My attempt at laser surgery roller coaster

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.

My attempt at laser surgery roller coaster

Postby bbarnard » Wed Feb 07, 2007 9:04 pm

Okay I had decided I wanted to try and do laser refractive surgery. I had gotten a recommendation from a friend of mine who is an OD (but doesn't do the surgery) for a place in town. Went in for the initial consultation. I'm 54 and currently wear monovision contacts. My goal was to have the correction so that I could see distance without glasses or contacts but I was going to go with a non-monovision correction and just use reading glasses. My hope was that this would last 10-20 years and I felt that at some point I'd have a regression and have to go to glasses again but at least they wouldn't be "coke" bottles and at that point they'd be bifocals as well. My current contact prescription is -6 right and -6.5 left (nondominant for my monovision contacts). I'm not sure what my actual left is but a 1.5 reading glasses worked when they had me try two distance contacts just to make sure that I would be okay moving away from monovision to just distance. I do have a small amount of astigmatism but not enough to have to wear torics. Regular soft contacts are okay.

Everything looked good and I agreed to go forward with LASIK. Set up a pre-op date and surgery date. Went in for pre-op and everything looked like a go. Told the doctor that I was a little nervous about the flap cutting but that I'd get through it. She indicated she'd give me some extra anti-anxiety medicine the day of surgery. That was a Friday. The following Wed (1/31/07) was my scheduled surgery date. The Tuesday night before surgery she called me to indicate that she had consulted with the other two doctors in her practice and they all agreed I'd be better off with PRK. She explained the differences and was helpful in answering any questions and told me if I had anymore questions to let me know. She also said it was no problem if I wanted to postpone the surgery to think about it. So I postponed a week.

So the PRK surgery was scheduled for today. Since I had researched LASIK on the internet pretty thoroughly I did a little research on PRK. Found out about the longer recovery (which the doctor had already told me about) but one thing that I did find was that PRK typically is used for "mild to moderate" myopia. And what I was seeing was that the range for that was about -3 to -5. Also what I was seeing was that the need for enhancements was perhaps slightly higher than for LASIK. So Tuesday morning I called her to ask her about those things. She indicated that because of my prescription strength the chance a non-full correction to 20/20 was higher but could give me no percentage on what that might be. She also said that there could be a greater need for enhancements again due to my prescription strength. I asked about the cost of enhancements and the cost was reasonable. So everything seemed to be settled.

So last night at 9pm I get a call from her indicating that she's not sure that my expectations of the surgery are consistent with the potential and indicating that we should cancel the surgery and that I should probably seek a second opinion.

I'm confused and bummed out and am not sure where to turn now. I'd still like to do the surgery but if it was PRK I'd have to put it off for a while as I don't have the time available right now for a recovery of more than a few days away from work.

Any feed back would be appreciated.
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Postby bbarnard » Thu Feb 08, 2007 4:43 pm

I was hoping someone would comment on why or why not I might not be a viable candidate for either PRK or LASIK. I am trying to get the actual prescription, corneal thickness and pupil diameter from the doctor who eventually turned me down, but I'm having a hard time in handling how I went from being a good candidate for LASIK with thicker than average corneas, to a candidate for PRK to a non-candidate.
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Postby chapmgre » Thu Feb 08, 2007 4:51 pm

I am by far not an expert, but a medical professional. While I can't answer your questions on the specific procedures, I think that her sending you for a second opinion and not doing the surgery is a feather in her cap.
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Postby LasikExpert » Thu Feb 08, 2007 6:29 pm

I absolutely agree that recommending a second opinion is the right thing for the doctor to do.

It is common for initial evauation to indicate surgery is appropriate and then later evaluation indicates an alternative or no surgery would be appropriate. That is why the doctors do the later evaluations.

I recommend you take your doctor's advice and seek a second opinion. You may want to ask the first doctor what clinic or surgeon she would recommend for a second opinion.

It is much, much better to deal with these issues and concerns before having surgery than after.
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Postby bbarnard » Thu Feb 08, 2007 6:52 pm

LasikExpert wrote:I absolutely agree that recommending a second opinion is the right thing for the doctor to do.

