Conflicting opinions from 2 doctors on corneal thickness

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Conflicting opinions from 2 doctors on corneal thickness

Postby mbenaresh » Fri Aug 04, 2006 3:29 am

Hello again, Glenn,

I hope you won't mind helping me again by giving me your take on this situation:

I had my first evaluation with Dr. M, who is a top clinical opthamologist with a prestigious university hospital. His clinic seemed to have pretty new stuff. After going through a number of tests with an assistant, the doctor came in and looked over my data. He said I had thin corneas and he would only recommend PRK, which was disappointing to me. He then mentioned a recent (in June) NYT article about all the aviators at West Point getting PRK.

I few weeks ago I went to Dr. E's clinic for a similar evaluation. He is an older guy who seems to have done tons of procedures. His office definitely had older equipment (which I know can be good and bad). After the tests, performed by 2 different technicians, I did not see the doctor but met with a "patient counselor." Right away she said I have "nice, thick corneas" and that I could choose among 3 LASIK procedures, the "best" of which is "B & L Wavefront."

Before expressing my surprise, I asked her if they offer PRK, and she said they did. Then I asked her why another doctor would say my corneas are too thin for LASIK, and she said some doctors are just very conservative. We went through the math: my corneas are 513 microns at the thinnest point, minus 130 for the flap, 250 for the untouched tissue and 45 for my 2.5 diopter correction, it looks like I have about 88 microns of margin, all told.

Naturally, I wanted to know where the discrepancy was. I called Dr. M's office to find out what they measured for my corneas, and they said 503 microns for the thinnest point. They also mentioned that there was "an irregularity in your orb scan," and this could account for me not being a candidate for LASIK.

I am wondering whether the type of laser is a factor in all this. Dr. M uses a VISX Star S4 for all procedures, and Dr. E uses a B&L Technolas 217z Zyoptix for wavefront procedures.

Should I be suspicious that Dr. M mentioned the article on PRK and may be pushing it for some reason?

Sorry this is so long, but I want to give you all the relevant info. I know you have the knowledge and experience to gain some insight into this.

Thanks very much for your opinon.

Monte
mbenaresh
 
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Postby LasikExpert » Fri Aug 04, 2006 5:02 am

One would expect - prefer actually - that all physicians would have the same set of rules, the same protocol, and everyone would just get along. That is not medicine. If you give ten doctors the same data on an average patient, you will likely get eight different opinions. It’s not just Lasik. That is the nature of medicine across the board.

The military provides surface ablation techniques for Special Forces and fighter pilots, but this is due to extreme environment. Unless you plan to eject from a plane or storm a beach sometime soon, this probably is not the reason to select PRK over Lasik. We have an article about Lasik and the Military.

I have a bias toward surface ablation techniques like PRK. I acknowledge that PRK has a slow recovery and is not as comfortable as Lasik, but by eliminating the Lasik flap you eliminate all possibility of a Lasik flap related problem during surgery and during your lifetime. Remember that once you have had Lasik you have always had Lasik. Additionally, recent studies have shown that in the long term, surface ablations like PRK do have better outcomes overall.

The numbers do seem to indicate that either procedure is okay, but an irregularity in the evaluations may make a difference in the recommendation. It may be that one doctor sees something that the other doesn’t. It may be that, like me, one doctor has a bias toward PRK.

You have a relatively low refractive error. The difference in the amount of tissue to be removed between the lasers is usually not great, but can be important if someone is getting close to the margin for error. It does not appear that you are so close to that margin of safety. Both lasers provide the doctors with a very close estimate to the amount of tissue that will be removed. The numbers can be determined in advance of surgery with a reasonable sense of accuracy.

As for suspicions; I say be a little suspicious of everybody and everything. That will keep you on your toes.
Glenn Hagele
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I am not a doctor.
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