Tag Archives: LASIK Complications

Scleral Lenses – An Old Dog With New Tricks

Eye with keratoconusScleral lenses have been around for over 100 years. Until the new gas permeable lens materials were developed patients could only wear scleral lenses for a few hours a day. With the highly oxygen permeable lens materials now in use, patients can comfortably wear these lenses all day. Scleral lenses are most commonly used to treat eyes with irregular corneas such as keratoconus and post surgical eyes (usually following corneal transplant surgery or related to complications from refractive surgery). Another common use for scleral lenses is in the special effects industry where they are used to protect the cornea and/or to give the eye an exotic appearance.

What Is A Scleral Lens?

Scleral lenses are large contact lenses that rest on the sclera (white part of the eye) with the remainder of the lens vaulting over the cornea. Tears are trapped between the lens and the cornea allowing sclerals to treat irregular corneas. The average soft contact lens has a diameter of about 14 mm whereas scleral lenses typically have a diameter exceeding 14.5 mm. 

How Are Scleral Lenses used?

At Total Eye Care Dr. Driscoll has  used scleral lenses to treat many conditions such as irregular astigmatism, keratoconus, high myopia, dry eye syndrome, and complications related to LASIK and PRK. Because of their size, sclerals are quite comfortable. Patients often report the comfort being similar to that of a soft contact lens. Most patients with irregular corneas will see better with a scleral lens than with glasses. 

Below is a good video that shows how scleral lenses are cared for and how to insert and remove them.

Good Morning America Investigates LASIK Complications

Good Morning America reports that the American Academy of Ophthalmology states 90% of patients achieve 20/20 vision following laser vision correction.  What the AAO report does not address is that 20/20 does not mean that the patients have a good quality of visual acuity.  The Good Morning America Video (video at the end) interviews both satisfied and unsatisfied patients.  Some patients complain of a worsening of their dry eye symptoms, halos or shadows, glare or starbursting, poor night vision, reduced contrast or simply uncorrectable blurry vision.  The vast majority of the patients that have had LASIK or PRK are happy with the result.   However, laser vision correction is not reversible and some of the resultant problems from refractive surgery are not resolvable.

Options available to patients that are not happy with their surgical result, of course depend on the symptom.  Some of the options available to patients are:

Post Surgical Contact Lenses

These special contact lenses are available as soft contacts, as gas permeable lenses and as a combination soft/gas permeable.  Post refractive surgery contact lenses are usually used when a patients vision can not be corrected by additional surgery, glasses or regular contact lenses because their corneal surface has become slightly irregular or distorted.  The symptoms may include, blurry vision, halos and shadows.

Dry Eye Syndrome

The most common complaint following refractive surgery is dry eyes.  Most often the dryness improves two to six months following surgery.  Ocular dryness can also cause blurry vision.  Should the dryness not improve there are numerous solutions to improve patient comfort and it is worth seeking help from an eye doctor that is familiar with treating dry eye syndrome.

Glare and Poor Night Vision

Often glare, halos and night vision problems are due to large pupils and/or uncorrected refractive error.  Night driving glasses will usually help patients that are still a little nearsighted following refractive surgery.  Treating the glare is little more difficult.  Glare often improves with time, however a medication called Alphagan has been known to improve night glare symptoms by causing the pupil to constrict slightly.  Alphagan may contribute to the ocular dryness, however.

Know Your Vision Correction Options

LASIK and PRK are good procedures and can greatly improve one’s quality of life.  Prior to taking the refractive surgery plunge patients should thoroughly research their options.  In an upcoming article I’ll cover the alternatives to refractive surgery.

At Total Eye Care we offer all of the refractive surgery and non surgical vision correction options available and we pride ourselves on giving our patients an objective opinion of all of their choices.  It is important for our patients to be well educated on the pros and cons of each option so that they can make an informed decision.

Check out the video below from the Good Morning America’s investigation on LASIK, it offers a balanced report on refractive surgery.

FDA Listens to LASIK Patients

On Friday, the Food and Drug Administration heard testimony from LASIK patients dissatisfied with the outcome of their surgeries. The ophthalmic devices panel heard testimony that approximately 1/4 of all patients that wished to have LASIK were poor candidates and 95% of LASIK patients were satisfied with the outcome of their surgery. Expert testimony before the panel concluded that the FDA should provide clearer warnings about the risks and possible complications of LASIK. Next year the FDA and the National Eye Institute will begin a landmark study to better identify which patients are more likely to encounter post surgical LASIK complications and how those complications affect quality of life. We compared the incidence of complications for patients having LASIK vs contact lens related complications in a prior blog entry.

I find that the FDA is not the only one that could improve their modus operandi here but that some of the marketing/advertising for refractive surgery is irresponsible. This over promise of results does not apply to just refractive surgery but also the bifocal lens implants promising to give your back your ability to see near and far without bifocals.

At Total Eye Care our role as optometrists is to provide the patient with an objective assessment, finding the best method of vision correction available for each patients situation. Today there are many refractive options available such as contact lenses, glasses, orthokeratology, PRK, LASIK and refractive lensectomies just to name a few. If a refractive option is selected it is our job to work with the patient to find the best surgeon and procedure for each patient to get the best, safest result. The Associated Press had good coverage regarding the ophthalmic devices hearing, if you would like to read it it’s available here.