Eyesight Stability

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.

Eyesight Stability

Postby ssmarsh8 » Wed Dec 27, 2006 3:58 pm

Hello. I'm scheduled for Custom Wavefront Lasik in both eyes in late January. I posted a while back that I'm concerned about whether my eyesight is stable enough for Lasik to be the right move. The doctor and his assistant both assured me that it is, but I'd like to post my prescription history and see what you all think:

Age 20 (2000): Got first glasses, -1.25 in both eyes.
Age 22 (2002): -1.25 right, -1.5 left
Age 24 (2004): -1.5 in both eyes. This was my last eye exam until I went for the Lasik assessment.
Age 26 (now): -1.75 right, -2.0 left

I think I've been at that current -1.75/2.0 about a year now, as that's when I started noticing things weren't quite as sharp with my glasses/contacts. But as I went a couple years without an exam, who knows.

The doctor says .25 difference is within the margin of error of an eye test, and that it is almost certain that one's eyes are "stable" by mid-20s.

I realize that I have a much milder prescription than many who need Lasik, and this is why I get jazzed over differences of .25 when others may not even notice that gradation--I was lucky enough to have perfect vision until 6 years ago, so I truly can see a difference with that minimal change. Like all of us, I would be regretful if I have the sugery, and then a couple years later my eyes proved to still be changing--requiring me to correct very minor miopia for years to come!

To be honest, the biggest motivating factor for me right now is that I'm in a new job with a "flex spending account," which allows me to pay for this $5200 procedure prior to my income being taxed. That amounts to a lot of savings, and I figure might as well do the surgery sooner than later, and reap the benefits that much longer. But it's hard to know when it's right. Thanks!! Sarah
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Postby LasikExpert » Wed Dec 27, 2006 7:02 pm

Only you can decide if the potential benefit is worth the potential risk of surgery, but the amount of fluctuation that is noted in your exam history is consistent with normal fluctuation for human vision.

With your very low refractive error, I highly recommend that you consider the surface ablation techniques of PRK, LASEK, or Epi-Lasik rather than Lasik. Discuss the advantages and disadvantages with your doctor.
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Postby ssmarsh8 » Wed Jan 03, 2007 5:15 pm

Thank you for the tip, but can I ask why you suggest these? It has been my understanding that, if one's corneal thickness, etc., qualify for the LASIK procedure, that this is more effective choice than PRK, Lasek, Epilasik. I have read that PRK is an option for those with very low myopia like myself, but that while the operation may cost less it is also less likely to render 20/20 or better vision. Thanks--
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Postby LasikExpert » Wed Jan 03, 2007 5:55 pm

There are several studies that show the surface ablation techniques of PRK, LASEK, and Epi-Lasik provide equal or better long-term outcomes when compared to Lasik.

An advantage of the surface ablation techniques is that they eliminate the Lasik flap. With no Lasik flap, there is no possibility of a Lasik flap related complication. Although Lasik flap related complications are relatively rare, no possibility of a complication is always better than a low probability of a complication.

Another advantage is that the nuanced sculpting of the cornea is not covered by a flap of tissue that may mute the effect.

I doubt that a surface ablation will cost much less.
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Postby ssmarsh8 » Wed Jan 03, 2007 6:12 pm

Thanks so much for that clarification. My doctor never even SUGGESTED any of the abblation techniques. Any thoughts on why that might be? He indeed has performed a great deal of all sorts of eye surgeries.

I have elected to undergo "custom" wavefront Lasik, after an exam showed that I have "moderate" abberations of the eye. However, I believe this procedure will still involve the flap and thus the potential complications you are pointing out. Regardless, the doctor at no point suggested anything other than Lasik. I will of course call to find out why, but would appreciate any thoughts you might have.

I'm sure many people prefer Lasik's quicker recovery time, but I (and hopefully my doctor!!) am most concerned with having the operation that will be best for my vision. God! I'm anxious to see what they say about this.
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Postby LasikExpert » Wed Jan 03, 2007 7:22 pm

Lasik is by far the most popular laser eye proceedure and you have pointed out what I believe to be the reason - quick recovery with virtually no pain. Patients get the "Wow!" effect that they do not get with PRK. PRK is often performed one eye at a time, which consumes more time and resources for both patient and doctor. Just about everybody knows Lasik and just about everybody knows someone who has had Lasik.
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Postby ssmarsh8 » Wed Jan 03, 2007 8:28 pm

I called the doctor about surface abblation. Here are the points they made:

--They have never heard studies indicating that PRK has better results than Lasik.
--They have stopped doing Epilasik/Lasek procedures due to the troubles associated with smoothing the "pushed over" cells back in place.
--Their Bausch & Lomb Zyoptix machine covers a large area of the eye and thus patients rarely report the "halos" and other problems sometimes associated with flap incisions.
--PRK is recommended for those with higher prescriptions, particularly those with thin corneas, whereas I have a very low myopia and plenty of cornea.
--PRK is more time-consuming but they indeed weigh all options for each patient and believe Lasik is right for me.

