I’m sorry to hear of your difficulties. You do have several options.
Repositioning of the lens may resolve the problem, however edge glare and night vision problems will probably not fully resolve with centering. The optics of the Verisyse phakic intraocular lens (P-IOL) are not larger enough to cover a 7.0mm pupil. In very low light environments the pupil will be larger than the optics and light will “leak” around the edges. What is not deflected by the P-IOL’s edge will be out of focus when it reaches the retina and is “seen”. The edge deflection can cause glare and flashes. The out of focus light can cause haloes around light sources.
Refractive Lens Exchange (RLE) also known as clear lens extraction, would be an obvious option for some aged 46, however your high myopia would put you at an elevated risk of retinal detachment. Eventually you will need this same procedure when you develop cataracts, but that is a different situation. Cataracts reduce your ability to see even with glasses. There really is not much of an option. You may not develop cataracts for 20-30 years, so that is 20-30 years that you don’t need to worry about retinal detachment caused by the trauma of surgery.
Staying at the cornea makes more sense because you will not elevate the risk of retina problems. Lasik is almost probably not an option because the large amount of tissue that would need to be removed to resolve your myopia plus the thickness of the flap would mean that your cornea would probably be too thin to remain stable. A surface ablation technique like PRK, LASEK, or Epi-Lasik would probably resolve the thickness issue, but these techniques have an elevated risk of corneal haze.
Epi-lasik is probably the most appropriate choice of surface ablation techniques. By saving the epithelium the incidence of haze is believed to be reduced, but there something more you can do.
It has been found that taking 500 mg of vitamin C twice a day for at least one week before surgery plus at least two weeks after surgery reduces the probability of corneal haze to almost zero. Another important step you can take to reduce the probability of haze is to wear 100% UVA and UVB filtering sunglasses if you even think of going outside for month after surgery.
Mitomycin C can be applied to the cornea during surgery can change the healing response. This also reduces the probability of haze. Mitomycin C is strong medicine that is probably best avoided it when possible, but is appropriate when necessary.
The business side of refractive surgery is... well... business. Whatever terms and conditions a physician offers and a patient accepts are what are appropriate. It is common for physicians to charge a patient in their out-of-pocket expense including facility fees. Whether or not that is appropriate is a matter of personal opinion.
A second opinion may be wise. It is not likely that the second opinion will be much different than the opinion of a certified and internationally noted authority on refractive surgery, however there is something else a second opinion will provide: peace of mind. A second opinion doctor will affirm if you're on the right track and if you're not will be there to help you down a different path. Knowing that you are receiving appropriate advice from your primary surgeon is of tremendous value and is almost as valuable as knowing you are receiving inappropriate advice from your primary surgeon.
Last edited by LasikExpert
on Thu Jun 22, 2006 9:15 pm, edited 1 time in total.