LASIK with Allegretto Wave Eye-Q > 4 astigmatisn

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LASIK with Allegretto Wave Eye-Q > 4 astigmatisn

Postby 06aggies » Tue Jun 03, 2008 5:50 pm

I am having surgery on thursday 6/3/08. I have been waiting for several years for the technology to get where it should be to correct my eyes with the astigmatism I have. I have worn glasses/contacts since kindergarten, and am currently 33. Have been wearing gas permeable contacts for 17 years, and have been out of them since April 16th, so it will have been 7 weeks and 1 day on the day of surgery. I have been in to the doctor 5 times where they have mapped my eye, and today they verified everything appears relatively stable. Prescription has not changed majorly since high school, and eyes, other than not seeing well, are healthy.

I have chosen the Allegreto Wave Eye-Q 400 mHz laser, from an OD who has performed thousands of surgeries because from what I can tell it is the fastest on the US market, but am a little confused since it is not 'custom', but rather wavefront optimized. My OD says the algorithms they use are superior because it actually leaves in some of the higher order abberations that seem to contribute to a better visual field than a custom provides. I am not sure about that, but from what I can tell, the speed of the laser is important since it won't leave the eye open to dehydrate as much, causing uneven ablation. Dr. says surgery should be less than 20 seconds per eye with my correction. Does anyone have any opinions on this.

Measurements are as follows:
Both corneas are averaging about 580 microns thick, tested with the spinning disk thing, as well as an ultrasound.
Right eye 5.89 diopter myopia 4.3 diopter astigmatism @ 15 degrees with 6.6 mm pupil
Left eye 4.46 diopter myopia 4.18 diopter astigmatisn @ 172 degrees with 6.3 mm pupil

This seems to be on the high side, although my dr has reported success on people with 5 - 6 astigmatism. Said that my myopia was not that bad all things considered.

I have been told by them to expect 3-4 weeks before my vision stabilizes and real clarity is achieved. I tend to think 4 weeks would be a great target, but am expecting 8 - 10 weeks from what I am seeing of others.

My eyesight has never been correctible to 20/20, the very best, when my eyes or on their A game is 20/25 with 20/30 being about average. I have been told not to expect 20/20, that my optic nerve is probably not capable of transmitting that fine an image, but I would be ecstatic with 20/30, happy with 20/40, and even satisfied with improved vision even if I needed to continue to wear a lower prescription without as much astigmatism. My biggest fear would be not to be able to correct it back to 20/30 after the surgery, which my doctor says is highly unlikely.

I have read a lot about halos and starbursts, which I don't really understand, as I already experience both at night, OD says that is from the astigmatism, and says it will be worse after the surgery, but should return to my normal pre-surgery level. He also noted that the Allegretto Wave generally gives the best night vision of all the lasers (again, not sure if this is 100% accurate, but his explanation as to why made sense :) ) He also said my pupil size should not be an issue.

My greatest concern is dry eyes. I live in Houston, with high heat and high humidity, so I am hoping that will help, but everyone at the drs office seemed to think being relatively young and healthy should get eyes back to normal hydration in about 3 months.

Dr. says there is a 15 - 20% chance of needing an enhancement, due to the high astigmatism, greater than his average, but says my corneas would have plenty of thickness to accomplish that.

Is there anything I should be aware of that I have not thought of? I have read that real stability takes 6 months on here, so I am definitely prepared for that. I have been a slave to glasses and contacts for as long as I remember, and as exciting as no glasses sounds, I want to make sure my expectations are in line with reasonable results.

Just to mention, the Dr. I am going to has 3 different locations all in this area, and pre and post op are handled by other drs and techs in the practice, but the dr does all the actual surgeries, and everyone I have met there has been absolutely fantastic, have not experienced a 'hard sell' yet. This is the only dr. I have seen concerning Lasik though, but he is also the only one in my area with the Allegreto, am I being too hasty? The practice itself also does cataract surgery, implantable lenses, and a few other things as well.
06aggies
 
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Joined: Tue Jun 03, 2008 4:15 pm

Very high astigmatism and Lasik

Postby LasikExpert » Wed Jun 04, 2008 5:50 pm

It is the very high astigmatism that will undoubtedly be the biggest problem. The probability of being able to resolve all of that astigmatism in one surgery is not great. Expect fluctuations in vision, ghosting of images, and night vision problems unless you wear glasses during recovery.

The upside is that a reduction in the astigmatism will likely make correction with glasses or contact lenses much more successful than before. This likely means thinner glasses or contacts and the ability to have "functional fuzzy" vision shortly after surgery.

With a very high topographical irregularity like your high astigmatism, a wavefront-optimized laser like the Allegretto or another laser in conventional mode would likely be the most wise choice for the initial surgery. After the first, a wavefront-optimized laser ablation may be appropriate, but you will not know until things have settled down.

Most importantly, you seem to have reasonable expectations. You understand that you are not likely to have vision better than what you currently have with glasses (although it is possible) and you are likely to be satisfied with vision that is better, but not perfect.

Please let us know how things go as it is rare that we find someone with such very high astigmatism.
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Postby 06aggies » Wed Jun 04, 2008 6:50 pm

I was actually thinking about postponing the surgery for a second opinion, but upon further research, from what I can tell, the Allegretto is the only Laser that is approved for up to 6.0 for astigmatism from the FDA. Not really to ecstatic at having a dr use one that at least hasn't passed the FDA muster (although I know other countires are more lenient).

Didn't ever really consider a standard laser, are they capable of correcting such a large astigmatism?

That is the best I can seem to gleam from what is available. If that is the case, and there is no other Allegretto available near me (I am in Houston), it would seem like my choices are somewhat limited.

I am getting slightly cold feet, but the thought of having lighter, less costlier eyeglasses is appealing all by itself. I am scheduled for tomorrow at 3 pm. I definitely am looking forward to the "Just Had It" forum.

I plan on posting on Friday, depending on how I feel/can see.

FWIW, my dr covers enhancements for a full 2 years past initial surgery (I have heard anything longer than a year is a gimmic, but it is a little reassuring, given the likelihood of an enhancement).
06aggies
 
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Postby LasikExpert » Wed Jun 04, 2008 9:48 pm

Although most enhancements are performed within the first year after surgery, you may require multiple enhancements to "fine tune" your irregular corneas. You will want to wait 3-6 months in-between enhancements, so having a two-year plan seems prudent.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


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