Man undergoes LASEK re-treatment with Visx CustomVue

The patient had LASIK 4 years prior and complained of halos around lights at night

Issue: May 15, 2005

ByMarguerite B. McDonald, MD

Case history: A 31-year-old male FBI agent who had undergone LASIK 4 years earlier presented with complaints of halos around lights at night. His uncorrected vision was 20/25–2 right eye and 20/25–1 left eye. It was correctable to 20/25 right eye with –0.75 + 0.25 × 030 and to 20/20 left eye with –0.75 sphere.

Preoperative examination:

Uncorrected visual acuity: 20/25 both eyes

Manifest refraction: Right eye –0.75 + 0.25 × 030, left eye –0.75 sphere

Visual acuity: Right eye 20/25, left eye 20/20

System: Visx CustomVue

Procedure: Surgery was performed with the Visx Star S4 laser utilizing a Fourier-driven wavefront-guided laser epithelial keratomileusis technique with the application of chilled balanced salt solution and mitomycin-C for 15 seconds. Bandage contact lenses were left in place for 5 days postop.

Postoperative refraction:

Uncorrected visual acuity: Right eye 20/16–1, left eye 20/16+

Refraction: Right eye 0.50 sphere, left eye plano

Lower-order aberrations (sphere and cylinder):

Preop sphere: Right eye 1.62, left eye 1.41

Postop sphere: Right eye 1.38, left eye 0.16

Preop cylinder: Right eye 0.32, left eye 0.22

Postop cylinder: Right eye 0.36, left eye 0.32

Higher-order aberrations:

Higher-order aberrations preop: Right eye 0.81, left eye 0.62

Higher-order aberrations postop: Right eye 0.50, left eye 0.75

Coma preop: Right eye 0.51, left eye 0.50

Coma postop: Right eye 0.11, left eye 0.66

Trefoil preop: Right eye 0.21, left eye 0.22

Trefoil postop: Right eye 0.19, left eye 0.14

Spherical aberration:

Preop: Right eye 0.51, left eye 0.21

Postop: Right eye 0.37, left eye 0.26

Discussion: One day postop, ETDRS visual acuity was 20/40 right eye and 20/50–1 left eye, and as early as 4 days postop the patient reported improved vision. The patient was symptom-free (no halos or distortion) and seeing 20/16–1 right eye and 20/16+ left eye without correction by 8 days postop.

Fourier-driven custom LASEK is effective in the treatment of night vision halos induced by LASIK. The case showed positive results in both safety and efficacy.

This study is important because it shows that Fourier-driven custom LASEK is effective for therapeutic treatment of eyes that had previously undergone LASIK. LASEK is an important therapeutic technique that allows physicians to re-treat patients without lifting flaps, which alters the wavefront in an unpredictable manner, or dealing with flap complications.


Preop WaveScans — WaveScans indicate increased coma, trefoil, and spherical aberration OU.
Preop topography — the central corneal flattening consistent with previous laser vision correction. Potential UCVA OD is 20/25-20/30 and potential UCVA OS is 20/20-20/25	Postop topography — The corneas in these topographies are still healing. There is an improvement in potential UCVA OD.

Postop WaveScans — OD shows a dramatic decrease in coma, trefoil, and spherical aberration while OS shows a decrease in coma and trefoil. Images: McDonald MB

For Your Information:

Marguerite B. McDonald, MD, FACS, can be reached at 2820 Napoleon Ave., Suite 750, New Orleans, LA 70115; 504-896-1240; fax: 504-896-1251; e-mail: margueritemcdmd@aol.com.