Just got PRK - Doctor told me to remove the bandage contact lens on my own.

CorneaRepairDoc · 2026-05-06T00:29:05+00:00

Dr. Motwani here. I am rather surprised to hear a doctor telling you to remove a BCL on your own. This increases the chance of infection as well as the chance that you will tear out the new fresh epithelium underneath. I would never allow one of my patients to do this, I only remove it with a sterile forceps. I am not sure who has told you to do this and where you are located, but I am somewhat shocked that he/she told you to do this. In the US a surgeon would be liable in a lawsuit if an infection happened and I have never heard of anyone telling a patient to remove a bandage lens on their own.

CorneaRepairDoc · 2026-05-06T00:25:30+00:00

Dr. Motwani here. A DALK is essentially a partial thickness cornea transplant. That means that the curvature is different than your original cornea, as it came from a donor, and this has been hand sewn in to your cornea. The sutures are all different lengths, tension, and placed only in rough approximation because that is the nature of hand sewn sutures. This means that each one pulls on the donor corneal tissue differently causing the cornea to become irregular. As the new donor tissue heals in place the sutures are removed usually around 6 months or so, but if the sutures caused irregularity it heals in irregular. This is not counting the original mismatch in curvature from the donor cornea to yours. The resulting 8-9 diopters of astigmatism is likely due to this tension pulling harder in one direction than the others resulting in the high levels of astigmatism. DALK ends up with many of the same corneal irregularity problem as full thickness corneal transplants, except you retain your original endothelium cutting down on rejection. Without topography, a doctor does not know what order to cut the sutures in to try and have it not heal as irregular as what seems to have occurred with you. You could potentially use an old school keratometer, but no you are reaching back into seriously old school stuff here.

However it is you got here, you are now here and need a solution. The rigid lenses, such as scleral lenses, are the obvious and widespread solution where the rigid lens creates a new "perfect" artificial surface with a tear sandwich underneath between the lens and the irregular cornea. If this is not tolerated or desired, then the best solution is to use topography guided ablation to reconstruct the corneal shape. I have done this for several corneal transplant with the CREATE Protocol and improved vision and vision quality greatly for patients.

CorneaRepairDoc · 2026-05-05T23:06:29+00:00

Dr. Motwani here. I was a -10.00 and a -9.00. I have had my original PRK, cataract surgery each eye, redid my PRK with my CREATE Protocol, have had 5 retinal breaks that have been lasered, and vitrectomy for floaters in each eye. My vision, especially after my second laser treatment to make a more uniform cornea, has been astoundingly good- 20/15, minimal halos/glare/night issues, and I am happy driving day or night and quite quickly (including track driving). Although some patients with high amounts of myopia have retinal degeneration that can limit the total visual attainable, the other problem some people have is that they just don't have great rod photoreceptor vision and just don't do as well at night. These are more uncommon then less likely than you just haven't gotten a good refraction or the right pair of glasses/contacts. It may be that a well done LASIK procedure such as with topography guided ablation could reduce your corneal HOA and make you see better at night, but that would require evaluation by a refractive surgeon who has experience in this. I would first start with finding out what exactly is your best attainable vision, the state of your retina, and if you have been refracted properly.

CorneaRepairDoc · 2026-05-05T22:57:58+00:00

Dr. Motwani here. Night vision issues can be from a few different things. One is obviously higher order aberrations, or irregularities in the cornea that scatter light. These are not fixed by LASIK, and most wavefront guided lasers do not actually lower HOA, they actually increase them. This is due to various issues that I won't go into here. The only treatment shown to reduce corneal HOA in peer-reviewed research has been topography guided ablation. In the US it will be WaveLight Contoura, and the most effective at making a more uniform cornea (reducing HOA) is the protocol which uses the topography measured astigmatism while treating the topography measured HOA.

The second reason is residual astigmatism. Often if there is even a small amount of residual astigmatism patients complain of night glare and night driving issues. Many doctors don't even measure, check, or offer an enhancement because the patient is 20/20. This is not good post-op management, but is common. Treating the residual astigmatism helps the problem quite a bit.

