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Limits to custom correction Lasik?
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| Talkin Horse 2005-04-21, 10:53 pm |
| I'm confused. I thought the technology was approaching the point where it
could help me, but now I'm not sure (I hear contradictory information, and
this is not my area of expertise, so I can't sort the truth from the
rumors). My correction specs are 5.50 - 3.50x160 and 4.50 - 4.50x180.
Because my astigmatism is irregular, I won't get Lasik until/unless a custom
correction is available that can treat me with very high probability of
success. I understand the FDA has been ratcheting up the limits of custom
correction. My question: Am I in range yet? Will I ever be in range? Is
Lasik just a bad idea for me? I've had glasses all my life, and I would love
to be shed of them, but I won't let my enthusiasm overwhelm my caution.
| |
| Glenn - USAEyes.org 2005-04-21, 10:53 pm |
| You are not in range, and to be very frank, you probably should not
have refractive surgery at this time. Possibly never.
The problem lies in your astigmatism. It is huge. As a (very)
general rule, one should probably not have refractive surgery if the
astigmatism is more than half the myopia, or if the astigmatism is
above 3.00 diopters. You exceed both these parameters.
Yes, you undoubtedly can find a surgeon who will do surgery on your
eyes, but the probability of a good outcome is, IMO, unacceptably low.
You can decide to take the risk, but you are asking for opinions and
this is mine.
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.
| |
| Talkin Horse 2005-04-22, 8:52 am |
| That's a disappointing evaluation, but I appreciate it. I have no intention
of putting my eyes at risk until and unless I have overwhelming reason to
expect a successful outcome. Thanks for your comments.
-- Dave
"Glenn - USAEyes.org" <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message
news:g7og61d40no40gk3l78p9afp7asvm9u8li@4ax.com...
> You are not in range, and to be very frank, you probably should not
> have refractive surgery at this time. Possibly never.
>
> The problem lies in your astigmatism. It is huge. As a (very)
> general rule, one should probably not have refractive surgery if the
> astigmatism is more than half the myopia, or if the astigmatism is
> above 3.00 diopters. You exceed both these parameters.
>
> Yes, you undoubtedly can find a surgeon who will do surgery on your
> eyes, but the probability of a good outcome is, IMO, unacceptably low.
> You can decide to take the risk, but you are asking for opinions and
> this is mine.
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
| |
| Ragnar 2005-04-22, 8:52 am |
| Where did you get the idea that it can't help you?
On Fri, 22 Apr 2005 01:16:00 GMT, "Talkin Horse"
<davidrolfeN0SP&AM@earthlink.net> wrote:
>I'm confused. I thought the technology was approaching the point where it
>could help me, but now I'm not sure (I hear contradictory information, and
>this is not my area of expertise, so I can't sort the truth from the
>rumors). My correction specs are 5.50 - 3.50x160 and 4.50 - 4.50x180.
>Because my astigmatism is irregular, I won't get Lasik until/unless a custom
>correction is available that can treat me with very high probability of
>success. I understand the FDA has been ratcheting up the limits of custom
>correction. My question: Am I in range yet? Will I ever be in range? Is
>Lasik just a bad idea for me? I've had glasses all my life, and I would love
>to be shed of them, but I won't let my enthusiasm overwhelm my caution.
>
| |
| Ragnar 2005-04-22, 8:52 am |
| I think a better answer would be that no method of correction is going
to be 100% effective for that degree of astigmatism. Certainly soft
contact lenses aren't going to work.
On Fri, 22 Apr 2005 02:29:46 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>You are not in range, and to be very frank, you probably should not
>have refractive surgery at this time. Possibly never.
>
>The problem lies in your astigmatism. It is huge. As a (very)
>general rule, one should probably not have refractive surgery if the
>astigmatism is more than half the myopia, or if the astigmatism is
>above 3.00 diopters. You exceed both these parameters.
>
>Yes, you undoubtedly can find a surgeon who will do surgery on your
>eyes, but the probability of a good outcome is, IMO, unacceptably low.
