Does Custom Wavefront technology help Monovision?

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Does Custom Wavefront technology help Monovision?

Postby lance » Thu Dec 07, 2006 3:52 am

I am thinking to do monovision. I know custom wavefront can help on the distance eye. Will it also help on the undercorrected reading eye?

Some people say it would, some say it doesn't, some say it is depend on which laser machine? Is it true? If so, which laser can help? Visx or Alcom, or Allegretto?

Thanks in advance!
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Postby LasikExpert » Thu Dec 07, 2006 4:46 am

Depending upon your individual circumstances, wavefront-guided ablation may be beneficial for both the fully corrected dominant eye and the undercorrected non-dominant eye. Wavefront-optimized would be beneficial for both eyes in nearly every instance. Be sure to read about Wavefront Lasik.
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which laser machine can use wavefront for undercorrected eye

Postby lance » Fri Dec 08, 2006 5:07 am

Thanks Glenn for your response.

I read the wavefront article on this web site. Here is a quote from it related to my question about Monovision:

"Monovision Limitations
If you are considering monovision correction, it will may be necessary to use conventional Lasik, PRK, LASEK, or Epi-Lasik rather than wavefront-guided. Current wavefront-guided lasers are very limited in their ability to undercorrect. It's full correction or nothing at this time. While the non-dominant eye will need to be undercorrected with a conventional ablation, the dominant eye may be fully corrected with a wavefront-guided ablation. Undoubtedly, each of the manufacturers will eventually allow their lasers to undercorrect in wavefront-guided mode. "

I have seen two doctors. One indicated he can use his Alcon LADARVision Customconea to undercorrect my reading eye. I quoted the above statement, he said his machine can help the undercorrection situation. Is he correct?

The other doctor who is using Visx CustomVue said since my high order aberration is not that sever, he can try to use wavefront customized method for my reading eye too. But he said he don't want to promise me that. It will depend on the measurement on the surgery day. What do you think of this? Can Visx CustomVue handle the undercorrected eye? What measurement do we need to determine that?

Thanks in advance.
lance
 
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Postby LasikExpert » Fri Dec 08, 2006 5:55 am

The short answer is that undercorrection is possible. The long answer is...well...long.

Monovision is not always the same amount of undercorrection for every person. Some people require significant myopia to get the effect they want. There is a limitation to the amount of undercorrection possible with wavefront-guided. For many people, the amount of undercorrection possible is the amount desired. For some, they require more undercorrection than is possible with wavefront-guided and they require conventional ablation.

Whether or not the amount of undercorrection for monovision that you desire is within the abilites of the laser depends upon the laser and the amount of undercorrection required. It appears that your one doctor is certain of this ability with the Alcon, and your other doctor with the Visx will not be certain until final measurements are taken.
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Postby lance » Fri Dec 08, 2006 10:38 am

Thanks for the very quick response. I do appreciate your knowledge and willingness to help!

One more follow-on question on this: after trying contact lense to simulate the monovision effect, I decide to try undercorrect by 0.75. Do you think it's in the range for Visx S4, Alcon LadarVision, and Allegretto to handle using wavefront technology?

Thanks again.
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Postby LasikExpert » Fri Dec 08, 2006 5:56 pm

I believe that a 0.75 diopter offset is possible on all wavefront-guided lasers. Verify with your doctor.
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Is 0.75 under-correction too much gap for Visx S4 CustomVue?

Postby lance » Sun Dec 17, 2006 8:27 pm

I went to have my monovision all-laser Lasik surgery done last Friday. Before the surgery I asked the doctor a couple of times about if he is going to use wavefront customized lasik (in this case Visx S4 customVue) for my reading eye. He assured me that he is going to do that so that both my eye will benefit from customized Lasik.

But right before the surgey when I was on the operatiing table, he told me that he couldn't do the customVue on my reading eye due to "too much gap". I didn't really understand it, but he didn't give me any chance to ask more questions about this by pressing on with the operation. I felt bad about this, but didn't want to harm my eyes by arguing with him at the surgery point. I thought with my minor undercorrection (0.75), any lasik machine (including the Visx CustomVue) should be able to handle it. I really like to have customeVue for my reading eye, as I was told it will help my vision. Plus I also paid for both eyes for CustomVue and it costs $500 more for each eye.

What did my doctor mean by "too much gap"? Was he misleading me by making me to believe I can get customVue while he knew all along I can not get that via Visx S4 machine? Will it affect my vision (day and night) in my reading eye? Can I at least ask for refund for my reading eye (customVue portion)?

Thanks in advance!
lance
 
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Postby LasikExpert » Tue Dec 19, 2006 3:30 am

I suspect that what occurred is that the final wavefront diagnostic evaluation created just before surgery generated a refractive error reading significantly different than your manifest refraction (which is better, one or two?). Put more simply, the eyeglass prescription based on wavefront was too different from the eyeglass prescription based upon your subjective manifest refraction. In this case, wavefront-guided is not recommended.

I believe it would be reasonable to ask for a refund of the portion of the fee that represents services you did not actually receive. If you didn't get wavefront-guided, you really should not pay for wavefront-guided.
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Postby lance » Tue Dec 19, 2006 9:10 am

I think I had manifest refraction exams before and after my eye dialated. I was told the two exams will prevent false reading. How come they still got different reading from wavefront exam? Also why when there is difference between manifest test and wavefront test, they can not do the wavefront-guide Lasik?

Thanks!
lance
 
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Postby LasikExpert » Tue Dec 19, 2006 5:49 pm

They could do a wavefront-guided ablation even if the wavefront diagnostic is significantly different than the manifest refraction, however that is almost a guarantee of a poor outcome.

The manifest refraction provides what the patient subjectively determines is the best vision. Seeing is more than just optics of the eye. Depending upon the unique nature of the optics, aberrations, and neurological processing, there can be a large difference between error determined by wavefront and error determined by refraction. Refraction is always the more reliable.
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