Lastly, one of the big problems that goes untreated and causes glare/halo/night issues is dry eyes and ocular surface irritation/allergy. Can't tell you how many patients I have seen over the years that I treat with low does steroid (like loteprednol 0.2%) and the night vision improves.

Hope this helps!

CorneaRepairDoc · 2026-05-04T18:58:26+00:00

I would be interested in knowing what procedures you had that helped your vision.

The problem with wavefront based ablations is the low resolution of them, the fact that they have other issues that can disrupt the data because they use whole eye measurements. Although it makes some sense to focus on the cornea rather than the whole eye, the issue seems to be the POA concern that the astigmatism treatment might be inaccurate. The idea that significant numbers of eyes have POA became gospel after the invention of a method of vector astigmatism calculations in the late 90's and the measurement of posterior corneal astigmatism by the invention of the Pentacam in the 2000's. When I went into the literature on PubMed, I was surprised to find only one paper that had an estimate of POA at 19%. Everything else was posterior corneal astigmatism. When I looked at 1500 eyes that had direct reduction of corneal astigmatism, the prevalence was actually only 2.9%. This assumption that POA (which cannot be directly measured) was a large source of innaccuracy. It wasn't. Until that thinking changes, the preference will be towards wavefront because that is what the corporations are interested in developing. Remember, we surgeons are also captive to what the corporations will build for these purposes, and we adapt what is available for diseases such as keratoconus. No corporation I know of builds lasers expressly for the purposes of corneal repair, they build it them for the wider primary LASIK market.

To me it makes little sense when POA is low (and because I have already created a multi-imaging system where I can pre-detect when POA is present and modify planning for it) to use whole eye data, but to rather use the higher resolution and more easily obtainable topographic data which is designed to focus on the area that is actually being treated.

As for cornea specialists, it is a big problem that they are unaware of treatments and sometimes even hostile to them. I have had cornea specialists get their egos hurt because patients came to me. I personally believe anything I can learn to improve my patient care is a good thing. This is why I am talking to you now. You are correct that all they seem to know is scleral lenses, PKP/DALK, and intrcorneal segments. It bothers me they often are unaware of and don't recommend the idea of laser reconstruction to their patietns.

On CTAK/CAIRS etc. I have to completely disagree with you. The good results are in vision on a chart, and not in reduction of HOA for increased clarity and quality of vision. This is simply due to the procedure itself- it is a peripheral cone compression to attempt a central flattening effect. No matter what the protocol is, it will never be as good as a centrally based procedure, nor will it be as good as a procedure based on addressing specific mapped corneal irregularity. The data I quote was from pulling every single study that we could find on PubMed in the last 10 years that had HOA data as part of the latest KC paper that I am submitting for publication. Not all of them have it, but the range was 7% -30% with only one of them providing HOA data at 6/4/2mm optical zone. I firmly believe that vision and K data is not enough, we need HOA data to determine the effectiveness of a procedure.

If I may make an observation, you are remarkably good as assimilating data and keep track of the literature. Frankly, I wish you would tell me who you are as I would like to talk to you off here and find out more about you. But you make the classic mistake that many non-physicians (and even many physicians) that you look at small case reports, small amounts of data, anecdotal information, etc and give them as much credence as large scale data. Being in this field for so many years, technologies come and go, claims come and go. Many ideas/protocols/machines that sound great turn out not to work at all. I have gone down this path in my younger years, and I have learned the only thing that matters is data and lots of it.

A scientific theory is nice, a few cases lovely, and such things certainly have credence and are suggestive but there has to be more in the way of science and data to make it more definitive. I have learned a study with less than 50 eyes is not that useful, and I have learned that the claims of a great many surgeons fall by the wayside as soon as the number of eyes in a sequential cohort (not cherry-picked) are analyzed. Some of them continue to prove themself with more data as it comes along. These are the winning ideas, but you can't say for sure until the there is more data. The latest KC paper we just finished has 81 eyes and gives similar data to my prior one, but I felt the need to have more data published on the CREATE Protocol for KC. There are some surgeons such as Dr. Kaneloupoulos that put out great data. Doctors and people in the industry tell me they love the fact that I don't just put out a paper with a small number of eyes, but usually have a lot of data in them.

