ICL vs. Epi-lasik - Same doctor, different recommendations.

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ICL vs. Epi-lasik - Same doctor, different recommendations.

Postby emrickallreds » Wed Nov 08, 2006 8:28 pm

I went for an evaluation one year ago, and epi-lasik was recommended due to the thinness of my corneas. I did not pursue surgery at that time. Went back to the same doctor yesterday, and this time he recommended ICL's. He said the ICL's would be better suited to me because of the thinness of my corneas, the improved recovery time, and the potential for clearer vision results. He proceeded to tell me epi-lasik treatments can result in halos, starbursts, blurred vision, and the reduction of an already thin cornea could cause problems for me down the road if I needed an enhancement, or simply as a result of the natural degeneration of the eye as you age.

I went prepared to move forward with epi-lasik, and now am further confused. The ICL procedure is significantly costlier, which I was not prepared for, and is really not an option. Now I am wondering if I am a good candidate for epi-lasik, and will I be happy with the results. (night vision problems, blurriness, etc.) Because of my high refractive error and thin cornea, I am also concerned about the possibility of an enhancement if regression occurs. I have had many bouts of GPC (from contact overwear), so contact lens wear is not really an option for me anymore, and my glasses are thick and uncomfortable, and do not provide me with the vision I want. (Especially after wearing soft lenses for almost 20 years; the past ten or so, I have worn them 24 hrs. a day.) (Also, had a bout of uveitis about 8-10 years ago; woould this impact either type of vision correction in any way?)

To further complicate matters, I have saved via a flexible healthcare account the $ to pay for the epi-lasik procedure. It must be used by year-end or forfeited. This adds an additional stress to a decision that I thought I had already made.

My contact lens prescription is -9.0 in right eye; -8.50 in left. I have been told I have a slight astigmatism in my right eye; my cornea thickness is in the mid 500's, and the size of my pupils had not ben mentioned at either evaluation as a cause for alarm.

I would appreciate any advice or recommendations. Thank you for your time.
emrickallreds
 
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Postby LasikExpert » Thu Nov 09, 2006 3:38 am

Hmmm. I wonder what your doctor would recommend next year?

8^)

Your high refractive error is a relative contraindication for any surface ablation technique including PRK, LASEK and Epi-Lasik. There would be an elevated risk of corneal haze (can be managed, but you don't want to go there) and regression is all but absolute.

Your refractive error would require between 110 and 170 microns of tissue removal the first time. Enhancement surgery would probably be another 10-20. That is a significant percentage of tissue removal.

Phakic intraocular lenses (PIOL) would seem like something to at least consider, but if you read our article you will see that they have their share of limitations and concerns too. PIOLs will not correct astigmatism, which may leave a small bit of ghosting (doubled vision) in lower light environments. To know if this is a real problem, try contact lenses (disposable, of course) that only correct your myopia (nearsighted, shortsighted) vision.

If you are well past age 40 and fully presbyopic, then Refractive Lens Exchange (RLE) may be an appropriate alternative to consider.

Your doctor will evaluate the health of your eyes for their current condition. Your history of GPC and uveitis a decade ago would probably not rule you out for refractive surgery. They are, however, and indication that you were not quite as diligent in contact lens care as you should have been...but then I'm sure you know that. Be sure your surgeon knows of this history.

Your Flexible Spending Account can be used for most any medical expense, even eyeglasses and contact lenses. Don't pressure yourself into surgery, especially surgery that appears to have an elevated level of risk.
Glenn Hagele
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Thanks for your reply.

Postby emrickallreds » Thu Nov 09, 2006 12:59 pm

I am 35. I appreciate your opinion on the epi-lasik recommendation; I certainly do not want further eye complications as a result of a surface treatment, and what happens if I need an enhancement? Will there be enough cornea left to reshape? (Please see post below for specific eye info. from my latest eval.)

Thank you again for your time.
Last edited by emrickallreds on Thu Nov 09, 2006 10:41 pm, edited 1 time in total.
emrickallreds
 
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Second evaluation w/ different doctor.

Postby emrickallreds » Thu Nov 09, 2006 10:30 pm

Thanks again for your reply. I wanted to add that I went for another eval. today at a different center. They provided me with the following info. and said I would be a fine candidate for PRK:

R. eye - -875 -125 x 175

L. eye- -850 -075 X 005

(Why are these number diff. them my contact lens script of -9.0 (R) and -8.50 (L)?)

Corneal thickness:

R. 536

L. 532

Pupil size - they said my pupils were small.

They also said my eyes/corneas were very healthy.

They said that in the PRK procedure that would have to remove a total of 115 microns of cornea in the R eye; 111 in the left (I undestood this figure to include the 40 microns they remove of epithelium [does this count as removal of part of my cornea?] - and shaping of my cornea based on my level of refraction), and this would leave plenty of room for enhancements, if needed down the road. (The doctor gave an example if I regressed to -3.0 diopeter, they would remove approx. 45 more microns.) They mentioned they would use mitomycin when I questioned about corneal hazing. They would be using the VISX Star S4 laser.

Do these figures sound correct? I have now had three different recommendations and am questioning my sanity. Are the risks greater with a more involved surgery, as with the ICL's, or greater with a surface treatment due to the thinness of my cornea. Why would the first doctor recommend epi-lasik over PRK if the amount of epithelium removed is less in PRK and recovery/results are similar? The second doctor also said to consider doing the PRK on each eye at separate times.

I felt very comfortable with all the info. provided to me today. They said they correct many patients with my level of refraction and cornea thinness w/ high success, but I am still confused. Should I stop considering surgery and resign myself to my very thick glasses?


Thanks!




Thanks for your time.
emrickallreds
 
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Joined: Wed Nov 08, 2006 7:26 pm

Re: Second evaluation w/ different doctor.

Postby LasikExpert » Fri Nov 10, 2006 6:09 am

emrickallreds wrote:Why are these number diff. them my contact lens script ...?


Contacts are commonly a little different than a manifest refraction (which is better, one or two?) and 0.25 diopter is within normal human fluctuation.

emrickallreds wrote:Pupil size - they said my pupils were small.

They also said my eyes/corneas were very healthy.

That is good news for many reasons.

The epithelium is not included in the tissue removal calculations, and it should not. The epithelium regenerates and removal is not permanent. Also, epithelium does not contribute to corneal strength. The epithelium is a moot point between PRK and Epi-Lasik.

Mitomycin C is a strong medicine that is best avoided if possible, but appropriate when needed. Due to your relatively high refractive error, Mitomycin would probably be indicated to reduce the probability of corneal haze. Also, the probability of corneal haze will be reduced if you take 500mg of vitamin C (yes, plain 'ol vitamin C) twice a day for at least a week before surgery and at least two weeks after surgery plus use 100% UVA-UVB blocking sunglasses when you even think about going out of doors.

The figures sound about right. Your doctor intends to manage your elevated risk of corneal haze due to high refractive error with Mitomycin C. Ask if you should also use therapeutic vitamin C.

Doing one eye at a time is a very good idea.

Based upon your doctors' evaluations, it appears that you are within the treatable range. Look at your informed consent closely, be an educated patient, and only you can decide if you should have surgery or stick with your glasses.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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Posts: 3309
Joined: Fri May 12, 2006 6:43 am
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