>You can decide to take the risk, but you are asking for opinions and
>this is mine.
>
>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.
| |
| Ragnar 2005-04-22, 8:52 am |
| If you think like that, you shouldn't have LASIK.
I'm curious... what do you do for correction now?
On Fri, 22 Apr 2005 06:28:20 GMT, "Talkin Horse"
<davidrolfeN0SP&AM@earthlink.net> wrote:
>That's a disappointing evaluation, but I appreciate it. I have no intention
>of putting my eyes at risk until and unless I have overwhelming reason to
>expect a successful outcome. Thanks for your comments.
>
>-- Dave
>
>"Glenn - USAEyes.org" <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message
>news:g7og61d40no40gk3l78p9afp7asvm9u8li@4ax.com...
>
| |
| CatmanX 2005-04-22, 8:52 am |
| In what way is the astigmatism irregular? Are you keratoconic? or is it
just that you have high astigmatism? Have you had topography? do the
topos show irregularity in the cornea?
Atigmatism and irregular astigmatism are 2 different things. Irregular
astigmatism is not astigmatism at all, it just appears that way and was
improperly named.
Irregular astigmatism is not suitable for RS at all, in any way.
Current treatment methodology does not customise the ablation for the
shape of the eye when there is variation in shape as with IA.
If you do have topos, feel free to email them to me if you want an
opinion.
dr grant
| |
| Talkin Horse 2005-04-22, 10:52 pm |
| "Ragnar" <ragnarsuomi@yahoo.com> wrote in message
news:0ikh61pfufcr9mc269j88nisfodq356cqe@4ax.com...
> If you think like that, you shouldn't have LASIK.
> I'm curious... what do you do for correction now?
I just wear ordinary glasses, nothing exotic. When I was a kid (long ago), I
wore hard contacts for a few years, but they were just too much trouble to
put in, and they rendered me sensitive to dust that might get in my eye.
I've gotten to the point where I need bifocals for reading, but I mostly
struggle by without them (or switch to full-field reading glasses) because I
find the split field of vision annoying.
As far as my thinking goes...For something as vital as my eyes, I don't want
to jump in until/unless my category makes me an excellent candidate for
success. I realize that no undertaking is without risk; you take your life
in your hands every time you drive to the market. But I don't want to step
into a high risk situation; especially considering that technology is
advancing, and today's high risk may become tomorrow's low risk. Assuming I
live long enough to enjoy the fruits, of course...
| |
| Talkin Horse 2005-04-22, 10:52 pm |
| About 3 years ago (before custom correction was available in the USA), I
visited a Lasik operation recommended by my optometrist and I was given a
"Waveprint" analysis. This was the basis for the recommendation that I would
be better-served by a custom correction, and certainly that makes intuitive
sense: I would expect that a custom-tailored correction based upon an
analysis of my eyes would do a better job than a generic correction. The
Waveprint had generated a printout that indicated the asymmetry; however I
wasn't given a copy of the print. So I can't say off the top of my head how
the astigmatism was irregular; this is all I know. They gave me the
impression that they would eventually be able to serve me, and I assume this
was a respectable business. Perhaps they were nevertheless a bit
overenthusiastic, or perhaps I've mistakenly used words that imply my
situation is worse than it is. I get by with ordinary glasses, so my vision
is serviceable enough.
"CatmanX" <grantm@connexus.net.au> wrote in message
news:1114169715.587990.152380@g14g2000cwa.googlegroups.com...
> In what way is the astigmatism irregular? Are you keratoconic? or is it
> just that you have high astigmatism? Have you had topography? do the
> topos show irregularity in the cornea?
>
> Atigmatism and irregular astigmatism are 2 different things. Irregular
> astigmatism is not astigmatism at all, it just appears that way and was
> improperly named.
>
> Irregular astigmatism is not suitable for RS at all, in any way.
> Current treatment methodology does not customise the ablation for the
> shape of the eye when there is variation in shape as with IA.
