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LASIK eye surgery


Guest Nightriders19

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Guest Nightriders19

Hi folks,

 

I was just wondering if anyone here has considered LASIK eye surgery, or has had it done. I'm really interested in it, because I have very poor vision and I'm worried about having to deal with glasses and contact lenses during long on-call hours once I get to clerkship. My vision is about 20/500 or so, and I am totally dependent on my glasses/contacts. I can't even tell if there is an eye chart on the wall or not, let alone see the big E or any other letters.

 

So, if anyone can tell me good stuff about LASIK (or bad stuff...i need to know that too). I've already been screened, and my optometrist told me I'm a good candidate for the surgery and that he highly recommends it for me, given my choice of profession and the fact that I'm a very active person (running, swimming, etc.). Now I'm just nervous about actually getting it done, and I want to know if anyone else has been in a similar situation.

 

thanks guys!

 

Nightrider

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Guest Koppertone

I've been considering it for some time. My prescription is -5 and -4.75 diaopters, so my eyesight is pretty bad. The one thing that I'm worried about with LASIK is the healing of the flap afterward. I've heard that in some people in results in scarring and at night you get scattering of light at the edges of the eyes. That and I've heard that with such bad eyesight, I'll need several treatments to get full results, and I'm not sure if I'm prepared for that. I'm currently waiting to see if anything better comes along, however I haven't really heard much from other people other than internet horror stories, so if anybody else would like to change my mind.. :)

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Guest physiology

In Vancouver nowadays, I've heard them advertising "no touch" surgery. They send a beam of cold light into your eye and don't even make contact with the eye.

 

I have no idea what it costs, but I'm very interested.

 

I remember shadowing a ophthalmologist in grade 9 who performed PRK (photorefractive keratectomy), and he performed a surgery even more invasive thant what you mentioned Koppertone, but apparently, it healed better or something.

 

I'm worried about the side effects: poor night vision, dry eyes, and I always think that I'll be the 1/1 000 000th case that will get blindness (very rare, but still possible).

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Guest cutieyellow

I agree with physiology, it's definitely the blindness factor that really worries me. I keep on thinking that if i do get blind, i'll always regret it, seeing how contacts/glasses aren't THAT MUCH of a hassle...

 

Then again, a friend of mine has gotten it done and she's absolutely loving it. Her vision is now perfect and has had no after effects.

 

CY

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Guest Agent999

The LASIK technology is quite mature now; the success rate of the operation is relatively high, think it's around 85% or soemthing. There are very few cases when severe side effects occur, and even less when the operation totally fails. I am planning to have one done if I get into medschool. :| Arraggh I hate having to wait, again. :(

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Guest Ian Wong

I refuse to have anything to do with my eyes getting lasered until I see all the ophthalmologists getting them done as well (very few, if any ophthalmologists have had LASIK or any other type of corneal refractive procedure). If the eye surgeons themselves aren't trusting enough of the surgery to have it done personally, I refuse to as well. Glasses or contacts can be a pain, but are certainly manageable enough, even on a long 30 hour call shift.

 

It's just my opinion, but it's not worth jeopardizing your future professional practice when contacts and glasses are so simple to use. If you have no feet, you can still be an internist. No hands, you can still be a psychiatrist. No eyes, well, you're pretty much screwed. :)

 

Ian

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Guest skiboot

I feel the same way.

 

I've worn glasses my entire life. My opthamologist even recommended that I wear glasses instead of contacts (I did try them once though). I can only wear hard contacts and could never really get used to them, so gave up and went back to glasses.

 

I have an appointment once a year and each year I inquire about the possibility of laser eye surgery. Each and every time, I have been told to refrain from the procedure due to the various risks, however minute, and relatively new technology.

 

Glasses are a pain sometimes, but considering the potential alternatives, I'll take the periodic annoyance instead...

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Guest Gill0927

I agree with all of you...my vision isn't that bad (but I do wear contacts every day and I'm guessing once I get to the stage of being on-call I'll be dusting off my glasses), but Lasik's crossed my mind too, and I'm a little scared.

