Hey Glenn,
This site was so helpful in my quest to free my dependence from glasses/contacts. I'm facing a huge dilemma of what I should do. Please help! Here is a bit of background on me and my eyes.
I'm a 26 year old male with high myopia and slight astigmatism.
My scripts are L -8.5D -0.5, R -8.5D -0.5. My best corrected vision acuity is 20/15 using both eyes and 20/20 with each 1 eye.
Cornea thickness: L 558, R 556.
Pupil size in a dimly lit environment ranges from 7-8 mm.
The steepness of my cornea or K values are L 41.4D, R 42.8D.
The first time I went for a lasik consultation was 4 years ago and was told b/c of my high script and relatively thin cornea, I should not consider lasik at that time and should either wait for better technology or explore an alternative. So I gave up the idea for 4 years and decided to revisit again late last year. I went to 2 more consultations and this time was told that I'm a great candidate. I got very excited and contributed money to my flexible spending account to do the surgery next year. But I remained a bit skeptical given the surgeons economic incentive. Whenever I asked the surgeons does risk increase with my high prescription, they only say they don’t see it as a problem as they have done patients with much higher prescriptions. So I started doing my own research and found this website, which has been so useful in educating me on the subject in a very objective way (pretty hard to come by in this field). I then went to a recommended doctor (who use to do surgery but not anymore so his economic incentive is less of an issue) for an independent screening and advice. I passed his initial screening but he noted two issues.
1) My upper lashes are pointed down and in towards my eyes (which are common in some Asian eyes), so at times they scrape my cornea, which has caused some dryness and little marks on the surface. I was told this is not a big issue and can be corrected with an incision on my eye lids to change the directions of where my lashes are pointing. Have anyone else had this problem and done anything about it?
2) The bigger problem that can't be resolved is that the curvature of my cornea is relatively flat. The K value is 41D-42D. And post surgery, Lasik or PRK, my cornea will be flattened further by 7-8D, down to 33 or 34 D, which the doctor said is getting the borderline of cornea’s stability. The surgeon can use conventional laser, not wavefront guided, to remove less tissue, but that can leave higher High Order Aberrations, which doesn’t help my vision acuity either.
The doctor then referred me to another surgeon for a final screening. This surgeon is affiliated with a prestigious university and said he turns away 60% of his patients, which I am comforted given his conservatism. He confirmed that I'm a candidate with elevated risk to not achieve my BCVA, given my high script, large pupil, and flat cornea. He would recommend lasik with intralase as long as I understand I'm a higher risk candidate. He said people in my situation probably will not achieve their BCVA and will seeing 20/25. I asked him about night vision issues, and he said that is a bigger unknown as research remains inconclusive (Steve Shallhorn did research on pupil size and night vision problems and showed pupil size is not the main cause). He also recommended phakic IOL but suggested for me to wait until the FDA approves the 3rd type that is under trials. what is this 3rd type? He thinks this new IOL will replace high myopic laser surgery.
I have read the article on this site regarding phakic IOL and like the fact that it is reversible but understand that it is an more invasive procedure (with higher % of surgical complication?).
Is phakic IOL a better alternative for me than Lasik/PRK? What is the typical cost for this procedure, I can imagine it being much more than Lasik/PRK. Is this surgery for limiting on one’s lifestyle than say PRK? Will a trauma to the eye have a worse impact when there is an implanted IOL than PRK? Where can I find more info on this procedure?
Also I know permanent night vision problems associated with lasik/PRK have limited treatment, if any given the irreversible nature of the surgery. I know I have higher risk to this problem, but how high of a risk is this for me? I don’t think I can tolerate an outcome where my vision is worse than what I have now to the point where I can’t live normally and causes a real disability (that can’t be treated with anything else).
Thanks so much for your help!