Two opinions: one say PRK, one says Lasik ?? Really confuse

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.

Postby ZinMe » Thu Apr 12, 2007 6:54 am

lvziggy wrote:Dave, obviously you need to do what's right for you. ~Alison

When I went to read the paper this morning I was quite happy with the monovision. But this evening I went outside at about 7pm to help my son with his pitching- I play catcher for him while we work on his throwing technique. I could see and track the ball OK, but not as well as I could with my regular perscription. So I'm beginning to see the trade-offs. I need the close vision more often than the distance/sports vision, so perhaps I would keep a stash of disposable -1.0 contacts for my left eye that I could use on occasions when I know I'll need the best distance vision for a long period of time. I hope that isn't as crazy as it sounds. I'm going to try one more day at -7.0 vs. -8.0 on the left eye and then switch to -7.5 to see if that is more acceptable.
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Postby bbarnard » Thu Apr 12, 2007 3:06 pm

While I was not intolerant like you my prescription was very similar (-6.5, -7.5). My corneal thickness was similar to yours as well. If you do a search on my user name you'll be able to read my saga. I have recently had lasik and it was very successful so far. I have posts in both thinking about it and just had it.

PRK had been suggested to me as well (after an initial consultation indicated I was a good lasik candidate). Then that same doctor cancelled on me for PRK (and lasik). My understanding of PRK is that there is some increased risk of scarring at higher corrections. I ended up doing All Laser Lasik. So far everything has been smooth.
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Postby ksoldan » Thu Apr 12, 2007 6:18 pm

Betty, Thanks for the heads up regarding the dryness. I've had this checked 2 times and things always look normal but I do feel that at the end of the day, my eyes need more moisture and I find myself washing off all eye makeup which seems to help. I hope over time, your dryness resolves itself. I'm sure that must be difficult to deal with.

lvziggy: I am encouraged by your info as we sound the same in terms of what we;ve been told and by whom. Both of the private Doctors whom seem to come highly recommended said I'm a better candiate for PRK. THe national chain center said I should have no problem with Lasik. As much as I don't like the idea of PRK, I've decided like you that I should listen to wisdom. How was your first week after surgery? One of the doctors I met with today has acutally had PRK and she stated that the first 4-5 days were pretty painful and she was not able to drive and work. After that things steadily improved.

Does anyone know about a time frame for the develppment of corneal haze?? I mean if you don't develop it within the first month, are you safe or is it something that can develop at a later time?? If it weren't for the possibility, I'd go in today! This is frightening to me.
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Postby ksoldan » Thu Apr 12, 2007 6:21 pm

bbarnard: Why did the DR cancel on you for the PRK?? just curious.

This is so hard!!!! I'm not much of a gambler but I hate being reliant on glasses for the rest of my life!
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Postby lvziggy » Thu Apr 12, 2007 7:19 pm

ksoldan, my surgery was on a Thursday for each eye, 2 weeks apart. For each eye, the Friday morning after the surgery was a little painful when I woke up, but as soon as I put in the "tylenol" drops my eye felt a lot better. Then I was okay until Sunday morning when the pain would start up again, I think because I was trying to wean myself off the tylenol drops. So I just took a naprosin that day and by Monday I was fine.

Good question on the haze issue. I'd like to know that myself. My surgeon really didn't think it was something to be concerned about as long as I do everything I'm supposed to like taking the Vit C and wearing sunglasses with 100%uv protection when I'm outside. I'm doing all that so I don't think I should be concerned, but I'd still like to know the answer to your question. Glenn could probably answer but he doesn't seem to be around. Maybe he's on vacation?

~Alison
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Postby bbarnard » Thu Apr 12, 2007 9:10 pm

ksoldan wrote:bbarnard: Why did the DR cancel on you for the PRK?? just curious.


I don't really know. I'm speculating that since I asked about the possiblity of having to have an enhancement and that I'd heard that PRK was primarily for people with mild to moderate myopia (about -3 to -5) that perhaps they were worried that I'd be a pain in the butt if things didn't go as well as planned. I had still planned on going forward with my procedure even with those risks but then she cancelled and suggested the second opinion. So I got the second opinion and I'm very happy with the results so far. Yesterday was my two month follow up and I'm 20/20 in both eyes although the left is somewhat clearer than the right at present.