 

I would add, though, that both my brother and sister have had it done and they've both been overwhelming successes. And they both had astigmatisms (like I do). They're huge advocates for Lasik now that they've had it done. I would also add, though, that my father, a dentist, who has been wearing glasses and/or contacts since he was a teenager, has not had it done -- he says it's because he's older, used to the glasses, will need reading glasses anyway, and needs to wear some sort of glasses at work for magnification regardless, but I think the fact that a mistake in Lasik would end his career in one fell swoop is probably the real reason.

 

Anyway, just wanted to add those different experiences...Just to remind everyone that there's good in addition to bad sides to this,

 

Gill :)

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Guest Adamanda

I had Lasik done 5 years ago and am really glad I had it done. my prescription was -4.5 d in each eye and now I have 20/20. I like not having to worry about contacts especially since I play a lot of sports incl swimming. My recovery was only 2 days and then I was back to work and the surgery was only like 15 min. Both of my parents have also had it done and are pleased with the outcomes.

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Guest shrinkage

...have both had it done.

 

My pre-op. refractive index was about -8.50 in both eyes, with mild (regular) astigmatism. I don't know my visual acuity at that time, but I was definitely "legally blind" (anything worse than 20/200 is considered such).

 

We had the LASIK done three years ago. My post-op. refractive index was more or less plano. Note that the biological variability and randomness inherent in healing tends to form some degree of astigmatism (irregular, the kind that cannot be easily mathematically modelled or corrected). Visual acuity (last time I had it checked) is 20/20 in one eye, and 20/25 in the other. You need 20/40 to have an "unrestricted" driver's licence.

 

I had the procedure done for a number of reasons:

- I was considering a career in law enforcement (there are many conflicting visual acuity standards, depending on the agency, but now I could pass at least some of them)

- I had a feeling of "potential vulnerability" re: my corrective eyewear. In the event of a natural disaster, or should the country turn into a police state, etc...I would not want to rely on my corrective eyewear for survival. Oh sure, I could still get my eyes poked out, even now, but I figure if it came to that I'd probably be dead anyway.

- The cosmetic effects of not needing glasses are nice, but irrelevant to me now that I am married, and not looking to "pick up" anybody.

 

If you are really that worried about a freak accident, you can always get one eye done at a time.

 

The crazy parts about the procedure are:

- they hold your eyes open with a speculum (this wasn't pleasant)

- the vacuum they apply to the eye before cutting the flap can be uncomfortable/painful in some individuals (I didn't mind)...it also makes you completely blind (temporarily)

- in the beginning, when they were "driving across my eye" with the microkeratome, I swear I could smell a singed/burning smell...also I felt wet flecks on my cheek, which I am assuming were bits of my cornea flying off the spinning blade

- then, for the 10 - 30 seconds when the LASER is blasting at you (it makes snapping noises), you are supposed to keep fixated on the same point so that the blasts are properly centred. This is pretty tough to do while blind though...

 

Negative outcomes I've experienced:

- I had eye dryness/crustiness issues for weeks afterward...I had to carry around drops all the time, and it was a pain

- When in a well-lit area, I feel that my vision is "perfect", but in semi-darkness, this is not the case (diminished contrast acuity, probably)...presumably, this would not be an issue in the OR, which is lit up like a Christmas tree.

- I feel that total body hydration status is now more important for my vision...being dehydrated and lacking tear content seems to affect it now (I've never noticed this before).

 

In summary, I'd highly recommend the procedure (IF it fits your lifestyle, and you can handle the risk:b enefit ratio), but it's not for everyone.

 

:P

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Guest Trinity

My eyes are really really bad too (about -10 on each eye) and it seems as though every single year, it gets worse!! Depressing indeed!! |I

 

I've considered laser eye surgery but am really reluctant to step forward for the procedure because of all I've heard/am afraid of. I don't want to risk anything going wrong with this delicate process, especially when it has to do with my eyes!! I can't imagine it...:\

 

And plus, I don't think I'm quite the perfect candidate for LASIK yet 'cause my eyes have not "stabilized" yet and my prescription is TOO high.

