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Home > Archive > Lasik Eyes Surgery > November 2005 > PRK x3?
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| Michael 2005-11-23, 5:59 pm |
| I had PRK on my left eye (-8D and -4 astigmatism) eight years ago and
was re-operated one and a half years later. Both PRK's were made here
in Europe with a VISX of that time (VISX 20?). The second operation was
made to expand the optical zone one more mm (maximum with the machine
at the time) and to take off a little bit more of the myopia since I
was under-corrected the first time. The result after the treatments is,
and still is, corneal haze and halos in dark environments and around
-1.5D of myopia. The halos are because of a large pupil (I informed the
clinic about that before the op since I had halos with stable contacts
but they thought it shouldn't be a problem...). The ablative zone may
also be a bit de-centered according to the clinic that did the surgery.
I have recently been examined by one eye doctor at a surgery clinic and
by one other "regular" eye doctor and discussed if there is something
that could be done to enhance the vision with that eye. Both said that
the thing to consider is to do a third PRK and because the equipment is
better today there is a fair chance that the haze and halos will be
reduced and the myopia can be decreased.
Do you have an opinion about that advice? Would Lasek (not Lasik) be an
alternative to consider? Or will Lasek not be able to "remove" the haze
in my eye even if the method is a better alternative for an un-treated
eye when it comes to the haze? Does Lasek require a thicker cornea than
PRK?
My right (-8.5D, -3.5 astigmatism) eye is not treated at all as a
result of the problematic outcome of the left one. If the treated left
eye could get a bit better it could be a large benefit to have the
right eye treated as well since one cannot where glasses with one -1.5D
eye and one -8D. I have dry eyes as well which makes a contact lens
hard to wear. The two doctors I consulted recommend treating the right
eye with ICL/P-IOL since my cornea is too thin to use Lasik on. The
most common P-IOL lens used around here seams to be STAAR's ICL. That
one is placed in the posterior chamber if I understand it right. Will
that fact decrease the long term problem with to much reduction of
endothelial cells? Will it on the other hand increase the risk for a
cataract caused by the P-IOL since it is placed closer to the
crystalline lens?
If I understand it right, when treating astigmatism with an ICL, the
lens must be stapled to the iris. Is that found to be a risk in itself?
Is Lasek generally better or worse than P-IOL when it comes to treating
an eye with a large pupil?
Thanks,
Michael
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| Hmm you are in a tricky situation. Getting one eye done will result in
anisometropia making glasses nearly impossible. Its not a problem for
contact lense wear but you cant tolerate them well(neither can I) I
guess IOLs are the way to go. I would leave the -1.5 eye alone so you
can see from near without needing reading glasses.
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| Glenn - USAEyes.org 2005-11-24, 1:00 am |
| Let's first talk about resolving the existing problem before moving to
your right eye and discussing what may be best for your high myopia
(nearsighted, shortsighted) vision and high astigmatism.
A wavefront-guided PRK on the left eye for the residual myopia,
astigmatism, and to expand the functional optical zone is most
certainly something to investigate. Each case is very unique so it is
difficult to compare the results you may attain with others, but a
knowledgeable doctor should be able to provide a reasonable
probability of improvement in your vision, especially at night.
Another PRK on your left eye is not likely to resolve much of the
existing corneal haze problem, but because you have a relatively small
amount of residual correction necessary, it is not likely to cause
additional haze.
If the haze in your left eye is reducing the quality of your vision,
you may want to discuss with your doctors a treatment with Mitomycin C
to resolve the existing haze. This would probably be done before any
additional surgery so the cornea would be able to react and your
refractive error to stabilize.
I am assuming that the reason doctors are recommending PRK on your
right eye over LASIK is because your corneas are too thin to
accommodate the 110-160 microns needed for the LASIK flap. The problem
is that even with today's technology, corneal haze is going to be a
concern.
PRK, LASEK, or Epi-LASIK for the correction of 8.50 diopters of myopia
with 3.50 diopters of astigmatism are all going to have about the same
probability of corneal haze...and that will be a significantly
elevated probability.
