does it work as well for small corrections / mostly astigmat

[EH21]

Hi,
I'm 42 yrs old and work as a photographer/artist. My eyes are very important to me obviously. My eyes are nearsighted about .75 diopters but I have 1.5 diopters of astigmatism in both eyes. This is not enough to have bothered me most of my life so far. I have prescription glasses for when my eyes are tired which I use mostly for reading or working on the computer even though I'm nearsighted.

I'm really having trouble achieving critical focus with my cameras that use a focusing screen. The camera guys say the astigmatism is causing the trouble and it does help some to use my glasses for focusing but they are a pain in the studio. I really hate to wear them. I have put a lot of effort into trying different corrective diopters and styles of focusing screens for the camera but none are helping me as much as I would like so I'm considering alternatives including lasik. My former optometrist says that I'm not a good candidate for contacts because of my astigmatism.

My questions are: 1) does lasik such as the allegratto eye q work for small corrections or will I just end up with about the same vision or worse? 2) at 42 is it better to keep my nearsightedness or go for long distance correction? 3) is there something better out there? 4) if lasik is a good solution then which type might be best? I had a consultation at one place here in San Francisco that suggested I needed the intralase+Allegratto wavefront 400hz at $2500/eye

Thanks in advance,
Eric

[LasikExpert]

1) does lasik such as the allegratto eye q work for small corrections or will I just end up with about the same vision or worse?

It does work for small corrections, however your astigmatism is - relative speaking - not small. It is significant and astigmatic correction can be more challenging. See Lasik astigmatism for details.

2) at 42 is it better to keep my nearsightedness or go for long distance correction?

Probably better to keep the small amount of myopia (nearsighted, shortsighted) vision, but this may be impossible if you have your astigmatism corrected. When reading the article above, note the issues regarding laser coupling.

You will want to read about Sudden Presbyopia.

3) is there something better out there?

Contact lenses. You may also investigate Orthokeratology (Ortho-K).

4) if lasik is a good solution then which type might be best? I had a consultation at one place here in San Francisco that suggested I needed the intralase+Allegratto wavefront 400hz at $2500/eye

All-Laser Lasik may be an appropriate solution, but I very highly recommend that you consider a surface ablation technique like PRK, LASEK, or Epi-Lasik. These have no Lasik flap. This may be valuable since you have such a small correction.

[EH21]

Hi Glenn,
Thank you very much for your reply and info.
May I ask you a few more questions?

1) I did read about Ortho-K and actually have contacted a Dr who specializes in this. Just over the phone, he thought I could be treated, however the cost would be about $5000. Why so much? And is the norm? Also I read on the FDA site about Ortho-K that while it worked for some, others had only 1-2hrs a day of benefit. A few got eye damage from rings that put too much pressure on their eyes - so I didn't seem any safer than lasik. What are your thoughts about cost and effectiveness?

2) So far I have done only one consultation (at the Turner eye institute in San Francisco) and the specialist that reviewed my data seemed to suggest that I might want to treat my non dominant eye differently such as to leave some myopia intact. He thought 1/2 diopter could be left? He said only about 40% of patients could tollerate mono vision but that this small amount probably would be okay for me? Does that sound true?

3) Thanks for your recommendation re: non flap lasik. I've done a little reading up. It seems like the max diameter of epithelial ablation this way is smaller than would be needed for effective treatment of astigmatism? Am I wrong? With the intralase and wavefront treatments it looks like a larger area can be treated with a more gentle blend area. Wouldn't this be a big advantage for handling astigmatism since it covers a larger area of the eye?

Thanks again,
Eric

[LasikExpert]

I did read about Ortho-K ...the cost would be about $5000. Why so much?

I don't know the norm, but that seems like one heck of a lot of money for a series of poorly fitting RGP lenses. I'd shop around a bit.

What are your thoughts about cost and effectiveness?

I would suspect that you would use the RGP lenses every night, but not need them during the day. Like all contact lenses you must be diligent in care and cleaning. Because Ortho-K, by design, is using poorly fitting lenses, the probability of stress on the cornea is high. Actually, that is the purpose of the lens...put stress on the corena to reshape it. This is why a series of RGPs is necessary.

So far I have done only one consultation...

About one-thrid of people who try monovision don't like it, but you can try monovision in contact lenses before having it lasered into your eyes. If you look at San Francisco Lasik you will see that our organization has certified doctors there.

...It seems like the max diameter of epithelial ablation this way is smaller than would be needed for effective treatment of astigmatism? Am I wrong?

In conventional mode, which is what is necessary for trans-epithelial PRK, the size of the treatment zone can be quite large. What is important is your pupil size with Lasik.

[EH21]

Glenn,
Thanks again for your follow up answers. I'm going to go out and visit some more Dr's and try and get as much info as I can on both Ortho-K and PRK or lasik.

Tell me is the reason for the flap method's mostly to avoid the patient's discomfort and longer healing time of just ablation of the epithelial cells or is there a long term advantage or vision correction improvement?

If you look at San Francisco Lasik you will see that our organization has certified doctors there.

I did go to your certified doctors, and googled the only ones in SF which appear to be a husband and wife team. I'd suggest you review that because on your own site here there is an article about them titled "[redacted]"
Considering that article here on usaeyes, I found it odd that they could be certified and recommended.

Regards,
Eric

Note: Name of article redacted.

[EH21]

that article was not on your site but [redacted] and not so favorable to you, Glenn. But you have been helpful so far. I appreciate that. What's your response to the other site?
Regards,
Eric

Note: Name of website redacted.

[LasikExpert]

Tell me is the reason for the flap method's mostly to avoid the patient's discomfort and longer healing time of just ablation of the epithelial cells or is there a long term advantage or vision correction improvement?

There is no long-term difference in the surgery outcome between Lasik or a surface ablation technique like PRK. Some studies give a slight edge to PRK, but not significant and not consistently.

By applying the laser energy under the Lasik flap, the eye is "fooled" into not realizing it has had surgery. This provides the rapid recovery and lack of discomfort commonly associated with Lasik.

I did go to your certified doctors, and googled the only ones in SF which appear to be a husband and wife team.
<snip>Considering that article here on usaeyes, I found it odd that they could be certified and recommended.

Once the facts are investigated it is not so surprising. The concerns raised several years ago were reviewed by regulating and licensing agencies and no negative patient result was ever found.

Our organization looks primarily at the actual patient results, as well as the history of the doctors seeking certification. You may want to see the process by which we certify Lasik doctors.

[LasikExpert]

that article was not on your site but [redacted] and not so favorable to you, Glenn. But you have been helpful so far. I appreciate that. What's your response to the other site?

My response has been litigation for defamation and invasion of privacy in California Superior Court against the perpetrator of the website you mentioned. The person behind this website, and other websites that attack me and this organization, has a permanent restraining order against him for threatening a Texas Lasik doctor, the doctor's family, staff, and even attorneys. The perpetrator has been found in contempt three times and ordered to jail, however he has never shown up to serve his time.

I'm hopeful that you and others will consider the work I've done here for the past decade when considering the statements of someone such as this person.

[EH21]

Glenn,
Thanks for your response. Certainly your site here has a lot of useful information and I thank you for that. I've already made 3 more appointments for lasik doctors for their free consultations so wouldn't have used either of your SF certified Doctors anyhow. It is useful to go through your pages here and the forum to try and find out what the differences are between the available options and know what to ask about with the different Drs/clinics.


Eric

[LasikExpert]

You may want to use our 50 Tough Questions For Your Lasik Doctor to help evaluate a potential Lasik surgeon.