Advice / expectations for high correction ? (-8 ish)

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Advice / expectations for high correction ? (-8 ish)

Postby mo » Thu Dec 13, 2007 5:22 pm


I have gone through LASIK/PRK evaluation at a reputable clinic, in cooperation with my home office optometrist. The outcome is that I have been told I am a "good candidate" for LASIK (recommending laser cut & custom treatment options), based on thick corneas, slightly flat corneas but the thickness makes this a non-issue, wavefront image/analysis, moderate tear production, etc. I have confidence in the clinic and practioners, based on the experiences of friends and family.

HOWEVER ... (there's always a but, right?) ... all of the people I know that have gone through this procedure had much better vision than I.

Can anyone elaborate on the risks, issues, considerations, etc. that are SPECIFIC TO CORRECTING STRONG PRESCRIPTIONS? Obviously more tissue needs to be removed, there is a good chance of needing enhancements (I am not quite sure if this means 1 or 2 enhancements in the 1-2 years post-op, or regular enhancements for life, of both), and there is a higher chance of regression.

What I'm really looking for is more detailed info. from people who have had high corrections done and/or practioners who have experience with high correction patients. Duration of healing? Night vision issues? Level of correction achieved? Level of visual impairment/function during the healing process?

Although my conservative practitioner and optometrist say I'm a good candidate, the nagging "what ifs" and unknowns are holding me back...appreciate any advice/feedback!
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Postby LasikExpert » Sun Dec 16, 2007 4:36 am

First, let's talk about what is going to be similar whether you have Lasik or a surface ablation technique like PRK, LASEK, or EpiLasik

The probability of regression of effect is high with 8.00 diopter correction. Your surgeon may deliberately overcorrect you with the expectation of regression bringing you back to the ultimate target, or may correct you to the target and the provide enhancement surgery to resolve the regression. Both are acceptable techniques and which is recommend will largely be due to surgeon preference.

The probability of vision fluctuation in the first few months after surgery is relatively high. Regression is not always even throughout the cornea and this can make for poor vision quality as the changes resolve.

Now let's talk about some differences.

You mentioned limited tear production. This would tend to indicate that a surface ablation like PRK, LASEK, or Epi-Lasik would be better as these tend to be less likely to induce dry eye - especially with higher corrections that disturb tissue deeper in the cornea. You can still get dry eye with surface ablation, but it is less likely and less likely to be as severe.

If you eliminate the Lasik flap by having a surface ablation technique then you eliminate the possibility of a Lasik flap complication during surgery or for the remainder of your life. Even though the probability of Lasik flap complications is relatively low, no possibility is better than low probability.

High correction with PRK was considered an elevated risk for corneal haze, but the use of Mitomycin C has pretty much eliminated that concern. Mitomycin C is strong medicine that is best avoided, but is appropriate when required.

You are undoubtedly going to need enhancement surgery. Correcting 8.00 diopters of myopia (nearsighted, shortsighted) vision is going to remove a lot of tissue and probably a pretty large percentage of your overall corneal thickness. I am personally biased toward the surface ablation techniques for all the reasons outlined here and more. It seems that if you are going to have surgery at all, surface seems the more reasoned choice.
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Postby SteveR » Sun Dec 16, 2007 10:46 am

Hi mo,

I was around –8.00 with a small amount of astigmatism. My eyes were under corrected (LASIK) to the tune of around –1.00D, and regressed a further dioptre. Most of the regression occurred within the first couple of weeks and touch more within the first 3 months. I found that while I was below around –1.25 dioptres, I could function pretty well without glasses most of the time (in summer months).

My night vision is pretty good, though in certain circumstances I see starbursts - some pretty impressive ones for quarter moon’s etc. Though I have huge pupils. Contrast sensitivity is reduced for a period (couldn’t see a pair of black socks on/in a black sports bag, etc), though is now improved. At six months post-op I still have trouble seeing behind lights (e.g. oncoming cars at night and in shadows) but these effects may improve and are no big deal. At your prescription you probably don’t see great with specs and are used to what you put up with. Basically I think with your prescription, and barring eye-health issues, in my experience you’ll be better off with any minor 2nd order aberrations that replace your severe first order ones. As long as your expectations are not too high. The only reason for waiting would be in the expectation of techniques improving, which inevitably they will. But that waiting game could go on forever.

I will be having one eye retreated to bring it to around –1.00D and the other left at –1.75D. I would hate not being able see close-up than distance, but horses for courses.
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Re: Advice / expectations for high correction ? (-8 ish)

Postby beingbobbyorr » Sat Dec 29, 2007 10:05 am

mo wrote:Hi,

I have gone through LASIK/PRK evaluation at a reputable clinic, ....

1) "A" reputable clinic? I wouldn't even contemplate surgery on my eyes without hearing at least 5 reputable opinions.

2) Somewhere along the line some refractive surgeon should be exposing you to the idea of ICLs as an option.

3) Also, you didn't mention anything about your age. Whether you are 21 or 41 might make a difference in the optimal treatment, and your liklihood for your myopia to get worse.
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Postby grumpyteach » Thu Jan 03, 2008 7:53 am

I had LASIK on the 3rd of September. Before this, I was around -7 in each eye, with a little astigmatism. I was told that because my refractive error put me into the 'severe' category, that I would experience a 'dramatic improvement' in my eyesight, but not to expect perfect eyesight straight away. I'm so glad that he said that, as I was not disappointed at when my eyesight settled at -1 and -2 (with no astigmatism). He was exactly right; a dramatic improvement, but not perfect. He's given me plenty of contact lenses to tide me over, so I was well taken care of.

I'm due to have my enhancement 24th January. I can't wait!
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Postby SteveR » Thu Jan 03, 2008 12:17 pm

Hi grumpyteach,

Snap. I was around (–7.00, -8.00) and am due to have my enhancement on 21 January, 9 months post-op. I’m currently (–1.75, -3.00) and have decided to have just one eye (left) enhanced and to leave the other (right) well alone. I will take counsel from the surgeon on the day of the procedure for the exact prescription to aim for in the left but currently my thoughts are to leave it slightly myopic, somewhere between –0.50 and –1.00. Having some minus lenses to play around with before that date would have been handy, though I expect the surgeon will let me have a little play around on the day of surgery.

Good luck with yours.
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