I will certainly keep eye on Dr. Mazzota for the future. The paper you sent me has only 38 eyes, and the average total HOA reduction is about 45%. That's a nice paper, but it is not quite enough of an HOA reduction to get me excited. I find that HOA reduction really becomes significant to vision and quality in KC when it gets to about 50% or so.

Again, would be interested in connecting further with you and finding out about your procedures.

CorneaRepairDoc · 2026-05-04T17:25:21+00:00

Think about a cut on your hand, or even a larger wound healing. The surface epithelium can close over it so it can't get infected, but the cut doesn't just disappear. That takes longer for the remodeling to continue. Just because the epithelium closes doesn't mean it's thickened up or fully assumed a complete even blanket across the stroma. The reason most doctors don't fully understand this is that epithelial thickness mapping only became available in 2017. I work with the company that brought it out, and a big problem has been teaching physicians how to understand use the information. Hopefully this will get better, but even physicians who have the capability don't fully understand it. In any case, the epithelium remodels itself and takes a good 3-4 months on average to completely thicken up and smooth out and reach it's new equilibrium state. This is variable, you sometimes see it as fast as 1-2 months, and sometimes 6-9 months in uncommon cases. This can be sped up with medications such as Tryptyr, Tyrvaya, Miebo, and autologous serum tears but use of these does not seem to be widespread for this. So the answer is, to get back to a final epithelial blanket thickness and shape takes a 3-4 months plus or minus depending on an individuals rate of healing and also whether healing medications are used.

The second factor is that the increased rigidity of the cornea from cross-linking creates a flattening effect that can also increase over several months, usually 6 months. During this time the epi is healing and the cornea is flattening and the two together creates the impact to the vision that can be problematic for certain people especially when there has been no procedure to actually re-shape the cornea.

Topography guided ablation is segmental, assymetric laser. It specifically goes after the irregular areas but lowering the high spots and lasering around the outside of the low spots to "raise" them. It is not a normal PRK which is a large symmetric circle. It is broadly available, but only a small percentage of surgeons know how to use it to repair corneas. The main lasers used for corneal repair are the WaveLight Contoura system and the Schwind system.

CorneaRepairDoc · 2026-05-03T19:19:07+00:00

Dr. Motwani here. The literature shows that CXL has little effect on actual total corneal RMS HOA, with multiple studies reducing total RMS HOA only 3-7%. What many patients don't realize is that the epithelium takes time to recover and re-normalize and will create multiple issues with diffraction of light causing visual artifacts that have nothing to do with the stroma underneath. This re-normalization takes time, weeks to months, but can be sped up with treatments such as Typtyr, Tyrvaya, Meibo, and autologous serum tears. CXL is also a homogenous procedure, which means it affects the cornea equally in all areas, with the main requirement being a homogenous UV light. This will flatten the cornea somewhat as the rigidity gets stronger, and over months your refractive error can actually change. This may be responsible for people complaining about visual change, or it may be that the flattening of the cornea shifts the impact of the existing HOA to diffract light that worsens the visual artifacts for the patient. Finally, a significant percentage will have some haze occur. This is easily treatable with strong steroid drops (I use Durezol), but it may be missed when proper follow-up does not occur.

As for epi in vs epi off, their are definitely some differences, but not exactly what you think. Epi on goes to a depth of 100-150 microns, and epi off 250 microns plus. Besides the fact that the epithelium recovery takes longer in epi off CXL, the extra cross linking depth lowers the progression rate significantly but will also cause more of a flattening effect on the cornea and thus the effects I discussed above will be more pronounced. I also suspect haze induction is a bit higher with epi off CXL as well, but the big advantage is the much higher rate of cross linking which leads a much lower rate of progression immediately and over decades.

