So confused!

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.

So confused!

Postby janahawk » Sat May 19, 2007 9:31 pm

First, this is a really great website! Not total doom & gloom like others I have come across. In any event I'm so confused! :?

I was referred to a national chain (yikes) by two clients of mine. In checking out the Dr. I felt good about his credentials, etc so I made an appt. I was told I was not eligible for Lasik due to thin corneas. I didn't get as much info as I would have liked (didn't meet the dr) but I do know the corneal thickness is about 509 and one eye is -7.00 and the other -8.00 (which is way off what my contact rx is, but I guess that is normal???)

I went to another consult yesterday (dr is partner of a usaeyes.org certified dr). He told me that although my corneas were thin (low 500's) that I WAS lasik eligible (90% sure). So off the batt, that makes me nervous, I would have expected the assembly line type place to tell me that. I did ask about my pupil size and he said 7.5, now I don't know if that is normal or dim....he uses Intralase and Epi-lasik and told me it doesn't matter 'cause the laser can go up to 8mm (sorry, not sure of the proper term to use)

I've worn contacts 20+ years, 40 yo. Took my contacts out on Tues in anticipation of the consults and am still wearing glasses. A 1/06 RX for glasses indicated OD 6.25-0.25x005 OS -6.25-0.50x135. 9/04 RX indicated -6.25-0.50x003 and -6.25-0.75x155

Thoughts? I have two more consulations this coming week (one is a dr listed on this website, one is not).

Thanks in advance :)
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Postby ksoldan » Sat May 19, 2007 11:30 pm

HI

Did either Dr. talk to you about PRK? I had a higher prescription (-7.75 & -6.50) with somewhat thinner corneas for that high of a prescription. I think my readings were 550. I had 2 Dr. tell me I could do Lasik but the Dr. I went with told me I'd have a better outcome with PRK. I am 3 week out from having it and so far things are progressing nicely. I'm hoping when I go back for my next follow up I'll be @ 20/20 but at this time I don't think I'm there yet. Anyway, the recovery is more involved then Lasik but is manageable if you can plan to put things on hold for a few days.
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Re: So confused!

Postby LasikExpert » Sun May 20, 2007 12:02 am

janahawk wrote:First, this is a really great website! Not total doom & gloom like others I have come across. In any event I'm so confused! :?


Thank you for your kind words and I'm glad you are finding our information useful. We do try to be objective.

janahawk wrote:I was referred to a national chain (yikes) by two clients of mine. In checking out the Dr. I felt good about his credentials, etc so I made an appt.


Some people don't like the look and feel of the chains, but you can find good surgeons at chains and poor surgeons in private practice. That is one of the reasons we recommend focusing on the quality of the surgeon.

janahawk wrote:I was told I was not eligible for Lasik due to thin corneas. I didn't get as much info as I would have liked (didn't meet the dr) but I do know the corneal thickness is about 509 and one eye is -7.00 and the other -8.00 (which is way off what my contact rx is, but I guess that is normal???)


That is interestingly a lot higher than the prescription you quote later in this post. Contact lenses may be slightly lower prescription than glasses, but there seems to be a major difference. Perhaps this is not the measurement of refractive error, but another related number.

janahawk wrote:I went to another consult yesterday (dr is partner of a usaeyes.org certified dr). He told me that although my corneas were thin (low 500's) that I WAS lasik eligible (90% sure). So off the batt, that makes me nervous, I would have expected the assembly line type place to tell me that.


Whenever one doctor says yes and another says no, you want to determine why. Your chain doctor appears to have determined a much higher refractive error. That may be one of the reasons for rejection. It may be that the chain does not use a laser microkeratome. That could be another reason.

janahawk wrote:I did ask about my pupil size and he said 7.5, now I don't know if that is normal or dim....he uses Intralase and Epi-lasik and told me it doesn't matter 'cause the laser can go up to 8mm (sorry, not sure of the proper term to use)


It looks like the doctor measured your pupil size at 7.5mm. This may be the number to which your chain doctor referred above. You will want to read about Lasik pupil size issues. An issue that may (emphasis on may) be important is if the size of the fully corrected treatment is equal to or larger than your naturally dilated pupils in a low visible light environment. If that measurement was made with infrared light (such as the Colvard device), then actual dilation would be about 1.0mm smaller, or 6.5mm.

Intralase is a manufacturer of a femtosecond laser used for creating the Lasik flap. Although mechanical microkeratomes are able to make thin flaps, thinner flaps are very often associated with Intralase because of the greater accuracy of the laser microkeratome.

janahawk wrote:I've worn contacts 20+ years, 40 yo. Took my contacts out on Tues in anticipation of the consults and am still wearing glasses. A 1/06 RX for glasses indicated OD 6.25-0.25x005 OS -6.25-0.50x135. 9/04 RX indicated -6.25-0.50x003 and -6.25-0.75x155


If your refractive error has changed up to 7.00 or 8.00 in the last year, then you may have refractive error stability issues. Have you noticed a significant degradation in the quality of your corrected vision during the last year?

Fortunately these numbers can all be determined with reasonable accuracy before having surgery, but let's do some rough guestimates. It appears that the 509 number is reasonably accurate to your corneal thickness in microns.

If you are 6.25 diopters myopic (nearsighted, shortsighted) and the optical ablation zone is 6.0mm, then about 75 microns of tissue would be removed. You are at the edge of when regression would be likely, so add a few microns to deal with regression. The larger the optical ablation zone the greater the amount of tissue removed to effect the same refractive change. If you elect to have custom wavefront-guided ablation, then there will be even more tissue removed to get the same effect. The actual amount of tissue removal will probably be between 75 and 150 microns – most likely about 100 microns, but let's use the worst-case scenario of 150 microns.

