-4 astigmatism, doctors want to do LASEK, not LASIK

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-4 astigmatism, doctors want to do LASEK, not LASIK

Postby GeneralPatientInquiry » Sun Jun 04, 2006 5:15 am

I am considering laser surgery. I am a myopic (-6 myopic, -4 astigmatism).
I have had a pre-op check last Saturday. They said that my cornea has 573 micron thickness, which is more than average. My dilated pupil is 5.9 mm. They have to remove 136 microns of corneal tissue. The thickness of the epithelium to soften for LASEK is 50 to 60 microns. Thay said that I do not qualify for LASIK. I understand that. They also say that I hardly qualify for LASEK, which I do not understand. When I add up the figures, I get 377 to 387 microns of residual thickness. Elly
Veldhoven, Netherlands
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Postby LasikExpert » Sun Jun 04, 2006 5:21 am

Elly,

The reason the doctors are concerned with corneal thickness is due to the combination of myopia (nearsighted, shortsighted) vision and astigmatism. It takes more tissue to correct astigmatism and myopia than just myopia.

I believe that if your doctors used a laser microkeratome to create the LASIK flap, rather than a mechanical microkeratome, you may be able to have LASIK. This is called IntraLasik. The surface ablation techniques of PRK, LASEK, and Epi-LASIK tend to provide slightly better long-term outcomes than LASIK or IntraLasik, and are marginally safer.

I am concerned with your level of correction, but not for reasons related to cornea thickness.

Your astigmatism is very, very high. It is difficult to resolve this much astigmatism with a single surgery. It is very likely that after surgery you will still have some astigmatism and it will be enough to cause blurred vision in the day and ghosting or doubled vision in low light environments. It is probable that additional enhancement surgery will be required to attempt to correct the full astigmatism. Simply put, do not expect the "20-Minute Miracle". Your road to recovery will be longer than most and undoubtedly a bit rough.

Surface ablation techniques tend to cause late-onset corneal haze in patients with more than 6.00 diopters of correction. Although your myopia is at this level, the astigmatic portion of your correction will require additional tissue to be removed. LASEK tends to reduce the occurrence of haze, but there are two simple techniques you can do that have been shown to be very helpful.

Take 500mg of vitamin C twice a day for at least one week before surgery and at least two weeks after surgery, plus wear 100% UV protection sunglasses if you even think of going out in the daylight. This helps reduce the probability of corneal haze

The reason you are borderline for LASEK is because of the possibility of late onset haze. The reason you are borderline for LASIK is because the amount of tissue required to correct both astigmatism and myopia is significant in your case.

You may want to read:
LASEK
IntraLasik
Glenn Hagele
Volunteer Executive Director
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Lasik Doctor Certification

I am not a doctor.
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Postby GeneralPatientInquiry » Mon Jun 05, 2006 5:10 am

Dear Glenn,

Thanks again for the clear explanation. I decided to postpone refractive surgery because my doctor was worried too about the large amont of tissue that has to be removed. He is consulting his colleagues in The US and Belgium about the possibility of lens implants. My anterior chamber depth is low (2.6 mm). Do you know if there are suitable implants available for me ?

Best regards, Elly
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Postby LasikExpert » Mon Jun 05, 2006 5:15 am

Elly,

In the US, it has been determined that the Artisan/Verisyse phakic intraocular lens (P-IOL) requires at least 3.0mm of anterior chamber depth. The STAAR Implantable Contact Lens (ICL) may be a more appropriate option, but even this has limitations. See Phakic Intraocular Lenses (P-IOL). You may want to consider Refractive Lens Exchange (RLE).

At age 41 you probably still have some accommodation (ability to change focus from distance to near). RLE would probably eliminate accommodation completely. Your vision would be focused for distance and you would need reading glasses, or for near and you would need glasses to see items at a distance, or with monovision for a limited combination of distance and near vision.

It may be that due to your unique circumstances, refractive surgery simply is not wise.

Best of luck, whatever you decide.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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