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Home > Archive > Lasik Eyes Surgery > May 2005 > Lasik versus Implantable contact lenses
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Lasik versus Implantable contact lenses
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| Little PussyCat 2005-05-18, 11:46 am |
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Hello,
I am considering getting Lasik done, I am going to book myself in for a
consultation at Optimaz - in the UK.
Everyone I have spoken to who has had it done has been really impressed with
it which is good!
But I have been reading the horror stories here, but am thinking that maybe
these people were not good candidates for the surgery anyway, and just went
ahead with it, what do you think?
I have also been reading up on implantable contact lenses.
I am a myopic roughly -5 in both eyes, with an astigmatism in my right eye,
Which do you think is better, Lasik or implantable contact lenses,
Or would Lasek be an option for me also?
Regards,
Jayne
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| Glenn - USAEyes.org 2005-05-18, 11:46 am |
| Hi Jayne,
An important question: how old are you?
Some of the horror stories you see here are accurate, some are
embellished, but much of what has been discussed is possible. The
important point is if it is probable. Being anxious about elective
surgery is a good thing. It shows you have knowledge of limitations
of refractive surgery. You may want to read
http://www.usaeyes.org/faq/subjects/lasik_anxiety.htm
After you respond with your age, I will be better able to provide
relevant information about if LASIK, implantable contact lens,
something else, or nothing might be appropriate.
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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| Sandy - LASIKdisaster.com - LASIKmemorial.com 2005-05-18, 11:47 am |
| Jayne, the most important lesson I learned from LASIK:
"Be careful what you agree to do when the risk is all yours."
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| Glenn - USAEyes.org 2005-05-18, 11:47 am |
| If Jayne were in the US, I'd have to say that she would be in a very
similar situation as Keller was when she had her surgery way back
when. In the US, only one phakic intraocular lens (P-IOL) and it is
not the STAAR ICL (Visian in the US). Few doctors have much
experience with P-IOLs.
In the UK P-IOLs have been around for about a decade. There are
different kinds. They can correct astigmatism. They are foldable and
require a smaller incision. They are much better understood, as are
their limitations.
I am hopeful Jayne will respond with her age and her prescription.
That would do a lot toward being able to provide relevant information.
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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| Little PussyCat 2005-05-18, 6:02 pm |
| Glenn - USAEyes.org wrote:
> Hi Jayne,
>
> An important question: how old are you?
I am 26, I'll be 27 next Sunday
Jayne
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| Glenn - USAEyes.org 2005-05-19, 12:06 am |
| First of all, happy birthday.
I do not believe a P-IOL such as the STAAR Implantable Contact Lens
(ICL, a name that is rather misleading, IMO) would be in your best
interests.
All P-IOLs must be removed at some time in your future. The removal
would commonly occur when your natural lens develops cataracts. That
would probably be in about 30-40 years. This means that under the
best of circumstances, the P-IOL would be implanted for in your eye
for about four decades.
The problem with this scenario is the loss of endothelial cells with
some P-IOLs. These are the cells on the underside of your cornea that
are important to the health of your eye. If the loss was only 1% per
year, you would stand to lose nearly half your endothelial cells
before the normal time for P-IOL removal.
The P-IOL could (and most hopefully would) be removed before
endothelial cell loss became critical, but now you will have multiple
invasive surgeries. P-IOL is a rather invasive procedure.
Some P-IOL designs are much less problematic with endothelial cell
loss than others, and in all cases a endothelial cell count should be
performed before any P-IOL is implanted to assure that you have a
healthy cornea to start.
The type of P-IOL that is the ICL is less problematic with endothelial
cell loss, but they are more problematic with cataract formation. In
a young healthy eye such as yours, the natural lens changes shape and
vaults forward when focusing on near objects. This movement can be
restricted by the ICL - the natural lens can even hit the ICL - and
this can cause trauma induced cataracts.
Before having the STAAR ICL implanted, I very highly recommend that
the anterior chamber of your eyes be accurately measured with an ultra
high frequency ultrasound device such as the Artimes. Dan Reinstein
in London has one of these devices.
Excimer laser refractive surgery procedures such as LASIK, PRK, LASEK,
and Epi-LASIK are somewhat less invasive than P-IOL, but they are
still surgery.
You need to have a detailed discussion with your doctor about all
possible procedures and discuss their implications now and for the
remainder of your life. Then make the decision that is best for you.
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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| Little PussyCat 2005-05-20, 5:57 pm |
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Thankyou Glenn,
That was most helpful!
I was under the misguided opinion that an implantable contact lens would be
more superior to laser eye surgery.
Seems I was misguided somewhat.
This is a decision I am not taking lightly. I will let you know what comes
of my consultation, when I book it.
Which procedure would you trust more to have done on your eyes, Lasik or
Implantable Contact lenses?
Jayne
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| Glenn - USAEyes.org 2005-05-20, 5:57 pm |
| Under the correct circumstances, an implantable contact lens is
superior to laser eye surgery. I'm simply concerned that yours may not
be the correct circumstances.
