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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Exp 50 years

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Suggest treatment for refractive error in the form of astigmatism

Answered by
Dr.
Dr. Dadapeer K

Ophthalmologist

Practicing since :2003

Answered : 5709 Questions

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Posted on Mon, 23 Feb 2015 in Vision and Eye Disorders
Question: hello doctor,
i had lasik laser in 2003 and now for the last 4 years my number has come back
my number is cylindrical now

i went for my number check up my left eye shows no increase but my number could not be corrected with lens in my right eye with specks.
doctor told me there is some problem with cornea in my right eye also when i press my right eye little bit i can see properly ,
my doctor suggested pentacam test to check cornea
what is pentacam and what could be the reason behind cornea problem?
doctor
Answered by Dr. Dadapeer K 1 hour later
Brief Answer:
Pentacam is scanning of cornea.

Detailed Answer:
Hello
Welcome to Health care magic.


Iam Dr.Dadapeer K, an ophthalmologist and I answer health problems related to eye.

I reviewed your history.
It seems from the history that you are having refractive error in the form of astigmatism which is not getting corrected with spectacle correction.
This indicates that you are probably having irregular astigmatism.
This can be caused by alteration of corneal curvature or thickness following lasik and other refractive laser surgeries.

Pentacam is scanning of cornea and it is used to measure corneal thickness and curvature.
Hence your doctor has advised this investigation.

Do write back with the examination report so that I can advice you more accurately after seeing the pentacam.

Hope this is helpful to you.

Thank you
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 1 hour later
i think the same has happened

can this be corrected without surgery?
also if i press my eye from lower side my vision gets corrected
what can cause it?
doctor
Answered by Dr. Dadapeer K 8 hours later
Brief Answer:
This indicates probable astigmatism.

Detailed Answer:
Hello
Thank you for the follow up question.

Improvement of vision on applying pressure over the eye indicates astigmatism as I have suspected and mentioned in my previous answer.

If the amount of astigmatism is mild this can be corrected without surgery. If there is corneal thinning and moderate to severe astigmatism this may require other surgical procedures.

Hence it is not possible to say about the next mode of treatment without seeing the pentacam report. Do undergo pentacam report and send it to me so that I can confirm the diagnosis and advice you accordingly.

Hope this is helpful to you.

Thank you
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 11 hours later
Hello doctor
I ve updated the reports please reply
doctor
Answered by Dr. Dadapeer K 12 minutes later
Brief Answer:
The reports show ectasia because of thinning of cornea.

Detailed Answer:
Hello
Thank you for the follow up question.

I reviewed the reports.

The reports show steep corneal curvature and indicate ectasia of cornea secondary to lasik surgery resulting in astigmatism. This is same as I had suspected in my previous answers.
The next step that needs to be done is to assess the progression and the corneal thickness. If the thickness is decreased and if the condition is progressive then treatment is required.

Do discuss in detail with your doctor regarding further investigations and treatment.

Hope this is helpful to you.

Thank you
With regards


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 3 minutes later
What is the treatment for this ?

Can it effect my left eye vision also ?

doctor
Answered by Dr. Dadapeer K 2 minutes later
Brief Answer:
This will not affect the left eye, no need to be worried.

Detailed Answer:
Hello
Thank you for the follow up question.

The treatment is required if the condition is progressive.
The treatment is by the use of a surgery called as corneal collagen cross linking to increased the thickness of the cornea and to prevent further progression of the condition. Do discuss with your treating doctor regarding the need for this depending on the clinical examination and severity of the condition.

This will not affect the left eye, no need to be worried.

Hope this is helpful to you.

Thank you
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 28 minutes later
Hello doctor

Is my left eye ok or not I m attaching left eye report separately again ?
doctor
Answered by Dr. Dadapeer K 14 minutes later
Brief Answer:
Left eye is normal.

Detailed Answer:
Hello
Thank you for the follow up question.

The left eye is normal. The K value is 44 and it is within normal range.

No need to be worried.

Hope this is helpful to you.

Thank you
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 1 hour later
My doctor here told me that there is problem in left eye also as the k value is 48
I m confused really
I hope my left eye is ok ?
doctor
Answered by Dr. Dadapeer K 51 minutes later
Brief Answer:
Kindly send me complete report including topographic map.

Detailed Answer:
Hello
Thank you for the follow up question.

