BIG DOUBT PLS HELP

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.

BIG DOUBT PLS HELP

Postby decatur555 » Tue Nov 14, 2006 2:02 pm

We have a big problem, my girlfriend have vision problems since she was 7 years old. She always wanted to have surgery but she didn't have money, now she have money and she want to use the LASIK to see better than now, but we went to a doctor and she said she had a cataract in her right eye, she didn't want to make surgery before we confirm that the cataract was there when she was born. We went to other 2 doctors and both said it was there and it wasn't a problem for surgery, one of those doctors said that she will see better than now without correction (lens...), but the other said that she will see not good enough with the surgery because she had 40%right and 60%left of vision, but none of the other doctors told us before that problem; he also said that she will have cataracts when she'll be 35 (right now she is 28), and that she will loose more vision, right now she have 8.00 right & 7.25 left, and astigmatism of 1.75 each. What we can do, who told us the true, who¡s wrong, where in the US is the best place to have LASIK or whatever surgery she could have to have a better vision, the price won't be a problem, but we want to be sure. Thank you all
decatur555
 
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Postby LasikExpert » Tue Nov 14, 2006 8:52 pm

There are many reasons why your friend needs to proceed slowly and with great caution regarding any elective eye surgery. The information you provide is not quite complete, so I’ll try to make educated guesses to fill in the gaps.

Your friend is very myopic (nearsighted, shortsighted). Myopia is when the light entering the eye is focused in front of the retina, not on the retina as required for good vision.

Light entering the eye is bent (refracted) by the cornea (clear front of the eye) and the crystalline lens within the eye. Axial myopia is when the eye is elongated from the norm, causing the entering light to focus in front of the retina. Lenticular myopia is when the eye is of normal length, however the crystalline lens bends the light too much, causing the light to focus in front of the retina. Corneal myopia is when the length of the eye is normal, the crystalline lens is normal, but the cornea causes light to focus in front of the retina. These different causes for myopia are very important in your friend’s situation and I’m quite sure all are going to play a part in what is best for her.

A cataract simply means that the crystalline lens is cloudy. A cataract may form at the edge of the lens and not cause too much trouble, or can be central and cause a significant reduction of vision quality. As cataracts form, it is common for the shape of the crystalline lens change and induces myopia and/or astigmatism. This would be lenticular myopia and/or lenticular astigmatism.

From the information you provide, it appears that your girlfriend may have ambylopia due to congenital cataracts. Ambylopia is commonly when the visual function of the eye does not develop during the early years of life. In your friend’s case, the cataracts disturbed the quality and quantity of the light reaching the retina during the time the neural system of vision was learning to “see”. For this reason, your friend has low vision quality. If I am correct in my assumptions, the low vision quality is permanent and cannot be corrected with refractive surgery, however only a comprehensive examination from a competent surgeon can affirm my assumption.

Cataracts are resolved by the surgical removal of the crystalline lens and replacement with an artificial intraocular lens (IOL). The IOL would be of a power that would also resolve myopia. In your friend’s unique circumstance, cataract surgery may vastly improve the focus and the quantity of the light entering the eye (reducing the need for corrective lenses), but may not affect the quality of vision because of limitations induced by ambylopia. But even this has a caveat.

I usually tell people the most that can be achieved with refractive surgery is a reduced need for corrective lenses. Or another way to say this is that the best that can be expected is the same vision after surgery without glasses as vision before surgery with glasses. Your friend’s situation is a bit different. Cataract surgery will increase the quantity of light entering the eye. This would normally improve clarity and contrast sensitivity. The IOL used during cataract surgery would improve the focus of the light entering the eye. This would normally reduce the need for glasses or contact lenses. The great unknown in your friend’s situation is how much vision quality is reduced due to ambylopia, and that is not going to be known until after surgery.

To reiterate my points: low vision quality due to ambylopia cannot be corrected. Myopia may be corrected by the replacement of the crystalline lens and/or manipulation of the cornea such as Lasik. If your friend is amblyopic, then there are significant limitations on what can be achieved with surgery.

I concur with the doctor who stated that Lasik (or any other corneal refractive surgery) is not appropriate at this time. Your friend needs cataract surgery now or in the immediate future. That surgery will reduce her myopia, may reduce or astigmatism, and thereby reduce the need for corrective lenses. It is difficult to predict exactly how much vision limitation is due to axial myopia, lenticular myopia, lenticular astigmatism, corneal myopia, corneal astigmatism, cataracts, or ambylopia.

Cataract surgery should provide a valuable improvement, but how much and where is not going to be easily predicted. Because it is clear that cataract surgery must be performed relatively soon and that surgery will reduce her myopia, it does not make sense to do surgery on the cornea at this time. Your friend should have the cataract surgery first, let her vision settle, be re-evaluated, and then decide if a cornea-based surgery like Lasik is appropriate. It seems to me to be very counterproductive to have Lasik first.

Although it may appear that what your friend needs is immediate cataract surgery, this is not necessarily the case. If your friend's high myopia is due to axial length, then there is an increased risk of retinal detachment during cataract surgery. Detachment caused total blindness in the area of vision affected by the detachment.

Retinal detachment risk is increased because an elongated eye places a great amount of stress on the retina. What needs to be checked is if your friend's myopia is due to axial length or is due to the cataract. If the axial length is near normal, then cataract surgery now may be reasonable. If the axial length is high, then waiting until cataract surgery is absolutely necessary would probably be best.

I’ve tried to provide some detail for my logic, but the bottom line is that your friend should probably not have Lasik or any similar refractive eye surgery at this time. She needs cataract surgery, but when is a question that needs to take into consideration the risks and benefits of cataract surgery. After cataract surgery there may (emphasis on “may”) be some potential benefit to Lasik or similar surgery. The wild card in all of this is if your friend has ambylopia and how much it is affecting vision quality.

Please tell me where you are located and I will email to you directly a recommendation of a surgeon for evaluation.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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