Opinion Requested

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Opinion Requested

Postby -5.25 » Sat May 19, 2007 11:28 pm

Hello everyone,

I went for a pre-op exam last week and am wondering if I should get a second opinion. Below are the results of the visual assessment; the doctor's notes are in bold.

OD
Uncorrected VA: DV 20/CF NV 20/400
Corrected VA: DV 20/N/A NV 20/N/A
Current RX: Age: None ADD: N/A
Motility: Ortho (this is circled) EOM: full
Confrontations: FTFC (this is circled) See Diagram
Dom. Eye: OD OS: Monovision: Yes No. Mod.
Pupils: PERRL - MG (both are circled): Dim: 7.5 Bright: 4.0
Keratometry: 43.7 143.1 x 002
Pachymetry: Orb: 516 US: 538
AR: -5.50 -0.25 x 010
MR: ou 201.5: -5.50 -0.75 x 015 20/20
Cyclo Ref: -5.25 .075 x 007 20/20

OS
Uncorrected VA: DV 20/CF NV 20/400
Corrected VA: DV 20/N/A NV 20/N/A
Current RX: Age: None ADD: N/A
Motility: Ortho (this is circled) EOM: full
Confrontations: FTFC (this is circled) See Diagram
Dom. Eye: OD OS: Monovision: Yes No. Mod.
Pupils: PERRL - MG (both are circled): Dim: 7.5 Bright: 4.0
Keratometry: 43.6 142.7 x 177
Pachymetry: Orb: 515 US: 536
AR: -5.50 -0.25 x 164
MR: ou 201.5: -5.75 -0.50 x 150 20/20
Cyclo Ref: -5.50 .025 x 150 20/20

I was recommended for PRK with custom visx because of large pupils and my moderately high prescription. I am a bit concerned because the eye exam for glasses I had in Nov. 2006 had me at OD -550 -025 -18 and OS -525 -025 140 and exam for contact in Feb 2007 OD/OS -5.25 BC 8.6 both of which are different from above. I am 28 years old if that helps. Opinions?
-5.25
 
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Joined: Thu May 17, 2007 2:06 am
Location: Columbus, OH

Postby -5.25 » Sat May 19, 2007 11:36 pm

Heh, replying to my own post... Does anyone know what the AR, MR, and Cyclo Ref mean? Thanks!!
-5.25
 
Posts: 4
Joined: Thu May 17, 2007 2:06 am
Location: Columbus, OH

Re: Opinion Requested

Postby LasikExpert » Sun May 20, 2007 12:46 am

-5.25 wrote:OD

Latin oculus dexter, right eye

-5.25 wrote:Uncorrected VA: DV 20/CF NV 20/400

Snellen visual acuity. Distance vison count fingers. Near vision 20/400

-5.25 wrote:Corrected VA: DV 20/N/A NV 20/N/A

For whatever reason, the corrected distance and near visual acutiy are not noted. I assume your vision with corrective lenses is 20/20

-5.25 wrote:Current RX: Age: None ADD: N/A

The Current RX could mean your current eyeglass prescription or may be used to indicate if you take any meds.
Age is not noted probably because you are not near age 40 and/or presbyopic.
You do not use bifocals.

-5.25 wrote:Motility: Ortho (this is circled) EOM: full

You are able to move your eyes about without apparent problems.

-5.25 wrote:Confrontations: FTFC (this is circled) See Diagram

You are able to report the correct number of fingers exposed in each quadrant of vision. No field restrictions: FTFC (Full To Finger Count).

-5.25 wrote:Dom. Eye: OD OS: Monovision: Yes No. Mod.

Your dominant eye is left. Monovision is probably not circled because you are not presbyopic.

-5.25 wrote:Pupils: PERRL - MG (both are circled): Dim: 7.5

Your pupils are equal, round, reactive to light, and accommodation (PERRL).

Marcus Gunn (MG) relates to a defect in pupil constriction with introduction of bright light. Normally, there is an initial constriction followed by slow dilatation. In a patient with a profoundly positive MG sign, the initial movement is dilatation rather than constriction. With small afferent pupillary defects, there is a relatively brief constriction before the pupil dilates. With MG circled, it would appear that your pupil constricts briefly and then dilates more rapidly than the norm.

Your naturally dilated pupil size in dim visible light is 7.5mm
-5.25 wrote:Bright: 4.0

Your naturally constricted pupil size in bright visible light is 4.0mm

-5.25 wrote:Keratometry: 43.7 143.1 x 002

Curvatue of the cornea in microns.

-5.25 wrote:Pachymetry: Orb: 516 US: 538

Thickness of the cornea in microns. First is Orb, probably for Orbscan. Second is US, probably for ultrasound. Orb and US are two different methods to measure corneal thickness.

-5.25 wrote:AR: -5.50 -0.25 x 010

AR is automated refraction to determine refractive error. You are moderately myopic (nearsighted, shortsighted) with very low astigmatism. The automated refractor under-reported your astigmatism.

