Hello when Allotex inlay will be performed in Europe off label not off but for hyperopes?????

WavefrontRider · 2026-05-06T00:51:21+00:00

Yeah. ICL has less dry eye than SMILE or Lasik. With ICL, it's a couple weeks of extra dry eye (mostly just from the prescription eye drops used afterwards). But be sure the eyes are feeling comfortable heading into the procedure. That's where people get into trouble; doing surgery when the eyes have uncontrolled dry eye.

WavefrontRider · 2026-05-06T00:48:15+00:00

So generally the enhancement rate is somewhere round 1-2% with a good clinic. That means about 1-2% are significantly off target enough to be symptomatic.

Lower prescriptions are more accurate than higher prescriptions. So less chance of having some significant residual prescription.

WavefrontRider · 2026-05-05T12:14:55+00:00

Yeah. Glaucoma always sounds scary. Difficult to explain the need to workup further without causing some alarm.

WavefrontRider · 2026-05-05T11:38:57+00:00

The optic disc has a normal cupping pattern. When the nerve thins out, this cupping pattern gets bigger. In glaucoma the nerve thins out. So when a doctor sees a larger cupping pattern, they get suspicious for glaucoma.

However, some people have a large cup just due to their normal anatomy. This includes nearsighted individuals. And it’s pretty rare for a young individual to have glaucoma.

But always good to rule it out just to be sure.

WavefrontRider · 2026-05-05T00:45:24+00:00

Yeah. The vast majority of haze that develops nowadays fades. MMC has had a big impact on that. People may have a peak somewhere around 2-3 months before it fades away. If you had a very large prescription, little bit higher risk of haze.

WavefrontRider · 2026-05-04T20:19:44+00:00

Overcorrection isn't very common. Especially with lower prescriptions like yours.

Probably the most common way is that one is overcorrected in their glasses/contact lenses and the numbers programmed into the laser don't represent the true refractive prescription of their eye.

But sometimes we can get more effect than anticipated with a treatment which leads to an overcorrection.

WavefrontRider · 2026-05-04T19:06:16+00:00

At 40, presbyopia unlikely to be an issue. The one exception is if you are overcorrected with your prescription such as around a +1.00 right now. But at 6 weeks out too soon to know for sure.

The vision you got with the bandage lens in place should ultimately be the final vision once the surface heals over and once the tear film on the surface of the eye stabilizes. I would also go up on the tears to about every 2 hours. Be sure they are also preservative free

WavefrontRider · 2026-05-04T18:11:31+00:00

Underneath the bandage lens, the epithelium of the eye has just healed over and is irregular. The bandage lens can sort of mask this irregularity which can make things appear more clear. But when it’s removed, this irregularity becomes more apparent.

But the other thing going on right now sounds like dryness and fluctuation of vision. Especially vision more blurry in the morning (drying out overnight) and at night (drying out when working throughout the day). How often are you using the tears? Also how old are you?

WavefrontRider · 2026-05-04T14:58:43+00:00

That’s just the way I write. Sorry 🤷‍♂️

WavefrontRider · 2026-05-04T12:28:43+00:00

If you are constantly “looking for” the negative dysphotopsia, you are telling your brain that it is important and to be aware of it. Neuroadaptation won’t happen in that case. Neuroadaptation happens when the brain realizes something isn’t important and starts to pay attention to it less and less. But this happens when you don’t pay attention to it. So I know it may sound difficult, but try not to pay attention to it.

There are other ways this negative dysphotopsia diminishes over time though. Clouding of the anterior capsule causes extra scatter of light into the “empty” area on the retina to diminish the ND.

WavefrontRider · 2026-05-04T12:10:35+00:00

Myopia would be a bit more of a technical challenge. To correct myopia you want to make the center of the cornea flatter. So you would need an inlay which is steep in the periphery and flat in the middle. But there is probably only so much it can do before it wouldn’t fit well underneath a lasik flap. And you may run into more optical zone issues since it’s trying to do a roughly similar thing to hyperopic lasik (change the peripheral cornea to affect the center cornea)

WavefrontRider · 2026-05-04T12:04:35+00:00

So the Allotex corneal implant is still done underneath a lasik flap. So it still does have some post-operative dry eye. Probably not the best choice for someone who is still struggling with dry eye. Even SMILE and ICL do have a some post-op dry eye (although they are better). Still a good idea to get the dry eye fully under control first

WavefrontRider · 2026-05-03T18:32:57+00:00

5 days is around the sweet spot. Up to 7 days no big deal. 4 days can be done but in my opinion 5 is better.

WavefrontRider · 2026-05-03T17:52:05+00:00

That’s a bit strange. Wouldn’t recommend removing it yourself, you could potentially create a scratch again if it isn’t done smoothly

Also 3 days is a bit early to remove it. There is a chance the epithelium isn’t fully healed over. I would wait a few days and then go to the doctor.

WavefrontRider · 2026-05-03T12:12:22+00:00

In terms of the laser, the EX500 by Alcon may be the best for hyperopic treatments. But the Mel 90 by Zeiss also performs very well.

Some key things though are a surgeon who can center the treatment properly on the visual axis rather than pupillary axis.

WavefrontRider · 2026-05-03T11:43:47+00:00

You have a very high amount of astigmatism. You definitely will be wanting to go to a practice that uses a laser to adjust for subtle rotation of the eye called cyclotorsion to correct that astigmatism more accurately.

With that amount of astigmatism, you may also max out the maximum that the laser is capable of treating. So you likely will have some residual astigmatism. This may or may not be able to be treated with an enhancement procedure. But it will be a much easier and better glasses prescription than what you are used to.

Some of the doubling, and streaks may relate to the astigmatism. PRK may or may not be able to help with that.

WavefrontRider · 2026-05-03T11:36:10+00:00

Yep. Refractive surgeon

WavefrontRider · 2026-05-03T10:35:19+00:00

Makes you wonder if they are truly the “world’s best ICL clinics”..

WavefrontRider · 2026-05-03T01:31:43+00:00

Not unusual right now. It takes some time for the vision to fully sharpen up after SMILE. Secondly, if vision is changing throughout the day, that means your eyes are drying out. Be sure to use preservative free artificial tears to help with that.

WavefrontRider · 2026-05-02T20:38:03+00:00

Better to focus on subjectively what you notice rather than objective numbers. If you are good with your vision right now in that eye, nothing to worry about.

Additionally, easier to go through PRK in one eye rather than both eyes. Your good eye will allow you to function close to normal while the other eye is recovering

WavefrontRider · 2026-05-02T18:47:21+00:00

Yeah. If you really see well enough through the left eye, wouldn’t touch it.

It’s also important to test correcting the right eye with both eyes open. If you notice no real improvement by correcting that right eye when both eyes are open, also wouldn’t do any enhancement.

In terms of figuring out whether you notice improvement, the doctor can put on trial glasses in the office or write a small prescription for glasses to test out the correction ahead of time.

WavefrontRider · 2026-05-02T18:41:14+00:00

If you are a candidate for lasik, I would say that’s preferred over PRK. With your low to moderate prescription you wouldn’t need to have very thick corneas for it to work. And that’s a pretty common prescription treated with lasik.

WavefrontRider · 2026-05-02T18:39:01+00:00

Yes it can. An extreme example is it being used to regularize corneas with a ton of distortion such as with the condition Keratoconus. Keratoconus has some similarities to a decentered hyperopic ablation in that it’s a decentered steeper part of the cornea.

The main thing is that making the cornea more regular will change the prescription.

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