>
> If you do have topos, feel free to email them to me if you want an
> opinion.
>
> dr grant
>
| |
| Talkin Horse 2005-04-22, 10:52 pm |
| "Ragnar" <ragnarsuomi@yahoo.com> wrote in message
news:goih61t4ddes69k73jmuq2t0jof0dalhka@4ax.com...
> Where did you get the idea that it can't help you?
My fundamental question was whether my astigmatism rendered me a poor or
inappropriate candidate for custom correction. I thought I was, then I
thought I wasn't, then I decided I didn't know.
| |
| Ragnar 2005-04-22, 10:52 pm |
| My dear man, you know not what you speak of.
Standard LASIK does not adequately treat irregular astigmatism,
however Wavefront LASIK does in most cases.
Do a google on Zernike Polynomials and learn something.
And we still are wondering why Grant Mason is identifying himself as
Dr. Grant instead of Mr. Mason
.... kind of sounds like an old horror movie.. Dr. Grant & Mr. Mason
On 22 Apr 2005 04:35:15 -0700, "CatmanX" <grantm@connexus.net.au>
wrote:
>In what way is the astigmatism irregular? Are you keratoconic? or is it
>just that you have high astigmatism? Have you had topography? do the
>topos show irregularity in the cornea?
>
>Atigmatism and irregular astigmatism are 2 different things. Irregular
>astigmatism is not astigmatism at all, it just appears that way and was
>improperly named.
>
>Irregular astigmatism is not suitable for RS at all, in any way.
>Current treatment methodology does not customise the ablation for the
>shape of the eye when there is variation in shape as with IA.
>
>If you do have topos, feel free to email them to me if you want an
>opinion.
>
>dr grant
| |
| Ragnar 2005-04-22, 10:52 pm |
| Sounds to me like you should stick with glasses.. I think your idea
of success is perfection.
Obviously I don't know much about your eyes, but you might consider
how much you are bothered by your glasses. Without going into a long
diatribe, I found that in my case, glasses were quite ineffective.
One option you might consider is custom made z-wave rigid contacts
which are made from a topography of your eye. If you do try that,
please let us know how it worked for your troublesome eyes..
On Sat, 23 Apr 2005 00:48:37 GMT, "Talkin Horse"
<davidrolfeN0SP&AM@earthlink.net> wrote:
>"Ragnar" <ragnarsuomi@yahoo.com> wrote in message
>news:0ikh61pfufcr9mc269j88nisfodq356cqe@4ax.com...
>
>I just wear ordinary glasses, nothing exotic. When I was a kid (long ago), I
>wore hard contacts for a few years, but they were just too much trouble to
>put in, and they rendered me sensitive to dust that might get in my eye.
>I've gotten to the point where I need bifocals for reading, but I mostly
>struggle by without them (or switch to full-field reading glasses) because I
>find the split field of vision annoying.
>
>As far as my thinking goes...For something as vital as my eyes, I don't want
>to jump in until/unless my category makes me an excellent candidate for
>success. I realize that no undertaking is without risk; you take your life
>in your hands every time you drive to the market. But I don't want to step
>into a high risk situation; especially considering that technology is
>advancing, and today's high risk may become tomorrow's low risk. Assuming I
>live long enough to enjoy the fruits, of course...
>
| |
| Ragnar 2005-04-22, 10:52 pm |
| I doubt that was 3 years ago onyour waveprint... more like 2 years at
most.
Don't waste your time chatting with grant. You might not get the
right answers from me, but you are guaranteed to get wrong information
from grant mason. I don't know if he's just ignorant or
intentionally misleading people. We have had both types of people in
here.
