Am I crazy (or stupid!) to do this? Suitable candidate?

[browneyedgirl70]

I know this is long, but I would really appreciate anyone reading and giving opinions!

I ride horses, and would like to be free of glasses/contacts when riding. I have been to different doctors and have received conflicting opinions.

I am a 39 yo female. Some exam stats:
Manifest Refraction Spectacle Plane:
OD: -9.25 -1.50 x 92 (Wavescan OD: -7.36 -1.37 x 10)
OS: -8.50 -1.75 x 80 (Wavescan OS: -6.61 -1.46 x 177)
Pupil: 8.2mm per Wavescan
Pachymetry (Pentacam) 490 microns OD, 499 microns OS
Schirmers: 13 OD, 14 OS

Opinion #1
Local reputable eye center, free evaluation performed by a tech. After the tech consulted with the doctor it was recommended that I would be a candidate for ICL's, but must wait for FDA toric approval. The tech stated that Lasik would result in corneal transplants down the road.

Opinion #2
Local reputable university eye center.
After a 1 hour comprehensive exam, the surgeon felt I would be a suitable candidate for either LASIK or PRK, my choice. Surgery was actually scheduled for 3-4-10, and they said I could let them know when I got there which procedure I would prefer. I told him that opinion #1 had said my corneas were too thin, and he seemed unconcerned.

Opinion #3
Another reputable university eye center.
After a 2 hour comprehensive exam the surgeon needed the Pentacam scan from their main campus before making approval for LASEK. After receiving the scan results, the surgeon did not feel that I would be a good candidate, stating that I would have good initial results, but 6 to 12 months out I would probably regress and would then only be a candidate for hard contacts. It sounds like he actually means that I would develop ectasia? I told the tech who called me back about opinion #2, not mentioning who/where it was. Before the conversation was over she actually suggested I get another opinion, and recommended opinion #2! I told her that is where I went. After talking with the surgeon again, the recommendation was that if I still want to pursue correction there were other options, and that I should have a comprehensive corneal consult with the chief surgeon at their main campus to be evaluated for ICL's. When I questioned the receptionist about my astigmatism she seemed to think it would not be an issue in regards to needing an additional laser procedure or waiting for toric ICL approval (of course pending evaluation by the surgeon.)

I went for the consult with the chief of the department. I thought I was there for a P-IOL (ICL) consultation. They repeated every measurement that their branch campus office did, with the exception of dilating my eyes. I brought the records from the first university, and of course they had the records from their branch campus office. Then the surgeon came in with his resident entourage and asked me a series of questions: Family history of sleep apnea? CPAP usage? Do *I* have sleep apnea? Do I rub my eyes, and demonstrate how?

After this the surgeon, talking to the residents, explained how giving the patient the choice of procedures confused them. I am thinking that no, what FREAKED ME OUT was one surgeon approving me, and another declining me stating that serious complications would occur.

Next the surgeon told me I was a good candidate for thin flap lasik! I was SO not expecting that! He is very confidante, and very qualified, but I was not expecting that based upon what the other surgeon at the same university had said!

I really want vision correction surgery, but of course I want a good long term outcome. It is still stressing me some that three reputable university surgeons are giving me differing opinions.

Am I crazy for continuing to surgery? I am scheduled for next Tuesday, March 16, 2010 with the chief surgeon at the main campus of the second university.

Thanks in advance for any input!

[PRKorIntacs]

If you get surgery at all, don't get lasik, your corneas are too thin for the amount of tissue that will be removed. Were you told that your huge pupils will result in seeing poorly at night, especially if you don't get an 8mm optical zone(may not be possible anyway unless you can accept an undercorrection) also youll need reading glasses unless you get an undercorrection(I know I am) You also may want to get it done in one eye at a time because you are a contact lens wearer. Youll never be able to wear glasses, however due to aniseikonia.

[browneyedgirl70]

Thanks for your response.

I was wondering about the lasik choice because of my thin corneas. At the first place I was going to choose PRK. This last surgeon didn't give me a choice, but I am going to ask questions again.

