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Home > Archive > Lasik Eyes Surgery > December 2005 > Different approaches to Lasek
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Different approaches to Lasek
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| Michael 2005-12-18, 11:01 am |
| I found that different laser eye surgeons have very different rules
about the maximum of myopia they treat with lasek. Some has a maximum
level of -5 diopters and some treats up to -15 diopters with lasek. The
reason for not treating strong myopia with lasek is obviously the risk
of haze (even if Mitomycin C and vitamin C is used).
How should the different recommendations be evaluated? Are the clinics
stopping at -5D the serious ones that will not risk their patients'
eyes, or do they just want to treat the simple cases that gives an easy
profit? Are the ones treating down to -10D or -15D more skilled that
offers this treatment or do they just lack a long list of patients to
treat? Or are they just the kind of adventures doctors that want to try
out the difficult cases?
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| In my opinion, anyone in the double digits should not have laser
surgury, period. Thats a very high amount of myopia and phakic IOLs
would be less risky(but not without risk) Clear lense extraction may be
performed for those over 40. This also has the big benefit of never
having to worry about cateracts.
Contact lenses are very popular for strong pescriptions and many people
see better with them too, especially RGP lenses. High minus glasses can
make things quite small, they minify a fair amount and can easily
account for one(or more!) lines. There are many moderate and especially
high myopes unable to resolve 20/20 with glasses because that line is
too small. With contacts, the 20/20 line definately becomes easier to
resolve plus the whole world looks natural and true to size without the
minification and disortions of glasses.
What is your pescription and reasons for lasik/lasek? just wondering. I
can offer advice to help inform you.
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| Graeme Hewson 2005-12-18, 11:01 am |
| In case you haven't formed your own impression yet, please be aware that
Ace is not qualified to give advice -- far from it.
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| I am not a doctor so I am not qualified to give you a medicial
diagnosis but I can give my opinion and you can discuss the
possibilities with a doctor.
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| Graeme Hewson 2005-12-18, 11:01 am |
| Ah, your opinion. Several times recently I've noticed you've "told"
someone to do such-and-such. You're dangerous.
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| Theres nothing dangerous about not reccomending lasik, depending on the
info he gives, ill either not reccomend it or tell him to discuss lasik
with a doctor and learn all about it to be fully informed and make the
decision himself.
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| Glenn - USAEyes.org 2005-12-18, 6:06 pm |
| Many people believe that there is one set of rules (probably
determined by a government agency) that dictates not only who could
have refractive surgery, but also the exact steps that every surgeon
should take. Nothing could be farther from the truth. If you ask 10
refractive surgeons how they perform the same surgery on the same
patient, you will get 10 variations. They may be minor variations to
major variations, but the 10 will not be identical.
Some doctors are much more aggressive than others. Some are downright
nuts. All find an interpretation of the current published knowledge on
refractive surgery to justify their technique. You will see in this
forum different people looking at the same information and see
(distort?) many different things. The same is true with physicians.
The concern with any surface ablation technique, be it PRK, LASEK, or
Epi-LASIK, is the development of corneal haze when making large
corrections. The cornea tends to become hazy when over about 6.00
diopters of correction is attempted, but this varies. If the ablation
zone is very larger, more tissue is removed for the same amount of
refractive change. That means that someone with lower refractive error
but a large ablation zone may be at risk with less than 6.00 diopters
of refractive change.
LASEK and Epi-LASIK attempt to keep the epithelium to help protect the
cornea from hazing. Current studies are really not conclusive that
this is the case. It appears that the reduction in the percentage of
patients who develop haze after LASEK and Epi-LASIK could just as
accurately be attributed to the advancement of laser technology as
saving the epithelium. There are, of course, those who would disagree
with this opinion.
Using 500mg of vitamin C twice a day for at least a week before
surgery and at least two weeks after surgery with the religious use of
sunglasses did show a statistical reduction in corneal haze in at
least one study. Since massive doses of vitamin C for a short period
of time won't hurt, it is a good idea no matter what the actual
result.
The use of Mitomycin C does prevent haze formation, but at the cost of
some serious and dramatic changes to the healing function of the
cornea. Mitomycin C is strong medicine that is appropriate when
necessary, but probably best avoided when possible.
While there are techniques and technologies that can reduce risk, any
surface ablation technique on a patient who requires more than about
6.00 diopters of correction will elevate the risk of an adverse
outcome. How much that risk will be elevated and the exact nature of
the outcome is open to interpretation.
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 2005-12-18, 6:06 pm |
| Yes, there are many different answers to the question. I had one very
explicit answer when visiting a clinic: the doctor explained that it is
much easier for them to take patients who will presumably require
lesser post op appointments to the clinic and gain better results to
their stats. So they don't e.g. take patients with more than -5D and
not patients that are over 40 years old, among other criteria's.
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| Glenn - USAEyes.org 2005-12-18, 6:06 pm |
| That is not necessarily a bad policy. If every doctor only did young
healthy low myopes (nearsighted) patients, overall results would be
tremendous.
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 2005-12-19, 12:55 pm |
| Well.. that doctor was honest... but a jerk.
I would go someplace else for the surgery.
On 18 Dec 2005 12:09:07 -0800, "Michael" <mthqa@yahoo.com> wrote:
>Yes, there are many different answers to the question. I had one very
>explicit answer when visiting a clinic: the doctor explained that it is
>much easier for them to take patients who will presumably require
>lesser post op appointments to the clinic and gain better results to
>their stats. So they don't e.g. take patients with more than -5D and
>not patients that are over 40 years old, among other criteria's.
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