On Sat, 23 Apr 2005 01:03:15 GMT, "Talkin Horse"
<davidrolfeN0SP&AM@earthlink.net> wrote:
>About 3 years ago (before custom correction was available in the USA), I
>visited a Lasik operation recommended by my optometrist and I was given a
>"Waveprint" analysis. This was the basis for the recommendation that I would
>be better-served by a custom correction, and certainly that makes intuitive
>sense: I would expect that a custom-tailored correction based upon an
>analysis of my eyes would do a better job than a generic correction. The
>Waveprint had generated a printout that indicated the asymmetry; however I
>wasn't given a copy of the print. So I can't say off the top of my head how
>the astigmatism was irregular; this is all I know. They gave me the
>impression that they would eventually be able to serve me, and I assume this
>was a respectable business. Perhaps they were nevertheless a bit
>overenthusiastic, or perhaps I've mistakenly used words that imply my
>situation is worse than it is. I get by with ordinary glasses, so my vision
>is serviceable enough.
>
>
>"CatmanX" <grantm@connexus.net.au> wrote in message
>news:1114169715.587990.152380@g14g2000cwa.googlegroups.com...
>
| |
| CatmanX 2005-04-23, 8:54 am |
| The problem that you face if you have irregular astigmatism, aka
keratocunus, is that you may have central corneal thinning that will
not allow for the depth of ablation. Additionally, there is irregular
surface shape, cone shaped, not elliptical and this is not able to be
treated.
If you have keratoconus, the option may be to have a graft then Lasik,
assuming that the cornea is bad enough to require grafting.
dr grant
| |
| Talkin Horse 2005-04-23, 8:54 am |
| "Ragnar" <ragnarsuomi@yahoo.com> wrote in message
news:b8hj615j0krmp07ujrmhsn91mf9uuvequv@4ax.com...
>I doubt that was 3 years ago onyour waveprint... more like 2 years at
> most.
> Don't waste your time chatting with grant. You might not get the
> right answers from me, but you are guaranteed to get wrong information
> from grant mason. I don't know if he's just ignorant or
> intentionally misleading people. We have had both types of people in
> here.
I'm looking at my notes, and I find a reference to my Waveprint experience
in June of 2002. So I can report with confidence that I visited a medical
office before that date and was given an evaluation that they called
"Waveprint", resulting in a map of my astigmatism.
I appreciate all input, and I know that not all of the information I
encounter is correct. I figure the true picture will come clear eventually,
and in the meantime I certainly intend to err on the side of caution. I'd
like to keep the hope alive that one day I'll be able to walk down the
street and look at the world without a weight bearing down on my nose, and
without the imperfect and somewhat-smudged view I get through a lens. This
isn't a matter of life or death; it's clearly a luxury rather than a
necessity, but I'll get it if the opportunity presents itself.
| |
| Ragnar 2005-04-23, 11:50 am |
| Wow.. you got that done early then. Must have been on ladarvision.
VISX wavefront hasn't been available that long.
On Sat, 23 Apr 2005 10:58:13 GMT, "Talkin Horse"
<davidrolfeN0SP&AM@earthlink.net> wrote:
>"Ragnar" <ragnarsuomi@yahoo.com> wrote in message
>news:b8hj615j0krmp07ujrmhsn91mf9uuvequv@4ax.com...
>
>I'm looking at my notes, and I find a reference to my Waveprint experience
>in June of 2002. So I can report with confidence that I visited a medical
>office before that date and was given an evaluation that they called
>"Waveprint", resulting in a map of my astigmatism.
>
>I appreciate all input, and I know that not all of the information I
>encounter is correct. I figure the true picture will come clear eventually,
>and in the meantime I certainly intend to err on the side of caution. I'd
>like to keep the hope alive that one day I'll be able to walk down the
>street and look at the world without a weight bearing down on my nose, and
>without the imperfect and somewhat-smudged view I get through a lens. This
>isn't a matter of life or death; it's clearly a luxury rather than a
>necessity, but I'll get it if the opportunity presents itself.
>
| |
| Ragnar 2005-04-23, 11:50 am |
| Someone with keratocunus is going to have irregular astigmatism, but
irregular astigmatism doesn't mean someone has keratocunus.