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Guest peachy

I haven't looked seriously into laser eye surgery, but the thing that worries me about it is about long-term effects. If it has only been around the last couple decades, then how do we know what will happen to lasered eyes, say, forty years later? Is this fear totally unfounded?

 

Agent999, I'm just curious, what does getting into med school have to do with getting laser eye surgery??

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Guest quebecboy

Hey,

 

If you are considering surgery, you should check out Zyoptix (which is a newer technology than Lasik). You don't have the halos of light at night that sometimes happens with Lasik, it takes away less corneal tissue, etc. However, Zyoptix is more expensive than Lasik (it's twice the price I believe).

Quebecboy

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Guest marbledust
should the country turn into a police state, etc...I would not want to rely on my corrective eyewear for survival. Oh sure, I could still get my eyes poked out, even now, but I figure if it came to that I'd probably be dead anyway.

 

Is this something you are seriously worried about?

 

The cosmetic effects of not needing glasses are nice, but irrelevant to me now that I am married, and not looking to "pick up" anybody

 

Hmmm....If a person was concerned about glasses, I would imagine they wouldn't be worth "picking up" in the first place

 

:hat

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Guest Nightriders19

wow...lots of input on this!!!

 

notic2...what exactly are dream lenses? Are you just referring to the lenses you can wear all day and night? I am not a candidate for those lenses because my high prescription (-8) is unfortunately complicated by mild to moderate astigmatism, and I have to wear toric lenses (grrr...expensive).

 

I am still thinking that if I can find the money somewhere I will go ahead with the surgery. My optometrist told me that my high prescription puts me into the high price category (~$4800 for both eyes...ouch, but then again, eye surgery is not something you'd want to "bargain-hunt" for :) ) I'm just tired of being almost totally blind as soon as I take my glasses or lenses off.

 

Thanks for the input!

 

Nightrider

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Guest notic2

re dream

 

hi NightRider

 

Dream Lenses are basically very special lenses that are specially molded/formed to fit exactly your eyes to make them have 20/20 vision.

 

So Basically, this is what a typical Dream Lense User goes through.

He/she gets the dream lenses after specially conforming the eye through optomotrist, etc. Then, he / she wears it at the night. The lenses then work at the eyes, conforming them to have the perfect cornea shape. In the morning, he/she takes it off and has perfect 20/20 vision for the rest of the day.

 

I have heard from various Dream Lenses owners that actually they have survived like almost perfect vision by wearing the lenses for one night for about 2-3 days.

 

Oh, and Also Dream Lenses can be used also to wear as normal lenses as well...i think

 

hope that cleared it up for you!

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Guest peachy

I think that the "dream lenses" that notic2 is talking about refers to "orthokeratology lenses" ... a google search for "orthokeratology" turns up some interesting information.

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Guest ploughboy

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Hey there,

 

I'm not an opthomologist, optometrist or MD, so take the following as one guy's opinions...

 

Getting PRK (photorefractive keratectomy) was one of the smartest things I ever did. I wore glasses since the second grade. Every year my eyes got a little worse, until things finally leveled out at a very high prescription (-9.00 in both eyes, with slight regular astigmatism in the left eye). I'd wake up in the morning and fumble for my glasses right away, just to see the clock. Shrinkage's points might sound a little paranoid, but they totally resonate with me. Losing or breaking one's glasses doesn't happen very often, but if it leaves you helpless, you worry about when/how it could happen. I didn't like the feeling of vulnerability that came with having vision that bad.

 

I'd thought about laser surgery for years, but my SO was adamant that I not get it done. Touching, but kind of annoying. A little while after she became not-so-significant I happened to come into some money, so I started researching laser surgery. As I'm sure you've found, there are lots of websites out there both pro and anti. Be a critical reader. Don't take everything you read on the Internet at face value (distortions, exaggerations and untruths on the Internet? Say it ain't so!). Everything out there has some degree of bias, and that includes this post.

