Lasik Advice

[ste71m]

Thanks for this great forum so rich of usefeul informations.
I’m 39 yo and have myopia (-5.5) and astigmatism (+0.5) on both eyes.
My glasses are ‘lighter’about -4.5+0.5 and I can see quite well
I work as software developer and usually spend 8-9 hours daily in front of a computer . Near sight is very important to me.

1)Given my age, I don’t want to leave my glasses just to switch to reading ones, I think that risks of an operation don’t worth while. Would you suggest me an undercorrection (ie same amount of my glasses) to avoid presbyopia? Or to wait some years to see if and how presbyopia occur?

2)I’m very concerned about HOA and night vision problems. I read that Schwind Amaris has an ablation profile called ‘aberration free’ that should reduce HOA (http://r-optics.ru/products/media/downl ... 4-2008.pdf)
Is it a good laser? Anyone had lasik with it? Or is it just hype?

3) Finally since I prefer to avoid flap complications, I would eventually choose Lasek or Epi-lasik. The fact that no flap is created can help to reduce HOA and night vision problems?

[LasikExpert]

Thank you for your kind words.

1)Given my age, I don’t want to leave my glasses just to switch to reading ones, I think that risks of an operation don’t worth while. Would you suggest me an undercorrection (ie same amount of my glasses) to avoid presbyopia? Or to wait some years to see if and how presbyopia occur?

It appears that you have a satisfactory history with undercorrection and that probably should be the target for laser vision correction.

2)I’m very concerned about HOA and night vision problems. I read that Schwind Amaris has an ablation profile called ‘aberration free’ that should reduce HOA (http://r-optics.ru/products/media/downl ... 4-2008.pdf)
Is it a good laser? Anyone had lasik with it? Or is it just hype?

As a general rule, all laser vision correction surgery induces some higher order aberrations (HOA). Not always, and sometimes it can go down, but much depends upon your HOAs before surgery. You may be so low that an increase would put you up to "normal" vision. You need a comprehensive evaluation from a competent surgeon to know your options. Focus on the quality of your surgeon. Keep in mind that no amount of technology will compensate for an inferior surgeon.

3) Finally since I prefer to avoid flap complications, I would eventually choose Lasek or Epi-lasik. The fact that no flap is created can help to reduce HOA and night vision problems?

In my opinion (I am not a doctor), Lasek and Epi-Lasik are so much expensive luggage. Straight PRK will provide the same results without the fluctuation in vision quality during the first several weeks that is often associated with Lasek and Epi-Lasik. Discuss PRK with your surgeon.

[ste71m]

Thanks very much
i will ask a competant surgeon a deep analysis of my eyes

[ToolBoy]

To be quite honest, as a very left-brained person, I would analyze life and discern what hobbies I had that require distance sight. What are your hobbies that require 20/20 vision without glasses?

The bottom line is that I hear too much about Lasik sometimes, and if most of your life revolves around close vision, I would always think twice.

The only reason I respond like I do, is that I know what a software developer does, to about a 99% extent, and usually those individuals who spend much time behind a computer are better off keeping the myopia if it hasn't affected life to any large extent.

In my estimation, irrespective of what my outcome was, of what I consider very very good, you are going to lose a bit of close vision capability. You may want to understand what it is in your life that would benefit from not wearing or having to search for glasses.

I have been considering the psychological, and unless you really have hobbies that could benefit without searching for your glasses in the morning, think about it wholeheartedly. I find that left-brained thinkers that spend much of their time in a close vision (myopic) atmosphere, without other reasoning as to why Lasik would benefit, do not end up as satisfied as people who are extremely physically active. JMHO.

[ste71m]

Toolboy thanks for your advice
There is no special reason to quit glasses, just a little tired of it and of contacts too
It's a little annoying to switch from glasses to contacts especially when doing sports like jogging.
And most important since i'm 39 i'm afraid that i will need another pair of glasses for presbyopia. And a little vanity too lol
I'm thinking quite well about it and i'm quite scared about outcomes and complications.
Probably i will ask a medical evaluation of my eyes but you know..surgeon can tell you you are a perfect candidate just to make money and in this forum i read of perfect candidates withh poor outcomes

[ste71m]

Today i saw a surgeon and had corneal topography
here are my exact numbers
Pupils in low light: 5 mm
Left Eye
-5.25 myopia -1.25 astigmatism
Mean pupil=2.734 mm
(BFS) best fit sphere =45.27D
(BFC) best fit cylinder =0.72D
(TI)topographic irregularity =0.42D

Right Eye
-5.50 myopia -0.25 astigmatism
Mean pupil=2.925 mm
(BFS) best fit sphere =45.71D
(BFC) best fit cylinder =0.87D
(TI)topographic irregularity =0.24D

Can someone explain me these parameters in simple words and shed a light about possible HOA?
I'm quite happy about pupil seize but have no idea about other parameters
Surgeon said i have 97% chance to completely correct my vision and given my eyes low possibilities to suffer from HOA
Thanks

[PRKorIntacs]

You have a similar prescription to my -4.5 and -5 myopia. You may want to read into Intacs as another possible option. It's something im considering myself. Yes ill be around -2 after Intacs but like you, I also spend most of my time on the computer and currently wear -3.5 glasses except when I go out of the house. I of course can still wear -2 glasses for distance after Intacs and not need glasses the rest of the time, not even reading glasses. I made a thread about the advantages of Intacs over lasik/prk.