I repeatedly raised the issue of flap vs. no flap, and the woman (the surgery coordinator) said there is no advantage to "no flap" except for those in risk of blows to the eye (cops, etc.). She said nothing of the issue you raised, that the flap may "mute" the effects of the procedure. She was very pleasant and seemed to welcome my questions, but also seemed 100% certain that I had received questionable information.

Perhaps there are two types, those who swear by Lasik and those who swear by surface ablation, and I'm getting information from both sides?

At any rate we all appreciate your time and thoughtful contributions to this forum.
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Postby ssmarsh8 » Wed Jan 03, 2007 8:28 pm

One other point from them:

--Lasik and PRK cost exactly the same at their office.
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Postby LasikExpert » Wed Jan 03, 2007 9:48 pm

ssmarsh8 wrote:--They have never heard studies indicating that PRK has better results than Lasik.


Several studies have compared Lasik and PRK or Lasik and PRK's cousin LASEK. They tend to find the visual acuity results comparable, however complications are less with PRK/LASEK including the elimination of the Lasik flap and a lower incidence of long-term Lasik induced dry eye.

A laser eye surgery outcome is more than just if the patient sees 20/20. It is about the presence of complications and the quality of that 20/20.

A search at the National Libraries of Medicinewill produce these peer-reviewed articles.

ssmarsh8 wrote:--They have stopped doing Epilasik/Lasek procedures due to the troubles associated with smoothing the "pushed over" cells back in place.


LASEK and Epi-Lasik are viable procedures, but many doctors concur that they may be just so much expensive luggage. PRK may be the best overall. A recent debate at the conference of the American Academy of Ophthalmology determined that Epi-Lasik was not advantageous over PRK. This was an opinion debate, but the opinions presented were based on factual studies.

ssmarsh8 wrote:--Their Bausch & Lomb Zyoptix machine covers a large area of the eye and thus patients rarely report the "halos" and other problems sometimes associated with flap incisions.


I think there may be some confusion. In all Lasik, the laser ablation zone is within the Lasik flap, no matter how large the ablation zone.

Halos and other night vision problems have not been limited to an association with just the Lasik flap. Read our article about Lasik pupil sizeissues for details. The issue of night vision problems would undoubtedly be moot in a debate between PRK and Lasik. The probability (which is relatively small and even smaller for a low nearsighted prescription) would be virtually the same.

ssmarsh8 wrote:--PRK is recommended for those with higher prescriptions, particularly those with thin corneas, whereas I have a very low myopia and plenty of cornea.


There may be some confusion on this issue too.

PRK is not recommended for people with very high prescriptions because of the increased probability of corneal haze. This can be mitigated with the use of Mitomycin C, but Mitomycin C is a strong medication that is probably best avoided when possible, but appropriate when necessary.

Lasik removes tissue deeper in the cornea so people with thinner corneas may only have PRK as an option, however if Lasik is appropriate for a low prescription patient, then PRK is undoubtedly an option.

ssmarsh8 wrote:--PRK is more time-consuming...


Yes, PRK has a slower vision recovery and the doctor will undoubtedly spend more time with a PRK patient than a Lasik patient.

ssmarsh8 wrote:...but they indeed weigh all options for each patient and believe Lasik is right for me.


Perhaps the question to ask is: “Why is PRK not appropriate for me?”

ssmarsh8 wrote:I repeatedly raised the issue of flap vs. no flap, and the woman (the surgery coordinator) said there is no advantage to "no flap" except for those in risk of blows to the eye (cops, etc.).


I strongly disagree. Flap striaeand Diffuse Lamellar Keratitis (DLK) are only possible with Lasik and are impossible with PRK and its cousins LASEK and Epi-Lasik. Yes, they may be rare complications, but impossible is better than rare.

You may want to discuss with this counselor why one of the most respected surgeons in ophthalmology who has been published in many peer reviewed journals has quit Lasik and provides surface ablation in virtually all cases. I'm sure the doctor will know of this surgeon.

ssmarsh8 wrote:She said nothing of the issue you raised, that the flap may "mute" the effects of the procedure.


