SO confused

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SO confused

Postby falldrive » Wed Mar 19, 2008 4:39 pm

Hey all,
So I have an apointment booked with a well known doc to have PRK done. As I have already posted, I have concerns about the use of MMC on my eyes (I like long term results, and MMC isn't there yet). So based on what I have read, I figured that since my prescription of -5, I would not have to deal with the MMC issue cause Ive read its only used on those above -6, but after phoning the clinic and speaking to my doc, he says they use MMC on almost every PRK case, and that he would definitely use it with my eyes because they are above -4?!
So now I am confused about what I'm going to do...
Do most docs use MMC on eyes that are slightly lower than 6?
I was all ready to take vitamin C to reduce my haze...
Any help would be greatly appreciated
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Postby lvziggy » Wed Mar 19, 2008 4:58 pm

Fall, my surgeon used MMC when I had PRK done. My script was -6.75 and -7, so haze was definitely a concern. I even asked about it before I signed up and my surgeon just said he uses MMC so haze would not be an issue.

I didn't really give it much more thought. I'm a year out now and, as far as I know, I don't have any effects from the MMC. I'm not sure what your concern is. All Glenn has said on this forum is that it is strong medicine, but I'm not really sure what he means by that. I think he has also said that if you don't go with the MMC and then you have some haze, the dr. can use MMC after the surgery and it will still work.

Hopefully Glenn will shed more light on the subject, but in the meantime maybe you could ask your surgeon about using it after the surgery IF haze becomes an issue?

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Postby LasikExpert » Wed Mar 19, 2008 5:10 pm

Before the use of MMC became popular, the (very) general rule for PRK was that correcton of more than 6.00 diopters presented an elevated risk of corneal haze. This was with the older technology broadbeam lasers.

Today the smaller beam flying spot and split beam lasers seem to be much less traumatic to the eye, however the old rule of 6.00 D still seems to be the point where (it is my observation) nearly all surgeons would insist on MMC.

There are some doctors who use MMC on every PRK patient no matter what the preoperative prescription, and obviously there are some doctors who have different thresholds.

My concern with MMC is similar to your own. It dramatically changes the healing response within the cornea and there is not a lot of very long-term data for the use of MMC on the cornea. If the only purpose of MMC is to reduce the risk of corneal haze and the patient's condition does not indicate an elevated risk of corneal haze, then my personal opinion is that less is more and MMC should probably be avoided. There are many surgeons who would not agree with this opinion and keep in mind that I'm not a doctor. My opinion is based upon research.

MMC does not need to be used peri-operatively. It can be used only if corneal haze occurs and if that haze interferes with vision quality. If you were a higher myope, if you need a significant amount of tissue removal, or were otherwise at an elevated risk of corneal haze, then MMC would be prudent. Your circumstances seem to indicate that MMC is an option, not required.

You may want to seek another opinion about PRK for you, or make it clear to your surgeon that MMC is simply not desired. Your surgeon may elect to not provide surgery, which is reasonable. It is the surgeon's job (with all that education and training to back it up) to decide the best treatment plan. If the surgeon feels that the patient's demands interfere with the probability of getting the best possible outcome, then it is reasonable for the surgeon to decline the patient.
Glenn Hagele
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