Author Archives: Scleral Contact Lens Specialist

Prevention and Treatment of LASIK Problems

If you are experiencing contact lens intolerance and are thinking about LASIK, STOP!

Stop Sign

Before making this decision you need to know the truth:  LASIK surgery has side effects and can lead to permanent disabling complications affecting your lifestyle permanently. Proceed with caution. According to recent studies between 10-40% of LASIK patients experience symptoms of complications. Symptoms include dry eyes, glare, halos and star bursting.   Our own in-house experience, together with 10 other contact lens practices demonstrates the #1 reason patients seek LASIK is due to contact lens intolerance relating to dryness and blurry vision.

If you’ve had LASIK and are now experiencing problems, there is HOPE to get you back all day comfort with clear vision.

Prevention and Treatment of LASIK Problems

Dr. Irwin Azman maintains a contact lens specialty practice since 1977 with a special interest in the prevention and treatment of LASIK problems and restoration of vision and comfort lost as a result of refractive surgery: LASIK, PRK, RK, intacs, corneal transplant or keratoconus. Many of his patients travel from all parts of the United States and are referred by other eye care practitioners.

Unfortunately, most LASIK patients have some level of complication which has affected their lifestyle permanently. Some are out on total disability, while others suffer from depression.  Symptoms range from dry eyes, burning eyes, glare, light sensitivity, ghost images, star bursts, double vision, loss of contrast sensitivity, fluctuation of vision, eye pain, and loss of sight.

Many of Dr. Azman’s patients have seen several other eye doctors before seeking his expertise and were told “nothing can be done” or that they needed a corneal transplant. Dr. Azman says “there is HOPE for the majority of these patients and to hold off on corneal surgery.”

Each case is different. Each patient will go thru 2-3 evaluations including:  phone and in-person consultations, review of all previous eye records. Incorporating and using the latest technology to determine the exact problem and solution. Special tests range from: wavefront aberrometry, anterior and posterior OCT, tear scan, specular microscopy, meibography, tear osmolality, corneal evaluation, advanced refraction, refractive wavefront topography, and vital stainings.

Simple solutions can vary from a combination of dry eye treatment, prescribing of specialty soft lenses, to specialty post op LASIK rigid lenses.  More complex solutions vary from the prescribing of customized reverse geometry lenses, customized piggy back lenses, hybrid lenses, to the most complex lens called post refractive surgery scleral lenses. If a patient has a highly irregular and distorted cornea, and experiences halos, star bursts, double vision, and decreased vision scleral lenses are usually the best option that can minimize/eliminate all the symptoms.

Unfortunately, most practitioners have very little experience, if any, while Dr. Azman has treated 100’s of patients.

With over 25 years of LASIK experience, Dr. Azman is one of the pioneers in preventing LASIK complications and treating those with Post LASIK / PRK / RK patient. Together with his knowledge and experience, Dr. Azman and his team employ the newest technologies in instrumentation and treatment modalities. Dr. Azman is able to prescribe each patient with a solution in resolving their Post LASIK / PRK / RK difficulties.

If you are suffering from contact lens intolerance, or are thinking about LASIK surgery, or have any symptoms caused by refractive surgery please call
Dr. Azman personally for a free consultation. Call Today (240) 782-2020!

Post LASIK Dry Eye Treatment

According to the Eagle Vision-Yankelovich poll, one out of every five U.S. residents suffer from Dry Eye Syndrome; that’s 59 million Americans!
Dry eye is the most common complication of LASIK.  In fact, about half of all LASIK patients will have dry eye after LASIK. While the condition is usually temporary and mild, significant numbers of people continue to suffer from dry eye for months or even years after the procedure.
Many people who have had LASIK  had a previously undiagnosed dry eye issue, and the procedure actually exacerbated the problem. For example, contact lens wearers who find their contact lenses uncomfortable due to dry eye, may investigate LASIK as an alternative (since they do not want to wear eyeglasses).  They then, regrettably, proceed to LASIK without proper dry eye treatment. Fortunately, pre-LASIK procedure screenings have advanced, and dry eye detection is now a condition that is hopefully detected in advance. However, there are still many, many post LASIK patients who experience dry eye.

Post LASIK Dry Eye Treatment

Dr. Irwin Azman O.D.