Every person's eyes are different. You would not expect to get a good
result if you wore a friend's contact lenses. Likewise, what would be
best for me is not necessarily going to be best for you. You need to
investigate refractive surgery based upon your own unique set of
circumstances.
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 2005-05-21, 8:52 am |
| Why aren't p-iols more popular?
Also, it would seem to me that a p-iol could be inserted under the
lasik flap instead of having an enhancement.
On Fri, 20 May 2005 21:48:08 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>Under the correct circumstances, an implantable contact lens is
>superior to laser eye surgery. I'm simply concerned that yours may not
>be the correct circumstances.
>
>Every person's eyes are different. You would not expect to get a good
>result if you wore a friend's contact lenses. Likewise, what would be
>best for me is not necessarily going to be best for you. You need to
>investigate refractive surgery based upon your own unique set of
>circumstances.
>
>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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| Glenn - USAEyes.org 2005-05-21, 5:52 pm |
| There are many reasons P-IOLs are not more popular. In Europe where
they have been available for about a decade, they are used in about 5%
of refractive surgeries.
P-IOL is much more invasive than LASIK. A P-IOL is surgically placed
inside the eye, whereas LASIK is all done on the cornea. I takes a
tremendous amount of surgical skill to implant a P-IOL without causing
a cataract or massive endothelial cell loss, such skill many doctors
who I lovingly refer to as "LASIK Jockeys" (who have not been inside
the eye since residency) do not possess.
Because of the skill factor, a cataract surgeon is probably the better
doctor for a P-IOL, but there is a mind-set with most cataract
surgeons that is not conducive to the PR, marketing, advertising,
hype, world of refractive surgery. Also, refractive surgery patients
tend to be much more demanding than cataract patients. If you miss by
a full diopter with LASIK, you are going to have a very unhappy
patient. If you miss by a diopter with a cataract, the patient is so
delighted to be able to see without clouded yellowed images that
wearing glasses is not such a big deal.
A P-IOL under a LASIK flap is called a lamellar implant and has been
tried for years. In fact one of the reasons I first visited the
former Soviet Union was to meet with a Russian surgeon who had
experimented for years on lamellar implants...without much success.
There are multiple problems with lamellar implants. One is that the
cornea needs to be able to pass oxygen and nutrients from front to
back and back to front. Even the best material will reduce this
exchange. No matter what style of lamellar implant edge has been
tried, there always seems to be an opaque cell formation at the edge
of the implant. Talk about halos. And lastly, the darn things move
around. That could probably be resolved with a more precise incision
with Intralase, but the other problems still exist.
Lamellar implants, if they worked well, would be ideal for a hyperopic
patient where the addition of materiel is needed.
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 2005-05-21, 10:53 pm |
| Well, I guess that answers why P-IOLs are not more popular.
As an aside.. I think that some surgeons who specialize in cataracts
prefer to stick with cataracts exclusively. Medicare covers most if
not all the costs, and if the patient complains... they are already
elderly and not too far from the big sleep or being physically or
mentally too weak to put up much of a fight.
On Sat, 21 May 2005 18:36:22 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>There are many reasons P-IOLs are not more popular. In Europe where
>they have been available for about a decade, they are used in about 5%
>of refractive surgeries.
>
>P-IOL is much more invasive than LASIK. A P-IOL is surgically placed
>inside the eye, whereas LASIK is all done on the cornea. I takes a
>tremendous amount of surgical skill to implant a P-IOL without causing
>a cataract or massive endothelial cell loss, such skill many doctors
>who I lovingly refer to as "LASIK Jockeys" (who have not been inside
>the eye since residency) do not possess.
>
>Because of the skill factor, a cataract surgeon is probably the better
>doctor for a P-IOL, but there is a mind-set with most cataract
>surgeons that is not conducive to the PR, marketing, advertising,
>hype, world of refractive surgery. Also, refractive surgery patients
>tend to be much more demanding than cataract patients. If you miss by
>a full diopter with LASIK, you are going to have a very unhappy
>patient. If you miss by a diopter with a cataract, the patient is so
>delighted to be able to see without clouded yellowed images that
>wearing glasses is not such a big deal.
>
>A P-IOL under a LASIK flap is called a lamellar implant and has been
>tried for years. In fact one of the reasons I first visited the
>former Soviet Union was to meet with a Russian surgeon who had
>experimented for years on lamellar implants...without much success.
>
>There are multiple problems with lamellar implants. One is that the
>cornea needs to be able to pass oxygen and nutrients from front to
>back and back to front. Even the best material will reduce this
>exchange. No matter what style of lamellar implant edge has been
>tried, there always seems to be an opaque cell formation at the edge
>of the implant. Talk about halos. And lastly, the darn things move
>around. That could probably be resolved with a more precise incision
>with Intralase, but the other problems still exist.
>
>Lamellar implants, if they worked well, would be ideal for a hyperopic
>patient where the addition of materiel is needed.
>
>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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