Concerned you may have a wrinkle in your lasik flap? Perhaps you just went though lasik and your vision isn’t quite as sharp as what you noticed with your glasses beforehand. Wrinkles are rare, but there are a few distinct symptoms of a wrinkled lasik flap that you can notice.
Lasik flap wrinkles occur when the lasik flap isn’t sitting totally flat on the surface of the cornea. This creates an irregular surface which leads to blurry vision, distortions and occasionally double vision. Significant wrinkles can be removed with a follow-up procedure.
Following up with your eye care provider is the best way to determine if you have any folds in your lasik flap.
What Is A Flap Wrinkle
Today’s lasik is being done entirely by lasers. A femtosecond laser is used to create a three-dimensional flap on the surface of the cornea. This flap is folded back for the lasik treatment and then replaced.
Side view of lasik flap; cornea graphic courtesy of Jmarchn, CC BY-SA 3.0, via Wikimedia Commons
But the lasik flap is a large flat and thin structure. While it has some walls to help hold it in place, like any flat thin object it is possible that the lasik flap can contain a wrinkle or fold if not placed back perfectly in position or if something slightly dislodges the lasik flap.
Ever get your foot caught on a rug while walking and the rug bent up into a fold? The same thing can happen on a microscopic level on the lasik flap.
These lasik flap wrinkles (also known as flap striae) don’t happen entirely that often. With experienced surgeons, a flap wrinkle requiring treatment occurs less than 0.2% of the time with lasik.
And not all wrinkles actually cause symptoms or require any treatment. Wrinkles fall into two main categories:
- Microstriae - These wrinkles are so small as to not cause any issues with vision. These wrinkles can often be harder to detect at the microscope. No treatment is needed with these wrinkles.
- Macrostriae - This is the opposite of microstriae. These wrinkles will cause issues with vision. These are easy to see and frequently will require treatment to fix.
Multiple significant lasik flap wrinkles; image © 2020 Khaled Abdelazeem et al., used under CC BY 4.0
Symptoms of Flap Wrinkles
Our best vision happens when the cornea is smooth. Macrostriae are large wrinkles. These wrinkles are so large as to cause small distortions in the smooth surface of the cornea.
You may be familiar with astigmatism, astigmatism occurs when one direction of the cornea is flatter than the other direction of the cornea. Astigmatism blurs vision but astigmatism can be corrected with glasses and lasik because it has a regular pattern.
The distortions in the cornea from the macrostriae, however, are typically irregular. This in turn creates something known as irregular astigmatism.
Irregular astigmatism can affect vision in a variety of ways:
- It causes general distortions or scattering of light. This includes starbursts and glare.
- Blurred vision may result which can’t be corrected with any additional prescription lenses (because things are too irregular).
- It can cause ghosting of images or even double vision.
If you have any wrinkles after lasik, it doesn’t take long to notice these symptoms.
Immediately after the procedure, a small amount of swelling in the lasik flap may mask some of these symptoms. This is the same swelling which causes a subtle haze or glow to your vision. As this swelling goes down over the course of the first 24 hours, the irregular surface of the cornea becomes exposed causing the extra scattering of light and symptoms.
At your one day post-operative visit, your surgeon is able to easily confirm whether or not any flap wrinkles are present.
At-home test to screen for wrinkles
Put on your detective hat, here’s a way you can figure out if your blurry vision is being caused by a wrinkled lasik flap.
The symptoms of lasik flap wrinkles are caused by the surface of the eye being distorted - it isn’t smooth like it should be. But if we make the surface smooth, the symptoms should go away. While you can’t physically make it smooth yourself (that’s the surgeon’s job), you can temporarily provide a smooth surface.
Take one of your preservative free artificial tear drops and place it in the eye. This artificial tear floods the surface of the eye with a large volume of tears. This increase in tear volume will coat the surface of the cornea and mask subtle imperfections, such as those caused by a lasik flap wrinkle. This will make the surface of your eye smooth again; the blurred vision and distortions from the flap striae will go away. At least in the short term.
Note: this isn’t a foolproof test to evaluate for lasik flap wrinkles. If the flap wrinkle happens to be large enough that the tears can’t cover it, you will still have symptoms. Also, if you have blurry vision from dry eye, this artificial tear test can also lead to improvement in your vision without having any flap wrinkles. But nonetheless, this is a very quick, easy and cheap test you can perform yourself.
How Wrinkles Are Fixed
The treatment for lasik flap striae is relatively straightforward:
- Lift up the lasik flap
- Smooth out the wrinkles
- Replace the lasik flap
Depending on how severe the wrinkles are or how long the wrinkles have been present, this can be a quick fix with a quick recovery or this can require a much longer recovery.
Small wrinkles treated early is a quick fix. The lasik flap tends to flatten out pretty easy. The recovery afterwards isn’t too much different from the initial scratchiness that you experience initially after lasik.
Large wrinkles or delays in fixing wrinkles requires more work. The skin or epithelium on the surface of our eye will try to “fill-in" the wrinkle. To make the lasik flap flat again, often the surgeon will need to scrape off this epithelium out of the fold. This will lead to a much larger scratch on the surface of the eye that needs to heal up. Until this occurs, which can be anywhere from a few days up to close to a week, your vision will be blurry and your eye will feel scratchy.
But either way, once a wrinkle is fixed, it isn’t coming back.
(unless you accidentally rub your eyes)
Summary
Lasik flap wrinkles create distortions and irregular astigmatism on the surface of your eye. This causes you to experience blurry vision, glare, starbursts, ghosting and in some cases double vision. Fortunately these are rare, but if it does occur, it can be fixed by your surgeon to smooth out the lasik flap.
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