Dr. Irwin Azman O.D.

Dr. Irwin Azman, who has been in practice for over 30 years, specializes in post LASIK complications and side effects. Dr. Azman, a PRK patient himself, has been involved in refractive surgery for over 20 year and is always committed to staying updated on the latest, most advanced research, education and technologies. Dr. Azman utilizes his knowledge, experience, and expertise to provide his patients with treatments for post LASIK complications and side effects, without further surgical procedures. Each dry eye patient is different, and Dr. Azman utilizes his vast knowledge to customize a treatment program that is tailored for each individual patient.

Treatment for glare after LASIK

Many patients have undergone radial keratotomy (RK), LASIK, PRK and other refractive surgeries with significant success. However, unfortunately, there are many people out there who have even had the newest LASIK procedures, but are still experiencing post Lasik side effects such as glare, starbursts, loss of night vision, and dry eye.

Glare after Lasik

Glare after Lasik

What can be done for post LASIK, PRK, and radial keratotomy (RK) complications and side effects?

Some doctors will continue to recommend additional surgical procedures, which inevitably exacerbate the problem

With over 30 years of experience, Dr. Irwin Azman, a PRK patient himself, utilizes his expertise with the newest technology to resolve and treat side effects from post LASIK, radial keratotomy (RK), PRK and other refractive surgeries.

Contact Dr. Irwin Azman for a free consultation at (240) 782-2020 | www.lasikfailures.com

New Treatment for Recurrent Corneal Erosion

What is Recurrent Corneal Erosion:

Recurrent corneal erosion is the failure of the cornea‘s outermost layer of epithelial cells to attach to the underlying layer. Due to loss of cells, and exposure of sensitive corneal nerves this condition is agonizing and painful. Recurrent corneal erosion may be due to corneal dystrophy or corneal disease, but is generally caused from a previous corneal injury. Some predisposing factors, such as diabetes or a corneal dystrophy, may be the underlying cause.

Cornea Abrasion

Cornea Abrasion (Photo credit: GogDog)

Signs and Symptoms

New treatment for Recurrent Corneal Erosion is now available at Global Complex Eye Care. Utilizing amniotic membrane tissue, PROKERA® has natural therapeutic actions that help damaged or inflamed eye surfaces heal faster. Eyes treated with PROKERA® have quicker healing, less pain, less scarring, and less inflammation.The amniotic membrane in PROKERA® is thin and clear like the tissue on the surface of your eye and protects your eye’s damaged tissue while inserted.

PROKERA® was developed to treat eye diseases such as recurrent corneal erosion, infectious/inflammatory keratitis, Herpes, superficial epithelial defects, severe dry eye syndrome, and other corneal diseases.s PROKERA® is a safe, effective treatment provided by a tissue bank regulated by the FDA. The tissue has passed many quality control tests before it is provided.

Correcting Radial Keratotomy (RK) Complications

Radial keratotomy (RK) is a refractive surgical procedure to correct myopia (nearsightedness) that was developed in 1974. It has been superseded by newer operations, such as photorefractive keratectomy (PRK), LASIK, Intra-Lasik, Wavefront Lasik, and others. Although rarely done now, millions of people underwent RK in the 80’s and 90’s around the world with over a million procedures done in the United States. In addition, many of these RK patients had LASIK in an attempt to undo damage caused by their initial RK surgery.

With the RK procedure, incisions are made on the cornea with a scalpel (knife). These tiny cuts flatten the surface of the cornea and reduce nearsightedness. The surgeon may make additional cuts to flatten the misshapen part of the cornea for those people who have both astigmatism and nearsightedness. The long term results of radial keratotomy (RK) complications have truly been horrific for many people. Numerous problems occurred years later. These include:

• Loss of Best Corrected Visual Acuity
• Severe Dry Eye
• Unstable or Fluctuating Vision
• Double or Triple Vision
• Irregular Astigmatism
• Halos, Glare, and Reduced Night Vision

Many RK patients also underwent additional RK procedures followed by one or more LASIK procedures. In every instance, the additional procedures only exacerbated the problem. In recent years, advances in specialty lenses including Scleral lenses and other unique advanced lens technologies have become available which will allow patients to see clearly and comfortably once again, without the risk of further surgery.

