Age and high myopia

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Age and high myopia

Postby yammy » Thu Aug 14, 2008 4:28 am

:?: I'm scheduled for lasik intralase surgery on Aug 20th. But I am still concerned about my age and high myopia, and I feel like the answers I am getting are just the usual doctor's pat on the head - "don't worry dear. it will be fine". I am 64 years old and my vision correction is -9.50 OU. The left eye has a minor +.50 astigmatic correction. I can no longer wear contact lenses for more than a few hours a day due to some dryness issues. I work and spend most of the day in front of a computer screen. Are there any of my contemporaries out there who have had lasik surgery and what were their outcomes? There is absolutely no information on the long term effects past 1 to 2 years in the literature, and even the internet has been very uninformative, especially in my age bracket.
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Postby tomas-smetka » Thu Aug 14, 2008 6:28 pm

Your age is too high. Maximum age for LASIK is 40 years (with us in Europe), that maybe you do not know it otherwise.
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Postby LasikExpert » Thu Aug 14, 2008 6:37 pm

You have several separate issues that need to be addressed:

Doctor condescension When you ask real questions you should receive real answers. If this doctor does not take your concerns seriously, then you may want to seek the opinion of another doctor...or two.

Presbyopia At age 64 you are undoubtedly fully presbyopic. Presbyopia is when the natural lens within your eye is unable to change shape and thereby unable to focus on near objects. To see objects near, you need reading glasses, bifocals, or trifocals. Unless you are undercorrected or have monovision, you will continue to need reading glasses, bifocals, or trifocals. If you are undercorrected you will need glasses for distance vision.

High myopia Your myopia (nearsighted, shortsighted) vision is high, at 9.50 diopters. Although many with high myopia have successful Lasik, it is more challenging. A significant amount of corneal tissue will need to be removed. It is important that at least 250 microns of corneal tissue (more is always better) remain untouched and that more than half of the thickness of your cornea is untouched, whichever is greater.

Lasik Regression You will undoubtedly deal with Lasik regression. This may be accommodated by overcorrecting you into hyperopia (farsighted, longsighted) vision and allowing you to regress to plano (no refractive error), or with Lasik enhancement surgery. Either way, this means more tissue must be removed. If you are 9.50 diopters myopic and regress 2.00 diopters, then the actual tissue removal is for 11.50 diopters of refractive error.

Dry eyes You are currently contact lens intolerant due to dry eyes. Lasik commonly induces dry eye during the early healing stages. Dry eye normally resolves in the first 3-6 months, however Lasik can exacerbate an existing dry eye problem. You need dry eye treatment and your dry eyes need to be fully managed before you have corneal refractive surgery like Lasik. Dry eyes is a medical condition and would likely be covered under your major medical insurance, including Medicare.

Extensive computer work Computers use for long periods of time commonly exacerbates dry eyes because of less blinking. Try closing your eyes for a count of ten ever 30 minutes.

Gender Post menopausal women tend to have dry eye issues. Hormone Replacement Therapy (HRT) can affect dry eyes and can affect refractive error, causing fluctuations.

Lasik Alternatives Due to your age, presbyopia, and high myopia, Refractive Lens Exchange (RLE) should be considered as an alternative to Lasik. Many Lasik surgeons do not perform RLE and would be unlikely to recommend it. For this reason a surgeon who provides laser vision correction and RLE may be better prepared to advise you.

RLE Disadvantage A big disadvantage with RLE is that it is a significantly more invasive surgery than any cornea-based refractive surgery. An extremely myopic patient would have an elevated risk of vitreous or retina problems after RLE. Before RLE you should be evaluated by a retina specialist.

RLE Advantage You will never develop cataracts, which would require exactly the same surgery to resolve. Since all of us will likely develop cataracts if we live long enough, RLE now or cataract surgery later is the real decision.

RLE does not normally exacerbate or cause dry eyes.

Insurance payment If you have cataracts, then you could have the same surgery as RLE and it would be paid by your major medical insurance, including Medicare. You would probably be required to pay extra out of your own pocket for premium IOLs.

Premium IOL RLE involves removing the natural lens of the eye and replacing it with an artificial intraocular lens (IOL). The ReZoom, ReSTOR, and Crystalens IOLs are designed to provide near, mid, and distance vision, thus reducing the need for reading glasses, bifocals, or trifocals. Each of these lenses have their own limitations and they are significantly more expensive than a conventional single focus IOL, but they should be considered.

There are 10 year studies on laser vision correction and smaller 15 year studies. All show relative stability and safety, however the majority of the study patients have much lower myopia than you.
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64 years young!

Postby yammy » Wed Aug 27, 2008 5:57 pm

To the respondent from the Czech Republic - You are really wrong about age.

I had the lasik last week. My vision is 20/20 in my right eye. My left eye flap developed some wrinkles; so the Dr relifted and smoothed it back down the day after the lasik. The vision in the left eye is still not as good, but is 20/30. Since I have not seen 20/20 without glasses or contacts since I was about 10 years old, this vision is incredible. I am totally aware of the issues. In fact, I took in the 50 hard questions to ask your refractive surgeon, and he went down the entire list and answered every question without hesitation. My original corneal thickness was 570 (microns?); the flap he made was 110. He said he removed 107 corneal tissue. So I am still well within the safe zone for corneal thickness. I suspect he may recommend a touchup on the left eye in 3-4 months. I'm willing to wait closer to six. (the relifting of the flap was very uncomfortable) The touchup cost is included in the surgery fee. We debated the RLE because that was a major issue to me. But the increased risk of retinal and vitreous issues which are already at higher levels due to my high myopia, plus the fact there is no sign of cataracts yet and the RLE cost is SIGNIFICANTLY higher, made me decide on the lasik.

PS For your information, I had gone to the refractive surgeons listed in this area on your website. With them, I did not see the surgeon or any MD at my original evaluation. I would not have seen the surgeon until the day of surgery. In fact, within minutes of the Ophthalmic Tech looking at my eyes, I heard nothing but, "You're a great candidate for lasik surgery" from every person I saw. (the tech, the optometrist, and the surgery coordinator) So, I decided that I would not have surgery there even before I found your website and your list of recommendations. You need to revisit these folks. To me, they just seemed like a mill, grinding out surgery cases with minimal involvement of the MD's time.
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Re: 64 years young!

Postby LasikExpert » Wed Aug 27, 2008 7:13 pm

yammy wrote:In fact, I took in the 50 hard questions to ask your refractive surgeon, and he went down the entire list and answered every question without hesitation.


I like that surgeon's attitude!

yammy wrote:PS For your information, I had gone to the refractive surgeons listed in this area on your website. With them, I did not see the surgeon or any MD at my original evaluation. I would not have seen the surgeon until the day of surgery. In fact, within minutes of the Ophthalmic Tech looking at my eyes, I heard nothing but, "You're a great candidate for lasik surgery" from every person I saw. (the tech, the optometrist, and the surgery coordinator) So, I decided that I would not have surgery there even before I found your website and your list of recommendations. You need to revisit these folks. To me, they just seemed like a mill, grinding out surgery cases with minimal involvement of the MD's time.


Sorry about your experience. Our patient survey doctor evaluation process primarily looks at the surgery outcomes, not the "look and feel" of the practice. Some practices, especially those with higher volume, can be off-putting to some. Others seem not to mind. I totally understand both responses and all patients need to go where they are most comfortable. That is one of the reasons we have the 50 Tough Questions For Your Lasik Doctor. It helps patients find the best doctor for their needs. I’m glad we were of service.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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Joined: Fri May 12, 2006 6:43 am
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