Done enough research to confuse me...Q's about Lasik

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.

Done enough research to confuse me...Q's about Lasik

Postby Rocksville » Fri Mar 28, 2008 8:36 pm

Hi,

I've done the rounds to the larger Lasik centers around here, and also to an independent Dr. who doesn't market himself as a Lasik surgeon but came highly recomended from a handful of people I've spoken with.

I have a relatively high level of nearsightedness (-6.25) ,a moderate astigmatism, and a slightly thinner cornea (520). I've heard 2 different Dr's ([a national chain], and the independent) tell me that I wouldn't benefit from custom lasik and and 2 others tell me I'd be crazy not to get custom.

I've also had 2 dr's tell me that intralase cuts a thinner flap, and 2 say that the blade cuts a thinner flap--but all seem to agree that for my corneal thickness a thinner flap is preferable. Probably just supporting the technology they possess.

So I guess what i've come down to, is the independent Dr. and a facility called [another national chain] (which is national, so I'm sure you're familiar). The independent wanted to do non-custom lasik, with the blade on a B & L laser (because custom removes more tissue and the blade is a thinner flap--according to him), while TLC wanted to do custom (wavefront guded) with bladeless intralase, on a Visx? laser?

I kind of lean towards [the second national chain] even though they are a little more expensive, I just felt more comfortable with the time the Dr. took with me to explain some of the procedures and technicalities....but both Dr's have very contrasting oppinions.

Thoughts? Is one machine better than the other? I'm concerned about night vision because of my relatively high level of correction. I've never had problems with dry eyes before either.

the 3rd option was much more expensive and felt more like a hi-volume/less persoanl facility, but they use an Allegretto 400 laser which they claim is the end all. Is this laser really worth the extra money, or are the Visx and Bausch and Laumb lasers fairly comperable?

Thanks in advance for any insight you can give me. I only have one set of peepers and obviously want to do this the right way the 1st time.




Also, I've been told PRK is another option, but all 3 Dr's that mentioned PRK because of my corneal thickness all said they would still choose Lasik for my situations.

Note: Post edited to remove name of clincs.
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Postby LasikExpert » Fri Mar 28, 2008 9:32 pm

I am decidedly biased toward the surface ablation techniques like PRK, LASEK, or Epi-Lasik. The reason is simple: if you eliminate the Lasik flap, you eliminate the possibility of a Lasik flap complication. Even though Lasik flap related complications are relatively rare, no possibility is almost always better than a low probability.

With its realitively fast vision recovery and virtually no pain, Lasik is much more convenient than PRK, but in the long term PRK should be considered.

In your situation, a surface ablation is possibly the most appropriate choice. It is reasonable to expect a small amout of regression with your moderately high refractive error. Even a thin flap will require about 100 microns deeper penetration into the cornea. That would be 100 microns for a margin of error and to resolve regression issues.

As to the facilites you are considering - focus on the doctor. The higher price does not dictate that the surgeon is better, nor does a lower price mean the surgeon is inferior. I recommend you use a USAEyes certified Lasik doctor or our 50 Tough Questions For Your Lasik Doctor to evaluate an uncertified surgeon.
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Postby Rocksville » Fri Mar 28, 2008 10:07 pm

Both Dr's at the chain say they are in the nation's top 100, although they don't cite the source of that list so it could be something along the lines of "who's who among america's top high school students". They are also professors at the local University which has a very well recognized medical center. But that doesn't necessarily make them great surgeons.

I checked the USA eyes list and nobody is listed for Utah. I did however look over the list and I've asked many of those questions, although I did put a note by a handful to ask when I speek with them again on Monday.

PRK is a difficult option for me due to my work schedule. I can't really afford to be out of work for a week, nor does the though of having cloudy vision for a month sound particularly appealing to me. Obviously it's more appealilng than a flap complication, but the odds of flap complications are slim enough that I'm probably willing to take the chance.

I believe the Dr. said they base their numbers upon a 300 minimum thickness as opposed to the standard 250....I'm not totally sure if that is accurate but his point was that they are relatively conservative when recomending between PRK and Lasik.

If I were to have Lasik, and in the future my eyes regress to the point that I need a touch up, is PRK an alternative at that point, or does Lasik automatically eliminate the possibility of PRK in the future? Can you only get a touch up using the same procedure that was originally done?
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Postby LasikExpert » Fri Mar 28, 2008 10:20 pm

Rocksville wrote:If I were to have Lasik, and in the future my eyes regress to the point that I need a touch up, is PRK an alternative at that point, or does Lasik automatically eliminate the possibility of PRK in the future? Can you only get a touch up using the same procedure that was originally done?


PRK on the Lasik flap is a possibility and would allow a small amount of "touch up" enhancement surgery.

It looks like you are thinking this through and will make the decision that is best for you.
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Postby griffin » Fri Mar 28, 2008 10:48 pm

just out of curiousity, would performing prk on the flap eliminate the flap, especially since interlase creates a much thinner flap? Im not 100% on the thicknesses of tissue removal with prk or flap thickness with intralase.
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Postby LasikExpert » Sat Mar 29, 2008 12:38 am

You would not want PRK to go all the way through the flap because it would likely make an irregular edge and cause vision problems. Even a thin flap is about 100 microns. To correct 1.00 diopter of refractive error requires about 12-18 microns of tissue. The thickness of the flap should be enough to resolve normal regression from a less than 7.00 D start.
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Postby griffin » Sat Mar 29, 2008 12:57 am

how about a +1.00 d and 1.00 of astigmatism
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Postby LasikExpert » Sat Mar 29, 2008 1:41 am

Hyperopic (farsighted, longsighted) correction removes tissue from the outer edge of the treatment zone, like doughnut. A flap created with a mechanical microkeratome may be very thin at that area. A flap created with a femtosecond laser is likely the same thickness throughout.

The treatment area for astigmatic correction is oblong, being fully length on one axis and narrow on the perpendicular axis. Again, analysis of how much tissue and where will be needed.

Whether or not PRK on a Lasik flap is appropriate for you would be determined by accurate measurements of the flap thickness in the area to be ablated by the laser.
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Postby Rocksville » Mon Mar 31, 2008 6:16 pm

Excellent information. I''ve made my choice in Dr's and will go with whatever procedure he feels is best, however I hope he prefers lasik because I don't relish the thought of a longer recovery time....but it is what it is.

Thanks for the help. This site really helped me sort through all of the information I was looking for and gave me the tools to make a decision based upon unbiased information, and not the marketing and propeganda that many facilities throw at you.

Cody
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Postby LasikExpert » Mon Mar 31, 2008 6:29 pm

Rocksville wrote:Thanks for the help. This site really helped me sort through all of the information I was looking for and gave me the tools to make a decision based upon unbiased information, and not the marketing and propeganda that many facilities throw at you.


That is high praise indeed and exactly what we seek to provide. Thanks!
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