About to go ahead with lasik custom wavefront. advice needed

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.

About to go ahead with lasik custom wavefront. advice needed

Postby Direwulff » Wed Jun 14, 2006 8:53 pm

just moved to the Naperville, IL area and have been thinking of getting laser correction done on my eyes for a while now. My quests are as follows.

1) I moved here and heard radio adds for LasikPlus Vision centers and they offer great financing. Any feedback or comments on this company would be great as I am new to the are.

2) How to you make sure you don't get overcharged but at the same time make sure you are getting quality pricedure done. Are there questions to asks to make sure you compare apples to apples?? I have seen pricing from $400 and eye to 3k and eye and while I don't want to go for a bargain and risk my eyes, neither do I want to overpay just do to fear.


My prescription is -4.25 left eye with .75 astigmatism -4.5 right .75 astigmatism with 7.5 pupil size and "good cornea thickness"

They told me with my pupil size i needed to do wavefront... which seemed like what everyone recomends anyway and that i would be able to get to 20/20 either first try or with a follow up procedure ( no extra cost ) The package offered to me was $1700/eye with lifetime "acuity" (adjustments or follow ups as i understand).

The Doctors name is {Redacted} and they use a "customvue laser".


The 2 other locations i called ( one the doctor recomended on this site) wanted upwards of $2500 per eye for what seemed like the same procedure. Laser in all cases visx4 custom wavefront

Any help or advice would be great.
Direwulff
 
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Postby LasikExpert » Wed Jun 14, 2006 10:27 pm

Large Lasik chains are often the subject of controversy. Some do not appreciate the “cow herding” ambiance of some of the high volume facilities. Others are uncomfortable with not being evaluated by their surgeon until the last minute, having all preoperative evaluations being performed by allied personnel or optometrists. These issues are more important to some and less important to others. You need to decide what is important to you.

In all cases, the most important issue is the quality of the surgeon and if that surgeon is able/willing to correctly evaluate all preoperative testing. We have a comprehensive 50 Tough Questions For Your Doctor that is an excellent tool to evaluate a potential surgeon. Download a copy and send it to your surgeon for responses.

Your pupil size is a caution flag. If your naturally dilated pupil in a low light environment (not zero light) is 7.5mm there may be the possibility of an elevated risk for night vision problems. Read Lasik and Pupil Size and keep in mind that the largest optical ablation zone for wavefront-guided Lasik is 6.5mm. As you read the article you will understand the significance.

The way to make sure you are not being overcharged is to shop around. Be evaluated at different facilities and receive a solid price quote. I suggest you visit at least three providers. Since you already have been to a national chain, I recommend you visit two independent Lasik surgeons.

Our organization has evaluated and certified a refractive surgeon in River Forest. You may want to consider this doctor also. Visit Chicago Lasik Doctor. Use the 50 Tough Questions For Your Doctor on each of the other potential surgeons.

Different doctors have different limitations and abilities, technology, and “standards”. You will get a better idea of what is best for you with multiple evaluations.

If you want to look up the outcomes on the Visx S4 Laser, visit FDA Lasik Information and follow the links.

Lastly, it is great that a doctor or facility is confident enough to provide a “lifetime” commitment, but there can be some problems with this. Read Lasik Lifetime Commitment.
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Repsonse to great info

Postby Direwulff » Wed Jun 14, 2006 10:49 pm

Thanks for the great info and links that did help a lot and I will be going over it more in the future. I printed out that question guide and will take it to the other appointments I have made.

A few follow up questions.

1) they told me the custom wavefront laser was able to go up to 9mm in size... from what you are saying the wavefront is only capable of 6? The doctor told me that larger pupils up to 8.5mm is what that laser was designed for working on and that it would fix the "halo" effect i would get almost for sure with a normal laser.

2) I think the measurements they took for me were with my pupils dialated by drops if that makes a difference.
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Postby LasikExpert » Wed Jun 14, 2006 11:23 pm

Your pupils being dilated by drops make a tremendous difference. The measurement that is important in this regard is the size of your naturally dilated pupils in a low light environment.

The Colvard Pupilometer uses invisible infrared light and measures pupils in total darkness. This commonly provides a pupil measurement that is about 1.0mm larger than dilation in low light. Humans are not expected to be able to see in zero light, but zero light provides a standardized measurement from which calculations can be determined.

