thin flap conventional lasik OR prk

If you are thinking about having Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL eye surgery, this is the forum to research your concerns or ask your questions.

thin flap conventional lasik OR prk

Postby padlom » Wed Feb 13, 2008 9:51 pm

hello.. i have a dilemma.. i don't know which procedure i should go for.. any advice is appreciated..

here's my profile:

29 year old asian female
R: myopia -4.50, astigmatism about 1.25
L: myopia -5.25, astigmatism about 1.50

2 months ago while i was still regularly wearing soft contacts, i had 2 lasik consultations. Both places said that i would be a condidate for lasik eventhough my corneas were on the thin side (about R-505, L-508).. but to be sure i had to be off contacts for at least a week.. and another test would be required before the surgery..

so after i've been off the contacts for about 1.5 month.. i went to another clinic for a consultation.. the thickness of my corneas were down to R-480 and L-470.. the doctor said that it's usual.. and that i have 2 options:

1. thin flap (110 microns) convertional lasik - the doctor is confident that with this procedure i would have at about 300 microns of the corneas unaffected.. eventhough there's no room for enhancement.. he's also confident that with his more than 10 years experience and almost 40,000 lasik procedures.. there is less than 1% chance that i would need an enhancement in a case like mine..

2. prk - the doctor said that prk is a very good and safe procedure (i would have about 400 microns of my corneas) but the healing time is longer and more pain associated.. and i may need to take 4-5 days off works... which is not convenient to me and also i am scared of the pain..

he also said that no matter which procedure i choose if i ever needed another surgery a few years later.. prk would be my only option..

so now i can't think which procedure should i go for.. i am leaning forward lasik.. since if i ever needed an enhancement i can still have a prk later anyway..
Last edited by padlom on Wed Feb 13, 2008 10:59 pm, edited 2 times in total.
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Postby Pappy » Wed Feb 13, 2008 10:27 pm

It seems there is some debate about thin flap, I'll give you a link and I'm sure you can search out more

Google Books

Basically saying that a flap thickness of 160 microns is prefered to reduce induced astigmatism.

My numbers (conservative since I had the same options as you -5.25 although no astigmatism) were that with a 110 flap, my doc said he usually gets 90 micron flaps, and lasik done the worst case scenario was 275 microns left. My corneal thickness was 485. I'm not sure how those numbers work out with your left eye at 410.

I chose to have PRK and it was definitely painful (pain meds helped) and it was 2 weeks before I could see "functionally" (meaning well enough to read a computer screen and drive) although now at 3 weeks my eyes are still "learning" to focus and still have some blurryness. The PRK option really has a long healing curve although each person can be different.

As to the 1%, I'm not sure about that only 92% of people achieve the 20/20 mark (and this does not talk about quality of vision) this is are national stats so it's possible an individual doctor could have a higher success rate, you might want to inquire what exactly his 1% is measuring.
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Postby padlom » Wed Feb 13, 2008 10:57 pm

pappy - thank you very much for your advice..

sorry there was a typo.. my corneal thickness is L - 470 not 410..

i decided that i would go see him again.. i would definitely question about his 1% rate.. i would go for a few more consultations for get different opinions..

are there any other questions i should ask the doctor?
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Postby Pappy » Thu Feb 14, 2008 12:40 am

I would ask him how many PRK operations he's done after lasik. I think that is still controversial as well (operating basically on the flap.

The top 50 questions here are very good if you haven't gone through it with him although some of them (referals) may take some time. I think I "interviewed" about 7 different places over the course of 6 years prior to getting surgery. I found I was not a fan of comanaged treatment (surgeon / opt being two different people) and really just searched out a skilled surgeon who I felt was reachable and didn't try to "sell" me. That's highly subjective but I felt some one who speak on the issues with out waiving aside concerns (regardless of how minor) helped a bunch.

I'm extremely happy with my doc, I have his cell phone in case I need him in an emergency and while more expensive than others I find that in the end $1000 more is not as significant as feeling secure in handing my eyes over to some one who I feel entirely confortable with.

Good luck with your searching!
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Postby cursorial » Sat Feb 16, 2008 3:54 am

I am going through a similar dilemma. I have less correction needed than you, but also have thinner corneas than you.

This book might help, it has two chapters about advantages and disadvantages of ultrathin flaps;

http://books.google.com/books?id=wjkr9oVgUK8C

chapters 29a and 29b
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Postby falldrive » Thu Feb 28, 2008 12:59 pm

Hey padlom,
Let me know what the doctor tells you bc I am in almost the EXACT same position. My main concern is enhancements. If something does go wrong (undercorrection, overcorrection, or maybe even regression down the road) what are my options bc of my thin corneas?
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Postby padlom » Thu Feb 28, 2008 9:35 pm

falldrive,

good to know there's someone with the same dilemma.. i haven't gone to more consultation yet since i was down with the flu for a week.. anyway i have an appointment with another doctor this week..

would u mind sharing some of the suggestions/opinions u receive from ur consultations?? and which procedure ur leaning towards?

thanks..
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Postby falldrive » Thu Feb 28, 2008 11:08 pm

hey padlom,
I just came back from my 3rd consoltation this morning. I spoke directly to a VERY experienced and well known suregon for over 30 minutes about this problem. He said that if I wanted to proceed with tissue sparing lasik, I could do it, but risks factor in if I regress. He told me flat out, for my corneas, PRK is a safer option. He warned me that the recovery time is longer etc. but in the long run, it is just a safer bet. I think I am probably going to go with PRK, but let me know what you hear after your consoltation.
All the best,
FD
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Postby lvziggy » Fri Feb 29, 2008 6:31 pm

Hi there. I'm going to chime in here. I had PRK almost a year ago. I was told by my surgeon that, due to thin corneas I was definitely better off with PRK, but if I really wanted Lasik he would do that as long as I knew that I would likely need an enhancement down the road and at that point it would have to be PRK. With PRK there was less chance of needing an enhancement. So I went with the PRK and couldn't be happier with the results.

