was farsighted now presbyopia

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was farsighted now presbyopia

Postby GeneralPatientInquiry » Wed May 31, 2006 4:41 am

I am 45 year old. Before LASIK I was +2.25/2.250 (Left eye/Right eye).After LASIK I was -1.0/-1.0. For reasons that I now regret (I thought that the original procedure was unsuccessful), I requested an enhancement, and now I am +.25/plano. BUT, the resulting presbyopia is causing a lot eye strain/headaches, and fatigue. I am regreting that I did not find this website before the enhancement. I was not well enough educated. Shame on me.

I thought I was one of the few whose LASIK procedure did not produce clear distance vision without glasses, but now I know that the goal is best vision for my lifestyle. Shame on me again.

Where can I find doctors near my area (Loma Linda, CA) that can measure the remaining corneal tissue to see if the enhancement can be reversed?

Are there other alternatives to correct presbyopia (besides bi-focals)?

Thanks in advance.

-Milt Miner
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Postby LasikExpert » Wed May 31, 2006 4:44 am

As you now know, there are two ways to describe myopia (nearsighted, shortsighted) vision. One is that you can not see things in the distance very well. The other is that you can see things close very well. The myopia induced by LASIK masked your presbyopia. Now that your myopia is gone because of the enhancement, you are hit with the full effect of your already existing presbyopia.

Rather than yet another LASIK procedure, I recommend you investigate something different. Look into NearVision CK. Conductive Keratoplasty was originally designed to correct hyperopia, but it has been refined for monovision correction to reduce the problems with presbyopia. CK does not remove any corneal tissue and can be done after LASIK. To learn more visit Monovision Information and NearVision CK
Last edited by LasikExpert on Fri Jun 16, 2006 5:14 am, edited 1 time in total.
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Postby GeneralPatientInquiry » Wed May 31, 2006 4:45 am

Glenn,

Thanks for responding so quickly. Would the CK be a viable option even if I am not a candidate for monovision? I have mild amblyopia in the left eye, which prevents monovision.

Thanks again,

-Milt.
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Postby LasikExpert » Wed May 31, 2006 4:47 am

Yes, CK is a correction for hyperopia, so it would be viable for bilateral or monocular correction.
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Postby GeneralPatientInquiry » Wed May 31, 2006 4:48 am

Surgical Reversal of Presbyopia, using Scleral Expansion Bands. It is currently in Stage 2 FDA clinical trials. Do you know anything about this?

-Milt.
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Postby LasikExpert » Wed May 31, 2006 4:50 am

Yes, quite a bit. Ron Schachar's theory of accommodation is put to the test with the scleral bands. I usually get together with Dr. Schachar at the medical meetings. I've gone through the training course.

SRP is definitely not ready for prime time. Here are a few reasons why:

Some people get accommodation, some do not, even with exactly the same procedure. If inappropriately placed, will cause blindness. I know this for a fact. The theory behind the surgery does not hold up. As an example, when placed in one eye the patient gets some accommodation in that eye, but will also get accommodation in the OTHER eye - the one that didn't have surgery.

Schachar's theory is not exactly correct, but has been shown to not be totally wrong either. At this point, SRP is not predictable, reliable, or IMO safe. Most certainly should be studied further, but not ready to be released on the public.
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Postby GeneralPatientInquiry » Wed May 31, 2006 4:56 am

Glenn,

I really appreciate your responses. I hope you don't mind that I continue to ask you questions. You are very knowledgeable and forthright, which I appreciate.

Regarding the SRP, I have requested information on this procedure from New York Eye and Ear Infirmary, New York Medical College and have been in contact with Dr. Z's office in Reseda, CA. (I live close by Dr. Z's office).

I have read about a dozen articles regarding this procedure and NONE of the articles mentions blindness as a result in any of the cases. Phase I only showed a 50% success rate, but improvements in the procedure have brought that up to about 80% (per my reading). Not perfect, but it seems to be on the right track.

My reading persuades me that Dr. Schachar's theory is heading in the right direction.

You seem to be down on the procedure, especially its safety. But I have not read of any major complications thus far. Are your concerns from having gone through the course and you saw something you thought was too radical, or do you know of bad outcomes?

Again, I appreciate your input.

Milt Miner
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Postby LasikExpert » Wed May 31, 2006 4:59 am

Milt,

You can ask me all the questions you want. Sometimes I may have an answer.

I don't know Dr. Z, but I know the doctor at the NY clinic quite well. The doctor was a part of the original SRP clinical trials and much of my opinion about SRP comes from several conversations with him.

The blindness was one of the early cases, before the FDA clinical trials. When a person is sitting upright, the eyes are aligned straight up and down quite well. When we lie down, the eyes tend to rotate slightly. This cyclorotation is why whenever a surgeon is going to do a surgery needs perfect registration, the surgeon marks the eye with the patient sitting up. When the patient lies down, the eyes can rotate all they want, but the doctor already has the 12 o'clock, 3 o'clock, 6 o'clock, and 9 o'clock positions marked.

The surgeon did the marks with the patient sitting up, and when the patient laid down the rotation was around 20 degrees. This was so much the surgeon assumed that he had incorrectly marked the eye. The surgeon put in the implants, but because of the cyclorotation that the doctor assumed didn't occur but actually had occurred, the implants were placed over the veins that supply blood to the eye. Shortly after the initial recovery period the patient complained of pain, headaches, vision fluctuation, loss of contrast sensitivity, and a host of other problems. Within 24 hours the doctor had taken the implants out, but the damage was done and the patient lost all vision in that eye.

