Very thin corneas, is ANY Laser surgery possible?

If you are thinking about having Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL eye surgery, this is the forum to research your concerns or ask your questions.

Very thin corneas, is ANY Laser surgery possible?

Postby Maestro_Ba » Mon Oct 23, 2006 11:42 pm

Hi there,

I'm 27 years old and my diopters are stable for more than 5 years. I wear soft daily contact lenses (3/4 days a week - everyday if I am on holidays), and I wear glasses the rest of the time.
About 5 years ago I developed an intolerance to contact lenses. That was due to wearing them ALL THE TIME (at that time I did not have glasses with the right diopters), sleeping with them, spending 24 hours in a row without taking them off, never using artificial tears, not having the necessary eye hygiene cares, ... I know, I was an very inconscient. To heal my eyes I spent 4 months without wearing lenses.
Two years ago my doctor told me to switch to daily lenses, since I still had some allergy on my eyes, and daily lenses are better for these cases (and they are thinner too).
Anyway, now I'm much more careful, but I sometime experience dry eyes when I wear lenses.

My diopters are:
(Glasses)
Left Eye: -6.50 Myopia 0.25 Astigmatism
Right Eye: -7.00 Myopia
(Contact Lenses)
Left Eye: -6.00 Myopia
Right Eye: -6.50 Myopia


So, 3 months ago I went to my doctor to see if a eye surgery was possible. I did an Orbscan Test, and the results for minimum cornea thickness were:
Left Eye: 428um
Right Eye: 442um
The pupil diameters were (although I don't know if these are the dilated pupil sizes):
Left Eye: 4.4mm
Right Eye: 4.3mm

With these results my doctor said Laser surgery could not be done, and that the only surgery I could do was putting phakic intraocular lenses (P-IOL). She didn't give me many details about the surgeries, and said I could find all the information I needed in the Internet, with much more details than she would give me. I was supposed to become informed about pros and cons and then make a decision by myself (choosing P-IOL or nothing).

Not that I found www.usaeyes.org I can see how poorly informed I was!
- I now know the only Laser surgery my doctor does is LASIC.
- I found out there could be alternatives (which I was not told about).
- I also learned that LASIC is not as problem-free as I supposed it was (however, all the people I know that had myopia correction had LASIC and didn't have any problem - until now).
- I also learned that a person is supposed to be without contact lenses for at least 1 week before doing the Orbscan Test! I did the test being only 2 days without them.


My questions are:
1 - Having such thin corneas, do you think that I could have an alternative laser surgery (LASEK/Epi-LASIC/Intra-LASIC)? I don't know if my diopters allow surface ablation surgery.
2 - Do you think that the Orbscan test may have been influenced by the small number of days I spent without contact lenses?
3 - Do you think that the misusing of contact lenses in my past had anything to do with my thin corneas?
4 - Do you think my doctor had a good procedure (not telling me there are other Laser surgeries beside LASIC)?
5 - Is P-IOL a "safe" surgery? Being so intrusive it scares me a lot more than any laser surgery. Do you have information about it's success rates comparing to Laser surgeries?


I have an appointment on the 15th of November with another doctor, one that does LASIC/LASEK/Epi-LASIC/Intra-LASIC surgeries. In the meantime, any advice would be very useful.
Thanks, and congratulations for the great web page & forum! (And sorry about all those questions...)

Maestro_Ba
Maestro_Ba
 
Posts: 2
Joined: Fri Oct 20, 2006 3:22 pm

Re: Very thin corneas, is ANY Laser surgery possible?

Postby LasikExpert » Tue Oct 24, 2006 1:12 am

Maestro_Ba wrote:1 - Having such thin corneas, do you think that I could have an alternative laser surgery (LASEK/Epi-LASIC/Intra-LASIC)? I don't know if my diopters allow surface ablation surgery.


The issue that is important is does the potential risk outweigh the potential benefit. It may be physically possible to have a surface ablation technique like PRK, LASEK, or Epi-Lasik, however you need to determine for yourself if the convenience of a reduced need for corrective lenses is worth the risk.