I figured that, since I was looking at a procedure that would affect me FOR THE REST OF MY LIFE, I wanted the procedure that would give me the best longterm outcome with the least risk, even if that meant a little more pain and longer recovery time in the beginning.

I hope that makes sense and helps someone decide what is the best option for them.

~Alison
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Postby padlom » Sat Mar 01, 2008 7:18 am

falldrive,

i have an appointment or a consultation tomorrow.. i'll let u know the result..

lvziggy,

yes.. i've been researching and re-thinking a lot about the procedures.. now i am leaning towards prk for the long term result.. i am just worried about the recovery time.. can u share with me ur recoveryu experience and how long it took u to be able to drive urself?

thank you.
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Same dilemma, perhaps worse

Postby ultrarunner » Mon Mar 03, 2008 4:08 am

I am facing a similar dilemma as the original poster. I am a 39 y.o. male with a glasses prescription in the neighborhood of 10.5 and 9.5 diopters (not much stigmatism). My corneal thickness is roughly 550-560 microns in each eye ... Lens implants are not an option for me b/c of the cost

The first place I went to told me without hesitation that intraLasik was the ticket and mentioned no issues with being too close to the 250 microns minimum. The second place, which is undoubtedly the 'authority' on this sort of thing in my area was less enthusiastic, and said I should consider PRK. However, being that there are possible issues with both SBK (thin flap Lasik) and PRK, they agreed SBK would work for me. "Doing the math" of calculating how many microns I'd have left after a 90 micron flap, etc, etc, leaves me with roughly 280-300. Given that I can still have PRK a later date if I need to, I am inclined to go forward with the SBK procedure. PRK on my current prescription would be much harsher and open to issues such as hazing as would PRK (down the road) on 1 or 2 diopters. Further, I am assuming technology will advance in the coming years, as well.

I am literally losing sleep over this decision, which is basically SBK or going back to contacts, because I'd rather wear contacts than deal with the after effects of PRK with my rather high prescription.

Any words of wisdom are greatly appreciated.
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Postby lvziggy » Mon Mar 03, 2008 6:22 pm

From what I've read on this board, recovery from PRK can really differ from person to person. My recovery wasn't too bad at all. The day after the surgery my eyes were very scratchy and I was EXTREMELY light sensitive, to the point that I wore sunglasses inside the house even with all the blinds closed. I was able to drive myself to the dr. for my follow-up that afternoon, but that was only because I had one eye done at a time. If I'd had both eyes done at the same time I would have needed someone to drive me there.

The second day after the surgery was better, but on the third day, I think since I was trying not to use the numbing drops so much, the pain was worse. But even then, I would only describe it as a really heavy ache in my eye. The scratchy feeling wasn't too bad by then. Even tho my surgeon prescribed lortab pain meds, I only needed to use ibuprofen. And by the 4th day even that pain was gone.

Like Glenn likes to say, although flap-related problems are rare with Lasik, with PRK there is NO chance of having flap-related problems. I've taken a lot of comfort over the past year knowing I don't have to worry about a flap. Like the time I went snorkeling and rubbed my eyes from the saltwater, I felt better knowing there wasn't a flap for me to worry about dislodging.

Ultra, I also had some concern about haze. My pre-surgery scrip was -7, so it was certainly a concern that I asked my surgeon about. He said with the Mitomycin (SP?), there was little chance it would be a problem, and it hasn't been a problem. Ask your surgeon about it.

For anyone on the fence about having PRK, I strongly recommend it for the long term benefits. The pain and recovery are just the short term issues that, once you are past them, you'll be so much happier that you don't have a flap to worry about for the rest of your life.

~Alison
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Postby falldrive » Mon Mar 03, 2008 6:43 pm

Thanks for the helpful info Ivziggy,
I've been debating it for awhile now, but I think I've finally decided that its PRK for me.
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still thinking...?

Postby epthorn » Fri Apr 25, 2008 5:52 am

It seems like this is one of the most frequent questions...

First, how important is it that you be at work in 5 days? Lasik is more likely to return you to work in a couple of days, but it's no silver bullet- there's still the possibility that it takes you longer than that (it's surgery, outpatient but still surgery). PRK does tend to take longer (it took me about 5-6 days before I could get a good deal of work done on a computer)

Second... well, the pain issue is important I suppose. My experience with PRK was that it was a somewhat painful recovery. Well, actually, it was mostly irritating, but there was one night of pain that didn't seem to respond to drugs. Most doctors consider lasik just fine for everyone, although considering your ethnicity and thickness numbers you may want to seriously consider PRK... but then, you already are considering it of course. If you feel comfortable with lasik and have a low tolerance for pain (and trust your doctor, of course) then lasik still has a low chance of having a problem.
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