LASIK has come a long way since it was first performed many years ago. In the beginning, a lathe was used to cut a flap in the anterior section of the cornea, and the underlying tissue was then ablated, or burned away with a laser. While the lathe was gradually improved, and the technique refined, there were still issues with the blade. For one, it created an irregular flap that was thicker at the edge then in the center. This was the source for blurred vision, and additional problems if the flap moved.

A major development was the introduction of Intralase. This brought LASIK forward into the 21st century. Intralase employs a laser to actually create the flap. In doing so, the flap is equal in thickness 360 degrees around, thinner and more predictable. The edges fit better and thus heal faster and cleaner. However, with every improvement comes potential for trouble.

G.A.P.P. stands for Great Acuity Postoperative Photophobia. What we have seen in some patients several weeks to months post operatively is the sudden onset of either acute pain, and/or light sensitivity. It is believed to be the result of a sudden onset of inflammation and dry eyes, which may be related. A physiological change in the metabolism of the corneal regrowth process appears to occur as a result of the laser used in Intralase. The exact etiology is still under investigation.

Treatment for these patients comes in the form of use of the topical steroid Pred Forte every 2 hours for about a week, followed by Restasis. Restasis is Cyclosporin, an anti autoimmune medication which has been used to increase tear production by reducing inflammation in the Lacrimal gland that manufactures tears. Most patients do very well with this treatment. G.A.P.P. should NOT be a deterrent to have Intralase since its use appears to be a huge step forward in the LASIK procedure. Over time I am sure investigators will determine what it is about the laser that is causing their anomaly.