Scheduled for Epi-Lasik, but now having doubts

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Scheduled for Epi-Lasik, but now having doubts

Postby yemartin » Tue Feb 26, 2008 3:29 pm

Hi all,

I am 33 years old, and eligible for both Lasik and surface ablation (cornea thickness in the low 500, -6.75D and -5.75D, HOA RMS 0.27 and 0.12). I read a few threads here regarding Lasik vs. Epi-Lasik, and I also saw the following on this site:
Many studies have shown that the surface ablation class of Epi-Lasik, LASEK, and PRK provides better outcomes than Lasik and All-Laser Lasik.

and given the elimination of flap-related issues, choosing Epi-Lasik seemed like a no-brainer. However, given that I already understand and accept all the implications of Epi-Lasik (pain, longer recovery...), my doctor still recommends IntraLasik, claiming that:
    1. flap-related issues are extremely rare
    2. they get better outcomes (visual acuity) using IntraLasik

I was surprised at that second claim as it contradicts the above quote, so he showed me figures to support it: for medium myopia (-3.25D ~ -6.0D), they claim that with IntraLasik, 94% achieve 20/20, but only 88% do with Epi-Lasik. Looking at these numbers from the other side: 6% did not achieve 20/20 with IntraLasik. And this doubles to 12% for Epi-Lasik.

So now I don't know what to think... Is my doctor just trying to sell me the Lasik they know better and love? If I stick to my original choice of Epi-Lasik: is it worth doubling the risk of not achieving 20/20 in order to eliminate unlikely flap issues?

Thank you for your advice.


PS: in case it may be relevant, the laser will be a wavefront-optimized Concerto 500 Mhz (after a wavefront analysis, the doctor said I would not benefit from the wavefront-guided option).
yemartin
 
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Re: Scheduled for Epi-Lasik, but now having doubts

Postby LasikExpert » Tue Feb 26, 2008 11:17 pm

yemartin wrote:2. they get better outcomes (visual acuity) using IntraLasik


You know what they say about statistics, and medical statistics are no different.

I attend many medical conventions and read scores of medical publications. Although there are isolated studies that say one is better than the other, as a general rule the surface ablation techniques provide a slightly better outcome than Lasik or All-Laser Lasik (IntraLasik). The difference, however, is so slight that it may be considered within the margin of statistical error.

It may be helpful to know that the doctor uses exactly the same laser treatment plan with a surface ablation as with a Lasik technique. The laser energy application is the same.

There is a clear difference in the time for vision recovery, as you mentioned.

The probability of a Lasik flap related complication is relatively low, however no possibility of a complication is almost always better than a low probability of a complications.
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Postby yemartin » Thu Feb 28, 2008 8:39 am

Thank you very much for your reply, and for reminding me about statistics... :)

There was another suspicious claim that I would like to submit to your review. The clinic I am going to offers a 5 years guarantee during which a second surgery can be done, free of charge, if 20/20 was not reached the first time. If IntraLasik is done, both surgeries will be using the Concerto 500 laser. But my doctor claimed that if I choose Epi-Lasik, the second surgery may NOT be done using the same Concerto 500 laser, and that an older model would be used (maybe an Allegretto 400).

Of course I asked for an explanation. The answer, something about not risking over-correction, and some dazzling technical mumbo-jumbo, left me unconvinced, and with a feeling that again, they are just trying to push IntraLasik...

What is your take on this? Is there any technical reason that could explain this strange claim?

Thanks again for you opinion.
yemartin
 
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Postby LasikExpert » Thu Feb 28, 2008 6:20 pm

I am not knowledgeable with the two lasers enough to provide direct information, but some lasers have a tendency to overcorrect when used for very small corrections. It may be that your surgeon's practical experience has been that one laser is more accurate than another for small changes commonly associated with Lasik enhancement surgery.

This is likley not about using an "older" or "cheaper" laser. It is more likely about using the tool that is most likely to provide the desired result.
Glenn Hagele
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USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Postby yemartin » Sat Mar 01, 2008 10:41 am

Thanks again for a great explanation. That makes perfect sense: from what I have read, the Concerto ablates twice as fast as the Allegretto, so I guess that it would be preferred for larger corrections, but it may lack subtlety for finer adjustments.

So if my doctor does not have anything more convincing to say, I guess I will be sticking to my original choice of Epi-Lasik. I will talk with him again tomorrow, and if all is well, I will be undergoing surgery on Monday. As soon as I can, I will report in "Just Had It" (^_^)

EDIT:
Click here for the "Just Had It" post.
yemartin
 
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