Other devices measure pupil size at various light levels and even a ruler in a controlled environment can provide an accurate reading. Don’t try this yourself. There is no danger, but when you focus on the ruler your pupil size will change. Pupils tend to become smaller when you foucs on an object. This is another reason why pupil measurement in total darkness can be a good idea.

The largest optical ablation zone that is fully corrected with wavefront data with any currently FDA approved laser is 6.5mm, and this is smaller if you have astigmatism. The laser can ablate tissue to a larger diameter, however from the fully wavefront-guided optical ablation zone to the edge of the treatment will not be fully corrected and will not be corrected with wavefront data. This is known as the transition zone – the transition from fully corrected to no correction.

As you learned from the Lasik Pupil Size article, pupil size alone is a poor predictor of who will and who will not develop night vision problems. There are several other factors, such as curvature of the cornea, percentage of cornea to be ablated, amount of total correction, angle of transition zone, anterior chamber depth, and more that undoubted play a part. Your doctor can review previous patient outcomes or confer with other doctors to determine if someone with exactly the same measurements of all these parameters would be at an elevated risk of night vision problems.

It may be that in the opinion of your doctor and after an examination of your eyes that there does not appear to be an elevated risk of problems, but different doctors have different opinions. That is yet another reason to shop around.
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Exactly what i was looking for.

Postby Direwulff » Thu Jun 15, 2006 3:15 pm

Thanks again this has been very helpfull for me. I have scheduled 2 other appointments and will check with these doctors and ask the "50 tough questions" from you site.
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Postby LasikExpert » Thu Jun 15, 2006 4:21 pm

I'm glad to be of service. Please feel free to return to this thread with any additional questions you may have.
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Change to Custom PRK?

Postby Direwulff » Thu Jun 15, 2006 9:18 pm

Well I got back from talking to the actual surgeon and asked the questions provided by this site. Most of them came out well and in the process of asking custom PRK came up.

What was explained to me is that at my prescription i can do custom prk. The disadvantages being first 4-7 days vision is a bit shacky and time off is needed for recovery.

Benefits were that vision can be slightly better in the end and there is no flap cut so less options for complications.

Currently I see no reason not to do custom PRK instead.... is there anything I am missing.

Thanks again for the great help.
Direwulff
 
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Postby LasikExpert » Thu Jun 15, 2006 10:05 pm

I am glad to hear our 50 Tough Questions For Your Lasik Doctor are being helpful.

I have a bias toward surface ablation like PRK, LASEK, and Epi-Lasik. None demand the flap of stromal tissue that is required for Lasik and IntraLasik. The probability of flap related complications is relatively low, but no flap means no possibility of complications. I like anything that eliminates the possibility of complications.

Several studies have shown that wavefront-guided surface ablation has a better long-term outcome than Lasik or IntraLasik, but there is not a tremendous difference. It is an advantage, but a small advantage.

Don't have PRK, LASEK, or Epi-Lasik if you are the impatient sort or if you cannot handle a bit of discomfort. Your vision will be poor for the first few days and your eyes will be uncomfortable. Plan to take the meds and get lots of sleep. I describe this period as "functional fuzzy" vision. For a couple weeks after the functional fuzzy vision your vision will be pretty good, but not really clear. You will notice a difference from when you had glasses or contacts. You will undoubtedly be fully functional and can drive, etc., but that nice crisp vision that you want probably will not arrive until about a month after surgery, sometimes a bit longer.

The epithelium (which is removed or disrupted in all surface ablation techniques) has the fastest reproducing cells in the human body, but they do need to reproduce, cover the treatment area, thicken, and then smooth. That takes time.

If you demand the "20-Minute Miracle" then PRK is not for you, and perhaps nothing is. If you can be patient, then PRK may be an appropriate alternative to Lasik. I like to say that for the first six weeks you will wish you had Lasik, and for every day thereafter you will be glad you had surface ablation.
Glenn Hagele
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Once again exactly the information I was seeking.

Postby Direwulff » Thu Jun 15, 2006 10:20 pm

This matches up to what the surgeon told me about the procedure. I am the type that does not have a problem with pain/discomfort and can deal with short term vision issues. I told the doctor that I wanted the solution that gave me the "best long term results regardless or short term discomfort"

That was when he advised me to custom PRK and said that would be his choice were he in my position. Glad to here that you have the same opinions on this.

