corneal tissue. Note the differences in the shading of the cornea. The varying degrees and intensities of the hyper-flouresence indicates the degrees of scarring, cellular changes etc. It is not uncommon to see finite discolorations or alterations in these corneas. We have these all documented. I do not know the exact pathogenesis of how and why these small alterations occur. My job is to create a lens that will allow a post-LASIK patient regain vision once again. There are more things that we do not know with this patient population then we do know. Why did this LASIK flap separate from the surrounding cornea? No one can answer this. Notice that the surface epithelial tissue is separating from the underlying cornea. Why? This eye suffered a 360 degree retinal detachment several years after the LASIK. Again, why? Again, no one can answer this. This is a blind, painful eye. We fit this eye with a scleral lens not for vision purposes but to eliminate the ocular pain this patient was suffering from for a number of years. In summary, fine alterations in the appearance of the cornea seen with OCT technology are a fact of life. How the patient sees and processes their world is another matter and differs from patient to patient.