A little bit turned off after first consultation.....

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A little bit turned off after first consultation.....

Postby Rix2357 » Fri Sep 08, 2006 4:02 pm

I had my first of three scheduled consultations about getting LASIK or some other form of eye correction and I didn't think it went that well. I didn't get to see the doctor (redacted). I'm in Houston btw. Basically, the assistant handled all the prescreening and questions by more or less just playing a video simulating what the LASIK laser does. Is it normal for them to say that they can gaurantee 20/20 vision or better? Also, the assistant never mentioned what laser would be used. It might be my fault but I didn't ask which laser would be used because I didn't think of it at the time. She did offer the information that the laser was "one of 5 used in the nation and was personally designed by Dr. redacted". Basically, the assistant thought I was a perfect candidate for LASIK eye surgery and could be corrected to 20/20 or better in 1 treatment. Additional treatments were $300 each.

I'm just looking to get another opinion here...
My current prescription is
OD -2.75 x -1.00 x 008
OS -0.75 x -4.50 x 176
right eye dominant

I guess I'm a bit turned off because everything I've read says that I have high astigmatism and I've been told this throughout my teen years. I even looked at the laser guidelines in some of the older posts and found that only one particular laser was approved to do custom LASIK by the FDA. What does this mean for me if I were to elect to have custom done over standard? Also after that consulation, aren't they supposed to determine if custom versus standard LASIK is a better choice?
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Postby LasikExpert » Fri Sep 08, 2006 8:15 pm

You have enormous astigmatism in your left eye. It is possible, but this amount of astigmatism will not be simple or easy to correct. It is reasonable to expect that the majority of the astigmatism could be corrected with the initial surgery, but you would very possibly need additional surgery to "fine tune" the correction.

Another reason your astigmatism is difficult and enhancement surgery is likely is because of what is called "coupling". Due to the physics of laser assisted refractive surgery, there is an automatic correction of myopia (nearsighted, shortsighted) vision when astigmatism is corrected. The ratio is about 0.25-0.35 diopters of myopia correction for every 1.00 diopter of astigmatism corrected. With your very low myopia and very high astigmatism, you may be automatically overcorrected into hyperopia (farsighted, longsighted) vision.

There is some ability to counter the coupling, but it is limited. Simply put, you are not likely to be one of those 20-Minute Miracles you hear about. Your refractive surgery would be a process, not an event. That is not necessarily bad, if you are willing to accept the process.

It sounds like you really didn't have a medical evaluation, just an evaluation to determine if refractive surgery is possible based upon your prescription and personal interest. The doctor you mentioned (names are redacted) is respected in the ophthalmic community. I suspect that if you showed genuine interest that you would get a full evaluation and meet the doctor.

There is a Houston Lasik doctor who is certified by our organization that you may want to visit too. It is always a good idea to get multiple opinions.
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Postby Rix2357 » Tue Sep 12, 2006 12:24 am

Again, I'm just looking for another opinion.

After going through a few preops/screenings, I have basically confirmed that my astigmatism as well as a larger than normal pupil size may make the surgery more difficult to perform.

Also because each doctor I went to, specializes in using a different laser I wanted an opinion on which laser might be the best for my eyes which is (in first post):

OD -2.75 x -1.00 x 008
OS -0.75 x -4.50 x 176

Pupil Size (undialated but in very low light) ~ 7.5 mm and maybe larger under darker conditions

One preop doctor has recommended that I go with
left eye traditional lasik & right eye custom lasik
They use a Bausch & Lomb Laser for their surgeries and the reason for the left eye having traditional was because of the very high astigmatism and the right eye having custom because of .29% higher order aberrations in the right eye. They said they would do a 6mm treatment zone followed by a transition zone to 9mm. Also the doctor mentioned that to correct the left eye there was a 45% chance of retreatment because of the high astigmatism. Also due to the left eye having very high astigmatism, custom lasik wasn't recommended.


Another preop doctor recommended that I do both eyes custom lasik. He specialized in using the Visx laser. The reasoning for using custom Lasik was because of my abnormally large pupil size. Supposedly, his laser can do a 6mm treatment zone followed by a 9mm transition zone.

I'm just trying to get another opinion hopefully on someone who might know a variety of different laser types because I'm sure each doctor will say that his laser can perform the procedure and I do trust that they can. However, if doctor A specializes in laser X and can provide 90% chance of perfect vision vs. doctor B who specializes in laser Y and can provide 95% chance of perfect vision, I would be more preferential to doctor B.
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Postby LasikExpert » Tue Sep 12, 2006 9:12 am

It is nice that your doctors are confident in a good outcome, but they are also making it clear that you are not going to have an easy correction.

In my opinion, a conventional ablation for your left eye first does seem reasonable for two primary reasons. One is that astigmatism is a topographic problem and conventional is more about prescription determined topography ablation. The other reason is that you are very likely going to need enhancement surgery. If you decide to have an enhancement, it could probably be wavefront-guided for the "fine tuning".

It is important to keep in mind that the most you can expect from refractive surgery is a reduced need for corrective lenses. To achieve that convenience, you will need to accept some risk.

Your doctors have made it clear that you have an elevated risk of needing multiple surgeries for your left eye. Your relatively large pupils are another potential risk factor. The very high astigmatism combined with pupils is a compounding risk factor. I'm very much on the conservative side, so it seems like a lot of risk for the convience of a reduced need for corrective lenses. Of course, I have no idea how big a nusiance contacts and/or glasses may be for you.

Regarding the two lasers; I don't know of any studies of either laser that would specifically indicate one is better for the high astigmatism than the other.
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USAEyes

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Lasik Doctor Certification

I am not a doctor.
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Postby maxxed » Tue Sep 19, 2006 2:19 am

Excimer lasers correct astigmatism by applying an oval shaped ablation pattern. (example 5.5 X 7 mm)

The optical zone of the oval pattern will vary depending on the manufacturer of the laser. It is the smaller of the two numbers that may affect your functional optical zone.

I think the Visx laser has a smaller eliptical optical zone then the flying spot lasers (Ladar, Alegretto B&L) but I don't recall the numbers offhand.
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