I rechecked all the reports attached with the question.
No need to be worried. You have sent the final portion of the reports. If available kindly send me the topographic map and complete report so that I can analyze and tell you.

I will get back to you after seeing the total reports. From the history and the available limited information your left eye does not seem to be affected.


Hope this is helpful to you.

Thank you
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 14 hours later
I have sent you report of my left eye only as I wanted to know whether it is affected if not
doctor
Answered by Dr. Dadapeer K 1 hour later
Brief Answer:
It shows mild ectasia.

Detailed Answer:
Hello
Thank you for the follow up.

The report shows k1 48 and k2 44.
This comes in mild ectasia. Since corneal thickness is good no intervention is required.
As of now I advice you follow up with pentacam again after 6 months. If it shows progression then treatment like corneal collagen cross linking is advised.

Hence I advice you to wait and follow up as of now for left eye.

Hope this is helpful to you.

Thank you
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 18 days later
Hello again,

i got my eyes tested again and i can see very clearly from my both eyes but my right eye number is −0.75 spherical and −5.5 cylendrical which i think is v high.
also i got my topography done again after 2 weeks of last topography as i did not wear contact lens for 2 weeks.
my corneal thickness has gone down by 10 to 20 microns in both eyes otherwise the results are better.
i would like to add i got this topography done on the same machine
Could this difference in thickness be because of two different scans and results always vary or my cornea is thinning at very high rate ?
should i get the topography done after two weeks again?
also i think i have anxiety about ectasia now....:(
also i ve another question
i had lasik in 2002 and after 12 years my corneal thickness is 450 and 460 microns
is it agood sign that even after so long corneal thickness is ok?

what is normally average corneal thickness after lasik operation eyes?
doctor
Answered by Dr. Dadapeer K 3 hours later
Brief Answer:
Average corneal thickness after lasik is 500 microns.

Detailed Answer:
Hello
Thank you for the follow up question.

I reviewed your history.

The average thickness of cornea after lasik is around 500 microns. Corneal thickness of 450 and 460 microns is not very less but it requires monitoring.

No need to be worried, a thickness of 10-20 microns in corneal thickness is normal. Corneal thickness is a dynamic one and normal variation is in the range of 10 microns. There is no need for repeat corneal topography after 2 weeks, wait for atleast 1 month and after that time you can go for repeat topography.


Hope I have answered your questions and the information is helpful to you.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 6 hours later
So a variation of 10 to 20 micron in two topography can be a mechanical error ?
doctor
Answered by Dr. Dadapeer K 1 hour later
Brief Answer:
This variation is not significant.

Detailed Answer:
Hello
Thank you for the follow up.

A variation of 10 -20 microns is of medical significance unless associated with change in curvature or change in vision.

Hence there is no need to be worried about this.

Hope I have answered your question and the information is helpful to you.

Thank you
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 1 hour later
Thanks

Can I wear spectacles or soft lens or gp hard lens?
Which of these is advisable ? I mean does go lens help change the curvature?

Secondly someone told me about c3x procedure without taking out epithelial layer (transepithelial cross linking ?
Is it helpful in my case ?
I m just worried about doing anything with my eyes now and at the same time I feel c3x will star then my cornea ?
doctor
Answered by Dr. Dadapeer K 4 hours later
Brief Answer:
Soft lenses are ideal for you.

Detailed Answer:
Hello
Thank you for the follow up question.

Lenses will not help to change the curvature of the cornea.
Hence you need to use lenses which are comfortable and provide good vision. In your case I advice you to go for soft lenses.

Transepithelial C3R will help you. But right now C3R is not required for you.
You can undergo it if the cornea shows further thinning.

Hope I have answered your question and the information is helpful to you.

Thank you
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 5 minutes later
Just for future reference

Is there any side effects reported of transepithiliel c3 x?
And which is more effective epi on or epi off cross linking ?
Thanks again
doctor
Answered by Dr. Dadapeer K 1 hour later
Brief Answer:
Transepithelial C3R is better.

Detailed Answer:
Hello
Thank you for the follow up question.

Transepithelial C3R is as effective as epithelial C3R.
Transepithelila C3R is better as it is devoid of side effects of routine C3R.


Hence transepithelial C3R is better compared to routine C3R.

Hope this is helpful for you.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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