On the Fence

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.

On the Fence

Postby tbone » Sat Jan 27, 2007 7:43 pm

Hi all-

I'm new to the message board, although have been reading the posts as a guest. I recently had my evaluation for Lasik and I'm trying to make a decision.

I'm 46 and am myopic. I have a -3.00 in my left, dominant eye and -2.25 in my right. I didn't think to as for all the numbers. I've been pretty close to this level of myopia for 15-20 year. I have a very small astigmatism in my left eye as well. During the testing, they said I had small pupils (<4mm) and am, therefore, not a candidate for Wavefront. My corneas were 560 mocrons in my right and 580 in my left.

I know starting to become presbyopic. I can read the computer screen well with my glasses on. I can still read printed material, but it's more comfortable to remove my glasses to read it.

I'm most concerned with dry eye and some of the horror stories I've heard in my web research. I feel as if my eyes are on the dry side although I don't use drops or anything right now and don't seem to have any vision issues. They just feel dry/tired/itchy at times. I asked during the evaluation and was told they'd test my eyes for dryness before surgery to determine my eye drop schedule. I was assured that my eyes would return to their current state in time.

I honestly don't mind if I have dry eyes for a month or two. I've had surgery before and know that healing takes time. Any longer than a couple of months and at the discomfort levels I'm seeing sounds a deal breaker for me.

Any words of wisdom or advice is greatly appreciated. Sorry for the long post.
tbone
 
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Postby LasikExpert » Sat Jan 27, 2007 8:06 pm

You have several options.

Lasik induced temporary dry eye normally resolves within the first six months after surgery, but there are rare cases where it does not resolve and the use of artificial tears continues. The risk may be relatively small, but it is not impossible.

To reduce the risk of dry eye, consider instead of Lasik or All-Laser Lasik the surface ablation techniques of PRK, LASEK, or Epi-Lasik. Surface ablation techniques are less likely to induce dry eye problems.

You currently enjoy the option of removing your glasses to see objects close. That would change with surgery. You should read Sudden Presbyopia.

You should also consider monovision.
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Postby tbone » Sat Jan 27, 2007 10:54 pm

Thanks for the quick response.

I was really leaning at just going for the distance correction and that I'll switch to reading glasses (suddenly presbyopic). I figure, at my age, I'm not going to get rid of glasses for long no matter what I do. The way I'm looking at it, the presbyopia will continue to progress as I age. I'm guessing I'll be wearing bifocals within a few years because removing the glasses will become less effective in time. I would assume the monovision would only work for a similar time frame and then I'd need reading glasses anyway. Plus, one of the big issues I have with my glasses, is that I'm very active in outdoor sports (surfing, biking, snowboarding, golfing, etc.). The glasses have been an issue (either damaging them or no using them and dealing with the degraded vision) and I've never been comfortable with contact lenses.

One of the doctors did demonstrate monovision to me by holding a second lens in front of my right eye while i wore my glasses. To me it seemed that it was a trade off where I could see both near and far, but not as well as if I went for full distance or just left my eyes alone.

By the way, I was told my "best personal vision" for distance with my glasses on is 20/15.
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Postby LasikExpert » Sun Jan 28, 2007 2:22 am

Monovision's advantage is longer lived than you apparently believe. The effects do not change dramatically if you are already presbyopic. Once we have presbyopia just about everything will be a trade-off.
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Postby rgonyer » Wed Jan 31, 2007 9:04 pm

Just a quick comment about your dry eye concerns - I had epi-lasek a couple of weeks ago, and also very dry eyes (A couple of places wouldn't even do regular lasik on me because my eyes were too dry).

