Tear Break-Up Time and flap question

Discussion in 'Optometry Archives' started by crvc, Jul 25, 2005.

  1. crvc

    crvc Guest

    I had LASIK eight years ago which left me with severe night vision
    problems. I've tried several types of RGP lenses but cannot tolerate
    any of them for more than two hours a day. I have been told I have a
    2-3 second tear break up time which is why I can't tolerate the lenses.

    A second opinion surgeon is suggesting a flap lift to clean out scar
    tissue followed by suturing the flap back down. She says I have high
    and low spots on the cornea which is why the tear break up time is so
    low. It sort of makes sense to me, visualizing wiping a squeegee across
    uneven glass. The squeegee collects water from the high spots but not
    the low spots. She is suggesting my eyelids are doing just that. She
    says I cannot have more lasering because I'm 20:20.

    I'm hoping the procedure will level the cornea and improve the TBUT.
    Is that likely? If so, will that allow longer RGP wear?

    crvc, Jul 25, 2005
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  2. crvc

    Dr. Leukoma Guest

    Of course is makes sense that the TBUT would be affected by the
    regularity of the surface. We see this all the time in the case of
    EBMD, which is why dry eyes and EBMD often occur together.

    What I don't understand is how this would affect contact lens wear,
    since the "squeegee effect" would apply to the surface of the contact
    lens, which is highly regular.

    Perhaps the poor TBUT has other additional causes.

    Dr. Leukoma, Jul 25, 2005
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  3. I hope Dr. Robins chimes in here, but I don't much like the thought of
    sutures on the cornea. Seems to me they can cause some serious
    astigmatism of the irregular (bad) variety, and the surgery itself could
    cause MORE dryness (by additional severing of corneal nerves, thus
    decreasing corneal sensitivity (again)...

    w.stacy, o.d.
    William Stacy, Jul 25, 2005
  4. crvc

    crvc Guest

    Thanks for the replies. I seem to have exhausted the other possible
    treatments for TBUT: blepharitis treatment, cyclosporin, etc.
    Although I'm 20:20 it's not quality. Even in rainy weather, like
    today, it's difficult to see well. The RGPs solved 90% of my problems
    but the poor TBUT makes wear time low. The surgeon is suggesting this
    in hopes of clearing some of the HOAs. There was no mention of its
    effect on contacts. I don't expect surgery will do much so I'm banking
    on it improving the TBUT. Just wondering if anyone had been through
    the process.

    crvc, Jul 25, 2005
  5. crvc

    Dr. Leukoma Guest

    Well, perhaps the proposed surgery WILL increase the TBUT when there is
    no contact lens in the eye, but I doubt that it will have much effect
    on the wearability of contact lenses.

    Dr. Leukoma, Jul 25, 2005
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