[ste71m]

First of all i wanna thanks this forum and especially Glenn
I had lasek yesterday on my left eye, righ is scheduled for next week.
I was targeting an undercorrection of -0.5 D but my surgeon preferred to go for a -0.25 and leave some astigmatism
I will not describe every steps since there are so many excellent posts here. Procedure is very similar to the ones described with some small differences (they didn't gave me valium before the surgery and i will have first check after one week when contact will be removed and i will do the oher eye)
What was most amazing for me is..no pain at all. And right after surgery i watched my eye and it wasn't red and looked normal. Just a little pain and discomfort after 1 hour when effect of numb drops disappear. Too early to judge outcome but i can see much better then in the other eye that had no surgery and this makes me hope for the best.
Now it's difficult because of imbalance between my eyes, most of the time i wear no glasses and now for writing i have a patch on my eye and glasses over.
I have one more question for Glenn
I always had undercorrected glasses.Many thinks that you are fully corrected your eyes have to accomodate more making myopia worse.
What do you think about this? And would you suggest me to use reading glasses when working at pc even if i have no reading problems

[PRKorIntacs]

Hi ste71m,

See my reply to you above. Guess you decided on lasek over Intacs. What's your new prescription in the treated eye? I see your surgeon wasn't keen on an undercorrection. I would want a -1 undercorrection myself and ignore any slight astigmatism I have(even my glasses don't correct for it, makes no difference) I don't want to need reading glasses for near(40cm) or intermediate(80cm) but I am fine with occasional use of very thin glasses for distance. How well do you see from near?

[ste71m]

I asked for a slight undercorrection because
1) I'm just 39
2) When full corrected with contacts i have a good near vision
3) After laser there can be a slight regression

My glasses were -1D and that was too much for me so i decided my target was about -0.5/-0.25
Targetting -1D undercorrection it's a little dangerous for me, if you end up -1.5D you could need glasses all the time
And also here in Italy -1D it's the limit to drive without lenses
So far (day 2 post op) my vision is blurred but i'm writing now without glasses and close vision seems as good as before
After all it's a swap, you choose how much of good far sight you wanna loose for near sight and it's very personal
I prefer to have good vision when i have to drive and eventually wear reading glasses when working at pc, but it's very personal

[LasikExpert]

Thank you for your kind expression of gratitude for my assistance.

LASEK does not have a linear vision recovery pattern. That is, you don't just go from bad to good. You start sort-of okay, get a bit better, go really bad, and then continue to get better until vision changes are complete. Be patient with LASEK.

[PRKorIntacs]

I asked for a slight undercorrection because
1) I'm just 39
2) When full corrected with contacts i have a good near vision
3) After laser there can be a slight regression

My glasses were -1D and that was too much for me so i decided my target was about -0.5/-0.25
Targetting -1D undercorrection it's a little dangerous for me, if you end up -1.5D you could need glasses all the time
And also here in Italy -1D it's the limit to drive without lenses
So far (day 2 post op) my vision is blurred but i'm writing now without glasses and close vision seems as good as before
After all it's a swap, you choose how much of good far sight you wanna loose for near sight and it's very personal
I prefer to have good vision when i have to drive and eventually wear reading glasses when working at pc, but it's very personal

You probably have better accomodation than me and im only 28. I have tried full power contact lenses(can't tolerate them for long, only to try) and was surprised how blurry things were from near. I could see perfect at distance but not near. I then tried contact lenses that undercorrect me by about -1.5 and I am much happier. Yes things in the distance are a little blurry but I can still see quite well at distance, yet I can see quite well at near so it's the best compromise. My glasses are also -1d undercorrection and I see perfectly clear as I type this. I would target a -1d if I go the PRK route instead of Intacs. I will be fine ending at -1.5 or even -2, it will just keep me out of reading glasses. I am fine needing glasses for distance. I spend 75% of my time using my eyes for near and only 25% for distance so yea. Intacs should get me to about a -2 which will reduce my dependancy on glasses by 75%. You are right, it's a personal decision. I don't like driving so I don't mind much not having perfect distance vision. Most people I hear of choose distance, the risk is being overcorrected. It's another reason im choosing an undercorrection if I go with PRK.

[ste71m]

If you are happy with lenses -1.5 D that should be probably your target
You are young, i think you have 15 years to go before presbyopia so i wouldn't worry too much about that
I know it's a very difficult choice, i thought about it many days
You are right if you end -1D probably won't need reading glasses in future, at least until your presbyopia is less than that (my father is 60 yo and needs 2D reading glasses. So if he was -1D i guess he would need them anyway, just 1D)
I'm at day 5 post op so my vision is far from optimal but i can say this. When comparing very close vision (since i've done just 1 eye) let's say from my nose to 5 cm my miopic eye sees sharper. Don't know if this is because of myopia or because other eye is far from being healed.
Probably in 4-5 years i would need reading glasses and since i work at pc most of the time i will need them most of the time.
Anyway before i needed them all of the time so i will be less dependent on glasses
Good luck

[PRKorIntacs]

My top choice is Intacs, I am honestly surprised why Intacs isn't done far more often, especially for those low myopes. I have a bunch of questions about Intacs which I posted in a thread on this forum. Ill also be asking the Intacs center about Intacs. VS PRK. My presbyopia isn't that bad yet but itll get much worse by the time im 40. I tested a few years ago at 20/40 near vision(16 inch) with distance glasses. Intacs should take my -5 myopia to -2 which would avoid the need for readers entirely. PRK could get me to -1 or even plano but this would not be as good as -2 in terms of reducing dependancy on glasses, plus Intacs has many other advantages over PRK from what ive read. Being plano is certainly better than -5 but being a low myope is better than plano for my needs. Besides, Intacs can't correct all of my -5 and PRK sounds alot riskier from what ive read than Intacs.