Updated: Borderline Lasik / Epi-Lasik -- your advice?

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Updated: Borderline Lasik / Epi-Lasik -- your advice?

Postby ahall2006 » Fri May 11, 2007 11:40 pm

Adding a note: Please advise if you have questions or need more information. I'm still undecided (as of Monday the 14th May) and planning for surgery by this Saturday May 19th... as of today.
Would like your advice on the choice between lasik (custom wavefront) and epi-lasik.

Would you advise to do Lasik as long as it is an option? I'm leaning towards epi-lasik. The flap concerns me as well as the additional reduction in corneal depth.

High Order = 4.7% OD/OS

OD = -5.79DDS + 1.21DC x 116 degrees at 12.55mm (4.0 Rx calc) --- using Custom Vue by VISX
· Max ablation depth = 84.5
· corneal thickness = 498 min., 509 max.
Pupil Size =6.4x6.1mm (undialated)

OS = -6.83DS + 1.51DC+54 degrees at 12.5mm (4.0 Rx calc)
· Max ablation depth = 102.6

· corneal thickness = 496 min. 505 max.
Pupil Size = 6.1 x 5.9mm (undialated)

Thanks, in advance.
Last edited by ahall2006 on Sun May 13, 2007 3:46 pm, edited 2 times in total.
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Postby LasikExpert » Wed May 16, 2007 3:59 am

I am biased toward a surface ablation technique like PRK, LASEK, or Epi-Lasik for two primary reasons:

1) No Lasik flap means no possibility of a Lasik flap complication. Even if the probability of a complication is relatively low, no possibility is almost always better.

2) Some studies have shown results to be slightly better with a surface ablation technique over Lasik, but admittedly not by a large margin.

Some downsides to surface ablation techniques are the relatively slow vision recovery and discomfort. If you search this forum you will see experiences that range from no problem to several weeks of poor vision.

I like to say that for the first several weeks you will wish you had Lasik, and then each day thereafter you will be glad you had a surface ablation.

Based only upon your refractive error as you have provided here, you are within the treatable range for Lasik, All-Laser Lasik, PRK, LASEK, and Epi-Lasik. You need to consider your short-term and long-term needs. Ultimately, the decision is yours.
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Postby ahall2006 » Wed May 16, 2007 4:33 am

Thank you, very much Glenn. Appreciate your opinion and advice. The flap adds a complication that I also wanted to avoid.
Out of curiosity, have you had eye surgery and if so which one?

Do have questions about mytomycin (sp?) C since I don't know yet if it would be applied in epi-lasik. Read that it is radiomimetic which raises some concern for longer term impact that is not yet studied. Although the posts state it is to used to reduce corneal haze, is it to be avoided if at all possible and focus on using Vitamin C religiously? Or, would Vitamin C be "enough" to reduce the risk of haze?

Given my starting point, am I at risk of regression after surgery?

Being a bit risk averse, how automated is epi-lasik vs. lasik? I'm thinking more automation would minimize opportuniy for human error, wrong math calculation or data entry mistype. The clinic has advised there is no way the equipment allows for an error in swapping the refractive corrections for each eyes. So that's a good thing!
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Postby JPD » Wed May 16, 2007 5:17 am

ahall2006 wrote:Being a bit risk averse


This might be a good reason to strongly consider not having any procedure at all. No matter which one you choose there are always risks, and some people always end up having problems. Contacts and glasses are pretty risk free.
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Postby LasikExpert » Wed May 16, 2007 7:02 am

ahall2006 wrote:Out of curiosity, have you had eye surgery and if so which one?


I had PRK, which is what my surgeon recommended after a complete evaluation. What was appropriate for me, however, may not be appropriate for you. Your eyes are not my eyes.

ahall2006 wrote:Do have questions about mytomycin (sp?) C since I don't know yet if it would be applied in epi-lasik.


Mitomycin C is strong medicine that is probably best avoided when possible, but appropriate when necessary. Different doctors have different opinions about when to use Mitomycin C. Some use it on every surface ablation patient. Some use Mitomycin C only on those with more than a certain amount of tissue removal. Some only use it on those over a certain diopter correction (commonly around 6.00 diopters). Some never use Mitomycin C unless haze develops, and then it is applied.

The long-term impact of Mitomycin C on human corneal tissue is not well studied as it has not been used on the cornea for all that long. There is no doubt that it causes significant changes in the healing response.

The combination of the newer laser systems (less traumatic on the cornea), your moderately high correction, and 500mg of vitamin C twice a day for a week before surgery and at least two weeks after - with the use of 100% UVA and UVB blocking sunglasses - may be enough to prevent corneal haze, but you absolutely must rely on your surgeon's advice on this.

ahall2006 wrote:Given my starting point, am I at risk of regression after surgery?


Yes, at least a small amount. This may be resolved by initial deliberate overcorrection and regression back to target, or ablating only to target, allowing regression, and then enhancement surgery to "fine tune" the correction.

ahall2006 wrote:Being a bit risk averse...


You may not want any more risk than necessary, but it is difficult to be risk averse and at the same time contemplate elective microsurgery on your eyes.

ahall2006 wrote:...how automated is epi-lasik vs. lasik? I'm thinking more automation would minimize opportuniy for human error, wrong math calculation or data entry mistype.


We have already discussed the relative advantage of a surface ablation technique over Lasik. As for automation, each has its own set of unique potential problems. I don't know that anyone is suggesting Epi-Lasik is "safer" than PRK or LASEK, which do not use a microkeratome at all. For the most part, if Epi-Lasik epithelium flap creation goes wrong, you just have a PRK. In fact, some doctors use the Epi-Lasik microkeratome to remove the epithelium for PRK.

ahall2006 wrote:The clinic has advised there is no way the equipment allows for an error in swapping the refractive corrections for each eyes.


Have you ever seen anything made by man and assisted by computers that is perfect?

The possibility of getting the wrong numbers, wrong eye, or wrong whatever, will aways be there. It is the probability that is undoubtedly more important. Think of all the things that can harm you every day. The possibilities are seemingly endless, but the probability that you will get through another day is pretty good.
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Postby ahall2006 » Wed May 16, 2007 7:35 am

I am grateful for the feedback and information. Thank you, Glenn for making the details so accessible and following up.

Glad to hear you had PRK and still consider it the preferred approach. I'll ask about the Mitomycin C and planned usage. Appreciate the suggestion to think about deliberate overcorrection.

Although I am a 'bit' risk averse, I've decided this is a surgery I am willing to proceed with now. It's just taken me 20 years to get to this point!
I have been a little worried about the math skills needed to adjust or need to calculate during surgery by a single individual. Computers are programmed by people, so anything is possible. Just keeping the risk levels down and multiple checks on the inputs will help me relax. I expect this will be scary for me, regardless.

Have a good evening.
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