hyperopic laser surgery

[isa]

hi
I am a 36 year old male with high hyperopia +4.25 with the eye drop
I am around +5.75 with 0.5 astigmatism. thinking of laser surgery.
is lasik better than lasek and what machine(allegreto, technolas 217 etc)
please any feedback will be appreciated.
thanks
isa

[PRKorIntacs]

You are way too hyperopic for a full correction. There will be lots of regression. You may be better off with IOLs and reading glasses. Discuss IOLs with your surgeon.

[Paul]

hi
I am a 36 year old male with high hyperopia +4.25 with the eye drop
I am around +5.75 with 0.5 astigmatism. thinking of laser surgery.
is lasik better than lasek and what machine(allegreto, technolas 217 etc)
please any feedback will be appreciated.
thanks
isa

My eyes were similar to yours - I suggest you read my story to date here viewtopic.php?f=2&t=2305

There is no harm in getting a consultation from a professional.

[PRKorIntacs]

hi
I am a 36 year old male with high hyperopia +4.25 with the eye drop
I am around +5.75 with 0.5 astigmatism. thinking of laser surgery.
is lasik better than lasek and what machine(allegreto, technolas 217 etc)
please any feedback will be appreciated.
thanks
isa

My eyes were similar to yours - I suggest you read my story to date here viewtopic.php?f=2&t=2305

There is no harm in getting a consultation from a professional.

He is a +5.75 which is much worse than yours. He can get a free consultation but no reputable center will even attempt a full correction of +5.75. They will probably recommend IOLs.

[isa]

thanx paul
I read your story I guess at 48 you are probably full presbyopic. and at +4.75 you are about 1 dioper less than
my prescription with the eye drop (+5.75).
at 36 I am wearing +4.25 glasses but the doctor says passed the age of 40 I will need bifocals and will get hit with
my full prescription(+5.75) ( presbyopia)
so I think even if lasik is possible, doctor has to take into consideration first the regression from the surgery and also the presbyopia.I guess they have to make me myopic first!
do you know what was ur prescription at 36 and how much it changed?
and what was ur pupil size and the optical zone used for the surgery?
how much was your astigmatism and how is your night vision right now?
I am very glad to hear from an hyperopic person like me because there is not too many of us
thanks again

[Paul]

Sorry, I can't remember my prescription from 12 years ago, I can barely remember last week!!

But I can tell you that I have worn glasses since about the age of 10. I stopped wearing them through my teens wherever possible - because that's what teenagers do. By age 30 I had to wear them for any reading or other stuff less than 2~3 meters and by age 36 I was wearing them full time - it was simply no longer possible to function without them. I was wearing varifocals for about the last 10 years.

Personally I didn't take note of my pupil size - sorry.

If you do find a clinic that can handle your eyes (and as mentioned above you may not) then for sure they will need to overcorrect you to myopia if there is any chance of getting close to plano.

I am only 3 weeks post op so I am still in the myopia stage - it is a strange experience being able to focus on my wristwatch. Sorry, I don't have my astigmatism figures to hand but from a practical level I can function very well at the moment except for night driving with tired eyes for which I use a pair of temporary -0.75 / -0.25 specs.

My eyes are definitely no perfect yet, I still have a long way to go - my doc was very up front about my chances of being glasses free (slim to zero) so my target is to be less dependent only. Even if the regression goes as planned, I will still need some fine tuning which I hope will reduce the astigmatism. And for sure, even if I get a perfect result (fingers crossed) then I will definitely need reading glasses.

Another possibility might be for you to try surgery as far as possible - bearing in mind that you will still be hyperopic with a reduced prescription. Apart from the general hassle of wearing glasses, I really didn't like how my last prescription made my eyes look larger, sort of like one of those creepy photos of pedophiles.

Aside from your prescription, there may well be other factors such as corneal thickness that prevents you from having surgery - so all of this discussion may be a moot point.

In your shoes, I would at least go for at least one or two independent consults, then you will know for sure what is and is not possible - nobody (as far as I know) on this forum is a qualified expert.

[isa]

thanx paul for all the info
thats true i dont like the way my eyes look with the glasses
if it is not too much trouble ask your doc what was your prescription BEFORE surgery WITH THE EYE DROP.
because I have seen a doctor and he did some tests (my cornea is 575 mikrons) which he told me I could do lasik
but with my prescription I am right at the border
I will keep my fingers cross for you and hope everything goes well

[PRKorIntacs]

which he told me I could do lasik but with my prescription I am right at the border

Are you fine with needing a thinner pair of glasses? I have read around and most hyperopes above a +4 will end up with +1 or +2 residual hyperopia. Youd need IOLs if you want a full correction. I won't be free of glasses either and know this. My -5 myopia can be fully corrected but I would be better off with a -1 undercorrection to avoid reading glasses.

http://bmctoday.net/crstoday/pdfs/CRST1109_02.pdf

Good read for you and others. I am letting you make your choice, if you want lasik, I respect this. I just want to inform you. Personally if I were +5.75 I would get IOLs for myself as results would be better.

