Q:
Kera-gurus:
I have a 52 year old guy who had Custom LASIK one month ago for myopic astigmatism (OD -3.00 + 0.25 and OS -3.25 + 1.25). He is slightly overcorrected with refraction of +0.50 + 0.25 in each eye. He’s doing fine for distance activities such as soccer and driving. But he is a little blurry watching TV and in the 5-20 foot range. He is fine using +2.50 readers for computer and near activities.
At this age and after this amount of treatment, is any regression likely to occur to bring him back closer to Plano?
Would the Contact lens and Acular treatment be at all useful this far out from surgery ?
Curious how others in the group would manage this?
Thanks as always for your expert advice,
Mike
Bellevue, WA
A:
Mike
Put him on diclofenac QID for a month. Will hit Plano. Stop when Plano. QID more effective than less frequent dosing. Works much better than Acular. CL isn’t necessary. Mechanism is Epi hyperplasia.
I’ve tried every NSAID over 15 years. Voltaren works best
I’m going to anticipate people saying QID dosing is risky and can cause a corneal melt. Simply not true. Wish that article never got published BC it’s prevented hundreds of MDs from treating thousands of pts like this safely BC of a bad batch of generic NSAID with a bad vehicle that’s no longer on the market and hasn’t been for a decade
How do I know? BC I’ve used NSAIDs to regress about 1,000 pts over the past 15 years w zero complications
Works better in ASA than w lasik. Can get up to 1 D regression in ASA. In lasik only .75 max. Must start therapy within a month postop or it doesn’t work very well. Can take up to 3 mos so need to be patient ie effect might be .25 D/yr. effect is permanent
If you guys think I should publish my results BC this modality isn’t widely known I’ll have my fellows do so
Hope this helps and good luck
—
Emil William Chynn, MD, FACS, MBA
Harvard/Columbia/Dartmouth/NYU/Emory-trained
1st eye surgeon in NY to get LASIK himself (1999)
Performed 5,000 LASIKs from 1996-2002
Switched to non-invasive LASEK in 2003
Have performed more LASEKs than any MD in US
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