My biggest worry for you would be if you are intolerant to contacts due to dry eye, PRK could very well be a better way to go, but I'd shop for someone with LOTS of PRK experience and really quiz them on the risks of scarring, etc. with your prescription.
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Postby Betty39 » Fri Apr 13, 2007 5:46 am

If you feel like that at the end of the day then I think you probably do have some dryness issues even though things appear normal. BTW..my doctor examined my eyes pre surgery and they appeared to not be dry. I wish I had insisted on a Shimers test or staining or something. But I didn't know. If I were you I would insist on these tests so you know where you stand. Don't underestimate how much dry eye can effect your life, it's more than just putting in drops and then you feel fine.
Thank you for your well wishes, I really appreciate it :)
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Postby LasikExpert » Sun Apr 15, 2007 4:21 pm

ZinMe wrote:I'm beginning to see the trade-offs. I need the close vision more often than the distance/sports vision, so perhaps I would keep a stash of disposable -1.0 contacts for my left eye that I could use on occasions when I know I'll need the best distance vision for a long period of time.


Using corrective lenses to provide full distance correction for those ocassions when depth perception and distance vision with the most clarity is required is a good idea. Using corrective lenses for full near correction is a good idea too. I'm not sure how practical contacts would be compared to glasses. Glasses you can easily put on and take off. Contacts are going to be less convenient, but would certainly work for an extended time.

ksoldan wrote:Does anyone know about a time frame for the develppment of corneal haze?? I mean if you don't develop it within the first month, are you safe or is it something that can develop at a later time?? If it weren't for the possibility, I'd go in today! This is frightening to me.


Late onset corneal haze does develop, but normally within three months after surgery. If the development of corneal haze is a concern, the surgeon can use Mitomycin C eye drops during surgery. Mitomycin C is rather strong medicine that is probably best avoided if possible, but is appropriate when necessary. Mitomycin C changes the wound response after laser eye surgery. Corneal haze is a wound response.

Although Mitomycin C can be used during surgery when there is an elevated probability of corneal haze, it can also be used after surgery if unexpected haze develops.

You can also reduce the probability of developing corneal haze by taking 500mg of vitamin C twice a day for a week before surgery and at least two weeks after surgery, plus using 100% UVA and UVB protection sunglasses if you even think of going outside.
Last edited by LasikExpert on Sun Apr 15, 2007 4:28 pm, edited 1 time in total.
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Postby ksoldan » Sun Apr 15, 2007 7:01 pm

Glenn
I am so glad you are back! I am having a very difficulty time making my final decision on whether or not to 'pull the trigger'. I am someone who reads too much so that's both a blessing and a curse. My biggest concern with the PRK is the possibily of corneal hazing. I don't want to make my situation worse but relying on glasses for every waking moment is depressing to me and something that I have not easily accepted. Are there any statistics on teh appearance of hazing if mitmycin C is used follwing treatment? I see that you have PRK done also. Can I ask what your prescription was and if you used the mitocyin? I am hoping that planning on taking it easy for 5 days following suregery will be enough time and that I'll be able to return to work on the 6th day. DOes that sound reasonable? I'm sorry to ask so many questions, it's just this whole thing is on my mind almost constantly! I'm impressed with the information that you are providing to others on the site.
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Postby ZinMe » Sun Apr 15, 2007 8:18 pm

My monovision test has been interesting. My contacts perscription is -8.0 in my left eye. I have experiemented with -7.5, -7.0 and -6.5 contacts.

I am losing too much distance vision at -6.5. I can even notice less clarity at about 12 feet, which is giving up too much in my opinion.

The -7.0 was helpful last night when reading menus in a dark restaurant. I think this level of monovision ie 1.0 allows me to read small print about 10-12 inches closer than I would have otherwise. And during a baseball game, i was able to see well-- I did notice a slight loss of distance vision, but it wasn't too much.

The -7.5 lens buys my only about 6 inches of close reading distance, so it it doesn't have that much impact, however, at my current level of presbyopia- it is all I need.