The images below show how one of our patients, Sharon B., sees at night after having RK surgery vs. how she now sees with a Scleral lens.

 Post RK Surgery with glasses                   Post RK Surgery Corrected with Scleral lens                                                                       Post RK Surgery Uncorrected and corrected

Diagnosing Keratoconus

We are now able to detect the presence of keratoconus well before subjective symptoms develop. Diagnosing keratoconus with Wavefront Corneal Topography and Aberrametry measurements have become the standard of care in diagnosing and management of keratoconus. Utilizing new technology, ophthalmic instruments now capture images of the shape of the cornea together with the entire optical system by taking tens of thousands of data points. The results are instantly analyzed and Wavefront topography maps are generated. These printouts will show Dr. Azman a map of the eye-print  (just like a finger print) of the location and severity of any corneal distortion and high order aberrations (HOA).
Keratoconus w/ IntacsKeratoconus Uncorrected with HOAsKeratoconus Corrected with contact lenses
Corneal specialists agree that it is best to exhaust all non-surgical options for keratoconus before undergoing corneal transplant surgery, especially for younger patients. Optometrists and Ophthalmologists from all over Maryland and surrounding states refer their challenging keratoconus patients to Dr. Azman.
Keratoconus Evaluation
Tear Scan
Tear Osmolarity
Anterior OCT
Posterior OCT
Tear Film Analysis and Dry Eye Evaluation
Lid Evaluation
Wave front corneal topography
Aberratometry
Specular Microscopy
Refraction
Pupil measurement
Ulltrasound corneal thickness		Keratoconus Treatment Options
Keratoconus Glasses
Scleral contact lenses
Keratoconus soft contact lenses
Hybrid contact lenses
IPL
LIPIFLOW
CRT CORNEAL Reshaping Therapy
Dry eye treatment
Intacs
Cross linking
Corneal transplant(last option)
Prescription and/or OTC medication
Tear ScanAnterior OCTPosterior OCT

Treating LASIK Failures and LASIK Complications without further surgery!

LASIK

LASIK (Photo credit: Wikipedia)

When people hear the term “laser eye surgery”, the first thing they think of is LASIK. However, most people are not aware that LASIK is not the only “laser eye surgery”. The other laser eye surgery options include PRK, LASEK, and IntraLase. Each of these optionshas an excellent safety record, and high success rates. These surgeries are intended to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism, and, unbelievably, can allow you to lead a life without glasses or contact lenses.  Although severe LASIK complications and LASIK failures such as complete or partial loss of vision are extremely rare, many side effects can occur.

Like all other surgical procedures, there are potential risks and side effects. LASIK complications commonly include, glare, halo’s and other issues, which are delineated below. LASIK failures and LASIK complications can occasionally be resolved with additional surgery; however more surgery can exacerbate the symptoms.

LASIK Eye Surgery Risk Factors and Limitations

Not every patient is a candidate for LASIK. Specific health and eye conditions and anatomical factors can put you at an increased risk for LASIK complications and LASIK failures. These conditions include, thin or irregular corneas, large pupil size, your specific degree of refractive error, whether or not you suffer from dry eyes; your age, whether your vision is stable, whether you are pregnant, and if you have specific degenerative or autoimmune disorders.

Post LASIK Side Effects and Complications

Although LASIK eye surgery has been performed on millions of people in the United States, experienced LASIK surgeons report that serious complication rates can be held below one percent.  However, like any surgical procedures, there are potential risks and side effects. LASIK failures and LASIK complications commonly include, glare, halos, dryness, ghost images, star bursting, smeared images, loss of contrast, vision fluctuation, blurry vision, and double vision. LASIK failures and LASIK complications can occasionally be resolved with additional surgery, but often exacerbate the problem.

Vision disturbances: Halos, glare and starbursts in low vision, especially at night; dry eye symptoms; hazy vision; and reduced sharpness of vision.

Flap complications: One of the crucial steps in LASIK surgery is the creation of a thin hinged flap on the front surface of the cornea. In the course of the surgery the flap is lifted for the laser to reshape the cornea. The flap is then replaced and heals naturally. If the flap is not made correctly, it may fail to keep to the eye’s surface causing corneal striae. These LASIK flap complications can lead to an irregularly shaped cornea and cause distorted vision.