It is common for initial evauation to indicate surgery is appropriate and then later evaluation indicates an alternative or no surgery would be appropriate. That is why the doctors do the later evaluations.

I recommend you take your doctor's advice and seek a second opinion. You may want to ask the first doctor what clinic or surgeon she would recommend for a second opinion.

It is much, much better to deal with these issues and concerns before having surgery than after.


I will be seeking a second opinion. Both of these changes were made AFTER my pre-op evaluation. Had Pre-op on 1/26/07. Surgery (LASIK) was scheduled for 1/31/07. Call to change from LASIK to PRK was made the night before surgery with suggestion that I could delay surgery if I wanted to discuss with my wife and/or think it over. I delayed surgery for one week after thinking about it and discussing with my wife (coupled with talking to a person who posted on here and had used my doctor group for PRK surgery). NO ADDITIONAL EVALS WERE DONE BETWEEN THE CHANGE IN SURGERY DATES! The only additional information that was conveyed was my call the day before the PRK surgery to ask about the mild to moderate myopia vs my somewhat stronger prescription and about the chance for having to have an enhancement. Again the call came the night before surgery (after hours in both cases).

I'm wondering if it had anything to do with my questioning.
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Postby LasikExpert » Thu Feb 08, 2007 8:41 pm

It could have been your questioning. It could have been that after talking with collegues concerns were raised. It could have been that looking at the whole, Lasik didn't seem as wise as a surface ablation like PRK and after talking with you it appeared that PRK's delayed healing did not suit your needs as well. You are going from what could be a virtually painless and near instant vision recovery to what can be quite uncomfortable with delayed vision recovery. That is a big difference.
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Postby bbarnard » Fri Feb 09, 2007 8:00 pm

Okay I now have a second consultation scheduled with a provider in Jacksonville (I'm in Gainesville, FL) that performs Intralase LASIK. If he indicates that I'm a candidate for that I'll be strongly considering it although it is a fair amont more expensive than what I was going to pay for the LASIK/PRK here in town. I've heard that it was about $500 per eye more but the amount is actually more like $750 per eye and that's with a discount from my vision insurance provider.

Glenn,
I'm not sure what it was. I was prepared for the longer vision recovery time for PRK, which is why I had scheduled the surgery.

If this second provider indicates that PRK is the way to go for me I'll likely wait until this summer to do it, since I've got some time commitments that won't allow me to have a reasonable return to vision if PRK is indicated.

FYI, I did call the first provider to try and get my prescription and my measurements for corneal thickness and pupil diameter but they did not call me back to give them to me.
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Postby bbarnard » Fri Feb 09, 2007 9:50 pm

Okay my first doctor called back with my measured info. Here is what I was measured at:

Undilated pupil size in dim light:
4.5 mm L, 5.5 mm R
Corneal thickness:
548 microns L, 546 microns R

Measured Rx undilated:
-8.25+1.75 x 88 R
-9.25 + 1.75 x 80 L

Measured Rx dilated:
-7.75+1.00 x 75 R
-9.00+1.50 x 72 L

Again, I'm surprised with some of these numbers because I'm wearing as I said contacts that are -6 right and -6.5 left (the monovision eye).
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Postby LasikExpert » Sat Feb 10, 2007 1:43 am

The prescription is written in plus cylinder and contact lenses tend to be of a lower power than glasses. It may also be that a little bit of myopia provides you better overall vision quality.
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Postby DryEye » Sat Feb 10, 2007 5:40 pm

bbarnard
Take your time and see as many doctors as possible before you decide on doing it
Two benefits:
#1 They will all see you for free beforehand vs afterwards
#2 If you then decide to do it and unfortunately fall into the small % who has a problem you should have no regrets becuase of your thorough research
Also, by taking your time and seeing and doing as much research as possible (which you are one up on most people by being at this site before vs after) you will probably make an more informed decision than just rushing to get it done.
You want to be those ones that get's it done and walks away a happy camper a few days later.
Best Wishes on whatever you decide to do.
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Postby bbarnard » Sat Feb 10, 2007 5:45 pm

Glenn,
Thanks for pointing that out. So in considering whether I'm a reasonable candidate for LASIK would that be based on a plus or negative cylinder value? In other words is my myopia in my left eye considered to be -9.25 or -7.5 (=9.25+1.75)? That would make a difference for making me a candidate I'd think since if there are about 12 microns per diopter, then 7.5X12 = 90 microns coupled with a flap of about 130-160 microns equals about 220 to 250 microns. With a corneal thickness of 548 would leave me with about 300 microns of corneal thickness which should be enough to be stable. And if I'm understanding all of this, they wouldn't have to take the full 90 since my astigmatism provides about 0.25-0.35 diopters per diopter of correction.