This case study was presented at one of Ron Schachar's training programs in Dallas TX during the American Academy of Ophthalmology meeting some time ago. I was in the audience when the doctor presented this case. The patient was the doctor's best friend all the way back to college days and the patient's wife was the doctor's wife's best friend. I have no reason to question the accuracy of this information. This information would not be in the FDA data as the surgery was done in Mexico (although a US doctor) and was never introduced in any of the FDA data.

I am very open to new theories that turn old beliefs on their heads. Clearly, something is happening with SRP, but neither Helmholz nor Schachar are able to fully explain what happens (and more importantly, what does not happen) with SRP. Where all can agree is that Schachar has proven that what was believed to be true for about 150 years may not be true, but it may also not be what Schachar thinks it is either. Many great minds are working on this, but thus far the reproducibility, predictability, and overall safety of SRP has not been established to the point I believe it is something for the general public.

I consider something safe when there is a reasonable understanding of what is going to happen when you do it, with a 1-3% margin of error for the unexpected/unknown. SRP is not anywhere near that kind of predictability and I am generally not to enthused about invasive surgery on the eye without reliable predictability. Simply put, the potential risk does not seem to outweigh the potential benefit.

Philosophically I equate SRP to ghosts. Those who have seen a ghost are absolutely positive that they have seen a ghost and know absolutely in their minds that ghosts exist. Those who have never seen a ghost may either dismiss them as a figment of one's imagination, or might be open minded enough to accepting that ghosts may exist, but they just have not seen one. I hold that the ghost of scleral implants safely, reliably, and predictably inducing accommodation in presbyopic patients may exist, but I have not yet seen it. I have seen glimpses of this ghost. I have heard from some who have experienced this ghost for a while. But the ghost of scleral implants is neither reliable nor predictable.

I guess you will need to ask yourself if you believe in ghost stories! 8^)

Glenn
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Postby GeneralPatientInquiry » Wed May 31, 2006 5:02 am

Glenn,
Thanks for your prompt response. Do I believe in ghosts? Well, I know that I WANT to believe that SRP works.
As far as the risk of blindness, I suppose that there is a risk in all surgeries. An associate of mine here in my hometown (I'm a CPA) had LASIK surgery last September in Dr. T's office. A corneal haze developed and he has returned various times to Dr. T's office, but still (as I write this) without resolution. So there's always a risk. With the presumption that the blindness was a rare exception, my thinking pattern is as follows: Have the procedure, if it works great, if it doesn't, then have the bands removed. With the exception of the $money$ (a fact that I do not take lightly), an unsuccessful outcome would leave me where I started. Is that a reasonable thought process? Where is the flaw in my thinking?
Do you know if the sclera is made weaker, or if the globe is compromised? Having an implant in the eyeball seems, well, rather odd, but medicine if full of implants, artificial lenses, pacemakers, etc... Have any long-term complications been reported (in either USA or in other parts of the world)? (I know "long-term" would mean less than 4 years because the procedure is so new).
You mentioned that much of your opinion about SRP comes from conversations with the New York doctor. Is he encouraged by results, or does he feel that there is still a long way to go (or maybe both)? Is he reluctant to do the procedure because of its varied results?
Glenn, I wish I had you as my resource before I had my enhancement. My surgeon did a great job medically, but IMHO, he (and his staff) did a terrible job of educating me about intended results, and how early presbyobes may be treated by leaving a small amount of induced myopia. I simply thought that the hyperopic shift was not complete and was not educated otherwise.
The good news is that I am 45 years old, and the great minds of medicine are working to find a long-term safe and effective solution to presbyopia. I hope they are successful in time for me to reap the benefits. -Milt Miner
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Postby LasikExpert » Wed May 31, 2006 5:03 am

We ALL want to believe that SRP works, and sometimes it does, but not reliably, predictably, or IMO safely.

As a CPA you need to have excellent near vision. To be honest, I'm not sure that even monovision would be appropriate for your professional needs. I know personally that when I desire to read an article in a journal, I use special reading glasses over my monovision. Monovision works well in the day-to-day things that requires a brief period of reading, but really is not ideal for the eight hours of close work (12 January to April 15th) of an accountant.

Dr. T is considered one of the better ophthalmologists out there and is certified by our organization. Corneal haze is often cleared with Mitomycin C, but this is strong medicine that is appropriate when required, but best avoided if possible. If the clouding was caused by something like DLK, then there is a totally different set of treatments. Too bad the staff didn't really consider all the factors when you were advised to have the enhancement.

To my knowledge, the sclera, conjunctiva, and globe are not seriously compromised with SRP.

I think it would be fair to say that Dr. S in New York was initially encouraged by SRP results, but is not exactly a fan. He is as much a scientist as a surgeon and scientists like to see the same results every time.

Glenn
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Postby GeneralPatientInquiry » Wed May 31, 2006 5:05 am

Hi Glenn,

FYI, I met with Dr. Gene Z today (refraction and consult). It was a very informative visit. He outlined the theory of SRP, its inherent challenges (proper placement of the expansion bands, potential elasticity of sclera to "absorb" and offset the effect of the bands, and depth of placement in the sclera). Fascinating stuff.

I would say he is encouraged by results, but admits that there are variables that make the overall success rate approx. 85%. And of course, he cannot know beforehand how much accommodation will be restored in any given patient.

Someday I will undergo treatment for presbyopia. But when that someday is, I do not know. For now, I ll enjoy the good distance vision and put on the readers.

I have appreciated your messages and the work your organization does.

-Milt Miner
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