Other problems associated with LASIK flap complications include:

  • Irregular astigmatism: Caused by an unequally curved corneal surface. Resulting symptoms may include double vision or “ghost images.”
  • Keratectasia or Keratoconus: Bulging of the cornea can occur when too much tissue is removed during the LASIK procedure. Or when the cornea, prior to LASIK is weak as evidenced from corneal topography mapping. Rarely does keratoconus develop after LASIK with no known risk factors.  Enhancement laser surgery is usually not suitable, and scleral contact lenses, gas permeable contact lenses or, corneal implants may be prescribed.

starburst
Left: Post LASIK uncorrected HOAs with starbursts at night.
Right: Corrected Post LASIK HOAs at night

Dry eyes after LASIK: LASIK surgery can cause a decrease in tear production and cause your eyes to feel scratchy and blurry. Almost half of all patients experience some degree of temporary dry eye syndrome. People who already have severe dry eye should have been eliminated as LASIK candidates.

Significant under-correction, overcorrection or regression. Not all patients will patients will receive 20/20 vision after LASIK eye surgery, and contact lenses or glasses for some or all activities may still be required. If the laser removes too much or too little corneal tissue, or you do not have typical healing, your best vision outcome can be less than optimal. Furthermore, if the laser removes tissue in an uneven manner or your eye heals unevenly, astigmatism can result.

LASIK Failures and LASIK Complications:

Complications

Symptoms

Incomplete corrections (under-correction, over-correction, residual astigmatism) or regression of effect

Blurry, less-than-perfect vision

Decentered ablations

Visual distortions & aberrations (HOA)

Oversize pupils

Visual distortions & aberrations (HOA)

Haze

Visual distortions & aberrations (HOA)

Irregular flap

Visual distortions & aberrations (HOA)

Dry eye

Dry, itchy or scratchy eyes.

Diffuse lamellar keratitis (eye inflammation)

Visual distortions & aberrations (HOA)

Dr. Irwin Azman has over 25 years of experience in the diagnosis and management of the Post LASIK patient with LASIK failures and LASIK complications. Dr. Azman utilizes non-surgical restoration techniques to restore quality vision to those who have lost it due to  LASIK failures and LASIK complications, R-K surgery, corneal transplant surgery, ocular trauma, dry eye and corneal disease. Together with his knowledge and experience, his team of technicians, new technologies in instrumentation and new treatment modalities, Dr. Azman is able to prescribe each LASIK failure patient with the perfect solution in resolving their LASIK complications, without any further surgical procedures.

Keratoconus Specialist in Baltimore

English: Scheme of keratoconus compared to nor...

English: Scheme of keratoconus compared to normal cornea Polski: Schemat porównujący prawidłową rogówkę do stożka rogówki Hrvatski: Skica keratokonusa u usporedbi s normalnom rožnicom (Photo credit: Wikipedia)

Keratoconus is a condition in which the cornea (the lens of the eye) begins to have structural fluctuations, causing it to thin and change to a more conical shape than its normal gradual curve.

The cornea has three major parts, the outer layer, epithelium, the central structural portion, the stroma, which provides the cornea’s shape, and the endothelium, which prevents swelling of the cornea. Keratoconus is a disease of the corneal stroma. The stroma comprises over 85% of the cornea, and is made up of collagen, similar to the material on the tip of your nose. With keratoconus, the cornea loses its usual round shape, and develops in to a cone-like shape.

In the initial stages of keratoconus, vision will fluctuate, causing astigmatism.  As the condition progresses, the cornea becomes too irregular for the use of glasses, and special contact lenses, called Scleral Lenses are needed.  The new generation of Scleral lenses are now very comfortable in the eye and most importantly correct the distortion caused by keratoconus.

Keratoconus is a progressive corneal condition, and regularly starts in the teenage years.  Now with Scleral lenses, people with keratoconus can have great comfortable vision. It’s always in a person’s best interest to avoid corneal transplants and other surgical procedures.

Dr. Irwin Azman specialists in the fitting of Scleral contact lenses for keratoconus, Lasik failures and complications, Pellucid Marginal Degeneration, Stevens-Johnson Syndrome, and other corneal irregularities.