 

After some research I was comfortable with the idea of surgery, and had a good idea what the risks were. I realized with a prescription as high as mine I might not have perfect vision after surgery. I would have been perfectly happy with 20/40 vision. I figured even if I still had to wear weaker glasses after the surgery it'd be better than having a -9.00 prescription.

 

My eye doc recommended Focus in Ottawa (where I was living at the time). I went in for a consultation with one of the surgeons and found out my corneas were too thin for Lasik. Cutting a flap plus zapping enough material to correct my prescription wouldn't have left enough material behind. It wasn't an "ohmigod your eyes are going to implode" situation, but the surgeon was not comfortable with doing the procedure on me. So he referred me to the big cheese at Focus. Dr. Edmison has been doing refractive surgery for over 10 years, and did cataract removal for 20 years before that. He's lasered tens of thousands of eyes, with a pretty good success rate (where success = 20/40 vision or better). He actually prefers PRK to Lasik, since it doesn't affect the integrity of the eyeball the way Lasik does (among other reasons). I can't remember word-for-word what he said, but it was essentially: "you're trading a few days of post-op discomfort with PRK for a better procedure."

 

I didn't think to ask whether he'd had corrective surgery himself (good one Ian!). Since he was wearing reading glasses (presbyopia) and isn't exactly a spring chicken I suspect he hasn't undergone the procedure.

 

So I got zapped. At $2000 per eye it wasn't cheap, but it was worth it. Absolutely no regrets, it was definitely the right choice for me - but that might not make it the right choice for you. Be an informed patient.

 

My experience with the common problems/concerns:

 

Night vision (haloing) - I asked my surgeon about night-vision complications, both haloing and diminished acuity. New technology has reduced the amount and severity of haloing in patients prone to it. I don't notice any halos at night except when I'm really really tired, and after a few blinks they go away. This happened before my surgery too, so I don't think there's a connection.

 

Night vision (acuity) - Focus used to test pre and post surgery night vision in all their patients. They stopped after a few thousand patients, since they felt it was wasted effort. Although there was a slight, measurable loss of acuity in almost all patients, the vast majority of patients didn't notice it. I actually arranged a consultation at the Ottawa Eye Institute, and paid out of pocket to have my pre-op night vision assessed. So that will give me a base-line for comparison if I ever feel things are slipping. I haven't felt the need to have my night vision checked since I had the surgery.

 

Dry eyes - I stopped using eyedrops months ago. The only time my eyes are dry is first thing in the morning, and a few blinks fixes that.

 

Haze - With PRK there is an elevated risk of corneal haze after the surgery, especially in patients with high prescriptions like me. This was the one complication that worried me, since as I recall the percentage of patients with this complication was in the low single digits, whereas most of the other complications occurred in well under 1% of patients. I just had my one-year checkup, by an optho completely unaffiliated with the clinic where I had the surgery done (I've moved across the province). I have absolutely no haze at all in my right eye, and very very very (yes, she used three "very"'s) slight haze in the left. Cool.

 

Going blind - IIRC there hasn't been a documented case of a non-experimental laser completely blinding a human subject, and only one case of an experimental laser doing so (and that was a fairly bizarre situation all around, if memory serves). I'm sure the folks over at some of the "anti" websites will beg to differ, but as I recall the standard of proof on some of those website is pretty low. On the flip side, there are documented cases of some horrible things happening to certain patients. I haven't done any sort of formal analysis, but it seems that bad things happen most often to patrons of bargain-priced clinics. You get what you pay for.

 

Long-term effects - all the pro-laser surgery propaganda I've read makes the point that opthos have been studying wound healing in eyes for over a hundred years, and it's a fairly well understood area. The anti's will say "ya, but we don't know the long-term effects of using a laser on the eye like this." I think they've got a good point there, and I can't recall what the pro side's counterpoint is. For me, it was a risk I was willing to take. Talk to me again in 50 years and I might have a different opinion.

 

Misc - Refractive surgery isn't a magic bullet that will give you 100% healthy eyes. As my optometrist pointed out to me last week, the front of my eye is normal, but the back of my eye is still physiologically that of a high myope. That means I'm still at elevated risk for things like retinal detatchment (due to the elongated shape of my eye, nothing to do with PRK). Yearly checkups, dialation etc will continue to be part of my life going forward.

