Scheduled for IntraLasik - have some questions/concerns

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Scheduled for IntraLasik - have some questions/concerns

Postby SRasmussen » Thu Aug 10, 2006 5:47 pm

I'm scheduled for IntraLasik Aug. 31 and I'm pretty nervous about it. I've read through many (if not most) of the relevant articles on this site. Thank you for having this information - it's difficult to find it on the Internet (I've looked), and the FDA site has nothing on IntraLasik in their Lasik section (I was quite amazed at that).

I want to know all the ins and outs of my eyes before the surgery and I'm having difficulty getting info from the surgeon and his nurses. My pupils are large (7mm) and I was told my corneas "are on the thin side" - today I learned that means 502 and 503 mm. The flap will be either 110 or 130 microns - probably 110 in my case - but they need to "do the calculations" before they can tell me how much of my cornea will be removed in the procedure.

The surgeon told me most of his patients have 7-15% chance of needing an enhancement. In my case, the probability is 15 to 20% and that they would know in 3 months - and that 3 months is the earliest they can do an enhancement.

My refractive error is -5 in my left eye and -4.75 in my right, and I have a -.50 astigmatism in each eye.

The planned ablation zone is 5.5 mm - which is clearly smaller than my pupil, and I've read the article on that, so it has me a little concerned.

The office doesn't have the data readily available on prior patients with my refractive error and pupil size and corneal thickness - I asked so I would have some data as to results (20/20 or 20/40, complications, etc.).

One of the nurses is calling me back about the specs for the lasers - model numbers, etc. I know the flap one is IntraLase, but not the model number (and the FDA lists about 5 different types); the excimer is a Bausch and Lomb 217 - but again, the FDA lists 4 different B&L 217's.

Here are the things that I'd appreciate some feedback on:

- How important is it to know the specs of the lasers (217a versus 217z)?
- Are there other questions that I should be asking to get a better sense of my outcome and the possibilty of needing an enhancement?
- How successful are enhancements - do they actually work?
- The nurse told me my refractive error was "on the high side" - is that the case? I know my sight is pretty bad, but I always figured I was in the middle range.
- With my pupils, I have an increased chance of glare, starbursts, halos in dim light. If this happens and I get an Rx for lenses to wear while driving, etc. - do the glasses remove the glare, starbursts, and halos? I was on our motorcycle the other night, and my face shield is really scratched up - and the halos I was seeing were huge. It freaked me out thinking that that's what I might end up with permanently - not being able to see the stars or city skyline at night.
- Is IntraLasik the best option for someone in my situation?

Again, any insight or perspectives on my situation - or other things I should ask - would be appreciated. My surgeon is an expert in this technology (apparently) and helped pioneer it in my state. Their clinic is one of the few in the state that offers IntraLasik (it was the first in the state to offer it to patients), and he's performed 1,000 procedures in the last 12 months. His bio reads he "worked on one of the first excimer laser prototypes in the United States. He has been, and remains today, a principal clinical investigator on the Technolas Excimer Laser and studies of the LASIK and PRK procedure."

Thank you for the help!!
Sarah
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Re: Scheduled for IntraLasik - have some questions/concerns

Postby LasikExpert » Thu Aug 10, 2006 6:17 pm

SRasmussen wrote:- How important is it to know the specs of the lasers (217a versus 217z)?


The laser will be a Bausch & Lomb Technolas 217z Zyoptix. The previous FDA approved versions are updated by the manufacturer. This is the most current version.

SRasmussen wrote:- Are there other questions that I should be asking to get a better sense of my outcome and the possibilty of needing an enhancement?


You have asked and the surgeon has provided his answer. You are seeking data to affirm that this is an accurate answer. It sounds like you are covering your bases.

SRasmussen wrote:- How successful are enhancements - do they actually work?


Enhancements are virtually equal to initial surgery, but with a few advantages. Enhancements almost always lift the existing flap - no flap creation. The surgeon knows with more accuracy how your cornea will respond to the laser ablation. You know what the process is like and tend to be less stressed.

SRasmussen wrote:- The nurse told me my refractive error was "on the high side" - is that the case? I know my sight is pretty bad, but I always figured I was in the middle range.


"High" is relevant, but I would consider this to be a moderate refractive error. It is in the range that achieves the highest level of success in most clinical trials. It may be that this is a conservative surgeon who simply does not do higher myopes.


SRasmussen wrote:- With my pupils, I have an increased chance of glare, starbursts, halos in dim light. If this happens and I get an Rx for lenses to wear while driving, etc. - do the glasses remove the glare, starbursts, and halos?


If your natually dilated pupils are 7.0mm and you have a 5.5mm optical ablation zone, your risk of night vision problems is very elevated. Read about IntraLasik and Pupil Size. Glasses may improve night vision, but contact lenses would probably do a better job. It is possible that neither will improve the night vision much.

SRasmussen wrote:I was on our motorcycle the other night, and my face shield is really scratched up - and the halos I was seeing were huge. It freaked me out thinking that that's what I might end up with permanently - not being able to see the stars or city skyline at night.


That was a very good similation of what could occur.

SRasmussen wrote:- Is IntraLasik the best option for someone in my situation?


I believe that you should investigate a surface ablation technique like PRK, LASEK, or Epi-Lasik. These techniques will increase the amount of untouched corneal tissue, make a larger ablation zone possible, and have statistically provided better long-term outcomes. They have their disadvantages too. You may want to read LASEK and Epi-Lasik.

If you have not already, you may want to submit to your doctor our 50 Tough Questions For Your Lasik Doctor.

In my opinion, the area of greatest concern is the pupil size issue. Verify that your pupil size measurement is in low light (not total darkness) and that the optical ablation zone would be that much smaller than your pupil size. With this exception, it sounds like you have a conservative surgeon...but that is a large exception.
Glenn Hagele
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Postby SRasmussen » Thu Aug 10, 2006 7:01 pm

Thanks for the info. I will digest, and may ask for other insights.

The first thing that occurs to me is that I did ask the surgeon about the possibility of wearing contacts after the procedure if the results aren't great. His answer was that he never puts patients in contacts - and he seemed to have some disdain for glasses, though his nurses are the ones that have talked to me more about this possibility. Why would he be so opposed to contacts/glasses? Is it ego or something else?

The nurse did say he was conservative - in terms of not recommending the surgery if it was possible I wouldn't have enough cornea left for an enhancement. He said to me two or three times that if I were his sister, he would tell her the same things - some elevated risk but also that he still feels I will have a positive outcome.

He mentioned the possibility of losing - uhmm - "best possible vision"? So, if I get to 20/30 or 20/40, contacts or glasses wouldn't ever be able to improve on this. This seems to contradict some of what the nurses have said, and what I've found in my research. Thoughts?

Thanks again - I'm headed for a walk to mull things over and may have additional questions.

Best,
Sarah.
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Postby LasikExpert » Fri Aug 11, 2006 12:53 am

Why any doctor would be against glasses and contacts is beyond me. If improvement is needed and they provide improvement, then they are certainly appropriate.

If the doctor does not provide PRK, LASEK, and/or Epi-Lasik, then be sure to be evaluated by another doctor who does. It is always a good idea to be evaluated by 2-3 doctors before making a decision.
Glenn Hagele
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USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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