Should I get a third opinion????

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.

Should I get a third opinion????

Postby quasi100 » Thu May 03, 2007 1:55 am

After years of debating, I finally went in for a consultation to see if I was a candidate for eye surgery (PRK, LASIK, ect) in Oct 2006. The doctor said my corneas were too thin (I never wrote down the measurements back then), and he didn't feel comfortable performing surgery on me. He referred me to a doctor who specializes in Verisyse implants. I was really disappointed about not being a candidate and wasn't a big fan about having a lense implanted in my eye....so I just gave up.

Well, last week I went to another doctor for a second opinion....to see if I would be a candidiate for PRK, LASIK, ect.

I'm 38 years old and have been wearing contacts for 20 years.

OD: -7.25, -2.50 X 70
OS: -7.75, -1.25 X 110
Cornea thickness: 525 and 520

He said, "Although you are not a 'great' candidate (because of your high prescription and astigmatism), you do fall within the acceptable range." And of all the procedures he performs, he said that the CustomVue LASIK with IntraLase would be my perferred method.

I have a couple of questions:

1. Should I get a third opinion, or does CustomVue with IntraLase sound about right?

2. Do you think the thickness of my corneas will be a problem with this procedure?

3. I've researched this to no end....what holds the LASIK flap down after surgery, and for that matter, the rest of your life? Is it just gravity?

Any info would be great....
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Re: Should I get a third opinion????

Postby LasikExpert » Thu May 03, 2007 1:52 pm

quasi100 wrote:1. Should I get a third opinion, or does CustomVue with IntraLase sound about right?


Another opinion would be wise.

quasi100 wrote:2. Do you think the thickness of my corneas will be a problem with this procedure?


Yes, it is a problem. If you have a 120 micron flap and a 6.0mm wavefront-guided ablation that removes 18 microns of tissue per diopter of refractive error, you would be taken down to the absolute minimum of residual corneal thickness with no margin for error and no room for enhancement. Enhancement will undoubtedly be required after regression from such a high refractive error. It may be possible to create a thinner flap. A smaller ablation zone would reduce the amount of tissue removed, but may cause night vision problems. Also, you would be affecting nearly half your total corneal thickness. All of this is a recipe for corneal instability and poor vision quality. It is possible that all would go well, but the probability is lower than the norm.

A situation like yours is when Phakic Intraocular Lens (P-IOL) "helper" lens would be considered. A surface ablation technique like PRK, LASEK, or Epi-Lasik may also be considered, but each has their own limitations.

quasi100 wrote:3. I've researched this to no end....what holds the LASIK flap down after surgery, and for that matter, the rest of your life? Is it just gravity?


The cornea sucks. We have a detailed article on Lasik flap healing.
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Called My Doctor...

Postby quasi100 » Thu May 03, 2007 11:26 pm

Glenn

Thank you for your response. I really appreciate your input. I called my doctor and voiced my concerns (that you mentioned).

Here's what he said: He said that my corneas were definetly thick enough (525 and 520), he would create a 100 micron flap, and that they are thick enough for enhancements (if I need them later). He also said that I am a candidate for PRK (as you mentioned), but I am a 'better' candidate for CustomVue LASIK with Intralase because of my high prescription, astigmatism, cornea thickness, pupil size, ect.

He said that ultimately it is my decision on what procedure to get...as long as he feels comfortable doing it. He said that he feels comfortable doing both PRK and LASIK...but feels that I will have better results with the LASIK.


Do you still think it would be a good idea to get a third opinion, or is my doctor right on par with what he said?

Thanks again for your input...
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Postby LasikExpert » Fri May 04, 2007 2:31 am

All of your doctor's answers appear to accommodate the concerns I have raised. Based upon the numbers, All-Laser Lasik could be possible, but considering the total tissue disrupted I think you should discuss with your doctor if a surface ablation like PRK would be better for you in the long run. He is correct that ultimately this is your decision.
Last edited by LasikExpert on Sat May 05, 2007 11:46 pm, edited 1 time in total.
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Postby quasi100 » Fri May 04, 2007 12:06 pm

Glenn

Thanks a million for your input and help. I'm going to meet with my doctor next week to discuss 'in detail' the pros and cons of PRK and LASIK.
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Postby lvziggy » Fri May 04, 2007 5:12 pm

quasi, I'm kind of butting in here, but I just wanted to give you my perspective since I was in a similar situation as you are now. I had high myopia and thin corneas and pupils a little on the big side. My surgeon told me exactly what Glenn said above.

"Yes, it is a problem. If you have a 120 micron flap and a 6.0mm wavefront-guided ablation that removes 18 microns of tissue per diopter of refractive error, you would be taken down to the absolute minimum of residual corneal thickness with no margin for error and no room for enhancement. Enhancement will undoubtedly be required after regression from such a high refractive error. It may be possible to create a thinner flap. A smaller ablation zone would reduce the amount of tissue removed, but may cause night vision problems. Also, you would be affecting nearly half your total corneal thickness. All of this is a recipe for corneal instability and poor vision quality. It is possible that all would go well, but the probability is lower than the norm. "

It surprises me a little that your doctor would say that you are a better candidate for Lasik than for PRK, which is what my doctor recommended for me. Something else my doctor told me that you may want to ask your doctor is, if you have Lasik and then need an enhancement, can he do Lasik again or would the enhancement have to be done with PRK? In my case, my doctor said if I had Lasik I would likely need an enhancement, and because of my thin corneas the enhancement would have to be done with PRK. Then, I would end up having to go through the longer PRK healing process anyway after already having gone thru the Lasik procedure. That's why I ultimately chose to go with PRK.

While I'm not a doctor or an expert of any kind, I did have PRK done in March, and all I can tell you is my results are fabulous! I don't have any dry eye or night vision problems, which are both more likely with Lasik from what I've read. My vision is 20/20 and I couldn't be happier.

Just a little more food for thought.

~Alison
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Postby quasi100 » Fri May 18, 2007 2:32 am

Well, we just had it done.

You can read all about it in the Just Had It section...."We both had Lasik"
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