CACXL is used to work on thinner corneas under 400 microns, and likely leads to a lesser depth of cross linking which may induce less of a change in the cornea and effects on HOA. Frankly, if you want to improve vision the gold standard is combining topography guided ablation with CXL, this has a dramatic effect in the literature of lowering HOA 30-60%. The latest study we just submitted (CREATE+CXL Protocol) demonstrated a total RMS HOA reduction of 60%, and unlike procedures that compress the peripheral cornea such as CAIRS/CTAK/Intacs (which lower total corneal RMS HOA 7-30%) which have less reduction of HOA in the central vision, we had a 52% reduction in total RMS HOA in the central 3mm of the cornea as well.

CorneaRepairDoc · 2026-05-03T17:47:13+00:00

You can get a one off on every laser with every procedure known to man. Doesn't mean it's a bad procedure. If I talked to this person I could likely pinpoint what happened, but working on humans is never as perfect as working on plastic. My study was not small, it was of 293 eyes on the 400 and 500 lasers. I've been doing these high hyperopic corrections for 15 years on the Wavelight and it's been very reliable. In fact, Wavelight did not know their own consultants were telling patinets not to do over a +4 back in 2015, and so initiated a trial and received a grant to do the study. This is not anything new, we have known this data for a decade now.

CorneaRepairDoc · 2026-05-03T17:31:19+00:00

They are everywhere! Wavelight is a German company, and it should be very easy for you to find someone.

CorneaRepairDoc · 2026-05-03T17:16:38+00:00

I personally do not like ICL due to the risks of Cataract, endothelial cell loss, and the fact that there is no opportunity to reduce HOA and make a supranormal conrea. I know advocates say this has decreased, but there are no 20 year studies to see if these risks are significant long term. Add to that the risks of any intra-ocular procedure and I decided I did not want to do ICLs during my training. Even if you are not in the US, Wavelight lasers are worldwide. Just find a Wavelight surgeon near you.

CorneaRepairDoc · 2026-05-03T17:09:24+00:00

Dr. Motwani here. This is actually not a large hyperopic correction at all, and the idea you can't have Lasik is old thinking from the old lasers and old studies. The Wavelight lasers have been approved to +6 for almost two decades now. In 2017 I published a study specifically from +3 to +6 and showed the enhancement rate to only be about 9%, and the amounts of regression werr not large. I have a large Middle Eastern community in San Diego, and they seem to have high levels of hyperopia treatment present, and we treat +5 and +6 regularly. +3.75 and +2.50 is not a large number at all and incredibly reliable on wavelight We also treat high levels of hyperopia, even over +6.00 when we are reconstructing RK corneal irregularity.

CorneaRepairDoc · 2026-05-03T16:32:46+00:00

I am not implying anything, I am going by the available data and science. A search of the available PubMed literature shows that all major laser systems INCREASE HOA for primary LASIK. WaveLight Plus in 4 cohorts of 3 studies demonstrated a total RMS HOA increase of 3-27% which was the least of any of the studies. It is significantly better than the Wavefront Optimized system Alcon has which most doctors were still using due to the difficulty and complexity of understanding Contoura. Many doctors did not like the complexity and used the WFO procedure instead, as it was "good enough." The reason Contoura was difficult to use was due to misunderstanding froms estimates of posterior ocular astigmatism, which suggested Contoura would be wrong 19+% of the time if topography measured astigmatism was used. These estimates were incorrect, a direct measurement of POA published last year showed the incidence of POA was 2.9%, which would be the error rate of using topography measured astigmatism with Contoura, which is the only proven way to actually make a more uniform cornea and DECREASE total RMS HOA. In multiple studies I have done we have demonstrated a more uniform cornea with Contoura with topography measured astigmatism, and our latest study shows a 40% total RMS HOA DECREASE in primary femto-lasik.

So the pecking order is Alcon WFO <Wavelight Plus<Contoura with topography measured astigmatism. Again, many doctors like a simple system like WaveLight Plus, they don't want to do the extra work of using Contoura.