Here is a non peer-reviewed article about PRK and wavefront that you may find interesting. I'm not the only one who affirms the relative advantage of surface ablation with a nuanced ablation pattern.

ssmarsh8 wrote:She was very pleasant and seemed to welcome my questions, but also seemed 100% certain that I had received questionable information.


I have no doubt that she is doing her best to provide you with the information she has available that applies to the services that the surgeon offers.

This is an issue of preference and availability. If you have read my posts you will see that I'm rather conservative. Certainly Lasik is a viable procedure and has its advantages, but the elimination of potential complications is a good thing. When a patient is a low myope and there are no other contraindications, then PRK is a procedure to consider.

ssmarsh8 wrote:Perhaps there are two types, those who swear by Lasik and those who swear by surface ablation, and I'm getting information from both sides?


Indeed there are advocates for both types of procedures, both have their advantages and disadvantages, and both are considered medically safe and effective.

ssmarsh8 wrote:At any rate we all appreciate your time and thoughtful contributions to this forum.


Thank you for your kind words. You have more food for thought, but ultimately you need to go with what you decide is best for you, based upon the comprehensive evaluation of a competent surgeon and your own preferences when presented alternatives.

In all cases it is a good idea to be evaluated by more than one doctor. This provides you with a built in "second opinion" that may be helpful. You may even select one of those doctors to be someone who specializes in surface ablation techniques.
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My opinion...

Postby mike r » Wed Jan 03, 2007 11:53 pm

I would wait...
after reading all those script changes and your age...

When you start growing hair out of places other than where it is supposed but no longer grows... and you have to read a book beyond arms length then it is time...

I was issued glasses in military at 18 and threw them away... Squinted my way to 35 before permanently needing glasses. Now at 44 I just had the lasik and yes my prescription even changed from 2000 til recently not much though.
I went ahead and got reading/distant and to new to conclude on whether this was best choice.
But hec at least I can spot the pretty girls again from a distance without spectacles and if there not that pretty I can always use my 20/150 eye and there all fine!!! hee hee!!!

Good luck on your decision <mike r >
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LasikExpert is right..

Postby Kean » Tue Jan 09, 2007 12:59 am

Before going for my evaluation, I had the impression that the person that checks my eyes would be an expert in this field (since they are dealing with another person's eyesight). Well I was sorely wrong, dead wrong. Keep in mind that I am not refering to the surgeon, which 99.99% do not perform the screening for obvious reasons. The 'screeners', many are optometrists, cannot even answer some simple questions regarding refractive surgery (which is his/her job to do so) let alone the hard questions. I was so sorely disappointed with all of them. Eg. one have not heard of Epi-Lasik, another one gave me the absolutely wrong residual cornea thickness after surgery. When I asked the 50 tough questions, I later found out the 'greeter' is just a salesman (who answered those questions teribbly, eg. 99.99% success rate of acheiving 20/20).

The only time I had a satisfactory discussion regarding my concerns was with the surgeon. Out of this experience, if possible I would like to suggest having several screenings to discuss your concerns. All the best!
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Postby ssmarsh8 » Wed Jan 10, 2007 6:27 pm

Well, I began with a question about eyesight stability for a scheduled LASIK surgery, and following Glenn's suggestion and a thorough talk with the surgeon, I am now seriously weighing getting PRK instead.

I have plenty of cornea, but also have very low myopia (-2.0), which can be corrected just as well by PRK or LASIK. My biggest "pro" for PRK is that it eliminates the "flap" incision and potential related complications. My biggest "con" for PRK is of course the longer healing time.

I'm getting one or the other, with the added "custom wavefront," on 1/25. So you can imagine that I'm stressing over this decision. The surgeon is very experienced and lauded in both techniques, and was honest with me that he assumed I would want LASIK for its convenience (as in his opinion the flap risk is negligle, and the outcome for both procedures is eventually equal). So essentially I've been told to let them know a few days in advance what I personally want to do. On the one hand this feels like a burden (you're the doctor! tell me what's right!), but on the other hand the surgeon pointed out that I'm lucky to be an excellent candidate for two excellent technologies.

When I got my exam and signed on for LASIK about a month ago, all tests and forms signed and explanations given were for LASIK. I was given some samples of an anti-infection eye drop to be used. Will this be the same drop I need for PRK post-op? The surgeon said that with PRK he would not prescribe the high-powered medicine some get (myocin-C...something like that?) since my ablation will be minimal. Basically I'm wanting to know, for post-op meds, will I be paying for/requiring anything other than what was planned with LASIK?