The risk of an unstable cornea after surface ablation does not seem to be exceptionally high. You would have about 340 microns of untouched cornea with a conventional laser ablation and a 6.0mm optical ablation zone. If your corneas are otherwise healthy, this may be determined appropriate by your doctor.

The risk of corneal haze may be elevated. This may be managed with the use of Mitomycin C during surgery, and/or taking 500mg of vitamin C twice a day for one week before surgery and at least two weeks after surgery. Discuss this issue with your doctor.

Maestro_Ba wrote:2 - Do you think that the Orbscan test may have been influenced by the small number of days I spent without contact lenses?


The topography of the Orbscan would probably be influenced by the recent use of contact lenses. The thickness measurement would probably be accurate.

Maestro_Ba wrote:3 - Do you think that the misusing of contact lenses in my past had anything to do with my thin corneas?


It is possible, but not highly probable. If you abused contact lens use so badly that you caused corneal thinning, you would probably have had more severe symptoms. This is something to discuss with your doctor who has examined your corneas.

Maestro_Ba wrote:4 - Do you think my doctor had a good procedure (not telling me there are other Laser surgeries beside LASIC)?


It is my opinion that all appropriate alternatives should be discussed with the patient, and the doctor make his or her recommendation based upon the patient's unique circumstances.

Maestro_Ba wrote:5 - Is P-IOL a "safe" surgery? Being so intrusive it scares me a lot more than any laser surgery. Do you have information about it's success rates comparing to Laser surgeries?


I do not personally consider a phakic intraocular lens (P-IOL) an appropriate alternative for someone your age with your level of myopia (nearsighted, shortsighted) vision. P-IOLs are rather invasive. In my opinion they are most appropriate for those with very high myopia and no other options. You have many options.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Posts: 3309
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Postby Maestro_Ba » Thu Nov 16, 2006 3:41 am

Hi there, again.

First of all, thanks LasikExpert for the quick answer. I delayed my answer until today because I went to an appointment with another doctor, in order to get a second opinion.

And this doctor said "I wouldn't touch your eyes with laser!" when he saw my minimum cornea thickness:
Left Eye: 428um
Right Eye: 442um

He said I have extremely thin corneas and therefore I do not apply to ANY laser surgery (Lasic/PRK/Lasec). He doesn't recommend laser surgeries in corneas below 500um.

He said however I am a perfect candidate for P-IOL.
According to him, I should put a IOL in the anterior chamber (in front of the iris), because it's an easier procedure and the lens put behind the iris (Visian ICL) may cause cataracts. My ACDs (anterior chamber depths) are more than sufficient for this kind of procedure:
Left Eye: 3.37mm
Right Eye: 3.41mm

This doctor did not recommend the Artisan lenses, but instead the newer Artiflex lenses (http://www.ophtec.com). Apparently these new lenses only correct myopia (not astigmatism) but they are foldable, and due to that they only need a small incision in the eye, and no stitches, resulting in a faster recovery. I believe this is very recent technology, I had never heard about it before.

He said Artiflex is the P-IOL method he prefers (and the one he does more), and that he only does Artisan if astigmatism correction is needed. He also does cataract surgery, but very rarely does P-IOL in the posterior chamber, as he doesn't like this method. He operates one eye at a time (with an interval of two weeks/one month), and with general anaesthesia!
He also warned me that being an invasive surgery, the risks are a bit higher than the risks of Laser surgery... However, when I asked how many people he had to re-operate due to lens movement, or because complications happened so the lens had to be removed, or how many cases he had of eye infection that could not be solved, he said ... "none"! And he does eye surgery for 20 years! However (quoting him), "It can happen. It's all in the books."
Also, apparently I do not need to do any more exams before the surgery (?!?!). Since I have already done a Tomographic Map of my eyes, a blood analysis is all that is needed, for the anaesthetist.

So, the only solution this doctor presented is the same as my previous doctor's, but putting Artiflex instead of Artisan.