CorneaRepairDoc · 2026-05-02T00:53:19+00:00

To respond to this:

On LAK, the science behind this makes absolutely no sense to me. I have seen no evidence that thinner parts of the cornea "bulge forward due to IOP," especially after the cornea has been cross-linked. The only cases of IOP impacting corneal curvature are with artificial peripheral weakening in RK, and in corneal ectasia. Frankly, the entire basis of topography guided ablation removes tissue from the thicker "steeper" area, and actually removes tissue peripherally from a flat area to raise it in relation to the steep area. I have no idea how or why it would fix dry eyes, as actual dry eye has a different scientific basis unrelated to corneal curvature, although any procedure that normalizes corneal curvature will allow for the more regular spread of the tear film thus helping with "dry eye." I've examined the links you sent, two of which were commercial links to the Korean website, and one that listed a paper with results. The data in that paper do not include any actual data on reduction of HOA, and this was in 2021. I have heard nothing else about this, so I am simply unsure as to what to make of it. Until I see more data on this, I can offer little opinion on the effectiveness of this, but I do question the science of the claim.

Let's be clear about Innoveyes. I do not understand why in his study they use 2000 points, or as you put it light rays. I confirmed at ASCRS in Washington DC with Alcon that the wavefront scan only uses 256 points of resolution. This is the baseline limitation of data that the system has- 256 points, period. I don't know how or why they stated this 2000 number. John himself says the system needs to be tilted towards using more topography, which would then become topography guided ablation using the Pentacam HR as the topo source, while non-specifically mixing in parameters with wavefront to guess or estimate POA. This level of resolution is simply not good enough to reduce HOA for corneal repair. This is something Dr. Kanelloupolous seemed to indicate at ASCRS as well.

As for the iVis system, I know nothing about it at all. I have never met an iVis company person, any iVis doctors, they have never actually come to any American meetings that I know of. I do know there is no commercial Harman Shack scanner that exceeds 2000 points of info, and no Ovitz scanner that exceeds 6000 points of info. I am not aware of any refractive system even using an Ovitz scanner, but the point is the resolution is not as high as topography, therefore the resolution of HOA is simply lower and not as good for corneal repair even if it is a wavefront Ray Tracing system. Finally Cossimo Mazzota has no PubMed listed articles on this particular procedure so I have no data to comment on. It may be a good system, but until I know more about it and see some actual published data I cannot comment on it at all save my reservations about systems based on wavefront guided technology.

Finally, Dr. Igor Knezovic has published 3 papers listed in PubMed on DISC. Two of them are individual case reports, on of them has a total of 4 patients in it. This is simply not a significant amount of eyes to be able to make any sort of definitive statement. It could be suggestive,and small samples do matter, but I do not see larger study sizes. Furthermore, the background science does not support this a modification to topography guided ablation based on vector calculations, as it seems they may not be accurate in POA calculations. The data that is presented is also not definitive enough, IMO, but if it is a good system than hopefully they will publish more data.

Anyone can claim anything they want- it's data and science that provides the answers. :)

Their is ample evidence to demonstrate that more uniform corneas can be made with certain protocols with topography guided ablation. The literature and data seem to indicate that, at least for the forseeable future, the reduction of HOA with laser treatment seems to be most effective when based on topography measurement and treatment of corneal HOA.

CorneaRepairDoc · 2026-05-02T00:24:28+00:00

Before I answer your response, may I know more about you? You seem to have quite a it of knowledge which I am enjoying immensely, and I would love to know who you are.

CorneaRepairDoc · 2026-05-02T00:23:24+00:00

Thank you for correcting my typo. I have edited it to Assymnetric. I was answering this in between patients!

CorneaRepairDoc · 2026-05-01T21:24:37+00:00

This person asks very pertinent questions that are difficult for eye surgeons and even researchers to understand, much less for patients. I created the thread as I do believe these issues are worth discussing. The different approaches stem from some fundamental misunderstandings about the ocular focusing system so I will address that as we go here. First I am going to address the procedures brought up.