I was not told that I would have poor night vision. Since I obtained my records from the first surgeon, I know they measured my pupils at 6mm and 7mm, and were planning a 6mm zone. I am not sure why the difference in measurements, both were taken in low light.

I wondered how long I might have before reading glasses. That was going to be another of my questions. I think an undercorrection is likely anyway due to my high prescription?

Why one eye at a time due to contact lens wear? Also, I didn't include that I have been out of my contacts since Jan. 23rd.

I had never heard the term aniseikonia, and I just googled it. How do you know I will have it?

I just wanted to get out of corrective lenses, especially for horseback riding/sports. It's not so easy, is it?

[PRKorIntacs]

I understand your desires, I want PRK or Intacs myself so I can reduce my dependancy on glasses. Please see my threads on this in the forum. May I ask if you can no longer tolerate contact lenses? I never could, if I did, id be wearing contacts like you did.

Your cornea is 490. Assuming a very thin flap of 100 and removing another 100 to 130 microns by laser, your cornea will be 260 to 290. This is below 300 and your Opinion #1 fears youll develop ectasia and need cornea transplants. Thus you are right to be worried. I would never want lasik on myself either, PRK is safer in many ways, such as no flap to worry about for life.

If you go the ICL route, you can only wear them for around 10 years before they must be removed due to endothelial cell loss. Im guessing this is one reason ICLs aren't alot more popular. I thought about ICLs myself but PRK would be safer for my -5 myopia. You are almost -8 in your worse eye.

There's IOLs, also known as clear lens exchange. You will lose any accomodation you still have left and unless you ask to be undercorrected, youll need reading glasses for everything at close range. At least youll never have to worry about cataracts. If I don't get PRK by the time im 40-45, I may consider IOLs to both improve my vision(im asking for a -1.5d undercorrection) plus to insure ill never get cataracts in my life.

Intacs won't be of any use for you as they correct an average of -2.75d for the 350 segments. They will correct me to about a -2 which is decent for good near vision and ill only need a thin pair of distance glasses to be worn occasionally, but won't need reading glasses due to presbyopia.

PRK is FDA approved to treat up to -7. You may need to sign waivers to treat your myopia should you decide for a full distance correction instead of asking for around -1.5d undercorrection to keep you out of reading glasses and greatly reduce the risk of overcorrection. I am asking to be -1.5 after PRK for this reason. I also plan to only do one eye at a time, starting with -2d correction each time. Ill be looking to get PRK twice on each eye. You could consider getting your -7.75 eye to -5.75(give or take a diopter) then wait 3 months to allow healing then if you are happy, you can get PRK again in both eyes. If you are unhappy, don't get PRK again in either eye. Youll be able to go back to glasses and not have aniseikonia. Yes, it's not easy to correct your prescription. Look up big pupils and night vision. I am getting an 8mm zone but in your case, youll only be able to correct about half your myopia with the 8mm zone. Have realistic expectations and enjoy a reduced dependancy on glasses.

Print this out and show those options to your doctor on the 16th. Good luck on your choice and share your experience here.

[browneyedgirl70]

Thank you for all of this good information. I have also wanted to "fix" my eyes since getting glasses at 10 years old. I think I have an above average dislike of them! I have been able to wear contacts, but honestly I would like to be free of the hassle. I am very strict with them, which is probably why I have never had a corneal abrasion or infection of any kind. I would also love to be able to go swimming and see!

I am going to take this information to my doctor and ask lots more questions. Thanks so much!

[PRKorIntacs]

How was your appointment? What answers did the doctor say? As to contacts, what kinds of hassles are there? My sister and mom love contacts and say it only takes a couple minutes out of the day to insert/remove them. How much discomfort do they cause? If I could tolerate contacts, id be wearing them instead of glasses. They dry and irritate my eyes. I went to an optometrist who looked in my eyes and said I would never tolerate contacts. I kinda envy those who can, they get guaranteed 20/20 vision with less cost and risk than laser surgery.