Scleral Contact Lenses for Pellucid Marginal Degeneration

Pellucid Marginal Degeneration:

Pellucid Marginal Degeneration is a sub-category of Keratoconus. Pellucid corneas involve a larger distorted geographic area usually extending from the inferior corneal margins up to the center of the cornea. It is not unusual for 50% or more of the corneal surface to be involved. Because so much of the cornea can be affected, fitting this type of cornea can be challenging. The problem we face as eye care practitioners is fitting the steep areas if the cornea without adversely affecting the flatter areas.

Scleral Lenses:

Scleral contacts are large-diameter gas permeable contact lenses specially designed to vault the entire corneal surface and rest on the “white” of the eye (sclera). In doing so, scleral lenses functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by, keratoconus, Lasik failures, post-surgical complications, and other corneal irregularities.

Because scleral lenses are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, these lenses often are more comfortable for a person with corneal irregularities caused by keratoconus and other corneal irregularities  A special liquid fills the space between the back surface of the lens and the front surface of the cornea. This liquid acts as a buffer and protects the compromised corneal tissue. Scleral lenses are designed to fit with little or no lens movement during blinks, making them more stable on the eye, compared with traditional corneal gas permeable lenses. These lenses are almost always very comfortable and the vision provided by them is extremely good. The great majority of patients are able to wear their scleral lenses almost all of their waking hours without problems.

Dr. Irwin Azman, Keratoconus Specialists in Maryland, prescribes scleral contact lenses for a variety of hard-to-fit eyes, including patients with Stevens-Johnson Syndrome, Radial Keratotomy and Lasik Complications and Lasik failures, keratoconus, Corneal Ectasia, Post-Surgical Vision Loss, and Pellucid Marginal Degeneration.

Dr. Irwin Azman specializes in keratoconus, lasik failures and other corneal irregularities neither avoids nor declines the challenge of prescribing the most difficult cases. Dr. Azman tends to have a perfectionist demeanor.

Corneal topogram of a keratoconic eye

Corneal topog. of a keratoconic eye (Photo credit: Wikipedia)

 

Scleral lenses: Stevens Johnson Syndrome

English: Intraoperative pachymetric-guided cor...

English: Intraoperative pachymetric-guided corneal epithelium removal during corneal collagen cross linking in patient with post-LASIK corneal ectasia and inferior corneal thinning. Kymionis et al. BMC Ophthalmology 2009 9:10 doi:10.1186/1471-2415-9-10 (Photo credit: Wikipedia)

Stevens Johnson syndrome (SJS) and the more severe variant of the disease, toxic epidermal necrolysis syndrome (TENS), are intense autoimmune sensitivity reactions to infections or medications that primarily affect the skin and mucus membranes, including the eyes. Patients with Stevens-Johnson Syndrome have a tendency to have ocular difficulties including dry eyes, eye pain, light sensitivity, scarring, and corneal erosion.  Dr. Azman has helped many patients restore vision and quality of life transformed with his innovative treatments.

Scleral Lenses:

Scleral contacts are large-diameter gas permeable contact lenses specially designed to vault over the entire corneal surface and rest on the “white” of the eye (sclera). In doing so, scleral lenses functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by Lasik failures, post-surgical complications, and other corneal irregularities.

Because scleral lenses are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, these lenses often are more comfortable for a person with corneal irregularities. A special liquid fills the space between the back surface of the lens and the front surface of the cornea. This liquid acts as a buffer and protects the compromised corneal tissue. Scleral lenses are designed to fit with little or no lens movement during blinks, making them more stable on the eye, compared with traditional corneal gas permeable lenses. These lenses are almost always very comfortable and the vision provided by them is extremely good. The great majority of patients are able to wear their scleral lenses almost all of their waking hours without problems.

Dr. Irwin Azman prescribes scleral contact lenses for a variety of hard-to-fit eyes, including patients with Stevens-Johnson Syndrome, Radial Keratotomy and Lasik Complications, Keratoconus, Corneal Ectasia, Post-Surgical Vision Loss, and Pellucid Marginal Degeneration.

Dr. Irwin Azman neither avoids nor declines the challenge of prescribing the most difficult cases. Dr. Azman tends to have a perfectionist demeanor.