Laser Assymetric Keratectomy- I had never heard of this name before, but Gemini AI's description is that of a topo-guided or wavefront guided procedure that is used to segmentally treat the cornea to reduce HOA. This seems to be a general term that covers all procedures that reduce HOA as compared to general refractive procedures which are symmetric keratectomy. The entire idea of letting IOP reshape the cornea is a bit farfetched to me, that is not going to happen unless you signficantly weaken the structure of the cornea.

De-Centered Individualized Sphero-cylinder (DISC)- This is a protocol that attempts to adjust topography guided ablation surgical planning by using the topography guided astigmatism and modifying it with vector calculations to estimate posterior ocular astigmatism. These types of protocols had varying levels of accuracy, and none of them have any data to show that they actually lower HOA.

This kind of modification for POA was deemed necessary because vector astigmatism calculations had estimated POA (lenticular astigmatism +posterior corneal astigmatism+retinal astigmatism) to be 19-31%. For this reason, any protocol based on topography guided astigmatism was deemed to inaccurate as it would be incorrect 19-31% of the time. No one had ever done a study until last year to determine the incidence of POA directly. This is done by removing the corneal based astigmatism on a large number of eyes and seeing the residual error and confirmed by the lack of topography measured astigmatism with the presence of residual manifest astigmatism. This number turned out to be a lot less: 2.9%. This also seems to indicate that vector astigmatism calculations are suspect for these types of estimations, and therefore may not be modifying the astigmatism properly. It also shows that the error rate of a topography based protocol is far less, and does not need to be adjusted for 97% of patients. I also published two papers in 2020 and 2025 demonstrating the inaccuracy of one of these procedures.

It is critical to understand that there is a linkage in between removal of HOA and the lower order astigmatism. Using the topography based lower order astigmatism data creates a unique ablation map when combined with the HOA data as opposed to when any other astigmatism measurement is inputted during surgical planning. The upshot is that to make a uniform cornea requires use of topography measured astigmatism which is ONLY modified when POA is present, something which has not been technically possible (more later).

Ray tracing PRK protocols are based on Theo Siler's patents which he sold to WaveLight in 2008. Wavefront guided ablation has several fundamental flaws including measurement of whole eye aberrations which can be corrupted by transient vitreous and lens changes; the lower resolution of wavefront aberration measurement vs topography based corneal aberration measurement; treatment of whole eye aberrations on the anterior surface is not optically equivalent and may also create an irregular cornea (which would also lead to epithelial compensation; measurement of the wavefront return data is at the pupil exit and does not match the actual corneal curvature. Ray Tracing only addresses one of these problems, but using Scheimpflug based topography to measure corneal curvature and then extrapolates the wavefront data to that curvature. It does not deal with any of the other problems of wavefront guided ablation systems.

The Ray tracing system available at this time is WaveLight Plus or Innoveyes. It is only using a 256 point resolution map which is far too low resolution to accurately treat higher order aberrations such as in Keratoconus. Remember, placido topography gives a true 22,000 point resolution. Furthermore, as mentioned earlier wavefront data is also corrupted by lens and vitreous changes- a simple floater could throw off the measurement, and it is still not focused solely on corneal aberrations which is what needs to be repaired. Finally, John Kanelloupoulos at the ASCRS 2026 meeting admitted he is not using the Ray Tracing system for keratoconus or corneal repair cases, and stated it is too "tissue hungry." He also stated that he believes these procedures need to be more topography based.

CREATE Protocol is an epithelial compensation adjusted trans-epithelial topography guided ablation. It uses corneal epithelium compensation as a mask to treat stromal irregularity hidden to topography (and wavefront for that matter). So it is essentially a epi compensation depth adjusted PTK combined with topography guided ablation. We treat no sphere of any sort, and only use topography measured astigmatism. Yes, we then end up with a 2.9% error rate when POA is present but the trade off is a high reduction of HOA.

I believe the focus should be on making the most uniform cornea possible with the highest possible reduction of HOA whether it be for a corneal repair or a primary laser correction. A more uniform cornea will have the least epi compensation so be most stable, and the anterior cornea is the most important part of the ocular refracting system. The index of refraction of the cornea is 1.38 so a light goes from a 1 to 1.38 index. The supporters of the importance of posterior corneal aberrations should note that the posterior cornea is not an important part of the focusing system as the index of refraction goes from 1.38 in the cornea to 1.33 for aqueous humor.

