Had Lasik with flat corneas

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Had Lasik with flat corneas

Postby Edo » Sun May 22, 2011 4:36 pm

Just want to thank everyone on these forums, and Glenn. This has been an extremely useful resource for me. I had been thinking about having LASIK for a number of years now and finally went for it two days ago!

I did have some initial concerns about flat corneas and dry eyes as outlined in my post in 2007: viewtopic.php?f=1&t=1000&start=0

But in summary, the surgery went very smoothly, and the postoperative period so far (two days) is much better than I expected.

My prescription was as follows, no astigmatism in either eye:

RIGHT eye:
Manifest refraction -5.25
Keratometry 40.81
Pachymetry 605um
Schirmer 8mm

LEFT eye:
Manifest refraction -5.75
Keratometry 40.32
Schirmer 13 mm
Pachymetry 589um

Because of both my corneas being flat and having trouble with dry eyes, especially during allergy season,I stop thinking about having LASIK for a while. Every now and again, I would read up on the subject and think about how nice it would be not to need corrective lenses. While I was not declined Intraslase LASIK with the above prescription, I was not reassured by the assembly line like ophthalmology experience that I had on my assessment.

Recently, while I was talking about LASIK with an ophthalmologist friend of mine, I was doing some Pubmed searches and found this article that helped me: "Postoperative Keratometry: How Low Would You Go" published in Cataract & Refractive Surgery Today, page 39-40, July 2009. After reading this, was pretty certain that my keratometry wouldn't be a problem.

My friend did say however, that all these minimum numbers are just a guess. There is actually very little rigorous evidence as to what may define a minimum because Lasik surgery is so safe. To put it bluntly, he told me that the minimum numbers that the surgeon gives you is how low he would be willing to risk getting sued for your business!

I went and saw three more clinics for consultation, and all of them told me that my corneas would not be a problem, and that the dry eyes was not worrisome in their opinion. I'm guessing that my eyes were not dry enough to be significant. While my right eye was not ideal, it did not exclude me completely, as I believe some have Schirmer's test of <5mm (patients with connective tissue disease). I was understood that Schirmer's was only one aspect of care adequacy, and the tear breakup test (TBUT) may reveal more information. Slit lamp examination of my eye did not reveal any deficiencies in my tear film.

The surgeons essentially told me that I was pretty much a standard LASIK patient, with no particular concerns. And so, after more than five years of mulling over the surgery, I went ahead and did it!
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Joined: Fri Jun 29, 2007 10:27 pm

Re: Had Lasik with flat corneas

Postby Edo » Sun May 22, 2011 4:45 pm

Here's the long version of my experience:

The total price for the all inclusive package: $3500. That’s for the femtolaser, lifetime touch ups and collagen plugs. I find it funny how they’re called “touch ups,” as it it’s like touching up a paint dent on your car, when it's pretty much going through the whole surgery again.

The counselor when through the eye drops that I needed to take. There was moxifloxacin to be taken qid, dexamethasone q2h x 48 hrs then qid, Bion Tears (expensive preservative free tears) q30 mins x 48 hrs then minimum qid x 2wks. After 2 wks, I could use Systane Ultra (tears with preservatives).

Next, I was taken by the surgical suite where I saw the surgeon do a laser treatment on another patient. There was a great view as the whole wall was a window, on the way to the ophthalmology chair. I was seated in the dimly incandescently lit room where Dr. K, finishing his last surgery came to meet me.

Of course, he didn’t remember me, so I reminded him about my flat corneas, told him that I was having allergies and having some dry eyes taking Nasonex, and that my ophtho friend was psyching me up for the surgery. Dr. K asked me if I was ready “to see clearly without glasses.” I told him yes. He looked over my scans and reports and reassured me that this would be a pretty standard laser eye operation, and that the flatness of my corneas weren’t an issue, especially with the Intralase system.

I took one dose of Ativan, 0.25mg, which didn’t do anything. I wasn’t actually nervous at the time, but wanted the full effect of the a benzodiazepine so I asked for another dose. I don’t know if the meds really calmed my nerves or if I was already calm myself, but I wasn’t feeling too antsy about going through with the surgery and getting it over with.
I was given the disposable surgical cap and booties, and into the operating room I went. It turned out my wife got a front row seat and saw the whole surgery take place complete with a computer screen seeing what the surgeon saw of my eye through his microscope.

