ICL for hyperopia

[ness27]

Hello once again, I have faxed all our correspondence to my surgeon, the response went along these lines: you were right in saying the AK stands for Astigmatic Keratotomy but the P in PAK stands for penetrating. You stated that the incision goes partially through the cornea but penetrating astigmatic keratotomy goes all the way through the cornea, through the whole lot. He said that he has had success with this treating up to 10 diopters (he said that was a rare case) but regularly performs this on 5 & 6 so my 3 astigmatism is not really that bad. He also said the success rate is extraordinary. He also said that of course there is the chance of over or under correction as with any surgery and he did say that to me in our consultation also, and he said if that was the case a small amount of laser would be used to correct it. Their ultimate goal for me providing everything goes to plan is to NOT have to wear glasses at all WOO HOO! After doing some extreme investigation i also asked him about epithelial counts as i did not believe they had done this and he said they very rarely do it as it had something to do with damaging the back of the eye and they will know if they do that anyway. He said its more of an "academic" test. He also said my vision would be functionally hazy the next day and after having my second eye done i should be able to go back to work (i only do paperwork etc.) a couple of days after having the second eye done. So once again, my faith in this operation has been restored. I trust them for some reason, I don't know why i have only met with him once and very briefly but i have a quiet confidence in him. Anyway, your opinion would be much appreciated. And rest assured, I have seen how many people have been reading our correspondence, and i will be posting in the just had it done section when it is completed. Thank you for the 20th time for your advice.

[LasikExpert]

A small correction: It is endothelial count, not epithelial count. It appears that your doctor got this correct as he response related to the back side of the cornea, which is the endothelium and the corneal layer that is disrupted by PIOLs.

There is not doubt your doctor is confident. If you decide to have surgery, keep us informed of your progress.

[ness27]

Hello again, thanks for your reply... well i have decided to go ahead with the surgery ... yay... i think. I go this monday for my yag iridotomy in both eyes. Hopefully that wont be too daunting. I will most definately be posting afterwards for any considering this surgery.
My only standing question would be - have you heard of this PAK procedure my dr talks of? It sounds wonderful - maybe this is something only available here in oz? Sounds a little scary though, a cut all the way through my cornea?????
Anyway, wish me luck i will post after each procedure!
Thank you again for your invaluable advice.

[LasikExpert]

I have competed a search of the available medical journals through the National Libraries of Medicine, which is a repository of medical journals from throughout the world. There is no reference to Penetrating Astigmatic Keratotomy (PAK) as described by your doctor.

The only time penetration through the cornea during refractive keratotomy is mentioned is as a complication of Radial Keratotomy (RK), a method of refractive surgery almost universally abandoned for laser assisted surgery. The only other time penetrating through the cornea is mentioned is for Penetrating Keratoplasty (PKP), commonly known as corneal transplant.

I have been unable to find a doctor who performs, or a medical reference to, deliberate penetration through the cornea into the anterior chamber of the eye for the purpose of resolution of astigmatism.

I believe it may be appropriate to discuss with your doctor the history of this procedure and any studies that have shown its safety and effectiveness.

I spoke with a well respected ophthalmologist who practices in Australia and he confirmed that STAAR manufactures a toric ICL that is able to correct astigmatism. He was not positive if a hyperopic toric ICL was available, which is what you would require. This too should be confirmed. It would obviously be better to use an ICL that corrects both your hyperopia and astigmatism.

I urge extreme caution.

[ness27]

I emailed my surgeon asking him for documentation regards safety and effectiveness of the PAK procedure, I also informed him that no one i had spoken to has heard of this procedure - this was his reply via email:

I received your e-mail today

A PAK (Penetrating Astigmatic Keratotomy) is one of the commonest operations done as most surgeons doing anterior segment surgery make their incisions on the steep axis of astigmatism ( that applies to any anterior intra-ocular surgery – the most common procedure being cataract surgery of which there are 10’s of thousands done per year in Australia). The incision itself relieves astigmatism in a similar way to LRI (Limbal Relaxing Incision) which you may have heard of, except it is more effective and does not leave gape which the LRI’s are capable of doing. (the procedure also goes by the name of OCCI – Opposite Clear Cornea Incisions, except that often one incision suffices)

Does this make a little more sense as it is complete jargen to me - I will now attempt to look up OCCI on the net and see what i can find - thanks

[LasikExpert]

Yes, this does make more sense to me. An incision is required through the cornea to implant the lens. The doctor will create this incision at a location that will be most beneficial to reduce astigmatism. I have personally never heard this common technique refered to as PAK.

[ness27]

Hello again!
Just thought I would write to tell you i had my iridotomy done yesterday - that was an experience. It was kind of cool coz the dr put drops in my eyes to make my pupils real small and i could actually see! That made me real excited and more determined to have this all done. So it is all systems go for this Monday now to have my left eye done. I have the side effects of the iridotomy now - which i was told about - ie the image of having a hair in front of your face, it seems to be only when i'm driving or watching tv and if thats the smallest price i have to pay then i'll be over the moon! Incidentally, I spoke to my dr and he said toric ICL's are available for hyperopia in Australia - just thought you might like to know incase another annoying aussie comes along! Wish me luck, i will post in the just had it forum after its all done! Thank you again for putting up with me and for your invaluable advice.

[LasikExpert]

Luck is wished! I look forward to your next post.