Confused about wavefront Lasek and thin cornea.

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Confused about wavefront Lasek and thin cornea.

Postby Jabi » Sat Sep 01, 2007 9:50 am

Hi, I have been lurking around in this forum for some time now and words alone are not enough to wax lyrical about how wonderful this place is to a beginner who has aboslutely no clue to an unbiased advice about refractive surgery. Keep up the great work, Glenn.

I hope you don't mind a question from this side of the pond as I cannot find anything quite like this forum in this place. The problem is I am -6.00 with 1.00 astigmatism in the right eye and -6.5 in my left. Having read a lot about the new Intralase I thought that it was time to take the leap. The thing is, when my corneas were measured, I was said to have 470-490 microns thickness and even though from what I read over here it should be alright for the Intralase, the provider (Ultralase) said that I am ineligible for it and suggested the Lasek with wavefront (Ultralasek plus) as my only option with Ultralasek a far second.

When asked why wavefront, they said that even though my HOA was low enough (did not give me the %), because of the high myopia, wavefront is needed to decrease the corneal haze. When asked if mytomycin C could be used instead (no rewards for guessing where I got all these info from) they said that it is used only for prescriptions around -8 to -10 and since I am not at risk, I don't need it and even if I do I will have to travel some 500 miles for the doctor who is specialised in its use.

I have now booked a consultation with Optimax (another provider) for the 6th and get their opinion. My questions are-

1) Do you certify doctors here in the UK? If so can I get the name of one in Manchester?

2) Is wavefront of any use to me because it is a Lasek?

3) Why do you think there is such a price difference between various companies. Optimax has done the most amount of refractive surgeries in the UK and is very cheap, while Ultralase claims to have the best lasers. I know that the doctor is more important. But what is your suggestion? (A link to the price comparison is here.

Any other suggestions or things I should be aware of from your point of view?

Thanks in advance.
Jabi
 
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Joined: Fri Aug 31, 2007 9:08 pm
Location: Manchester, UK

Re: Confused about wavefront Lasek and thin cornea.

Postby LasikExpert » Sat Sep 01, 2007 4:01 pm

Thank you for the kind words. Be sure to blog and tell your friends about us.

Jabi wrote:When asked why wavefront, they said that even though my HOA was low enough (did not give me the %), because of the high myopia, wavefront is needed to decrease the corneal haze. When asked if mytomycin C could be used instead (no rewards for guessing where I got all these info from) they said that it is used only for prescriptions around -8 to -10 and since I am not at risk, I don't need it and even if I do I will have to travel some 500 miles for the doctor who is specialised in its use.


I actually laughed out loud reading their response to your query. Either they threw so much information at you that some of it became jumbled, or they are grabbing at facts and tossing them about as if they know what they meant.

Wavefront-guided ablation is not any more likely to cause corneal haze than conventional ablation of the same depth. Wavefront tends to require slightly more tissue than conventional, but that fact would indicate the exact opposite of what they claim as the reason to use wavefront. Wavefront may be the best option for you, but not because of corneal haze.

Mitomycin C is strong medicine that is best avoided when possible, but is appropriate when needed. A 6.0mm ablation zone for a 6.50 diopter myope (nearsighted, shortsighted) [BTW, I use 'shortsighted' just for you readers across the pond] is just at the border to where mitomycin would be needed. This may be a situation where surgery without mitomycin would be appropriate, and then use mitomycin if corneal haze develops.

As for the need of an "expert" to use mitomycin C: It is topical application of 0.02% Mitomycin C ophthalmic solution for 12 seconds in a trephine, wicked out with a mirocell sponge and area flooded with balanced salt solution (BSS). If their surgeon really does not know this, then you don't want that surgeon. I suspect that "need an expert" was probably the first thing a techician or counselor could think up while trying to look intellegent in the face of your pointed questioning while trying to not lose a sale. Yes, I'm a bit of a cynic.

Jabi wrote:I have now booked a consultation with Optimax (another provider) for the 6th and get their opinion.


Feel free to email me at glenn dot hagele at usaeyes dot org if you want to go to London. I can suggest someone who you should at least evaluate.

Jabi wrote:1) Do you certify doctors here in the UK? If so can I get the name of one in Manchester?


We only certify US licensed surgeons, but our 50 Tough Questions For Your Lasik Doctor would mostly apply on your side of the pond.

Jabi wrote:Is wavefront of any use to me because it is a Lasek?


Yes. The difference between wavefront and convention ablation is the map used to guide the laser. That map is the same if it is Lasik, All-Laser Lasik, PRK, LASEK, or Epi-Lasik. You realize the same relative benefits with all laser assisted cornea-based vision correction surgery techniques. As a general rule, wavefront-guided ablation will provide a better result.

