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Home > Archive > Lasik Eyes Surgery > October 2004 > CK Advice Needed
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| Suzanne 2004-10-20, 7:11 pm |
| I've seen the two top eye doctors in town for CK consultations. The
testing at both revealed that (1) I'm a perfect CK candidate and (2) I
have a slight distance problem as well as needing glasses to read. One
of the doctors recommended doing both eyes with CK at the same time and
feels I would be happier with the results. He said it would improve my
distance vision as well and that it would not compromise my distance
vision.
The other doctor recommended one eye with CK and the other Lasik (as it
was more precise for distance). He also said he never did CK in two eyes
at once. He wants to do one eye and wait 6 months to a year, and then
decide whether the other should have CK or Lasik. He also said that CK
in both eyes at once compromises distance vision in regard to driving
and other activities. He also told me he is conservative and would
rather under-correct and go back and correct further, than overcorrect
to begin with.
These doctors both have excellent reputations and credentials, though
their offices and styles are very different. One is older, more
established and his office tends to be more personal. The other is
younger, more modern with a more high-tech and efficient atmosphere to
the eye institute. Since I've basically been told two opposing opinions,
is there actually a right or wrong, or just a difference in approaches?
I'm really torn as to which route to go, and have not been able to
find anyone who has had CK to discuss it with. Most of what I have read
has said typically one eye is done with CK.
Any knowledgable input would be appreciated.
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| Dr. Leukoma 2004-10-20, 7:11 pm |
| Suzanne <nospam@rr.com> wrote in news:4176F14E.2070702@rr.com:
> I've seen the two top eye doctors in town for CK consultations. The
> testing at both revealed that (1) I'm a perfect CK candidate and (2) I
> have a slight distance problem as well as needing glasses to read. One
> of the doctors recommended doing both eyes with CK at the same time and
> feels I would be happier with the results. He said it would improve my
> distance vision as well and that it would not compromise my distance
> vision.
>
> The other doctor recommended one eye with CK and the other Lasik (as it
> was more precise for distance). He also said he never did CK in two eyes
> at once. He wants to do one eye and wait 6 months to a year, and then
> decide whether the other should have CK or Lasik. He also said that CK
> in both eyes at once compromises distance vision in regard to driving
> and other activities. He also told me he is conservative and would
> rather under-correct and go back and correct further, than overcorrect
> to begin with.
>
> These doctors both have excellent reputations and credentials, though
> their offices and styles are very different. One is older, more
> established and his office tends to be more personal. The other is
> younger, more modern with a more high-tech and efficient atmosphere to
> the eye institute. Since I've basically been told two opposing opinions,
> is there actually a right or wrong, or just a difference in approaches?
> I'm really torn as to which route to go, and have not been able to
> find anyone who has had CK to discuss it with. Most of what I have read
> has said typically one eye is done with CK.
>
> Any knowledgable input would be appreciated.
>
>
The fact that CK has been recommended for both eyes indicates that you are
farsighted. CK causes the collagen fibers in the cornea to shrink, whereas
LASIK removes the tissue completely. CK regresses at about 0.50 diopters
per year. How are you with contact lenses?
DrG
| |
| Suzanne 2004-10-20, 10:08 pm |
| Dr. Leukoma wrote:
> Suzanne <nospam@rr.com> wrote in news:4176F14E.2070702@rr.com:
>
>
>
>
> The fact that CK has been recommended for both eyes indicates that you are
> farsighted. CK causes the collagen fibers in the cornea to shrink, whereas
> LASIK removes the tissue completely. CK regresses at about 0.50 diopters
> per year. How are you with contact lenses?
>
> DrG
I've never had contacts. I had good vision until I needed reading
glasses about 6 years ago. Frankly, I was not aware I have a distance
problem. I don't wear glasses for driving or television, just for
reading. One doctor mentioned that I would notice the distance problem
more in about a year. He's the same one who said CK is not as accurate
for correcting distance. But will distance be a problem if I have both
eyes done at the same time?
| |
| Ragnar Suomi 2004-10-21, 2:08 am |
| On Wed, 20 Oct 2004 19:14:22 -0400, Suzanne <nospam@rr.com> wrote:
>I've seen the two top eye doctors in town for CK consultations. The
>testing at both revealed that (1) I'm a perfect CK candidate and (2) I
>have a slight distance problem as well as needing glasses to read. One
>of the doctors recommended doing both eyes with CK at the same time and
>feels I would be happier with the results. He said it would improve my
>distance vision as well and that it would not compromise my distance
>vision.