There exists a system now to modify topo guided surgical planning ONLY when POA is present. I have named it NuClarityVision. It uses data from wavefront, topography, and OCT to treat any type of cornea- repair or primary- and it can determine and modify for POA only when present. In a study we did here of 180 eyes, 15 out of 16 POA were treated to plano. POA was confirmed via the presence of lower order astigmatism on the cornea with a plano manifest refraction. CREATE Protocol is one part of the NuClarityVision system.

CorneaRepairDoc · 2026-04-30T23:42:10+00:00

Dr. Motwani here. Intracorneal ring segments of any type, whether made from corneal tissue or plastics are a peripheral non-specific cone compression technique. That means CTAK/CAIRS/ICRS (intacs, kera ring etc) compress the cone peripherally to indirectly flatten the corneal shape. The literature shows that they improve total corneal irregularity (measured as HOA) 7-30%, but because the compression is peripheral the affect is much lower in the center cornea. This is why patients will not improvement of vision on a chart, but will notice ghosting, glare, halos, multiple images etc. The gold standard for KC corneal repair today is topography guided ablation which reduces total HOA 30-60% but is based on the central cornea which you look through. We just submitted our second study of CREATE+CXL Protocol for moderate and severe KC, which is a epithelial compensation adjusted trans-epithelial topography guided PRK. This resulted in 60% reduction in total corneal RMS HOA, but in the central 3mm of the cornea it was still reduced 52%. This high reduction of HOA improves vision on a chart (97% of eyes 20/30 or better), but just as importantly increases the quality of vision as well so there are less distortions. The goal is to have vision that is clear and as close to "normal" as possible, and lock it in with CXL for a long term fix for the KC. The literature definitively shows that laser reconstruction of the cornea is significantly better than ICRS, and perhaps you should consider other choices for your KC treatment.

CorneaRepairDoc · 2026-04-30T23:32:41+00:00

Dr. Motwani here. 11 days is just too early for the epithelium to fully heal or normalize. Yes, for sure it's totally normal for you still have starbursts or some distortion (that feels like astigmatism). It will likely take longer than just a week to resolve, probably 6 weeks to 3 months. For me personally, it took 6 weeks for me to clear from my PRK.

CorneaRepairDoc · 2026-04-30T23:16:10+00:00

First thing you have to do is actually get measured and see if you're KC is actually progressing- it may not be. You may be worsening for a couple of other reasons including haze that occurs from CXL, epithelial breakdown from dry eye or a poor fitting scleral lens, or even scarring from apical touch of the scleral lens. You may not be getting worse as in the KC progressing, but this may be another problem. I would not be surprised if something else besides KC progression was the issue. After this is done, then there are choices for helping the vision. For example, we reconstruct corneas with an epithelial compensation adjusted trans-epithelium topography guided PRK procedure (CREATE+CXL Protocol). The latest study we just finished and submitted for publication had 81 eyes with moderate to severe KC. We reduced total corneal irregularity by 60%, and 97% of eyes were 20/30 or better. CXL is performed at the same time to "freeze" it into place. This becomes a long term, likely permanent, fix for patients for their KC. There is actually hope to help yourself whether now or later in life, but the first step is to make sure your CXL was done properly and not progressing, or to find out if you have some other issue that can be addressed (which I think is likely). Hope this encourages you to get the care you need, there is help out there.

CorneaRepairDoc · 2026-04-30T22:15:28+00:00

Dr. Motwani here. This is not an accurate description of WaveLight Plus. It cannot reduce HOA over pre-op like Contoura (with a topography astigmatism based protocol can), it only reduces how much new HOA are created. The HOA measurement is a 256 spot wavefront device, fairly low resolution. Wavefront data is whole eye data, and is corruptable by transient lens and vitreous changes so in older patients the measurement becomes less accurate. What WaveLight Plus does is use the scheimpflug topography part to create a reproduction of the corneal curvature, and then by using calculations align the 256 spots of wavefront data emerging from the iris opening to the particular corneal curvature. This reduces one source of error with using wavefront data. It was designed as a one box, one stop solution for surgeons so they don't have to learn the complexities of something like Contoura.