I'm guessing that over the next several years I will experience increased presbyopia, so I'm going to talk to my doctor about undercorrecting me to the equivalent of -7.0., but it is a total guess.

the other idea I had was to get perscription sun glasses and a batch of disposable -1.0 contacts for my left eye after the monovision which would give me full correction when I play golf or need full correction. Seems like an easy adjustment.
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Postby LasikExpert » Mon Apr 16, 2007 12:37 am

ksoldan wrote:My biggest concern with the PRK is the possibily of corneal hazing.

Since your prescription is over 6.00 diopters, your surgeon is likely to use Mitomycin C as a matter of course. This would virtually eliminate the probability of haze. If you combine this with taking vitamin C, you have additional reduction in the probability of corneal haze.

My eyeglass prescription was slightly lower than yours.

ksoldan wrote:I am hoping that planning on taking it easy for 5 days following suregery will be enough time and that I'll be able to return to work on the 6th day. DOes that sound reasonable?

It does sound reasonable and you should confirm the reasonableness of this plan with your surgeon, however everyone heals differently. Be prepared and able to limit your computer work and keep a good eye health maintenance regimen.

ksoldan wrote:I'm sorry to ask so many questions, it's just this whole thing is on my mind almost constantly!

I have a very pointed question: If PRK is on your mind constantly before you have it, how will you react if things do not go exactly as planned. For that matter, how would you react if things do go as planned, since PRK has a comparatively long and variable recovery. Laser eye surgery is not just about the physiology of the eye. It's about the expectations and personality of the patient too. Since there is always risk with surgery you need to consider your ability to handle adversity, even if a temporary adversity.

It's really easy to become obsessive about your vision when it is not as you expect it to be. An unhealthy obsession (no accusations meant) can be more destructive than anything a laser could do.

ksoldan wrote:I'm impressed with the information that you are providing to others on the site.

Thank you for your kind words, but I can take credit for very little. All I present is the result of the work of much smarter people than me.

ZinMe wrote:My monovision test has been interesting.

Yours is a perfect example why it is so very important to try monovision with contact lenses before having Lasik or similar surgery.
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Postby ksoldan » Mon Apr 16, 2007 1:08 am

Hello again Glenn

Thanks again for your quick response.

You asked:

""If PRK is on your mind constantly before you have it, how will you react if things do not go exactly as planned. For that matter, how would you react if things do go as planned, since PRK has a comparatively long and variable recovery. Laser eye surgery is not just about the physiology of the eye. It's about the expectations and personality of the patient too. Since there is always risk with surgery you need to consider your ability to handle adversity, even if a temporary adversity""

I guess the main reason this is on my mind so much is that's how I make decisions which I feel are major ones and I want to be sure that I could handle side effects should they occur. As long as I am prepared for fluctuations, pain and longer recovery, I think it will be worth it in the long run. I do not have to have perfect vision. I am just not functional at all without my glasses and when your prescription is so high, glasses that are almost 'coke bottles' are about your only option! I could handle mild regression and the need for glasses for reading, driving etc. if needed. My concerns again (I'm a broken record I know) are the possibility of hazing. Since you stated the mitocyn pretty much elimates that, I wonder about what side effects I may have 10 years from now because of it's use. I know, I know I sound like a major pessimist. I just think about things very serioulsy until I reach a point that I go one way or another. It would be so much easier if this wasn't 'elective'! Anyway, I sure appreciate this site and your feedback. I leaning heavily to calling Monday morning and getting scheduled.

Kristyn :)
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Postby LasikExpert » Mon Apr 16, 2007 1:54 am

Mitomycin C makes some pretty significant changes to the healing response of the cornea. The studies go back to 1991 with a flury of studies after 2000.
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Postby ZinMe » Mon Apr 23, 2007 6:36 pm

Yours is a perfect example why it is so very important to try monovision with contact lenses before having Lasik or similar surgery.


Update for anyone thinking about monovision: I had two conversations last week- one my optometrist and one with my sugeon before my first eye PRK procedure. My optomitrist recommended undercorrectly by about 1.5 while my surgeon said they almost never undercorrect by more than 1.0, an usually by about 0.75- which is interesting because if i had to pick a specific number based on my trial, i would have piced 0.75. I think my optomitrist is basing his recommendation on the number of people who need that level of adjustment in their bifocals/reading glasses as they get older and thinks its better to optimize for the long run. Anyway, i won't have the PRK procedure on the second eye for at least another three weeks, so we'll have more time to discuss.
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