The nurse gave me a quick briefing of the whole surgical operation while putting anesthetic drops in my eyes. My lashes were taped away and my eye was held open with some contracption. There was an urge to blink, but couldn’t. The need to blink eventually went away. There was bright ring of light when the stabilizer was placed over my eyeball, and that was probably the most uncomfortable part of the whole operation. They warned me that there’d be pressure, and yes there was pressure, but it wasn’t as bad as I expected. Being at the dentist was worse. Eventually, my vision did dim out, which was a relief, because that was when the Intralase laser created the flap. The nurses gave me a countdown, and when it was completely, the suction ring snapped off and my vision started to return.

When that was completed, the head of the bed pivoted over to the other laser. Dr. K did some rinsing and lifted the flap up. I could see the flap lift away, actually like taking off a contact lens, and everything became much more blurry. There was some more rinsing and then the sculpting laser started clicking, burning away my cornea.

I asked ahead of time whether or not I needed to be worried if I happened to move my eye during the surgery, and I was reassured there wouldn’t be a problem. With the flap, by eye was held rigidly in place by the suction cup, and because I wouldn’t see anyways, there wasn’t anything to look at. With the cutting laser, I focused as hard as I could on the flashing red light, trying not to dart my eye elsewhere. The nurse told me that the computer tracked the eye, and if it moved out of range, the laser would stop.

Yes, you would smell the burning of the cornea, much like cautery in surgical ORs.

When the laser was completed, there was more rinsing, and the flap was replaced, again like putting in a contact lens. The surgeon used something to flatten the flap back on the cornea, wiping up and down and around, to secure it in place, and I’m guessing, to get rid of any bubbles, like putting on a screen protector on a phone. My treated eye was taped shut, and the whole thing was repeated for the other eye.

When it was all done, I sat up, and Dr. K shook my hand telling me everything went perfectly.

He sat me down at a slit lamp in the OR to check that everything was in place. After flushing my left eye of some debris, I was good to go. Everything was blurry, not the same type of blurriness as before. It seemed like my visual acuity was better, but wearing foggy goggles.

My wife drove me home, and after taking some Advil just in case, and a few more eyedrops, I taped the protective covers on and went to sleep.

Amazingly, I slept five hours from 4-9pm. When I woke up, I continued to rest my eyes, listening to the movie No Strings Attached while my wife watched it. The instruction for the first day was rest! No computer, no reading and no television. So I went to bed again at midnight waking up at 7am the next morning.

This morning, I peeled back the protective covers and was amazed to see clearly, just as advertised! I wasn’t sure what to expect really, but was surprised. I was thinking there’d be more haziness, more dry eye or some pain, but there wasn’t any. My eyes felt well – certainly not any drier than usual with my allergies – and the vision was pretty similar to having contacts on towards the end of the day when they were getting dried out.

My next day assessment at the clinic involved auto-refraction. It turns out that machine that had a picture in it that clears up into focus, actually starts off in focus! Then it was the manual refraction, and I found I would barely read 20/15 with my right eye and barely 20/20 with my left. The acuity was definitely not as good as it was before laser, but this keep in mind this is without wearing glasses!

Remembering the annoyances with contacts, and the discomfort with glasses, if my eyesight were to stay as it was right now, I think I’d be pretty satisfied with the result. But knowing this is only the first day out of surgery, I’m expecting further improvements.

There is definitely some haloing around lights. I thought it was worse with my left eye at first, but comparing two eyes independently at a grocery store, the haloing is equal. The diameter of the halo was appoximately 1.5-2x the diameter of the light source, so certainly not debilitating.

Reading small parking signs in the distance, my acuity is noticeably better with my right eye, but not significantly worse with the left. If things remain the same, I would be hesitant to undergo a “touch up” for this minor of a problem. Day to day function probably wouldn’t be affected. I’ve had this difference with contact lenses and I’ve gotten by, and I wondering if the acuity was even this good wearing glasses.

I am very surprised with how little pain there was. Essentially, no pain to speak of. My biggest worry, and I suppose we’ll have to see how this pans out in the next couple of days to weeks, is how dry my eyes will be.

I do have some brusing around my eye on the sclera. It’s really only noticeable when I point it out to someone.

Postop day 1, I’ve been putting drops in every half hour minimum, and have been doing fine. By 9pm, my eyes were getting a little tired, so I went to bed early.

This morning, once again I was expecting to open my eyes in pain because of dryness, as would normally happen if I for some reason left my contact lenses in after a nap. But this was not a problem. My eyes were fine and I could see!

But overall, I’m really happy with the result!
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