[browneyedgirl70]

It is true that contacts only take a couple of minutes to insert. When taking them out, you are supposed to rub them in your palm with the multi-solution to clean them, but at the end of a long day I usually didn't want to take even that couple of extra minutes. Sad but true. So when I got the disposable contacts that you wear for two weeks and throw out, I didn't bother to clean them and would just throw them into the disinfecting solution. Bad me, but I suspect I am not the only one doing that, and I also suspect that in general I took better care of my contacts than a large percentage of people do. Also, in general I would NOT do things like wearing them swimming. I KNOW other people do, in fact my brother-in-law just told me at Christmas that he wears his contacts swimming all the time and just wears goggles. Since I have the disposable ones I must admit that I did try that with a pair that I threw away after that wearing. I didn't want to take the chance of holding chlorine, etc. that was picked up by the contact against my cornea! Things like that is how people get into such trouble with contacts though, and I was going downhill. Like I said, I have never had a corneal abrasion or infection, and I didn't want to start going down that road.

I also was continually afraid that I would lose a contact, and an experience last fall just drove that point home. I had taken my horse along with two friends and their horses to a park 2.5 hours from home to ride. It started drizzling rain on the way there, but we had already paid for the ride so we continued. During the ride it rained, but I always wear my helmet and that protected my face from the rain. After the ride we were getting ready to load the horses back on the trailer, and the bottom fell out. I still had to handle my horse and get him loaded, and by the time I could get to my truck to get a towel my contacts were literally floating in my eyes from the rain poring down my face. I very nearly lost both of my contacts before I could get the water stopped. It really scared me, because I was the only driver that could handle my big truck and trailer loaded with three horses in the mountains. I really don't know what we would have done if I had become incapacitated by losing my contacts. So that experience meant that I started having to remember to carry my glasses along everywhere I went.

I never could figure out how to better tolerate my glasses when riding, exercising, or playing sports. They are so heavy, and they continually slide down my nose. This necessitates my pushing them back into place, only to have them slide right back down. It was more than a matter of looks or how they felt, because they would actually fall off my face if not checked. Also, when riding a horse it is very disruptive to both horse and rider, and to any kind of performance, to continually have to shift one rein to the other hand to push glasses back into place and then recover contact with the horse again. I know other people manage, but *I* never figured it out no matter how many times the darn things were adjusted.

So I went to my appointment very nervous, and with a long list of questions. I am very confident in my surgeon's qualifications, but the words of the surgeon who had turned me down kept echoing through my head. My correction with contacts or glasses has always been good, and this is perhaps THE most elective procedure there is.

Well, he answered every question I had, and he answered the majority of them before I even had to ask them! I went to Dr. [redacted] at the [University Affiliated] Eye center. He is one of the most experienced Lasik surgeons in his field, and has done well over 10,000 Lasik procedures to date. He has been teaching refractive surgeons for over 17 years, and is nationally and internationally recognized for his work in the prevention and management of surgical complications. I felt as comfortable as I could going into such a totally elective procedure...and I decided to proceed with the surgery. So I guess the rest of this post should go into the "Just Had It" section of the forum! So far so good!

Dr. [redacted]did say that should I need an enhancement I will most likely have to have PRK because my corneas are thin. I also did know for sure going into surgery that he was going to measure the flap and stromal bed before applying the laser! He also said that he was aiming to undercorrect me just a bit in my non-dominant right eye. Since I am 39 and not yet presbyopic, there was no discussion of true monovision, but he said that by undercorrecting my right eye just a bit I would still have good distance vision, but rather than needing readers in say 5 to 6 years that could be pushed back to say 8 to 10 years. That sounded good to me!

Note: Doctor and clinic name redacted.

[PRKorIntacs]

I was wondering where you went, I was worried you had a bad outcome and couldn't see the computer. I am glad you are doing well. I read many horror stories and talked to people with both good and bad outcomes. Those with bad outcomes warn me and everyone else away from any laser surgery. They say everyone should wear glasses forever because it's in their best interest. 6 million people(just in America) disagree. I am doing lots of research and have a PRK consultation on the 25th.

