High Altitude, Low Oxygen and Lasik

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.

High Altitude, Low Oxygen and Lasik

Postby Nikolay_s » Sun Jan 14, 2007 9:27 pm

Hi Glenn,

I am planning to have Lasik surgery (for my eyes –6.0 and –6.5) in order to avoid contact lenses and specs in general life and my extreme hobbies. However I am very concerned about side effects of such surgery that can make difficult or even dangerous high altitude mountaineering.

There are some researches on this issue made within the period 2001-2003. They reveal that after Lasik one may suffer at high altitudes from eye blurring and impaired vision due to hypoxic corneal swelling as well as the dry eyes. Here is a short list of those researches:
________________________
Aconcagua (6962 m.) –
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11738908&query_hl=1&itool=pubmed_docsum

Everest (8848 m.) –
http://www.journalofrefractivesurgery.com/showAbst.asp?thing=4604
http://www.usaeyes.org/lasik/faq/lasik-altitude.htm

others –
http://www.liebertonline.com/doi/abs/10.1089/152702903322616173
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/03-02-2001/0001439621&EDATE=
________________________

I wonder whether there are any up-to-date (2004-2007) researches or recommendations for high-altitude climbers? According to the recent data how safe would it be for me to have Lasik surgery 3 months before assaulting summit 8848 meters high?

Kind regards,
Nikolay
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Postby LasikExpert » Sun Jan 14, 2007 11:11 pm

As you have learned from the research there have been many people with Lasik who have climed to high altitudes with little or no negative effect, but this is not always the case. The dry eye problem seems to be the most prevelent.

Since you seem to be involved in more extreme sports than most, you probably should evaluate the surface ablation techniques of PRK, LASEK, or Epi-Lasik before deciding if you should have refractive surgery.

It is possible that your vision will have recovered from surgery within the three months, but what will you do if it is not? Would you be able to cancel or postpone your climbing?
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Safety comes first

Postby Nikolay_s » Sun Jan 14, 2007 11:49 pm

Thank you for your prompt response, Glenn.

Initially I rejected the idea of PRK, Lasek and other variants because it seemed to be less predictable and more risky than Lasik. Please confirm whether I am right or not.

Suppose the safety of Lasik is 90-95% (happy outcome + stabilized good vision), what would be the safety of PRK, Lasek and Epi-Lasik?

Thank you.

Kind regards,
Nikolay
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Postby LasikExpert » Mon Jan 15, 2007 1:15 am

The primary advantage of PRK over Lasik is that there is no Lasik flap. No Lasik flap means no possibilty of a Lasik flap related complication during surgery or at any time thereafter. This is the primary reason why US military special forces and fighter pilots are not allowed to have Lasik, but can have PRK.

The long term results are virtually the same, but some claim PRK provides a slightly better result than Lasik.
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Epi-Lasik can be a good choice

Postby Nikolay_s » Mon Jan 15, 2007 2:18 am

The primary advantage of PRK over Lasik is that there is no Lasik flap. No Lasik flap means no possibilty of a Lasik flap related complication during surgery or at any time thereafter. This is the primary reason why US military special forces and fighter pilots are not allowed to have Lasik, but can have PRK.


Ok. I have briefly studied the procedures similar to PRK. Among others Epi-Lasik seems to me more attractive. However I have heard that for high myopia (-6.0 or higher) Lasik surgery would be better than PRK and its analogues. Is that right?

The long term results are virtually the same, but some claim PRK provides a slightly better result than Lasik.


Some doctors say that the eye vision stabilization occurs only one year or later after PRK surgery. As for Lasik that takes up to 2-3 months. Is that right?

What is the healing time for corneal after Epi-Lasik? (as far as I know for Lasik the healing time is aprox. 6 months)

By the way, can Epi-Lasik induce keratectasia, risk of permanent haze, astigmatism, regression that would be higher than in Lasik? About what other side effects of Epi-Lasik I should be aware?

Thank you.

Regards,
Nikolay
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Re: Epi-Lasik can be a good choice

Postby LasikExpert » Mon Jan 15, 2007 3:14 am

Nikolay_s wrote:I have briefly studied the procedures similar to PRK. Among others Epi-Lasik seems to me more attractive. However I have heard that for high myopia (-6.0 or higher) Lasik surgery would be better than PRK and its analogues. Is that right?


Six diopters is about the break point to where the surface ablation techniques have a higher probability of causing corneal haze. This is resolved with the application of Mitomycin C during surgery or the patient taking 500mg of vitamin C twice a day for at least a week before surgery and at least two weeks after surgery. Of course, 100% UVA and UVB blocking sun glasses are always needed.

Nikolay_s wrote:Some doctors say that the eye vision stabilization occurs only one year or later after PRK surgery. As for Lasik that takes up to 2-3 months. Is that right?


PRK definitely takes longer for vision recovery, but it is more like days to weeks than months. Vision recovery after Lasik is often a day or two. Vision recovery is not the same thing as full healing and the very crisp vision does may not come with PRK for several weeks.

Nikolay_s wrote:By the way, can Epi-Lasik induce keratectasia, risk of permanent haze, astigmatism, regression that would be higher than in Lasik? About what other side effects of Epi-Lasik I should be aware?


Epi-Lasik is significantly less likely to induce ectasia because more cornea remains untouched to retain stability. The probability of haze for someone needing more than about 6.00 diopters of correction is higher with Epi-Lasik than Lasik, but the use of Mitomycin C and/or vitamin C mitigates that concern. The risk of induced astigmatism and regression is probably about the same between the two procedures.

Epi-Lasik has a small roller coaster type of recovery. Initially vision recovery is usually very quick and good, then it goes downhill a bit, and then it goes back uphill again. This is because all of the epithelial cells are mortally wounded with the Epi-Lasik process and it takes a bit longer for the cells to die off and be replaced than with PRK which removes all epithelial cells and requires them to regenerate anew immediately.
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Postby peakaboo » Mon Jan 15, 2007 4:24 am

You may want to ask your surgeon about SBK...this is very thin flap lasik using the intralase laser. With a flap of only 70 microns thick, many of the issues with dry eye and possible ectasia are believed to be lessened with a flap this thin. It is pretty new though, although not really different from normal lasik with the intralase flap (mine was 110 micron flap).
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Postby Nikolay_s » Mon Jan 15, 2007 10:41 am

Thank you Glenn,

I have talked to some doctors in my venue and they said that the risk of “dry eyes” in Epi-Lasik is practically the same as in Lasik. I am not sure that it is true, I believe it should be much lower than in Lasik (though the nature of such “dry eyes” is still uncertain). What do you think?

Could you please recommend me a good surgeon or medical center in Russia that may perform Epi-Lasik (if you know any)? As far as I know only www.doktorvisus.ru has been practicing Epi-Lasik surgery in Russia (since 2004 or 2005) and still does not have a wide experience in it (they did not even hear about Mitomycin C applied during such surgery).

Regards,
Nikolay
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Postby Nikolay_s » Mon Jan 15, 2007 10:42 am

peakaboo wrote:You may want to ask your surgeon about SBK...this is very thin flap lasik using the intralase laser. With a flap of only 70 microns thick, many of the issues with dry eye and possible ectasia are believed to be lessened with a flap this thin. It is pretty new though, although not really different from normal lasik with the intralase flap (mine was 110 micron flap).


It can be a very good idea. Maybe I shall wait for a couple of years when it is widely applied. The Russian doctors may not even know about it:)
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