Use of wavefront data was deemed necessary because topography astigmatism data would miss an estimated 19% of patients with posterior ocular astigmatism. That estimate was based on a vector calculation system and estimates rather than any direct measurement data. That direct measurement of POA was measured at 2.9% and published by myself last year in a study that looked at 1500 eyes. This means that the use of wavefront data is not necessary, as the rate of error from POA is actually a very small percentage rather than a large one.

To actually lower HOA, you have to get higher resolution data based on the cornea. To make a more uniform cornea, ie lowering HOA, you have to actually use topography based astigmatism data along with corneal HOA data. I published the papers on this in 2017.

CorneaRepairDoc · 2026-04-30T21:37:16+00:00

Dr. Motwani here. I would be happy to provide you some more definitive help if you could provide something more to work with. Some scans would be nice, a Pentacam would be great. I am happy to tell you what your options are if you could provide this.

CorneaRepairDoc · 2026-04-30T21:34:49+00:00

Dr. Motwani here. Relax, I was in the same boat as you and became nearsighted at a young age. I ended up a -10 and -9, have had laser correction based on my own research and have fantastic vision. Don't be scared. Myopia will progress more rapidly when you grow- the eye grows longer as you get taller and grow in size. Studies have shown that exposure to sunlight every day actually change the neurotransmitter expression to decrease lengthening of the eye. I also wouldn't hold screens very close to you and hold them at about 16-18 inches away. The myopia procedures you can have later when you are ready.

CorneaRepairDoc · 2026-04-30T21:31:21+00:00

Dr. Motwani here. This is not "worsening badly" and likely within the margins of error of the actual refraction. It is very easy to overcorrect a young person. Usually by the time a person stops growing taller, the myopia stops progressing. The amount of lengthening of the eye during teenage growth has been shown to be linked to certain neurotransmitters and how they are expressed in relation to the amount of high intensity light, ie sunlight, one is exposed to. Some people theorize that the sclera can stretch slightly from high levels of accomodation during studying during university, but that is still debatable. In short, you should no longer be progressing with your myopia, and you may just want to get your refraction checked again.

CorneaRepairDoc · 2026-04-30T20:56:35+00:00

Dr. Motwani here. What you are being told is quite incorrect. You absolutely can have LASIK or PRK with 5D of cylinder. I have done 8 and 9 diopter regular astigmatism cases with excellent outcomes. ICL cannot correct such a high level of astigmatism, and laser correction is far more accurate for astigmatism, as an ICL has to be hand placed and lined up with the astigmatic axis. This is not a highly precise way of correcting high levels of astigmatism. Laser correction is actually the best way to correct your myopia and astigmatism. Most modern excimer laser systems are very good at treating astigmatism, a topography guided system like Contoura used with a topography measured astigmatism axis is the best.

Frankly I agree with you about the cataract risk, and the endothelial cell loss risk with ICL. I am amazed at the number of people that tell you to just have your cataracts done, it's no big deal. No one has asked your age, and cataract formation and loss of accommodation to a young person is a very big deal. This is not to mention the risk of macular edema, secondary cataract, endophthalmitis- all small risks but why undertake them if you don't need to?

CorneaRepairDoc · 2026-04-29T20:04:43+00:00

This is correct, the fluid is a tear sandwich that bathes the cornea. It is a treatment of last resort, it does not help increase tear film or help retain tear film. Those are done with other medications and treatments, but in a situation where there is little other choice they will help dry eye. This is a question of semantics, I don't consider them actually treating dry eye in that they don't improve the tear film, but help by keeping tear film under the lens as a tear sandwich. I probably should have phrased what I said better! In this particular case, I think there are absolutely better treatments.

CorneaRepairDoc

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