>
>The other doctor recommended one eye with CK and the other Lasik (as it
>was more precise for distance). He also said he never did CK in two eyes
>at once. He wants to do one eye and wait 6 months to a year, and then
>decide whether the other should have CK or Lasik. He also said that CK
>in both eyes at once compromises distance vision in regard to driving
>and other activities. He also told me he is conservative and would
>rather under-correct and go back and correct further, than overcorrect
>to begin with.
>
>These doctors both have excellent reputations and credentials, though
>their offices and styles are very different. One is older, more
>established and his office tends to be more personal. The other is
>younger, more modern with a more high-tech and efficient atmosphere to
>the eye institute. Since I've basically been told two opposing opinions,
>is there actually a right or wrong, or just a difference in approaches?
> I'm really torn as to which route to go, and have not been able to
>find anyone who has had CK to discuss it with. Most of what I have read
>has said typically one eye is done with CK.
>
>Any knowledgable input would be appreciated.
Glenn has presented a lot of CK information.
I will try to summarize. I might be wrong. He will probably
elaborate. CK is non-invasive and effective... BUT it's expensive and
it's effects are only temporary. I wouldn't recommend anyone have CK
done until they were made aware of their other options. Then if they
decide it's for them... fine.
| |
| Dr. Leukoma 2004-10-21, 11:09 am |
| Suzanne <nospam@rr.com> wrote in news:41771778.4070806@rr.com:
> Dr. Leukoma wrote:
>
> I've never had contacts. I had good vision until I needed reading
> glasses about 6 years ago. Frankly, I was not aware I have a distance
> problem. I don't wear glasses for driving or television, just for
> reading. One doctor mentioned that I would notice the distance problem
> more in about a year. He's the same one who said CK is not as accurate
> for correcting distance. But will distance be a problem if I have both
> eyes done at the same time?
>
>
Hmmm. CK is a procedure that is approved for presbyopia as monovision, and
for low hyperopia. If it was advocated for both eyes, it indicates that
some hyperopia was detected during the eye exam. Now, it is probably the
case that you are an early presbyope and still have some accommodation,
just enough to enable you to see well at distance. It is usually a bad
strategy to try to fix something that isn't broken, except that the
surgeon may be thinking that the uncorrected hyperopia in the distance eye
may cause a problem with the reading, hence the apparent desire to treat
it.
The conservative approach would be to treat the presbyopia first, leaving
the distance eye alone, see what happens, and maybe go back and do a second
treatment in a year. An even more conservative approach would be to trial
the whole thing with contact lenses to see if you are a candidate for
monovision correction. Recently I was referred a patient who had otherwise
good vision and then underwent CK for monovision. He was very unhappy with
the monovision. Unfortunately, the surgery couldn't be undone and he now
wears a contact lens.
DrG
| |
| Suzanne 2004-10-21, 7:12 pm |
| Dr. Leukoma wrote:
> Suzanne <nospam@rr.com> wrote in news:41771778.4070806@rr.com:
>
>
>
> Hmmm. CK is a procedure that is approved for presbyopia as monovision, and
> for low hyperopia. If it was advocated for both eyes, it indicates that
> some hyperopia was detected during the eye exam. Now, it is probably the
> case that you are an early presbyope and still have some accommodation,
> just enough to enable you to see well at distance. It is usually a bad
> strategy to try to fix something that isn't broken, except that the
> surgeon may be thinking that the uncorrected hyperopia in the distance eye
> may cause a problem with the reading, hence the apparent desire to treat
> it.
>
> The conservative approach would be to treat the presbyopia first, leaving
> the distance eye alone, see what happens, and maybe go back and do a second
> treatment in a year. An even more conservative approach would be to trial
> the whole thing with contact lenses to see if you are a candidate for
> monovision correction. Recently I was referred a patient who had otherwise
> good vision and then underwent CK for monovision. He was very unhappy with
> the monovision. Unfortunately, the surgery couldn't be undone and he now
> wears a contact lens.
>
> DrG
I spoke with the doctor who has advised both eyes today. He was very
nice and spent quite a bit of time on the phone with me addressing my
concerns and responding to my questions. He said he recommends both eyes
because after the one non-dominant eye is corrected for near vision,
there would be a noticeable imbalance between that eye and the distance
eye. He told me the numbers for my distance, but I cannot remember them.