2 weeks post epi, my eyes are no more dry than they were before epi, and it's the middle of winter.
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Postby yawny » Thu Feb 01, 2007 7:55 am

I had Lasik yesterday, and went for the monovision. Actually they only did one eye, and so far it is great. I can still see to read , work on the computer, put on make up,etc and have good distance vision. I think I would have been very unhappy with only correcting distance, because if I cover my distance eye, my close up is awful in the eye that had the surgery.I realize I am still healing. I need to be able to do some closeup work in my work, so I am glad that I did not do the distance in both eyes and loose that. I may have to wear glasses to read later when my eyes get tired, but at least I can see price tags etc while shopping and do tasks at work without using glasses. For more information read the post about monovision and the diopter difference.
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Postby tbone » Thu Feb 08, 2007 3:31 am

Thanks for the comments. It's great to read about some good outcomes.

I'm fairly certain that my dry eye is pretty mild. At least, that's what I get from what I am reading about other folks with dry eye. I may call them and have them do the testing so I have some quantitative data. I also probably should worry more about the other kinds of complications that can occur. For some reason, I'm most focused on the dry eye and not wanting it to get worse permanently. I think I should worry about the other, more serious, complications that can occur. Although I'm aware of them and the risks, they don't really worry me as much as the dry eye.

As for monovision, I can read pretty well still through my glasses (distance only, not bifocals). I can't read the small print on an aspirin bottle, but I can read the newspaper and I routinely work on the computer with my glasses on without issues. I think they said my close vision is 20/30-20/40 with my glasses on, if that makes any sense. Through my glasses, I notice things start to get blurry inside about 18 inches....I still have lots of arm length left : )

I would guess that my post lasik close vision, if corrected for distance only, will be like my vision is now with my glasses on. It's a tough choice and I'm probably over-analyzing....
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Postby LasikExpert » Thu Feb 08, 2007 12:36 pm

It is easy to become very "eye aware".
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Postby Betty39 » Tue Feb 13, 2007 6:46 am

If I may interject here....Just so you know. I didn't think I had ANY dry eye problems before surgery. I wore contacts for 21 years and had no real issues because of them. The doctor didn't detect a dry eye problem, nor did I.
I am now 4 months post op and the contstant mild to moderate burning is very uncomfortable. I am coming to terms that for me this may be long term..as in permanent. I hope that is not the case but I am preparing for it. I am not telling you this to influence you one way or the other. I am only telling you this so you will be informed. I am a woman and I have read that dry eye is more common in women although at 39 I have no homone related issues. If you are that concerned about dry eye make sure you do realize that for the "few" of us patients who do have this complication it greatly effects us.
At least you understand the risk involved. I didn't. The consent form said dry eyes could be a complication. But never having had dry eyes I didn't know how disruptive and uncomfortable the condition can be. Now I do.
Good luck in your decision.
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Postby tbone » Thu Feb 22, 2007 11:52 pm

Betty39- Thanks for your response. I'm sorry to read of your dry eye issues. I hope it gets resolved soon.

I did go back and have my eyes checked for dryness with the paper strips (Schirmer's Test?). after the 5 minute time, my left eye was 14mm and my right was 27mm. From what I'm reading, that's within the acceptable limits.

I still have one more telephone consultation with my surgeon and then it's decision time......Wish me luck (and a little wisdom).


Thanks
tbone
 
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my experience

Postby mike r » Fri Feb 23, 2007 3:01 am

I had the schirmer test with the little strip at one of the 3 evals pre lasik...
The strip on 1 eye stuck to my lower eyelid my eye was so dry...
I did nt get the result but they did nt act like it was of concern...
This eye was a dry eye and got red by evening most days PRE lasik...
I now have less problems with this eye post lasik...I do have mild dry eye in the morning...
Ever since they did my lasik and recommended the over the counter artificial tears aka refresh...I still like to use them even though it really is nt necessary. I just think it may be a good general therapy for the eyes...Kind of like brushing ones teeth preventative maintenance...

I also have a plug in that really does nt do much at all...I think...

Just my opinion- I think the more invasive corneal laser treatments
may lend to a greater result of dryer eyes...Just common sense dictates that...

<mike r>
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