Start with the 509 microns total corneal thickness, subtract a 100 micron thick flap, subtract 150 microns of tissue removal for refractive change, and you end up with 259 microns of untouched cornea. A healthy cornea will normally remain stable so long as 250 microns of tissue remains untouched. In our worst case scenario you just make it and with no margin for error. Lasik in this example is probably not wise.

In the better case scenario, start with 509, subtract 100 for the flap, subtract 75 microns of tissue removal, and you end up with 334, well above the 250 minimum and now Lasik seems like a more viable option.

The best case scenario (for purpose of untouched cornea) would be if you abandon Lasik or All-Laser Lasik and go for a surface ablation technique like PRK, LASEK, or Epi-Lasik. You would likely have plenty of room because you save the 100 microns that would have been required for a Lasik flap. Now you would have either 434 or 359 microns untouched.

PRK, LASEK, and Epi-Lasik all have their own limitations, so become informed before making this decision.

As you can see, there are so many variables that it is easy for one doctor to say yes and another to say no. Only after evaluating these kinds of details would you know for sure.

janahawk wrote:I have two more consulations this coming week (one is a dr listed on this website, one is not).


It's good that you are getting additional opinions. Even if every doctor said yes, more opinions are always better than just one. You may want to use our 50 Tough Questions For Your Lasik Doctor to evaluate the doctor not certified by our organization.
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Postby janahawk » Sun May 20, 2007 12:40 am

The chain did advise me I was eligible for PRK and I'm ok w/the longer healing time, etc, at this point, from what I have thus learned, I feel that is the way I am leaning to. But they are the ones who told me my #'s were -7.00 and -8.00 which was shocking to me because I see perfectly fine (I think, LOL) with both my glasses (rx in earlier post) and contacts (-5.50 and -5.75.....) Is it common to undercorrect that much for contacts? I inquired about the discrepancy to the 2nd dr but he told me one needs to understand eye physiology for it to make sense.

The non chain dr said my rx was close to my glasses rx (btw i have copies of rx's from 03, 04 and 06 and the #'s, while not exact, are pretty darn close).

I guess I will wait and see what I learn from the other two consults I receive. One exam includes dialation so I expect I will know a lot more from them.

Thanks again, I can't tell you how much I appreciate your responses!
janahawk
 
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Postby LasikExpert » Sun May 20, 2007 12:50 am

janahawk wrote:I inquired about the discrepancy to the 2nd dr but he told me one needs to understand eye physiology for it to make sense.


Hmmm. It may be that with a manifest refraction (which is better, one or two) you are -5.75, but with a cycloplegic refraction (which is better, one or two with the natural lens inside the eye paralized so you cannot change focus) that you are actually -7.00 or -8.00

janahawk wrote:The non chain dr said my rx was close to my glasses rx (btw i have copies of rx's from 03, 04 and 06 and the #'s, while not exact, are pretty darn close).


The stability is important. Normal human fluctuation is about 0.25 diopter.

janahawk wrote:I guess I will wait and see what I learn from the other two consults I receive. One exam includes dialation so I expect I will know a lot more from them.


Yes, I'm interested if you dilated exam (cycloplegic) is different.

janahawk wrote:Thanks again, I can't tell you how much I appreciate your responses!


I'm glad to be here to help you as I can.
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Postby quasi100 » Sun May 20, 2007 5:14 am

Hey janahawk

Just my 2 cents here: when I went for my initial consultation at a national chain Lasik center, they said I wasn't a candidate for Lasik or PRK because my corneas were too thin (508 right and 505 left). I left there totally heartbroken. I was really hoping that I was going to be a candidate. They referred me to a specialist who does lens implants...I think it's called Versycse (sp).

Well, I found this site about 4 months later....starting doing my own research...finally got the nerve up to get a second opinion, then a third opinion....and low and behold, I was a candidate for Lasik or PRK.

I have no idea why the first place that I went (national chain) said that I wasn't a candidate with my cornea thickness at 508 and 505?????

Long story short....I had CustonVue Lasik with Intralase 3 days ago. Knock on wood here....I am absolutely pleased.

Don't let it get you down....do your research...this website is a wealth of information. Good luck!
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Postby janahawk » Wed May 23, 2007 8:47 pm

Had another consulation yesterday. Dr does Intra and Epi, he told me Epi is the way to go for me. It would appear I have two options:

Epi or CustomVue PRK - Epi is approx $1,300 more than the PRK SO I'm wondering if you can tell me if Epi is worth that much more than PRK....

Thanks!!
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Postby LasikExpert » Wed May 23, 2007 9:44 pm

In my opinion (remember, I’m not a doctor), based in-part upon a recent debate at an ophthalmic medical convention, Epi-Lasik has not shown enough advantage over PRK or even LASEK to justify an extra expense. There is nothing inherently wrong with Epi-Lasik, but an additional $1,300 seems unjustifiable. There are many doctors who would disagree with my opinion, but many who agree.
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Postby janahawk » Wed May 23, 2007 10:35 pm

Yes, I remember you are not a Dr :o)

HOWEVER, you are obviously highly knowledgable and your opinion is very valuable to me (and others as well I am sure!); thanks for this wonderful forum. I will probably not schedule the surgery until the end of the month due to conflicts (+ it will give my eyes more time w/o contacts) but I will certainly post updates!

You rock!
Jana
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Postby LasikExpert » Wed May 23, 2007 10:46 pm

Thank you for your kind words. Be sure to discuss in detail with your surgeon why s/he believes Epi-Lasik is superior to PRK and how an additional $1,300 is justifiable.
Glenn Hagele
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