If you have PRK on the right eye, it is probable that the doctors will
use Mitomycin C during the surgery to reduce the probability of
corneal haze. Also, taking 500mg of vitamin C twice a day for about
two weeks before surgery and at least three weeks after surgery has
been shown to reduce the probability of corneal haze. The combination
of these can reduce the probability of corneal haze, but cannot
eliminate the probability. Haze will still be possible.
Now that you have one eye so different than the other, you are
probably more motivated than most to have surgery on the right eye.
That does not mean, however, that you should put yourself at too great
a risk as PRK/LASEK/Epi-LASIK for 8.50 D of correction would comprise.
Looking into the phakic intraocular lenses to correct your right eye's
myopia seems to be wise. You may find that it is ultimately
recommended to have a P-IOL for most of the myopia and PRK for the
astigmatism. This combination may be better than the toric P-IOLs.
With large pupils, the STAAR ICL may be a better selection than the
Artisan/Visian P-IOL, which clips on the front of the iris. Much
depends upon the measurements inside the eye.
If you decide to proceed with surgery, be absolutely certain that you
have selected a surgeon who has often performed EXACTLY the same
surgery for someone in the same situation as you. You don't want
somebody experimenting with a procedure that is new to him/her. You
need someone with extensive practical knowledge of wavefront guided
retreatment, phakic intraocular lenses, and corneal haze
prevention/treatment.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| Ragnar 2005-11-24, 10:59 am |
| I'm still not sure about you Ace.. HOWEVER.. you made an EXCELLENT
point. You should e-mail that arrogant Dr. Salz and explain to him
why doing one eye at a time is a terrible idea.
You struck gold with that point.
On 23 Nov 2005 13:15:20 -0800, "Ace" <acemanvx@yahoo.com> wrote:
>Hmm you are in a tricky situation. Getting one eye done will result in
>anisometropia making glasses nearly impossible. Its not a problem for
>contact lense wear but you cant tolerate them well(neither can I) I
>guess IOLs are the way to go. I would leave the -1.5 eye alone so you
>can see from near without needing reading glasses.
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|
| whats the pupil size limit for STAAR ICL? what pescriptions do they
come in?
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| Michael 2005-11-24, 5:58 pm |
| Glenn, thanks sincerely for your elaborate answer.
If I understand you correctly, it may be worth to treat the eye that
was operated over six years ago with Mitomycin C to try to reduce the
corneal haze. In other words, Mitomycin C is not only to prevent for
haze but may also has an effect on an eye with haze caused long ago.
I googled up Mitomycin C and it seems to be quite a potent substance.
Somewhere it is mentioned that it can have long term side effects that
occurs over a year after treatment of corneal haze. This example may be
a legal text that covers for everything that can go wrong but anyway:
http://shurl.org/TdnBT
On the other hand, I also found that Mitomycin C has been used since
the 80s to treat corneal haze cause by injury.
I will discuss those things with the doctor but it is always good to
have a second opinion and to do some homework first.
Michael
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| Glenn - USAEyes.org 2005-11-24, 5:58 pm |
| Thank you for the kind words.
Mitomycin C is strong medicine that is appropriate when necessary, but
should be avoided if possible. It has been used to change the wound
healing response in many of the medical specialties from cosmetic
surgery to ophthalmology.
When used to resolve existing corneal haze, the dosage is commonly
0.02% concentration for anywhere from 30 seconds to two minutes. It
seems to have a very positive effect on existing haze. When used
intraoperatively as a prophylactic against corneal haze, the dose may
be as little as 0.002% for 10-12 seconds.
The link you provide gives a good informed consent that should be
heeded.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
|
| Glen,
I would also like to thank you for detailed response to my questions they
were very much appreciated.
My son decided to have Epi/LASIK (PRK) on Wednesday and he is now slowly
recovering, his doctor also used Mitomycin C during the surgery. He is also
taking 500mg of vitamin C twice a day along with his antibiotics. Hopefully
he will have the contacts removed on Saturday if all goes well.
