Managing Post-LASIK

hyperopia with Acular and

Soft CL’s

Michael Duplessie MD.

Bethesda, MD 20817

301.493.6404

Case Example

JE, a 19 year old white female

7.5 mm Pupils (Covard)

MR OD -5.25 DS 20/20

OS -5.25-0.25 x 035 20/20

Cyclo OD –5.25-0.50 x 90 20/20

OS –5.25-0.25 x 040 20/20

Case Example

Ultrasound pachymetry

OD 490/493/494 microns

OS 490/491/494 microns

Orbscan pachymetry

OD 475 microns

OS 485 microns

Good Candidate?

Large pupils

Young age

Thin corneas

Surgical Options

PRK or LASIK?

She chose LASIK.

Post-OP 1 Day:

VA OD 20/30-2 PH 20/20

OS 20/50+2 +1.00-1.00 x 017 20/30

10 Day Visit:

OD +1.50 20/20

OS +1.50 20/25

Post-OP 3+ Week Visit:

OD +1.25 +0.50 x 125 20/20

OS +1.50 +0.75 x 60 20/20-2

Due to the patient’s RE, reading and night vision complaints, we discussed using Acular QID OU with a soft contact lens in an effort to correct the residual refractive error.

Acular and Soft CLs Acular :

Causes thickening of the anterior stroma

Causes epithelial proliferation

Acular reduces prostaglandin production

by inhibiting cyclo-oxygenase, an enzyme

responsible for prostraglandin synthesis.

Acular and Soft CLs

?? --Thought to result

from actions on

proteoglycans

Treatment Patient was fitted with Acuvue 2

(+0.75D, 14.0, 8.7) contacts to be

worn extended wear in each eye

Lots of Tears!

Post-OP 5+ Week Visit

Unaided VA:

OD 20/20-

OS 20/25

MR OD +0.50-0.75 x 120 20/20

OS +0.75-1.00 x 65 20/20-1

Post-OP 3 Month Visit

Unaided VA:

OD 20/20

OS 20/25

OD +0.50-0.75 x 120, 20/20

OS +0.75-1.00 x 65, 20/20-1

Acular with Soft CL’s Effective weeks 2-4

Patient education

Successfully treat without surgery

Great technique for nervous patients