Realistic Expectations

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Realistic Expectations

Postby brian1cj » Fri Jan 05, 2007 8:16 pm

My vision is:

-6.00 -4.50 x 015
-5.25 -5.00 x 165

I am more than averagely myopic and my astigmatism is obviously very bad.

I started wearing glasses when I was 8. I first tried contacts at the age of 15 in 1996. They were uncomfortable but I made them work. In 1998 it was back to glasses. In 1999 I switched eye doctors at age 18, and he is simply an amazing doctor, opening up my eyes to a world I had never seen before. 20/15 with comfortable contacts at my vision level is just wonderful… but it all ended this summer, when I ordered more of my custom make and Sunsoft discontinued them.

Back to 2001: In 2001, after having trouble fitting me with Toric lenses, he asked if I had ever considered Lasik. I hadn’t, but opted for the free exam which let me know that I was a great candidate. He didn’t do any surgeries himself but was able to refer me someone. I signed up right away. BUT…

A quick Google search came up with horror stories, and before making any rash decisions I got out any commitment ASAP! I need to become an expert on this before I jump in, I thought to myself.

It is now five years later and I have been reading up on patient outcomes, newer lasers, and realistic expectations. I feel fairly knowledgeable about the procedure and newer technologies.

I simply hate the look and feel of glasses. I don’t mind the hassle of contacts if they are comfortable and I can see. But now I can’t see well with any brand of toric lenses I’ve tried.

So here I am at the crossroad again. Do I do it? Or wait until something better comes along? I could wait a lifetime. So I made a consultation with one of two of the most-known and experienced doctors in the Detroit area. He has a record of 25,000 eyes, 15,000 of which are Lasik procedures. I know two people who have had great results with him but their vision isn’t as bad as mine and it is, of course, individually different for everyone. Worse vision usually means greater risk of a worse outcome.

With my severe astigmatism, I surely hope for the best but don’t expect to achieve 20/20.

My goal is to use this forum to regularly post my experience before, right after, and up to a year later. I am also interested in gathering opinions to make an educated decision.

I will use this thread to post right up until the day of my surgery, that is, if I commit to it.

I will have a few questions, but for now, I’d like to ask our LasikExpert and all of you how you feel about my case in general. Any advice, good or bad, is appreciated. Thank you.

Brian
brian1cj
 
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Location: Flint, MI

Postby LasikExpert » Fri Jan 05, 2007 10:36 pm

Your myopia (nearsighted, shortsighted) vision is moderately high and well within the range approved for correction.

Your astigmatism is astronomically high. Astigmatism means that your cornea is not spherical like the top of a ball, but elliptical like the back of a spoon. You have a very lumpy spoon.

The probability that all astigmatism would be resolved with initial surgery is not high. It would be reasonable to expect to need enhancement surgery. It may even be recommended that you consider two-step surgery. The first step would be to focus on reduction of astigmatism and moderate reduction of myopia. This may be performed with conventional laser ablation rather than wavefront-guided. Astigmatism is primarily a topography related problem. A topography guided conventional ablation may be considered most appropriate initially. At least, don't be surprised if this is your surgeon's conclusion.

A secondary enhancement surgery may likely be done with wavefront-guided ablation. Once the astigmatism is reduced, wavefront may be considered most appropriate the second time around.

Something to consider is the coupling effect of astigmatic correction. For each 1.00 diopter of astigmatism correction, the lasers automatically effect a 0.25 to 0.35 diopter myopic correction. That means that your 5.00 D of astigmatic correction will automatically correct 1.25 to 1.75 D of myopia. With your moderate myopia that is not much of a problem, but if you have all myopia corrected with an initial procedure and then need enhancement surgery for residual astigmatic correction, you may have a potential problem of overcorrection into hyperopia (farsighted, longsighted) vision. This would not be a desired result.

If the surgeon believes there is a high probability of residual astigmatism that will require enhancement surgery, then it may be recommended that your myopia be initially undercorrected to allow for the potential coupling effect during enhancement surgery.

Simply put, your high astigmatism makes yours a more complicated situation that will require foresight, planning, and patience on your part.
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Postby brian1cj » Fri Jan 05, 2007 11:20 pm

What does "conventional laser ablation" mean in terms of procedures and equipment? Does it involve creating a Lasik flap? What type of laser (if any) would be used to correct astigmatism only?

Do you know of any cases on this forum dealing with astigmatism as bad or worse than mine? I tried searching but I didn't find any. Am I better off to just not mess with my eyes since so much may be involved?

Thank you.
brian1cj
 
Posts: 11
Joined: Fri Jan 05, 2007 6:27 pm
Location: Flint, MI

Postby LasikExpert » Fri Jan 05, 2007 11:33 pm

Conventional laser ablation means that the laser creates a profile for targeted corneal tissue removal based upon your eyeglass prescription. Wavefront-guided (click the link above) means that the laser uses a profile based upon an analysis of your eyeglass prescription plus higher order aberrations that exist in everyone's eyes.

As a general rule, wavefront-guided ablation will induce less aberrations than conventional ablation, however this difference is not critical for every patient. Some have the option of conventional or wavefront and some would only have one or the other appropriate.

Wavefront-guided laser ablation can be performed with Lasik, IntraLasik, PRK, LASEK, or Epi-Lasik.

The most one can expect from Lasik is the convenience of a reduced need for corrective lenses. To achieve that convenience one must accept some risk. Elective surgery is always about potential risk v. potential benefits. Your surgeon can advise you on the potential risk and I have pointed out that your astigmatism may elevate your risk of needing enhancement surgery. Only you can decide what is the relative benefit of the convenience of a reduced need for corrective lenses.

A comprehensive evaluation by a competent surgeon will answer many of your questions regrading whether Lasik is appropriate for your needs.
Glenn Hagele
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I am not a doctor.
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Postby brian1cj » Thu Jan 11, 2007 1:05 am

In regards to safety, it is my understanding that there is greater risk the second time around because of the flap. Is that true?

In my case, assuming I would need two surgeries, what procedure(s) do you think my doctor may recommend when I go in for the consultation?
brian1cj
 
Posts: 11
Joined: Fri Jan 05, 2007 6:27 pm
Location: Flint, MI

Postby LasikExpert » Thu Jan 11, 2007 2:09 am

Lasik enhancement after initial Lasik surgery is arguably less risky because the creation of the flap is already done (the existing flap will be lifted) and how your corneas respond to laser ablation will be better understood.

I'll leave it up to the doctor's opinion on which type of surgery is most likely to be recommended. Both Lasik and PRK have their relative advantages and disadvantages.
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
Location: California

Postby brian1cj » Wed Jan 17, 2007 11:58 pm

Just an update...

Went in for my consultation. He says 20/20 will not be a problem and my chances of a redo are about 5%. His redo rate is about 1% on average. My case is an 8 on the scale of 1-10, 10 being the hardest he has ever done. I am getting a custom program, not custom-vue since the wavefront did not accurately measure my astigmatism in my left eye.

I will be on a regimen of drops two days before the surgery: A lubricant, a steroid drop, and an antibiotic drop. I will be given a relaxation drug before the surgery and also some Lunesta to help me sleep afterwards.

My procedure is scheduled for Feb 23rd so I will post in the "just had it done" section on the 25th. It will be done using the VISX star s4 activetrack. Total cost: $3190
brian1cj
 
Posts: 11
Joined: Fri Jan 05, 2007 6:27 pm
Location: Flint, MI

Postby LasikExpert » Thu Jan 18, 2007 1:50 am

Thanks for keeping us informed. We'll see you in the "Just Had It" section next month.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

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


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