-5.25 wrote:MR: ou 201.5: -5.50 -0.75 x 015 20/20

MR is manifest refraction. This is the "which is better, one or two?" process.

-5.25 wrote:Cyclo Ref: -5.25 .075 x 007 20/20

Cyclo Ref is cycloplegic refraction. This is the "which is better, one or two?" process with the natural lens within the eye paralyzed so you cannot accommodate.

It is a positive sign that all three of these refractive measurements are virtually the same.

-5.25 wrote:OS

Latin oculus sinister, left eye

The explanations above are consistent with your left eye’s results.

-5.25 wrote:I was recommended for PRK with custom visx because of large pupils and my moderately high prescription. I am a bit concerned because the eye exam for glasses I had in Nov. 2006 had me at OD -550 -025 -18 and OS -525 -025 140 and exam for contact in Feb 2007 OD/OS -5.25 BC 8.6 both of which are different from above.


Normal human fluctuation in refractive error is 0.25 diopters. Contact lenses are commonly slightly lower correction than glasses. It would appear that your refractive error is stable. You do not correct your astigmatism with contact lenses, which is not surprising considering the small amount.

At least 250 microns of healthy cornea must remain untouched to maintain stability. The larger the optical ablation zone, the greater the amount of tissue that must be removed to effect the same refractive change. A surface ablation technique like PRK will leave more cornea untouched for a greater margin of safety. You will probably want to read about PRK pupil size issues.
Last edited by LasikExpert on Sun May 20, 2007 4:50 am, edited 1 time in total.
Glenn Hagele
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Postby -5.25 » Sun May 20, 2007 4:04 am

Thanks for your answers, Glenn. Keep up the good work!
-5.25
 
Posts: 4
Joined: Thu May 17, 2007 2:06 am
Location: Columbus, OH

Postby LasikExpert » Sun May 20, 2007 4:51 am

Thank you for the kind words. Please keep us informed as you progress through your decision.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
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Re: Opinion Requested

Postby -5.25 » Tue May 22, 2007 1:25 am

Well, I went for a second opinion today, and of course I got a different recommendation :o\ Place #2 recommends Lasik with custom wavefront. This place also reported my corneas thicker and a higher prescription than the first place. Can anyone think of why this would be? Did I just have a bad vision day? The details are in the links below.

Visual assessment

CustomVue OD

CustomVue OS

Orbscan OD

Orbscan OS



-5.25 wrote:Hello everyone,

I went for a pre-op exam last week and am wondering if I should get a second opinion. Below are the results of the visual assessment; the doctor's notes are in bold.

OD
Uncorrected VA: DV 20/CF NV 20/400
Corrected VA: DV 20/N/A NV 20/N/A
Current RX: Age: None ADD: N/A
Motility: Ortho (this is circled) EOM: full
Confrontations: FTFC (this is circled) See Diagram
Dom. Eye: OD OS: Monovision: Yes No. Mod.
Pupils: PERRL - MG (both are circled): Dim: 7.5 Bright: 4.0
Keratometry: 43.7 143.1 x 002
Pachymetry: Orb: 516 US: 538
AR: -5.50 -0.25 x 010
MR: ou 201.5: -5.50 -0.75 x 015 20/20
Cyclo Ref: -5.25 .075 x 007 20/20

OS
Uncorrected VA: DV 20/CF NV 20/400
Corrected VA: DV 20/N/A NV 20/N/A
Current RX: Age: None ADD: N/A
Motility: Ortho (this is circled) EOM: full
Confrontations: FTFC (this is circled) See Diagram
Dom. Eye: OD OS: Monovision: Yes No. Mod.
Pupils: PERRL - MG (both are circled): Dim: 7.5 Bright: 4.0
Keratometry: 43.6 142.7 x 177
Pachymetry: Orb: 515 US: 536
AR: -5.50 -0.25 x 164
MR: ou 201.5: -5.75 -0.50 x 150 20/20
Cyclo Ref: -5.50 .025 x 150 20/20

I was recommended for PRK with custom visx because of large pupils and my moderately high prescription. I am a bit concerned because the eye exam for glasses I had in Nov. 2006 had me at OD -550 -025 -18 and OS -525 -025 140 and exam for contact in Feb 2007 OD/OS -5.25 BC 8.6 both of which are different from above. I am 28 years old if that helps. Opinions?
-5.25
 
Posts: 4
Joined: Thu May 17, 2007 2:06 am
Location: Columbus, OH

Postby LasikExpert » Tue May 22, 2007 1:47 am

Different corneal measurement systems often have slightly different results. The cornea is not the same thickness throughout. Placement of the diagnostic device reading can make a big difference. If you eyes are a little dry, thickness can be less. Well hydrated, more. The cornea is dynamic biological tissue and changes in many ways throughout the day.

The same is true with refractive error. Normal human fluctuation is about 0.25 diopter. Difference in hydration of the cornea can make a difference here too. A refraction is subjective and at that moment a different correction may have provided what you perceived to be a better result.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


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