Second Opinion and Cost Question

[Lars Bell]

I have read many of the posts on this forum and they have been very very informative. I truly appreciate your time, effort, experitise and willingness to answer these questions.

So here is my situation:
Left Eye
Sphere= -6.25
Cylinder= +2.00
Corneal thickness= 588
Pupil size= 7.0

Right Eye
Sphere= -6.00
Cylinder= +2.00
Corneal thickness= 568
Pupil size= 7.0


The doctor wants to perform IntraLASIK on a WaveLight Allegretto Laser. He also has a Visx S4 laser at his disposal. From some of the other posts and some of my readings it seems that there is more of a preference to the Visx S4 laser over the Allegretto, as well as PRK and LASEK over IntraLASIK due to the reduction in corneal tissue loss. So basically I have a two part question:

1) what do you think of his diagnosis of my eyesight regarding procedure and laser? I am well aware that my sense of sight is the most important sense that I have and I do not what to compromise this for anything, that is why I would like a second opinion.

2) The doctor wants to charge close to $5,000 total for both eyes. So my question is- what extra am I paying for if I choose the $5,000 doctor or conversely choose a doctor who charges $3,000 for the same surgery with the same equipment? Ultimately I am looking for a surgeon that will give me perfect vision and one that will not comprimise my eyesight, does $2,000 extra provide me with that luxury? These machines seem very automated, so I find difficulty in paying a lot extra for the same procedure with the same machinery. I am not a bargain hunter but I do not know if spending $2,000 extra is worth it.

[maxxed]

You have a moderately high amount of astigmatism and sphere as well as somewhat large pupils. If it were my eyes I would definately want a second opinion.

Did your doctor say why he wanted to use the Alegretto? Did he discuss the use of mitomycin with surface ablation? (LASEK or PRK)

[Lars Bell]

I asked why he recommended LASIK and he did not really give me a good answer (or what I thought was a definitive answer), and basically assured me that I am a good candidate for LASIK. He also did not say why he wanted to use the Alegretto vs the VISx S4. It really seemed as if this is the procedure that he performs and the laser he utilizes most of the time and is probably most comfortable with them. I do not know?

[LasikExpert]

1) what do you think of his diagnosis of my eyesight regarding procedure and laser? I am well aware that my sense of sight is the most important sense that I have and I do not what to compromise this for anything, that is why I would like a second opinion.

My opinion is hardly a second opinion. You need to seek that from another surgeon. My opinion isn't even a first opinion.

Lasik is about the convenience of a reduced need for corrective lenses. To achieve that convenience, you must accept some risk. The most you can expect from refractive surgery is vision after surgery without glasses to be as good as vision before surgery with glasses, and there is absolutely no guarantee that this will occur. It is also possible, although relatively unlikely, that your vision after surgery with or without glasses will be worse than it is with glasses before surgery.

Considering the amount of refractive correction required, PRK, LASEK, and Epi-Lasik would probably have an elevated risk of corneal haze. This can be mitigated with the use of Mitomycin C during surgery. Mitomycin C is a strong medicine that is probably best avoided if possible, but is appropriate when required. Lasik or IntraLasik would virtually eliminate the probability of corneal haze. Depending upon the thickness of the flap and size of laser treatment zone, your corneal thickness seems reasonable for Lasik or IntraLasik.

Be sure to read about Lasik pupil size issues.

2) The doctor wants to charge close to $5,000 total for both eyes. So my question is- what extra am I paying for if I choose the $5,000 doctor or conversely choose a doctor who charges $3,000 for the same surgery with the same equipment?

If the doctors' practical knowledge and outcomes are the same, you are paying $2,000 more because that doctor can get $2,000 more. Use our 50 Tough Questions For Your Lasik Doctor to help evaluate the surgeons. If all else is equal, there is no reason to pay more for the same thing.

Ultimately I am looking for a surgeon that will give me perfect vision and one that will not comprimise my eyesight, does $2,000 extra provide me with that luxury?

Forget the money issue for a minute and let's talk about reasonable expectations...you don't have them.

Although the vast majority of patients who have Lasik, IntraLasik, PRK, LASEK, Epi-Lasik are satisfied with their vision "perfect vision" is not the same thing as "satisfied". As a general rule, all cornea based refractive surgery induces higher order aberrations (HOA) in vision. Wavefront-optimized is better than conventional laser ablation. Wavefront-guided is better than wavefront-optimized. This HOA induction may not be enough to cause a degradation in vision, but then again it might.

Lasik is not about 'perfect vision', it is about a reduced need for corrective lenses. In my opinion you would be much more likely to get 'perfect vision' with rigid gas permeable (RGP) contact lenses than with Lasik, but RGPs are not as convenient.

These machines seem very automated, so I find difficulty in paying a lot extra for the same procedure with the same machinery.

No amount of technology can compensate for an inferior surgeon. Focus on the quality of the potential doctor and don't think that if the laser is the same the outcome will be the same with every doctor. That is far from the reality.

I am not a bargain hunter but I do not know if spending $2,000 extra is worth it.

I absolutely agree, but as I've noted above, I think you may need to rethink what you expect. It is possible, even probable, but you need to ask yourself; "Can I deal with having less than 'perfect vision' after surgery?"