1. I heard about daily disposable contact lenses you wear for one day then simply toss them in the trash. You wear another pair the next day and so on. The cost is higher for a box of them but no worries about cleaning them and less risk of infection from improperly cleaned contacts. Did you ever sleep in your contacts? I know people who do for 1-4 weeks without removing them. They are asking for big trouble down the road. I had looked into orthoK but the risks of sleeping in them made it no safer than PRK anyway. Also I can't even tolerate regular contacts, doubt id be able to tolerate orthoK contacts either. My cousin got an infection 3 times with contacts and also can't tolerate contacts. She's scared of the risks of lasik but hates her glasses.

2. Couldn't you have tied your glasses to your face or use prescription goggles? Regardless, those are good reasons for you wanting to reduce your dependancy on glasses. Ill present my own reasons here and to the surgeon. I hate how blurry my vision is without glasses and hate the inconvinences of glasses, although I can tolerate glasses.

3. I am surprised you got lasik instead of PRK. I thought you weren't a candidate for lasik due to thin corneas? One of your doctors warned you that youd need cornea transplants down the road with lasik because your cornea would be less than 300 microns after lasik. Even with my 550 microns of cornea, I am getting PRK instead of lasik. That and I don't want to risk any flap complications.

4. Your 20/25 and 20/30 vision lets you see without glasses better than my 20/30 and 20/50 I see with glasses! One of the reasons im looking into PRK or Intacs is the possibility of improving my BCVA by taking care of my irregular astigmatism and HOAs. Ill find out what my odds of getting 20/20 *with* glasses are. Im not expecting nor do I want 20/20 without glasses as ill just trade for reading glasses. Like you, I am aiming for a small undercorrection of -1.5d. How undercorrected are you now?

5. How large was the optical and transition zone? I read of plenty of horror stories of people with pupils larger than the optical zone who see poorly at night. I am getting an 8mm optical zone to preserve as much night vision as possible.

Good luck as your eyes continue to heal. Hope you can answer some of my questions here:

viewtopic.php?f=1&t=2291

[browneyedgirl70]

Oops, sorry for the scare! I stayed in Durham the night of the surgery (1 1/2 hour drive each way) since I needed to be rechecked first thing the next morning, and didn't even plug in the computer. Since then I have just been taking it easy and letting my eyes heal even though I am not encountering any serious problems.

I re-read a couple of the posts here (- Nothing But Complications? viewtopic.php?f=2&t=754 and Lasik Results - US Survey of Lasik Patients viewtopic.php?f=1&t=2226 ) and really started thinking about how true it is that this forum and others like it really do present a skewed representation of Lasik complications. Of course, if you are in that 2% with complications that are severe or always problematic, then it becomes 100% for you. That is my fear, too, of course.

I am finding more and more that you really never hear from those with good outcomes! Just prior to my surgery I found out that one of my family care practitioners had Lasik in 2004 and has been very happy with it. The day after surgery I found out that another friend had it done 4 years ago and is very happy. In doing my own research I posted a question regarding lasik surgery and outcomes on two separate horse forums, and did not get one negative response.

You are good to do a lot of research, this is a big decision. Everyone has to weigh the benefits and risks for himself, and decide what risk is acceptable. I hope your consultation goes well...and please let us know how it goes?

1. Daily disposable contacts were never offered to me by any of my doctors ever as an option, and I did not pursue them due to cost. I figured the every two week variety was a good compromise. I NEVER slept in my contacts with ONE exception in my whole life. That was in 1995 when I went with my trainer to a 3 day horse show, and we were camping in her horse trailer. I did not want to have to worry with handling contacts that weekend, and chose to sleep in them. Thankfully I didn't have any problems.

