Regular vs Custom Lasik

[bunny]

Hi all,

I went to 2 consultations for Lasik.

First surgeon said I qualify for Custom Lasik with Intralace. But the cornea thickness after the procedure will be 308, he also gave me the option of PRK, which will save about 100 microns in thickness.

Second surgeon said I'm a perfect candidate for regular Lasik with Intralace. I then ask him about the custom lasik, and he explain that since my eyeballs are in perfect shape, symmetrical and surface of the corneal is smooth, I would not benefit from custom lasik. He said that if he uses custom lasik, the flap will be another 30 microns thick. Furthermore, he claims that since custom lasik would go wider in diameter, it also means that he has to take out 50% more tissue for the procedure. He also said that he generally don't suggest custom for anyone who's above -5.0 (I'm am at -6.5) due to this reason, unless there's no other choice. My cornea thickness after the procedure will be 340. He also suggest that I do lasik on the worse eye first, then he'll see how I react to the procedure and will adjust accordingly when he does the second eye.

Based on what I have so far, which is 3 choices:
1. Which one sound more reliable?
2. I always thought custom will be the better but not according to the second surgeon. Does this make sense to anyone?
3. For my second consultation, what are the things that the surgeon could "adjust" during the procedure so that the 2 eye could be better?
4. I was seriously considering PRK due to the 308 microns given by the first surgeon, but I read the recovery is really long and could get very scary and discouraging. I'm tempted to take the easy way out if the second surgeon could leave 340 microns. Is that a good decision?
5. When I ask the second surgeon about PRK, he said that it's very possible that I could develop permanent haze at the 5th month after PRK dur to my high prescription (which the first surgeon kind of downplay this side effect). Is it true and what are the possibilities of development haze at 5th month?

Sorry guys, email's kind of long and tons of questions. I would like to have some pointers or opinion for all of you. Your help is greatly appreciated!!

Bunny

[LasikExpert]

1. Which one sound more reliable?

Funny thing about medicine is that you can have two doctors with nearly identical data and you get two very different treatment plans. Both plans will likely work, but keeping as much of the cornea untouched as possible is a very good idea. For tissue savings reasons, either Lasik without custom or PRK with or without custom.

2. I always thought custom will be the better but not according to the second surgeon. Does this make sense to anyone?

For some patients custom is contraindicated. Custom sounds better, but is not always best. If both surgeons actually provide custom and conventional (the second surgeon may not have answered what you thought), then it does not seem likely either surgeon is offering a particular treatment plan because that is the only plan that surgeon has available.

3. For my second consultation, what are the things that the surgeon could "adjust" during the procedure so that the 2 eye could be better?

The surgeon runs the laser, not the other way around. A surgeon's nomogram may include a three dozen or more adjustments based upon an individual patient's needs, down to the consideration of the relative humidity on the day of surgery.

4. I was seriously considering PRK due to the 308 microns given by the first surgeon, but I read the recovery is really long and could get very scary and discouraging. I'm tempted to take the easy way out if the second surgeon could leave 340 microns. Is that a good decision?

It may be an appropriate decision, but it is with all the wrong motivations and for all the wrong reasons. While about six decades of studies have shown a healthy cornea remains stable as long as 250 microns of tissue remain untouched, more untouched tissue is always better and you never know what the future will bring. You may need enhancement surgery at some point and could use that extra thickness.

WIth PRK there is no Lasik flap. Although the probability of a Lasik flap related complication during your lifetime is relatively miniscule, no possibility is almost always better than a low probability.

I tell people that for the first month you will wish you had Lasik, but for every day thereafter you will be glad you had PRK.

5. When I ask the second surgeon about PRK, he said that it's very possible that I could develop permanent haze at the 5th month after PRK dur to my high prescription (which the first surgeon kind of downplay this side effect). Is it true and what are the possibilities of development haze at 5th month?

You are at the margin of concern for corneal haze with PRK, however the use of Mitomycin C (MMC) immediately before surgery would reduce this risk no near zero. MMC is a strong medicine that should probably be avoided when possible, but is appropriate when indicated.

[LasikExpert]

Lasik has fast recovery and virtually no pain. PRK has slow recovery and discomfort. That is why Lasik is more popular.

The custom is not always better depending on the individual nature of the patient's wavefront and data retrieved. In some cases, the conventional ablation pattern does not get corrupted by the noise that can sometimes be captured during analysis.

[Rickeyes]

Mr. Glenn has covered everything succinctly; you’d do well to read through them. I’ll just add that a third consultation could, so to speak, break the tie. I’d volunteer Dr. A**** C******** based out here in North Carolina if you can visit him. He has decades of experience in performing LASIK surgery and should be able to provide the same, if not more comprehensive, pre-operation consult.

Note: Posting was edited to remove name of surgeon. Contact the poster directly if the surgeon's name is desired.