Intralase vs microkeratome, plus additional questions

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.

Intralase vs microkeratome, plus additional questions

Postby iskolcio » Tue Jan 30, 2007 2:21 am

Hello,

I had my initial consultation with a lasik surgeon and I fall in the “good candidate” category”. Below are my eye stats:
R -4.00 cyl +0.50 ax 120
L -4.00
Dilated pupil = 6.5mm
Corneal thickness = 586 microns

My next appointment they proceeded to use the Wavefront machine to get a fingerprint of my eye. Unfortunately, the readings were far from my current eye prescription of -4.00 (both left and right eye were showing around -5.50 and -6.00). The technician tried the procedure 3-4 times and each time the readings were far from what my actual prescription is. Am I correct to assume that if the Wavefront machine doesn’t get my eye fingerprint I won’t be able to get Intralase? I’m concerned with halos, starbursts, and ghostly images after the surgery, but from what I read, with the use of Intralase these side effects are minimized. Should I be concerned if Intralase is not used and the microkeratome is used? Will my slight astigmatism be eliminated with either technology?

Where can I get some hard statistics on:
(1) Side effects of laser surgery, i.e. halos, starbursts, and ghosting? Can these be side effects be corrected with enhancements?
(2) Long term side effects? I read a lot of horror stories of people flaps coming undone years later, or vision deteriorating to a worse prescription than before the surgery, I only see double vision, etc.
(3) 10, 20, 30, 40 years from now, what can potentially happen to my eyes? If I get cataracts, how will this be treated?

I apologize for the numerous questions, any help given would be much appreciated.

Steve
iskolcio
 
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Re: Intralase vs microkeratome, plus additional questions

Postby LasikExpert » Tue Jan 30, 2007 3:09 am

iskolcio wrote:Unfortunately, the readings were far from my current eye prescription of -4.00 (both left and right eye were showing around -5.50 and -6.00).


The manifest refraction (which is better, one or two?) is a subjective process that determines what correction is best based upon the patient's own evaluation of clarity. A wavefront diagnostic will create a prescription based solely upon the optics of the eye. If the difference between manifest refraction and wavefront diagnostic is 1.00 diopter or greater, then wavefront is contraindicated.

iskolcio wrote:Am I correct to assume that if the Wavefront machine doesn’t get my eye fingerprint I won’t be able to get Intralase?


Lasik has two primary and very separate steps. The first is the creation of a flap of corneal tissue. The second is ablation (removal) of tissue with an excimer laser to reshape the cornea.

The two ways to make a Lasik flap are with a mechanical microkeratome that uses a steel blade or a femtosecond laser microkeratome, such as the one manufactured by Intralase.

The excimer laser ablation mapping is conventional, wavefront-optimized, or wavefront-guided and uses a totally different laser than the laser used for flap creation. You can have a mechanical created flap or a laser created flap with any kind of ablation.

iskolcio wrote:I’m concerned with...


There is no such thing as a perfect surgery. Even if the probability of a good outcome is relatively high, there is still the possibility of an undesired result. There are steps you can take to help reduce the probability of a bad outcome – starting with surgeon selection - but you cannot eliminate risk in any surgery.

iskolcio wrote:(1) Side effects of laser surgery, i.e. halos, starbursts, and ghosting? Can these be side effects be corrected with enhancements?


Our Quality Standards Advisory Committee evaluated many different studies and direct patient outcomes to determine that about 3% of refractive surgery patients (all types of surgeries, all types of correction) have an unresolved complication at six months postop with 0.5% being serious complications that require either extensive management or invasive correction.

iskolcio wrote:(2) Long term side effects? I read a lot of horror stories of people flaps coming undone years later, or vision deteriorating to a worse prescription than before the surgery, I only see double vision, etc.


With about six million procedures having been performed, 0.5% is a lot of people and some are very vocal about their plight. There is a big difference between the possibility of something happening and the probability of something happening. There are a gazillion things that can kill you every day, but we all pretty much expect to see the sunrise tomorrow.

There will always be risk in any surgery. You need to focus on the probability of you having a problematic outcome and if that level of risk is acceptable to you. What happened to someone else perhaps years ago may have nothing to do with your circumstances.

iskolcio wrote:(3) 10, 20, 30, 40 years from now, what can potentially happen to my eyes? If I get cataracts, how will this be treated?


Lasik has been around for 10 years. PRK for about 15. The procedure for creating the Lasik flap is in its fifth decade. By medical standards Lasik is safe, effective, and permanent.

Cataract surgery after Lasik is exactly the same as cataract surgery without Lasik, however the calculations to determine the power of the intraocular lens (IOL) that will be implanted during cataract surgery are different. Many doctors will take the measurements needed before Lasik and save them to help with the later calculations, however this is not a requirement.
Glenn Hagele
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Lasik Info &
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Postby iskolcio » Wed Jan 31, 2007 1:59 am

Thanks for q quick reply. Regarding my question #1, you mentioned that 3% of refractive surgery patients (all types of surgeries, all types of correction) have an unresolved complication at six months postop with 0.5% being serious complications that require either extensive management or invasive correction.
a - what do you consider "unresolved complications"?
b - what do you consider "serious complications"?

Thanks,
Steve
iskolcio
 
Posts: 3
Joined: Sun Jan 28, 2007 11:42 pm

Postby LasikExpert » Wed Jan 31, 2007 2:12 am

For our purposes of reporting complications, any patient complaint about a condition that did not exist before surgery is a complication. A serious complication is any complication that requires either extensive management or invasive procedure to correct.

I realize this is somewhat vague, but the patient is the source of the perception of a complication, which can be a rather subjective target.
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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