2. I tried unsuccessfully throughout my life to somehow secure my glasses to my face. I can remember in 6th grade basketball using one of those lanyards that slip onto the legs of the glasses and then tightens behind the head. It did not really work very well. I also remember a teammate hitting me in the face with the basketball, breaking my glasses and cutting my face! I admit that I never tried prescription goggles, primarily due to cost. I suspect I would not have liked them either. My contacts were definitely better than my glasses when it came to riding or exercising. I am sorry you can't tolerate them.

3. Well one doctor (at the first university) unhesitatingly approved me for Lasik, using a microkeratome! When I started asking questions about my corneas being thin, he rattled off the numbers and calculations for my 490 micron cornea and said that he thought I would be fine, but then gave me the choice of having PRK instead.

I opted for a second opinion at the [University Affiliated] Eye Center branch near me. This is the surgeon who turned me down, and he did not present any other options. It was only when I told him that I had been examined by another doctor--and had been approved--that he recommended that I go to Dr. [redacted], the chief of the department at the main campus in Durham for a corneal consult for Phakic-IOLs (ICL's).

I did my research regarding Dr. [redacted] and his qualifications, and decided that he would be the deciding opinion. (He actually taught and mentored doctor 2!) I took my records from doctor 1, and of course the records from doctor 2 were sent to him. All the tests were repeated that day. Dr. [redacted] felt confident that I was a good candidate for thin-flap lasik, utilizing their technology that was not available to either of the other doctors. After much soul searching. research, and asking lots of questions I decided to go for it. (And now of course I hope that doctor 2 is NEVER proven right!!!)

4. I actually do not know how undercorrected I am right now. All I know is the 20/30 and 20/25 the day following surgery, using the eye chart. My refraction was not measured, and I did not think that necessary at that point anyway since my vision would still be fluctuating. I can tell it is fluctuating, too. Overall I am still very pleased at this point!

5. I do not know my optical or transition zones, but I would like to know and will ask when I go back. As you know my pupils are large (8.2 avg on wavescan), and my HOA's on wavescan were 5.0% OD and 3.9% OS. I am having some halos and starbursting at night, but it is not severe or disabling. I thought it would be dark when I drove home tonight, but it was more like dusk. I haven't been outside when it has been really dark since Saturday, but even then it was totally manageable.

So overall, my vision is not 100% spot on, but it is pretty darn good. It is still a bit hazy at times, things are fluctuating a bit, and my eyes feel tired more easily and are a bit dry at times. Considering that tomorrow will just be one week, though, I am pretty pleased so far!

I will read your post again, and hope that I can contribute something meaningful! Thank you for all of your comments/help on mine!

Note: Doctor and clinic names redacted.

[PRKorIntacs]

I updated my post. Haven't seen you for a while. How are things going with your vision?

[browneyedgirl70]

Hi again! I have been having some health challenges and not feeling well. I truly believe it is unrelated to my Lasik, even though the problem is dizziness, nausea, and headaches. I am also having some memory problems. I think it is my inner ear, which I am being treated for, and that the memory problems are due to a separate medication reaction. I am going to that doctor this afternoon. It is also possible that the dizziness and headache are due to this same medication. I believe it is unrelated to my Lasik because I had it some before my surgery. At that time I was treated for my inner ear (I had the dizziness, nausea, and pulsatile tinnitus too) and it cleared up prior to surgery with my finishing the treatment (pred) about three days prior to surgery. My surgeon knew about the treatment and cleared me for surgery. It returned about 2 days after surgery. Very disconcerting, I must admit. Thoughts?

I am also posting an update to my other post in Just Had It.

I still intend to sort through your post again (I actually have read it a few times.) You certainly have a lot of knowledge about all of this, and have done your research!

I just hope I don't regret my decision later down the road...that little worry is still there, but it is done now. The recent post in Just Had It about Corneal Ectasia...yikes. As of right now I am overall very pleased with my results, and hoping that the few issues I am having will clear up during this healing process.

BTW, Glenn, I am sorry for mentioning a specific doctor and clinic. I didn't see any guidelines, have seen some other posts do it, and thought it was OK since it was positive and not negative slander. It won't happen again!