He said he thought I would have better vision by treating both eyes and
therefore lessening the imbalance of the reading eye and the dominant
eye for distance (and I apparently do have a distance problem--both
doctors did agree on this). He also discussed treating the distance eye
with Lasik or even Epilasik (the newer less invasive procedure). He was
leaving for a week to teach lasik classes, and what he highly
recommended was that I try the contact lenses first so I could have some
idea what to expect after surgery. He feels that my concerns are caused
by having no idea what to expect after surgery and that I would be
happier if I did a trial run with contacts. This sounded great to me, so
I'm getting disposable contacts to try next week and will then decide
which route to go. Really both doctors are suggesting pretty much the
same treatment, just done in different stages.
| |
| Glenn - USAEyes.org 2004-10-21, 7:12 pm |
| DrG has provided you with excellent advice and I too suggest the
contact lens route first.
For some additional clarification, CK for both eyes is a common
technique to treat hyperopia (farsighted). Your symptoms are very
consistent with what DrG has already surmised, and that is that you
have hyperopia.
The doctor who is recommending laser assisted surgery such as LASIK,
LASEK, or Epi-LASIK is probably simply more comfortable with his
results with these procedures for hyperopia than with CK. As DrG
noted, CK does regress somewhere between 0.25 and 0.50 diopters a year
(a very small, but measurable amount) whereas laser assisted surgery
tends to regress less or not at all.
It is good to hear that your doctor seems knowledgeable and is willing
to discuss these issues with you in detail.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| Dr. Leukoma 2004-10-21, 10:09 pm |
| Suzanne <nospam@rr.com> wrote in news:41782DD0.6090002@rr.com:
> Dr. Leukoma wrote:
>
> I spoke with the doctor who has advised both eyes today. He was very
> nice and spent quite a bit of time on the phone with me addressing my
> concerns and responding to my questions. He said he recommends both
> eyes because after the one non-dominant eye is corrected for near
> vision, there would be a noticeable imbalance between that eye and the
> distance eye. He told me the numbers for my distance, but I cannot
> remember them. He said he thought I would have better vision by
> treating both eyes and therefore lessening the imbalance of the
> reading eye and the dominant eye for distance (and I apparently do
> have a distance problem--both doctors did agree on this). He also
> discussed treating the distance eye with Lasik or even Epilasik (the
> newer less invasive procedure). He was leaving for a week to teach
> lasik classes, and what he highly recommended was that I try the
> contact lenses first so I could have some idea what to expect after
> surgery. He feels that my concerns are caused by having no idea what
> to expect after surgery and that I would be happier if I did a trial
> run with contacts. This sounded great to me, so I'm getting disposable
> contacts to try next week and will then decide which route to go.
> Really both doctors are suggesting pretty much the same treatment,
> just done in different stages.
>
As with Glenn, I think the contact lens trial is the best way to go. You
should try it both ways, with and without a contact lens in the dominant
hyperopic eye. I am thinking that your prescription must be pretty minor
not to have noticed it all these years.
DrG
| |
| Suzanne 2004-10-22, 2:08 am |
| Dr. Leukoma wrote:
>
>
>
> As with Glenn, I think the contact lens trial is the best way to go. You
> should try it both ways, with and without a contact lens in the dominant
> hyperopic eye. I am thinking that your prescription must be pretty minor
> not to have noticed it all these years.
>
> DrG
A friend of mine who has a distance vision problem told me she didn't
even notice it until she put on her new prescription glasses and
realized all the detail she hadn't been seeing. But, yes, I think mine
is minor.
| |
| Dr. Leukoma 2004-10-22, 7:08 am |
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Suzanne <nospam@rr.com> wrote in news:41787B32.7060608@rr.com:
> Dr. Leukoma wrote:
>
>
> A friend of mine who has a distance vision problem told me she didn't
> even notice it until she put on her new prescription glasses and
> realized all the detail she hadn't been seeing. But, yes, I think mine
> is minor.
>
>
There is a reason why small prescriptions are generally not treated, and
that is because of the imprecision inherent in all surgeries, and the
treatment may result in something worse than the problem. Incidentally,
contact lenses often fail for the same reason. I have had numerous
examples of monovision patients who have small amounts of hyperopia in
their distance eyes, who reject the contact lens in that eye. Please let
us know the outcome of your contact lens trial.
DrG
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