-Much appreciated.
Direwulff
 
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Postby LasikExpert » Thu Jun 15, 2006 10:27 pm

Please be sure to let us know your outcome.
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Surgery tomorrow a few last minute thoughts

Postby Direwulff » Thu Jun 22, 2006 3:57 pm

Well so far everything is going well. A little bit of nerves as I have been told would be normal. I had a few additional questions as things get closer.

1) I have been told different things on intake of caffeine prior to the procedure. Is it recomended to have no caffeine the day prior to and day of surgery?

2) With the PRK surgery I Have decided on, I was told I will need to "rest" for 5 days afterwards. How limited should my activities be, again I have gotten differing opinions.

Can i watch TV? Use a computer? Read a book? Are these things I should maybe avoid for 2-3 days but am ok again on in the later "resting stage"? I was trying to think of things i can do to pass the time and there are not many things to do which don't involve use of my eyes :-)
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Postby LasikExpert » Thu Jun 22, 2006 7:55 pm

Being a bit nervous shows that you have an appropriate understanding that this is surgery and all surgery has risks. Even if the risks are relatively small, they do exist. I'd be nervous if you were not nervous! 8^)

1) It seems that the caffeine recommendation depends upon the individual surgeon. Ask your doctor about that one. I doubt that anyone will want you to have a caffeine withdrawal headache, but there may be an interaction reason for a recommendation against caffeine.

2) My recommendation is to have no responsibilities for those five days so you can totally convalesce if needed, but have things available to do if you are able and willing. You really don't want to be bored for five days if you quickly have highly functional vision. If you are married I'm sure your spouse can supply a list of projects to keep you busy.

You “can” watch TV, use a computer, read a book, etc. The two questions will be if you are easily able and if these activities are going to slow healing.

For the first 1-3 days your vision will be very poor. You will probably be able to recognize most objects and you won’t be bumping into walls, but clarity is simply not there. I recommend you get some books on tape. They can be entertaining, they don’t bother your friends and family if you want to use headphones, and can be entertaining for friends and family if they want to listen too. It is a great way to pass the time and catch up on your reading. Virtually every title is available.

If you want to get real creative, lean a new language. This too is available on tape. Between a reduced need for glasses and learning to say “Hi, give me something to eat.” in another language you will be ready for some travel. 8^)

Do you play (or did you once) play a musical instrument? Perhaps you could practice a bit.

The very best environment for healing is moist eyes that are closed. If your eyes are dry, then the environment is not conducive to healing. If your eyes are open, then healing can be delayed a bit. So the extreme is your eyes closed for five days. That is not very practical and really is unnecessary. The other extreme is probably working at a computer for 10 hours a day. Computers are the worst because we tend to not blink often enough when reading a computer screen.

Between a 10-hour per day computer stint and your eyes closed for five days is the balance that you must find as your heal. Key to healing is proper lubrication. If you are using preservative-free artificial tears appropriately, then you can do just about anything your vision allows you to do so long as it is not going to expose your eyes to trauma.

The problem is not likely going to be your eyes healing. They will do fine. The problem will be you going stir crazy at home. Books on tape, learn a new language, or playing the drums might keep you busy enough to not be bored.
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approx 2 weeks after the surgery and so far so good

Postby Direwulff » Wed Jul 05, 2006 5:44 pm

Well I went ahead with the procedure which went a lot smoother and faster then I had expected. The first 5 days were a bit rough with the PRK, but that expectation was set by the doctor at the start and was not as bad as i had thought. I mostly slept and put drops in every 4 hours. On my follow up appointment to get my "bandage lenses" out I was measured at 20/20.

So far I am very happy with my decision and my doctor. They have been good at supporting my questions after the procedure and following up with me. I am currently back at work and able to drive at night with no problems. I can see better then I could with my glasses and most of the time as well if not better then with my latest contact prescription.

My eyes are a little bit dry and I am using rewetting drops a few times a day for added comfort. Eyes are still a bit light sensitive and I get the occasional fuzzyness but so far MUCH better then I had expected them to be at this point.


Thank you again for all the help and answers to my questions.
Direwulff
 
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Postby LasikExpert » Thu Jul 06, 2006 2:34 am

I'm glad to have been able to provide you some of the information you needed. If you are satisfied with your vision now, which is so soon after surgery, you will be thrilled in about a month when the epithelium has thickend and smoothed even more.
Glenn Hagele
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