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.

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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