Thanks,
Bill
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Postby LasikExpert » Sat Feb 10, 2007 8:31 pm

Bill,

It appears that your untouched cornea would be much more than the minimum 250 microns, and more is always better.

Ophthalmologists tend to work in minus cylinder. Optometrists tend to work in plus cylinder. Your spherical equivalent is closer to 8.00 diopters than 9.00 and both are a bit on the high side although well within the approved range for treatment.

The Lasik surgeon will undoubtedly create a new prescription that will be in minus cylinder and will be appropriate for glasses and Lasik evaluation.
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Postby bbarnard » Sun Feb 11, 2007 11:43 pm

So I guess after my first experience I need to ask this question. I'd like to come out of this with the ability to perform most functions requiring distance vision without glasses or contacts. To me that means driving and most other things, which would be 20/40. Is that a realistic expectation for me given my prescription and corneal thickness measurements. That seemed to be the thrust for the first doctor as to why they wouldn't do it although those were my expectations going in for my eval. I do understand that I will have to wear reading glasses. I'd like to go 10-20 years before likely having to wear glasses again. I know that I'll likely have to do that as I age. I also realize there are no sure things here. Finally what would be my odds of having a successful outcome (20/20 with no enhancements and visual clarity as well) assuming that I don't have any HOAs?

Thanks.
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Postby LasikExpert » Mon Feb 12, 2007 12:34 am

Achieving 20/40 or better uncorrected distance vision is a reasonable expectation based on the limited information you have provided. Your doctor will be better able to determine what would be the likely outcome and can provide much better "odds" than I.

The eyes will change after Lasik at the same rate they did before surgery. Not needing glasses 10-20 years is difficult to predict, but it is possible with the exception of reading glasses. After age 40 glasses are usually needed for good near vision.
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Postby bbarnard » Wed Feb 14, 2007 11:16 pm

Okay I had my follow up/consultation with the new surgeon in Jacksonville today. He said I’m a really good candidate for the surgery so……I’m scheduled to have all laser lasik done on Monday, 2/19/07. My corneal maps are clean, showing no HOAs. Corneal thickness measured by them was slightly higher than the first doctor but consistent with what I saw from the first one. I'll be going the Intralase route. He has a LADARVISION 6000 for the actual correction.

FYI, this guy has done over 15,000 of these, was the first to use the all laser method in northern FL and routinely trains others on how to use it. He has done several of the Jax Jaguars football players and also Rocco Mediate (the golfer). Finally he has had the surgery himself (and his prescription was worse than mine) and performed the surgery on his own daughter (successfully). As with any surgery there are no guarantees but I’m optimistic. He did indicate that he thought that perhaps one of the reasons that the surgeon here in Gainesville opted out was because of my question about whether PRK was suitable for high/moderate myopia. He said that with higher prescriptions, PRK has a higher incidence of scarring that can cause some problems.

This surgeon only does laser refractive surgery (PRK, LASIK, CK, etc). He is also the [national Lasik chain] surgical center for refractive surgery in N FL.

I realize Monday is soon but the next available date was the last day that I could use my leftover 2006 flex spending account money and my sister is in town to visit from VA that week so that doesn't work well from a scheduling point of view.

I am continuing to go with distance correction only rather than monovision even though I currently wear monovision contacts. He says that he actually recommends distance correction unless people just can't handle reading glasses.

The surgery is somewhat more expensive (due to the Intralase procedure). I do get free enhancements for a year if the results don't come out exactly right the first time.

Comments are of course welcome.

Note: Post was edited to remove the name of a clinic.
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