 

If you're curious about what exactly happens during PRK, a quick account of my surgery is attached. Apparently I was channeling Ernest Hemmingway when I wrote it...

 

pb

 

 

 

 

Day of surgery (Wednesday) - arrive at clinic, sign waiver. Get take-home bag of medicated eyedrops etc. Take happy pill. World becomes a truly wonderful place. Final check of my eyes. Escorted into surgery. Chair tilts back like I'm in an Apollo capsule. Cool. Eyes frozen, lid speculum put in place. Weird sensation. Doc explains (again) what's going to happen, asks if I have any questions. Nope, go ahead. Ok, watch this red flashing light. Science-fictiony snapping sounds as big ol' laser warms up. Outer tissue of my eye lasered away. Doc wipes away the debris. Bizarre having somebody touch my eyeball without me feeling it. Second pass with laser, this time to shape the eyeball. Flashy red light alternates between blurry and less blurry, but I can still see it. 45 seconds later doc takes a break, wipes debris from eye. Third pass to finish correction. Keep watching the red light. Keep watching the red light. Red light disappears. WTF??? Tabarnac, he's blinded me!!! Happy pill no longer working. Red light reappears. Life is good. You could have freakin' warned me about that, doc.

 

Second eye, same deal as the first. This time no panic when red light disappears. Chair tilts back up. Nurse asks me to read the clock across the room. 11:57. Hey, I can see!

 

Taxi home. Eyes still frozen. Spend trip staring out window at traffic. Anesthetic wears off part-way home. Eyes feel gritty. Spend rest of day lying in bed with ice on my face, rising every few hours to put in eyedrops.

 

Day two (Thursday) - wake up. Vision blurry, but already better than my pre-op uncorrected vision. Cool. Cab to clinic, eyes examined. Looking good. Bandage contact lenses changed for fresh ones. Come back again tomorrow. Spend rest of day lying in bed with ice on my face, as before.

 

Day three (Friday) - wake up. Vision a little better. Head hurts. Eyes hurt. Nose running. Life sucks. Why did I do this? Cab to clinic, eyes examined. Bandage contacts are stuck to eyes. Small area of epithelium not fully healed where they stuck. Doc prys contacts off my eyes. Really hurts. Cry like baby in front of cute Vietnamese optho. New bandage contacts put in. Extra eyedrops. Come back tomorrow.

 

Day four (Saturday) - wake up. Eyes scratchy. Vision unchanged. Worried I'll be a case study for botched PRK. Cab to clinic. Eyes examined. Epithelium healed. Bandage contacts removed. Instant relief. Everything looks good.

 

Days five to eight (Sunday to Wednesday) - Wake up every morning, vision slightly better every day. Cool. One-week checkup. Prescription now +1.00. Reduce dosage of steroid eyedrops. Life is good.

 

Day 365 - One year checkup. Eyes look good, slight haze in left, none in right. Can read 25/20 line with right eye, 20/25 line with left eye (slight irregular astigmatism).

 

 

 

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Guest physiology

What are these?

 

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=+ndt

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Guest Ibraheem

this is a really good topic... very informative.... i was considering it.. but my eyes keep on changing... i can only get the surgery done when my vision levels of. right now my vision is like -7.25 and -5.5 AND I AM ONLY 17! So by the time my eyes level off, i believe that the research in such topic will be enhanced.... 8o

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Guest shrinkage

I'm glad that somebody agrees with me about the scariness of being dependent on eyeglasses for survival.

 

Incidentally, I got my eyes done at Focus Eye Ctr also, and by the same Doc...!

 

I was really lucky...my Dad works at OPG (formerly OHN-Pickering) and the company offered to cover corrective vision surgery of up to $3000 for any/all interested family members of the employees. I walked into Focus Eye with my forms and asked them if they'd let me get away with paying $3000 instead of the asking price (it might have been $3600 at the time). To my surprise, they bit at the offer (makes you wonder about their profit margins, eh?).

 

:P

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