The first day after surgery I notice his eyes were blood shot due to the
surgery, he told me could see the best on that day (blurry with no haze) so
far. On the second day he noticed haze as well. My guess it will take at
least a week before things start to improve. His Myopia has improved a great
deal (blurry with haze) he doesn't need his glasses anymore and can read
street signs etc. Only time will tell for sure I hope all goes well for him.
Thanks Again Glen!
BTW I found this site very informative regarding PRK and more. I thought it
might be useful for others.
http://www.chicagocornea.com/html/lasik.html#prk
"Glenn - USAEyes.org" <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message
news:ohico1tftvuv058r5qu71lji2p02fe3048@4ax.com...
> Thank you for the kind words.
>
> Mitomycin C is strong medicine that is appropriate when necessary, but
> should be avoided if possible. It has been used to change the wound
> healing response in many of the medical specialties from cosmetic
> surgery to ophthalmology.
>
> When used to resolve existing corneal haze, the dosage is commonly
> 0.02% concentration for anywhere from 30 seconds to two minutes. It
> seems to have a very positive effect on existing haze. When used
> intraoperatively as a prophylactic against corneal haze, the dose may
> be as little as 0.002% for 10-12 seconds.
>
> The link you provide gives a good informed consent that should be
> heeded.
>
> Glenn Hagele
> Executive Director
> USAEyes.org
>
> "Consider and Choose With Confidence"
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.
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| Michael 2005-11-26, 10:58 am |
| Thank you for your input Glenn.
One puzzling thing about my haze is that several eye doctors who have
examined my eye say that they cannot see much haze in the cornea and
that it should not be of great concern. What I know is that it came
with the PRKs and it is not the same thing as halos and starbursts that
I have problem with at night. The "haze" is disturbing in daylight as
well, and with correction of my remaining myopia and astigmatism, but
not in a pinhole test when my vision becomes clear. The haze, as I
experience it and has for eight years now, fits pretty much into the
ordinary description of the corneal haze: decreased clearness and
contrast and some blur that is not possible to correct. It is not just
a subjective patient experience; I have a significantly lower test
score with the eye corrected than I had with correction before the
PRKs.
Is it possible that there could be another side effect after the
treatments than haze that might have the same effect on the vision? The
eye doctors that have examined my eye have not been able to come up
with another explanation and have not seen any indications of other
things that are wrong.
Michael
| |
| Ragnar 2005-11-26, 12:55 pm |
| How old are you? Perhaps you have the beginnings of a cataract.
You might ask your doctor about a procedure known as PTK which only
affects your opithelium.
On 26 Nov 2005 02:04:23 -0800, "Michael" <mthqa@yahoo.com> wrote:
>Thank you for your input Glenn.
>
>One puzzling thing about my haze is that several eye doctors who have
>examined my eye say that they cannot see much haze in the cornea and
>that it should not be of great concern. What I know is that it came
>with the PRKs and it is not the same thing as halos and starbursts that
>I have problem with at night. The "haze" is disturbing in daylight as
>well, and with correction of my remaining myopia and astigmatism, but
>not in a pinhole test when my vision becomes clear. The haze, as I
>experience it and has for eight years now, fits pretty much into the
>ordinary description of the corneal haze: decreased clearness and
>contrast and some blur that is not possible to correct. It is not just
>a subjective patient experience; I have a significantly lower test
>score with the eye corrected than I had with correction before the
>PRKs.
>
>Is it possible that there could be another side effect after the
>treatments than haze that might have the same effect on the vision? The
>eye doctors that have examined my eye have not been able to come up
>with another explanation and have not seen any indications of other
>things that are wrong.
>
>Michael
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| Michael 2005-11-27, 10:59 am |
| I'm 38, and the doctors have not seen any signs of cataract in my eyes
yet.
Michael
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| Ragnar 2005-11-27, 10:59 am |
| At 38.. you would not have cataracts... but you are getting to the age
where presbyopia can be a problem.
On 27 Nov 2005 01:20:27 -0800, "Michael" <mthqa@yahoo.com> wrote:
>I'm 38, and the doctors have not seen any signs of cataract in my eyes
>yet.
>
>Michael
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| you may need reading glasses if corrected to plano unless you want to
hold things arms length away which is a pain
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