Barrie D. Soloway, MD

History: The patient is a 27-year-old Asian man who presented with a poor result after prior LASIK surgery in his right eye. Records showed the original prescription was —4.00 —1.50 × 10, BCVA 20/20 and normal topography (Figure 1). He underwent uneventful LASIK on June 4, 1999, with the Visx Star laser and Bausch & Lomb Hansatome, resulting in a superiorly decentered ablation (Figure 2). He complained of poor vision with ghost images, especially at night, consistent with the elevated levels of higher-order aberrations of coma and spherical aberration as measured on the LADARWave aberrometer (Figure 4). Aberrometry and laser treatment algorithm (Figure 6) were stable over the 5-month period from June to October 2003. This algorithm showed treatment for the coma as well as expansion of the optical zone for spherical aberration reduction. Due to a pachymetry of 444 (Orbscan) and 433 (ultrasound), a surface CustomCornea treatment using mitomycin-C and an offset of +0.5 D was performed on Oct. 31, 2003.