Expectations and Questions on Lasik Options

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.

Expectations and Questions on Lasik Options

Postby jessicag » Mon Jun 02, 2008 12:43 am

I'm 34/f. I've been considering lasik (or an appropriate alternative) for several years and am finally in a financial position to do it. I had a lasik evaluation yesterday, which seemed very thorough, and was told I was an excellent candidate. I didn't think to ask for my specific results - cornea thickness, pupil size, etc - so don't have those at the moment but here's some info:

I've worn glasses since about 12 years old and contacts for the last few years - the kind you sleep in and toss after 2 weeks, aspheric; D -1.75 right eye, D -1.50 left eye; slight astigmatism in one eye - don't remember the number but it's slight enough that I don't need a special contact; same prescription for at least 4 years. I much prefer my vision with contacts than glasses - its clearer, sharper, and I have little to no night-driving problems like I do with glasses (which is with distant lights - I can see them ok but have a hard time accurately determining their distance from me. This is only a problem while driving at night and for distant lights, my mother has the same issue. Also, I think but am not sure that I also have this problem with no glasses on but I haven't tried driving at night without something on my eyes for too long to be sure).


I have a few questions I'm hoping someone here can answer based on my research so far:

1) Are any stats available on the likelihood of achieving better than 20/40 vision from Lasik for starting prescriptions similar to mine? Similarly, is the likelihood of better than 20/40 vision associated with the starting prescription? I know there are no guarantees with this and that stats won't predict my specific outcome but they will help me evaluate.

2) After the evaluation, the recommendation for me was flying spot (B&L Technolas 217Z), or custom wavefront (B&L Zyoptix) if I preferred. Are there specific stats on outcomes with custom vs. flying spot. I've found general info but would like to know more specific, comparative stats (likelihood of low-light issues with one vs. other, for example). Since I have that weird night-driving distance thing with glasses, I'm concerned about the potential for permanent nighttime vision issues.

Thanks and thanks, too for an incredibly helpful site!
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Re: Expectations and Questions on Lasik Options

Postby beingbobbyorr » Mon Jun 02, 2008 5:12 am

jessicag wrote:D -1.75 right eye, D -1.50 left eye; slight astigmatism in one eye


Lucky you! That's mild myopia.


jessicag wrote:Similarly, is the likelihood of better than 20/40 vision associated with the starting prescription?


Generally, yes, BUT .....


jessicag wrote:Are any stats available on the likelihood of achieving better than 20/40 vision from Lasik for starting prescriptions similar to mine?


..... I suspect that those stats are hard to come by, not just because the industry isn't keen on publishing hard numbers that patients might misinterpret as guarantees, but because getting 20/20 (or better) vision is dependent on more than your starting myopia: cornea thickness, pupil size (both easily measured), and the cornea's healing response (unpredictable as of today?) are just a few for starters. Even if you get 20/20 (or better) vision, it also has to be accompanied by the absence of dry-eye and epithelial cell issues to be considered a rousing success.


jessicag wrote:After the evaluation, the recommendation for me was flying spot (B&L Technolas 217Z), or custom wavefront (B&L Zyoptix) if I preferred.


I'd be asking the Lasik doc (or my ICL doc who may have to do Lasik touch-ups) why he favors this laser over the Allegretto Wave or Visx S4. Do these B&L lasers do any of the following?

* Wavefront-capable?

* Iris Registration?

* Compensate for the “cosine-offset” effect (the beam at the cornea center is round w/ no scattering of energy, but the beam at the cornea periphery is elliptical w/ energy scattered & reflected)?

* Does it track the eye in 3 dimensions (Z- as well as X- and Y-)?
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Thanks!

Postby jessicag » Fri Jun 06, 2008 12:38 am

Thanks for all the info, BobbyOrr - it's a big help. I found out that my pupil size is 6.5mm, right corneal thickness is 547 and left 559. For the high order abberations, I averaged .3 for the right eye and .22 for the left. I asked them the breakdown so I'd know if any particular HOA was above or below the average and for my right eye, vertical trifoil (?), vertical coma (?), and 4th order spherical (?) were the highest; for the left eye vertical trifoil (?), horizontal coma (?), and 4th order spherical (?) were the highest. I'm not sure if I heard and spelled these right. I was told though that although these were my highest, none was above "average". I also found out that I have a slight astigmatism in both eyes, not just one, and this could be contributing to my HOA's.

As for the laser, they only use B&L and VISX there. They also only use blades, not lasers for the flap portion of the procedure. This is actually fine with me as long as the doctor is experienced and this doctor has done thousands so I feel comfortable with that part.

I'm still deciding between flying spot and custom - these are my eyes after all so I don't want to skimp but I also don't want to do custom if it's unnecessary since it cuts more tissue.

Anyway, I'll keep reading the posts here and researching. Thanks again for your fast response and help!
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Postby LasikExpert » Fri Jun 06, 2008 5:38 am

The decision is not between flying spot and custom. It is between conventional prescription-guided laser ablation or custom wavefront-guided ablation. The same laser will be used. The difference is the mapping system on how to guide the laser.

Your low myopia (nearsighted, shortsighted) vision would undoubtedly yield a relatively high probability of achieving full correction....however that may not be what you want.

In about 6 to 16 years the natural lens within your eye will become less and less able to change focus to see objects near. This is when reading glasses become necessary. Reading glasses are designed to instill myopia of about what you have today. This is the trade-off. You can have vision correction surgery now and not need any glasses for at least about 6 years and possibly up to about 12 years, but then need reading glasses to see object near, or you can not have vision correction surgery now, need glasses now and forever for distant vision, but in 2 to 12 years be able to simply remove your distance vision glasses to see object near

Either way you are going to need glasses after about age 40. The question is would you want to require them to see objects near or objects distant?
Glenn Hagele
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