It's kind of like saying all people with pneumonia will sneeze, but
that doesn't mean that all people that sneeze have pneumonia.
Since Mr Grant Mason who is not a doctor is here only to scare people
with his twisted, ignorance (I know it scares me) he is a terrible
source for information.
If you have keratoconus, you have problems beyond the realm of LASIK.
You might need a corneal transplant.
On 22 Apr 2005 21:54:17 -0700, "CatmanX" <grantm@connexus.net.au>
wrote:
>The problem that you face if you have irregular astigmatism, aka
>keratocunus, is that you may have central corneal thinning that will
>not allow for the depth of ablation. Additionally, there is irregular
>surface shape, cone shaped, not elliptical and this is not able to be
>treated.
>
>If you have keratoconus, the option may be to have a graft then Lasik,
>assuming that the cornea is bad enough to require grafting.
>
>dr grant
| |
| mdibiofuel 2005-04-25, 10:51 pm |
| Does not the Artisan IOL represent a possible option for Talkin Horse in
terms of partially correcting the astigmatism, making subsequent Las*k
refinements possible with less of a correction necessary in terms of
corneal ablation? This one-two punch of IOL and Las*k was thought to be
the answer for me, but I am learning to live with my astigmatism without
the Las*k especially as it is getting much better as time passes, and
was stitch-induced mostly.
Perhaps a CLE or an Artisan IOL is what you might be hoping for instead
of feeling depressed about Las*k's lack of application in your
particular case. I used to wish as hard as I could wish that the doc
would find cataracts in my eyes back in the 1980s so I could have an
early CLE.
It's just a question, no need to flame. Again, what about an IOL
(either CLE or ICL) which would then reduce the ablation obligation of
Las*k to correct the rest?
Talkin Horse wrote:
> "Ragnar" <ragnarsuomi@yahoo.com> wrote in message
> news:goih61t4ddes69k73jmuq2t0jof0dalhka@4ax.com...
>
>
>
> My fundamental question was whether my astigmatism rendered me a poor or
> inappropriate candidate for custom correction. I thought I was, then I
> thought I wasn't, then I decided I didn't know.
>
>
| |
| Glenn - USAEyes.org 2005-04-25, 10:51 pm |
| In the US, the toric Artisan/Verisyse phakic intraocular lens (P-IOL)
is not available. It is available, however, outside the US.
The Verisyse P-IOL has the advantage that it is affixed to the iris
and the angle stays reasonably stable. This would allow astigmatic
correction. The STAAR ICL P-IOL is not similarly affixed and would
probably be a poor choice.
CLE (now called Refractive Lens Exchange - RLE) does not have this
option as the intraocular lens tends to rotate and shift within the
capsular bag.
A problem with the Verisyse is that in the US it is not foldable.
This means that a relatively large 6.0mm incision is necessary for
implantation. Anywhere from 3-5 stitches would be required. That is
compared to a 2.5mm incision with no stitches for RLE. Such a large
incision and stitches of any kind can induce more astigmatism.
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.
| |
| CatmanX 2005-04-26, 8:51 am |
| Something like the artisan may or may not be an option depending on the
exact problem that TH has. I would strongly urge TH to see a qualified
OD or MD and get a proper evaluation which includes topography to
establish the exact nature of the corneal curve and what options are
available. Talking of options is rather pointless unless the exact
problem is known, not hypothesized.
dr grant
| |
| Ragnar 2005-04-26, 11:49 am |
| Note that dr grant is actually MR. Grant Mason and he is not a doctor.
On 26 Apr 2005 05:10:29 -0700, "CatmanX" <grantm@connexus.net.au>
wrote:
>Something like the artisan may or may not be an option depending on the
>exact problem that TH has. I would strongly urge TH to see a qualified
>OD or MD and get a proper evaluation which includes topography to
>establish the exact nature of the corneal curve and what options are
>available. Talking of options is rather pointless unless the exact
>problem is known, not hypothesized.
>
>dr grant
|
| |
|
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