Jabi wrote:Why do you think there is such a price difference between various companies.


Refractive surgery is in a free market and that market includes low-price high-volume providers and higher-price lower-volume providers. You can find good surgeons in each environment, however my bet is that after all the "extras" are added, the total difference in the actual price from one provider to another is less than about 20%. Nobody wants to pay too much for anything, but you are talking about microsurgery on your eyes.

Jabi wrote:...claims to have the best lasers.


This really is an issue of language, not laser. It is an issue of first person v. third person plural. "Their" laser is never as good as "our" laser. 8^)

The truth is there is no universal best laser. Some lasers may have some advantages for a certain patient, but that same laser is probably a bit inferior for another patient. The question is if there is a lower probability that you will have a good outcome with one particular laser. Nothing you have described indicates that the final result would be much different with any of the variable or flying spot lasers that are on the market today - but there are many factors that need to be considered that have not been discussed in this forum. This is where the best available surgeon become so important.

Jabi wrote:Any other suggestions or things I should be aware of from your point of view?


Keep reading here. Know about pupil size issues. Visit at least three doctors. Focus on the quality of the doctor. Take your time. There is no need to rush and elective surgery decision.
Glenn Hagele
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USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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Postby Jabi » Mon Sep 03, 2007 12:26 am

As you have noticed, mates/dudes here aren't nearsighted, we are shortsighted. :D

LasikExpert wrote:If their surgeon really does not know this, then you don't want that surgeon. I suspect that "need an expert" was probably the first thing a techician or counselor could think up while trying to look intellegent in the face of your pointed questioning while trying to not lose a sale.


Good guess! I was seen by an Optometrist and not by the surgeon. Things work there differently as all 'mass-distributors' of refractive surgery use Optometrist for the initial consultations thus being able to hook us in with their free consultations. Doctors are considerabily more expensive and hence the need to look intelligent.

That said, when asked whether the doctor can work with Mytomycin C, she went and asked the surgeon who had to confirm that an "expert" was needed. So much for that doctor. But atleast he was honest.

Feel free to email me at glenn dot hagele at usaeyes dot org if you want to go to London. I can suggest someone who you should at least evaluate


Thank you very much for the offer, but the problem is that London is really a bit too far away for me to go get the treatment done especially as I have no one to count on for the help with travelling from the clinic after the treatment if I were to go that far. Manchester and at the worst a bit neighbouring counties like Liverpool, Leeds or even Birmingham is OK.

I will definitely be taking the 50 questions along with me to grill the doctor I will be seeing on the 6th. By the way, Optimax gives consultation with the doctor and not the Opto. So, that is one big plus. I wanted to get the opinion of Dr Sheraz Daya as he is arguably the best eye surgeon here but he is all booked up for a good couple of months up until middle of next year! I am trying my level best to track down a doctor named Steven Doyle as he is considered good as well with affiliation to the teaching hospital in Manchester.

That map is the same if it is Lasik, All-Laser Lasik, PRK, LASEK, or Epi-Lasik. You realize the same relative benefits with all laser assisted cornea-based vision correction surgery techniques. As a general rule, wavefront-guided ablation will provide a better result.


As a general rule, yes it should. But the more I read the more I see that the doctors are indeed divided on that front, especially with studies showing that pilots in 'Top Gun' with "supervision" of 6/4 also have a lot more HOA in their cornea than the ones with 6/6. So, it boils down to understanding which HOAs to treat and which ones to leave behind and I don't think any research has been conclusive about it.

Also keeping in mind that the while the old HOAs will be treated, during the healing from the surface ablation technique, more HOAs will be formed, I begin to wonder why go for it in the first place? Don't get me wrong- if your and my doctor's opinion will be that it is better, then I will go for it, as a few extra hundred quids is no substitute for good quality vision for the rest of my life.

however my bet is that after all the "extras" are added, the total difference in the actual price from one provider to another is less than about 20%.


This is true here for the LASIK and the Intralase. But when LASEK is taken into equation, Optimax is like 100-120% cheaper than the next provider. The owner of Optimax is a bit of a maverick. He also sells it on e-bay at discount rates! Everyone is so sceptical about it until the day of treatment but then comes out singing praises the day after. When asked about why he provides them at such low cost compared to others, his reply was just to ask others why they are so expensive.

Be sure to blog and tell your friends about us.


Try and stop me from doing otherwise..grrr

Anyways, I will let you know about further developments after my consultation on the 6th and who knows, I might make you laugh out louder this time.
Jabi
 
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Joined: Fri Aug 31, 2007 9:08 pm
Location: Manchester, UK


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