I also do have to consider healing time. Luckily low-myopes tend to heal more quickly than other PRK folks. I go in on a Thursday and have my first checkup on Friday. Would my bandage contact be removed then or require an additional Monday visit to the surgeon? I had planned to be back at work Monday morning, but with PRK this seems an unlikelihood. My job is a 30-minute highway commute and involves a lot of looking at a computer. Unfortunately I don't have a lot of vacation time to work with--I could probably take off Monday and Tuesday with some difficulty but not more than that.

Thoughts? Thanks. This forum has altered a serious decision-making process, and I'm glad I found it, regardless of my choice.
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Postby Kean » Wed Jan 10, 2007 8:28 pm

ssmarsh8,
I would like to start by saying this, what Glen has said is absolutely correct in every one of his points (very consistent with what I've read). I think it's best that you see the stats and studies on your own. Instead of posting direct links (which may violate rules for posting here), simply google for ophthalmology (journal) and you shall find sites with free articles/studies. Do look through google results up to the 6th or 7th page, a couple of my favorites showed up there.

In a way, most 8-5 workers face similar irony, I know I was in your shoes a few weeks ago. I know exactly what you mean, however, it is truly your own decision based on your circumstances. As long as you truly understand the facts about both alternatives, you will be fine. You'll be at ease with whichever direction you choose once you have done your fair share of research.

As far as what is covered, I've seen different plans, so it's not a problem to ask your Doc.

Lastly since your Flex is effective till Dec 07, keep the option open for postponing your surgery date if you are truly unsure or if you would like more time to research, or get a second/third opinion. Best of luck.
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Postby LasikExpert » Wed Jan 10, 2007 8:48 pm

The medication regimine for PRK may be slightly different than Lasik, but not by much. Your doctor will be able to give you all the details in advance.

I'm glad to see that your doctor will not be using Mitomycin C. With your low refractive error it would probably not be needed.

The functional fuzzy vision you will have immediately after PRK is pretty functional by the third day. You may have some difficulty with reading, but copious amounts of artificial tears may resolve that problem (a few minutes at a time).

I like to tell people considering PRK that for the first few days you will wish you had Lasik, and then every day thereafter you will be glad you had PRK.
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Postby ssmarsh8 » Mon Jan 15, 2007 6:54 pm

I had scheduled Lasik for 1/25. Following Glenn's suggestion that I inquire about surface ablation for my minor myopia (-1.75, -2.0, with lots of cornea and moist eyes), I had a lengthy discussion with the surgeon. He said I was in the "risk-averse" group who is Lasik eligible but prefers PRK despite its inconveniences. I find the term "risk-averse" ironic since part of my leaning toward PRK involves my desire to some day do things such as jump out of airplanes and take martial arts classes. And anyway, I wouldn't say "risk averse" is a bad thing in the realm of one's eyesight.

At any rate, he assured me that he's done tons of PRK and that either was fine, despite their materials and marketing barely giving a mention of PRK. I should clarify that epi-Lasik/Lasek are no longer performed by this surgeon as he believes PRK has fewer complications (i.e. no replaced epithelium to do screwy things).

So... (drumroll) I just called and told them I want PRK instead of Lasik. Tomorrow I'll be informing my boss that I need two more days off work than planned. The surgery is on a Thursday and I truly hope to be back at work the following Wednesday. I'll carpool the rest of that week to avoid driving the 30-minute commute, but once I get there will be faced with a lot of computer time. Hope it works out, as my vacation time will be dry as of Wednesday.

I was told that in addition to the Vigamox drops already prescribed for the original plan, I would be provided with some other sort of relief drops and a prescription for high-powered oral pain meds. I'll ask them to write that for the generic version to save money. Should I ask that it be called in prior to my surgery, so that I can have it filled prior to going in? I just don't like the idea of things still needing done/acquired AFTER a laser zaps my eyeballs.

My other question is regarding the bandage contact lens. The surgery coordinator on the phone did nothing to schedule additional follow-up examinations, but won't this be necessary? As of now I have an appointment for the day after surgery, Friday. But I believe the bandage lens is supposed to stay in longer than that. So shouldn't I also have an appointment for the following Monday to remove the lens? And furthermore, is that actually too long for it be in? Thursday seems like an awkward day for the PRK, as the office is closed Saturday and Sunday, and from what I've read Sunday would be the ideal day to remove the bandage lens.

Thanks for reading.
Sarah
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