I'm a little concerned because since I do not have such high myopia (-6.5, -7) it scares me a bit doing such a invasive surgery. I currently wear glasses most of the time, and despite the fact they are inaesthetic the lenses depth and aberrations they cause really annoy me. Unfortunately my eyes can't stand wearing contact lenses all day long, specially because I work staring at a computer 8 hours a day.

So, I need to make a decision in my near future:
- P-IOL
OR
- a new pair of glasses + many soft daily contact lenses?

My doubts:
1 - Which are the concerns I should have and the complications that may result from this operation? Any long-term effects?
2 - I'm concerned about eye infection or needing to take the lenses out of my eyes due to loss of endothelial cells. Do these symptoms occur often?
3 - I also know that if the correction isn't 100% accurate, I may have to do a posterior Laser surgery to obtain perfect vision (apparently my corneas can handle a small correction laser surgery). Is this likely to happen? Having 2 different surgeries in both my eyes is something that I really don't like thinking about...
4 - Do you think the statistics my doctor presented to me are liable? And to the fact that no further exams being needed? I just have to set the date whenever I make up my mind!
5 - What about sports? Will I be able to practice contact sports / sparring sports immediately after / a long time after surgery?

Any information will be precious to me, and important to my decision. I want to be perfectly aware of the complications/secondary effects that may happen, and the likeliness of their occurrence.

Thanks a lot!
Maestro_Ba
 
Posts: 2
Joined: Fri Oct 20, 2006 3:22 pm

Postby LasikExpert » Tue Nov 21, 2006 7:02 pm

Maestro_Ba wrote:1 - Which are the concerns I should have and the complications that may result from this operation? Any long-term effects?

Maestro_Ba wrote:2 - I'm concerned about eye infection or needing to take the lenses out of my eyes due to loss of endothelial cells. Do these symptoms occur often?


They occur, but relatively rarely. As the doctor said, the Artiflex lens is in front of the iris and is more accessible. This means implantation, repositioning, or removal is less likely to be traumatic to the natural lens and cause a cataract. It is more likely to dusrupt your endothelial cells, but your AC depth is within required guidelines and it sounds like your doctor is skilled with the Artiflex. He has not been implanting this type of lens for 20 years (they have not existed), but he may have been doing surgery for 20 years. An endothelial cell count should be peformed before surgery and regularly after implantation.

Maestro_Ba wrote:3 - I also know that if the correction isn't 100% accurate, I may have to do a posterior Laser surgery to obtain perfect vision (apparently my corneas can handle a small correction laser surgery). Is this likely to happen? Having 2 different surgeries in both my eyes is something that I really don't like thinking about...


A surface ablation laser technique like PRK or LASEK to resolve residual refractive error is considered safe and effective. Any preoperative astigmatism will remain, so you may want to wear a pair of contacts that only correct your sphere. This will give you a real world example of what vision may be after P-IOL surgery.

Maestro_Ba wrote:4 - Do you think the statistics my doctor presented to me are liable? And to the fact that no further exams being needed? I just have to set the date whenever I make up my mind!


Your doctor has already measured the AC depth. Other than an endothelial count, all tests required would have probably been performed during your comprehensive examination.

The doctor may not have had an unresolved infection, but there is no way every patient has been perfect. Cataract surgery - what the doctor has probably been doing those 20 years - is successful, but being within 0.50 diopters of target is considered a success. That may be a big improvement for someone with vision degraded by pathology, but you have clear vision with glasses. What the doctor consideres "success" and what the patient expects may be very different. You need to talk this over with your doctor in great detail.

Maestro_Ba wrote:5 - What about sports? Will I be able to practice contact sports / sparring sports immediately after / a long time after surgery?


Trauma to the eye always needs to be avoided. Wear sport glasses and protection. If you do have severe trauma to the eye, the lens may cause damage. That would probably take a lot of trauma and directly to the eye. Discuss your probable sport activities with your doctor.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


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