[isa]

my cycloplegic prescription is +5.75. at 36 years old I am seeing through +4.25 pair of glasses that means I am acomodating 1.5 dioper.and probably could acomodate this figure till I hit presbyopia may be about 10 years. I dont mind if +1d is remained after lasik if I could accommodate it but my concern would be when I am older.
if I could do my daily activities such as playing tennis and driving WITH OUT glasses or contact lens wouldn t mind wearing glasses for reading or delecate work if that would be the case.
I like what Dr coleman said it is more accurate than just judjing by talking about prescription. and if I had your prescription -5 would do lasik right of way.
I would not consider lense exchange or(IOL). would do it when I have cataract hopefully when I am much older

[PRKorIntacs]

my cycloplegic prescription is +5.75. at 36 years old I am seeing through +4.25 pair of glasses that means I am acomodating 1.5 dioper.and probably could acomodate this figure till I hit presbyopia may be about 10 years. I dont mind if +1d is remained after lasik if I could accommodate it but my concern would be when I am older.
if I could do my daily activities such as playing tennis and driving WITH OUT glasses or contact lens wouldn t mind wearing glasses for reading or delecate work if that would be the case.
I like what Dr coleman said it is more accurate than just judjing by talking about prescription. and if I had your prescription -5 would do lasik right of way.
I would not consider lense exchange or(IOL). would do it when I have cataract hopefully when I am much older

You have +1.5d of latant hyperopia. Presbyopia starts at 40 for most people, some like me at much younger ages. Youll probably need reading glasses now since you are farsighted. Soon, your distance vision will start to blur once you can't accomodate for distance. You probably will need glasses to drive in a few years. How much blur could you tolerate? +1.5 diopters is about 20/80 vision. Your near vision will be far worse, of course, probably 20/400 uncorrected. You may want bifocals by then. Discuss ICLs and IOLs vs. lasik/prk with your doctor. In my case if I get PRK, I am aiming for a -1, maybe -1.5 to stay out of reading glasses. I am fine with needing glasses for driving(I hate driving anyway) and other occasional times. I spend most of my time on the computer and wear computer glasses most of the time.

[Mack]

Interesting discussion about hyperopic lasik and recovery.Those who have posted that most lasik centers will not do over +3 or +4 and advise doing IOL's for higher scripts have just not done enough research. Hi hyperopic lasik is getting better and there are specialists who know how to calculate the amount of expected regression and better handle astigmatism, which is always the wildcard. I was +3.75 and +5.25 iwth -1.5 astig in both eyes and had the procedure in 1999 by a hyperopic lasik specialist in VA. Like Paul, I was myopic for the first few months. After regression stabilized, I got enhancements at 6 months. After another 6 months, vision stabilized around plano but with +1.0 to +1.25 astig in both eyes. 4 years ago, I got CK (conductive keretoplasty) to correct that and it worked quite well. Vision has remained stable with perhaps +0.25 to +0.5 remaining astig, depending on lighting. In good light, vision is a solid 20/20. Many docs advised that CK would only be temporary and last about a year or so, but it has not changed at all in over 4 years. I did have a sharp 20/15 with correction pre-lasik, so I did lose one line of BCVA, but overall, I have been satisfied with the results.

[isa]

hi mack
thanx for the positive feed back
do you remember what your cycloplegic prescription in 1999 was? and how old r u?how is your night vision now?
I have talked to another doc who suggested to wait till I hit full presbyopia in about 5 years and do the surgery then
so I would not be myopic for a few month like your self and I guess have a faster recovery and may be no enhancement
but I like to be free of glasses and contact as soon as possible who would u suggest as an experienced surgen in hyperopia?
and where?

[vitaliny]

It depends on many factors. In some cases lasik is better in other cases - you should go for lasek. What is most important: there are cases when you SHOULD NOT make make any eye surgery

You should consult your doctor.

[Mack]

Isa....I recall my manifest and cyclopegic refractions were similar, since I was fully presbyopic in 1999 at age 53. The doc said my +2 add for bifocal pre-lasik at the time might gain another half diopter as I grew older and then level off, but that the distance hyperopia shouldnt change more than another quarter diopter. Since the procedure, enhancements and the CK, I continue to only use +1.5 for readers and only add higher + readers for really close detail work. Night vision does degrade a little compared to pre-lasik since my ablation area of treatment on 6 mm dark-adapted pupils with the VisX 2 laser could not produce wide enough full correction and still cover the 1.25 of astigmatism. So with lower light, more of the hyperopic error creeps in. Vision in bright sunlight is virtually as good as pre-lasik corrected.

If you are not yet into presbyopia, the issue of not having to over-correct so much to avoid temporary myopia does not really apply, IMHO. It's apples and oranges. Remember you are treating to achieve 20/20 distance vision, not for losing accomodation because of hardening lenses. With +4 and +5 patients, there is going to be a lot more regression than the lower scripts. It's just nature's way of fighting back to reclaim what the laser removed. I was intentionally over corrected by -1.5 D in both eyes to allow for that. The doc said that was by design for my age and for the amount of correction needed, and to enjoy the temporary clear close-up vision I had never ever had. I remember borrowing my brother's -1.25 glasses that helped with driving for the first few months and then I got an interim script at about 8 months as regression proceeded that was mostly + astig correction. It took well over a year for all the regressive changes to stabilize. The newer lasers and techniques might produce less regression with high hyperopes. That's something a hyperopic lasik specialist with years of experience would know best. The doc I used is now retired, so I wouldn't know who to recommend. Just do good research and interview all the lasik docs and treatment centers near you with the best reputations to find the one with the best hyperopic track-record for successful outcomes. There is as much art as science in this trade and there really is no substitute for experience.

Good luck!

[isa]

hi mack
thanx for all the usefull info
I will keep on researching and hopefully with the right surgen do the lasik surgery
thanks again