My Appointment today...mixed feelings

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My Appointment today...mixed feelings

Postby aspenice » Fri Aug 03, 2007 9:19 pm

I went today for my appt. and it went okay. The optometrist looked at my eyes and said they look fine but my reading went to 20/25 from 20/20. Then the surgeon came in and talked with me but I felt I wasn't being heard. He was very nice but when I asked to have my eyes tested fro dry eye he said no bother since I can see your eyes are a bit dry under the scope. I asked 3 times and he just wanted to give me restasis. He thinks (I think so too) that I am just a bag of nerves and am getting myself all worked up. He first said Let me ask you the questions and then you can talk. Well, I hardly got a word in edge ways and then fumbled over what I was saying. He was in btw/ surgeries and then had to go and I said I wanted to talk more so he said make an appt. to come in and talk tomorrow morning with him. I told him that I wished I didn't have lasik and had PRK and he said no you don't.

I also brought up the flap concerns and he said even if I rubbed my eyes now it wouldn't break away and that it would take some severe eye trauma to make the flap break away. He went onto say how people in the military and athletes have it done with no probs when they are hit in the face, etc. He said if the flap wrinkled then we would smooth it out or take the flap off??? Can that be done? He said the eye would just heal after the flap was removed. I don't even know what he meant by this.

He did say that I am using too many chemicals on my eyes. (sterlid and baby shampoo) and to use a warm compress for 5 days 3-4 times daily. Tat was our appt. in a nutshell. I think I will write my questions down on a list and hand them to him. I don't even know what to say tomorrow. Maybe a second/third opinion is in order.

Aspen
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Postby aspenice » Fri Aug 03, 2007 9:35 pm

Note: He thinks I am suffering from Blepharitis
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Re: My Appointment today...mixed feelings

Postby JPD » Sat Aug 04, 2007 3:12 am

aspenice wrote: I told him that I wished I didn't have lasik and had PRK and he said no you don't.


Besides some dry eye, it's very likely that your results would be no better then they are now, had you had PRK. It's not as if jumping into a time machine and going back in time to choose PRK instead of Lasik is the miracle cure for everyone who's unhappy with there Lasik outcome. Most recent studies have show that long term outcomes are almost identical between Lasik and PRK, with the slight advantage going to PRK.

aspenice wrote:I also brought up the flap concerns and he said that it would take some severe eye trauma to make the flap break away.


He's correct about that. It seems most people who begin to regret there lasik decision all of the sudden become very paranoid about flap complications. When in reality it would take some serious trauma to cause any damage. So much trauma that it would cause eye damage anyway. Meaning if you had eye trauma severe enough to dislodge your flap, then that same eye trauma is severe enough to cause eye damage even had you had PRK. So either way you're suffering some eye damage.

aspenice wrote:He said we would take the flap off??? Can that be done? He said the eye would just heal after the flap was removed.


As far as I know that statement is complete BS, and a straight out lie right to your face. If you have the flap cut off, you're going to need a cornea transplant in order to see again. Ya, the eye probably would heal after that, except you won't be able see SH*T!! But don't worry about that stuff happening. A Complication of that nature is extremely rare. You're more likely to go out and get severely injured in a car accident. But I bet you don't think twice about jumping into your car, do you? So don't worry about those things.

aspenice wrote: I think I will write my questions down on a list and hand them to him.


That's always a good idea.

aspenice wrote:Maybe a second/third opinion is in order.


That's never a bad idea. If for no other reason, just for peace of mind.
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Re: My Appointment today...mixed feelings

Postby LasikExpert » Sat Aug 04, 2007 4:27 am

[quote="JPD]As far as I know that statement is complete...[/quote]

Not quite, but perhaps close.

It is possible to remove the Lasik flap. The epithelium would reproduce over the exposed area, thicken, and smooth. The problem is that a Lasik flap created with a mechanical microkeratome is not the same thickness all the way across. The exposed bed would be irregular and would undoubtedly provide poor vision.

A Lasik flap created with a femtosecond laser (All-Laser Lasik) creates a more planar flap with a relatively even thickness throughout and a relatively even bed. I know of one case in Portland where the patient had All-Laser Lasik and soon after surgery was involved in a severe car accident. The Lasik flap was lost. After several weeks her vision returned to the same acuity she had before with the flap.

That is not to suggest that anyone would recommend the surgical removal of an otherwise intact and healthy Lasik flap, but it does show it is possible in unique circumstances without vision loss.
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Re: My Appointment today...mixed feelings

Postby JPD » Sat Aug 04, 2007 6:50 am

LasikExpert wrote:Not quite, but perhaps close.

It is possible to remove the Lasik flap. The epithelium would reproduce over the exposed area, thicken, and smooth. The problem is that a Lasik flap created with a mechanical microkeratome is not the same thickness all the way across. The exposed bed would be irregular and would undoubtedly provide poor vision.

A Lasik flap created with a femtosecond laser (All-Laser Lasik) creates a more planar flap with a relatively even thickness throughout and a relatively even bed. I know of one case in Portland where the patient had All-Laser Lasik and soon after surgery was involved in a severe car accident. The Lasik flap was lost. After several weeks her vision returned to the same acuity she had before with the flap.


Okay, I learn something new every day.

I still don't understand how with the removal of an additional 100-110 microns of corneal tissue(Intralase) how someones vision could return to normal, close to normal, or even functional. I guess that goes to show my ignorance regarding the refractive properties of the cornea.

Is it only the shape of the cornea and not the thickness which determines your visual outcome? If so, then the above scenario does make sense.
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Postby LasikExpert » Sat Aug 04, 2007 6:09 pm

It is the change of corneal shape that causes a change in refractive properties, not a change in thickness.

If when the Lasik flap is created its thickness is perfectly even, then the underlying corneal bed is an exact duplicate of the surface. An exact duplicate of the surface would have virtually identical refractive power - all it is doing is making the cornea thinner.

A flap created with a mechanical microkeratome is meniscus in shape. It is thin at the edges, thickest in the mid-periphery, and thinner in the center. This creates an uneven corneal bed that is not a duplicate of the surface. An uneven corneal bed would have different refractive properties if it does not have the equally uneven Lasik flap's bottom to balance the irregularity.
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Postby aspenice » Fri Aug 10, 2007 10:44 pm

Hi JPD,
THanks for getting back to me and giving me your view. Actaully, it has made me feel so much better. I went back to the doctor and we are doing warm compress 3-4 times a day and it has helped alot. If this doesn't do it then I have to go on restasis and I am nervous to do that for some reason. You are right maybe PRK wouldn't have been much better but I still would have done it b/c the flap makes me nervous but as you point out people get way too nervous over the flap. Couldn't PM you as this wasn't working.

Thanks Gelnn as always for giving me a clear description on how the flap can be removed. This site has been a god send to me and if I go for a second opinion I will go to Dr. Caster in Bev Hills. I have another appt. on 8/15 and then I will go onto restasis but the warm compresses have been great and have been using less drops. I see 20/15 but the vision is not good as far as sharpness, etc. I guess that will come in time.

He did share with me my results as of last week. 0.03+.25+63. I know the middle one is there is a bit of asitgatism left and when he put up the lens I could tell a difference. Can the leftover go away with an enhancement? What is the first and last number for? He said that they like all of those numebrs to be close to 0. I am feeling better and not so scared and thanks to this site and the members and Glenn who have helped me.

Will let you know how next weeks appt goes.

All the Best,
Aspen
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