|
Home > Archive > Lasik Eyes Surgery > September 2005 > Thinking about LASIK again
You are viewing an archived Text-only version of the thread.
To view this thread in it's original format and/or if you want to reply to
this thread please [click here]
| Author |
Thinking about LASIK again
|
|
| art_classmn 2005-09-28, 9:43 am |
| Hello,
I considered LASIK a few years ago and passed. Most of the reason I
passed was due to the fact that I see fine with glasses or contacts and
did not want to risk good vision with surgery.
I have astigmatisim in one eye and am very nearsighted (-7) in both
eyes and was worried about my chance of successful outcome.
I was wondering if anyone had any input on how LASIK technology has
progressed in the past few years.
I am getting very tired of contacts and glasses and have been getting
headaches and irritated eyes while wearing contacts lately. Everyone I
personally know who has had LASIK surgery has been thrilled with their
outcome, but none of them had as bad of vision as I do.
I have a consultation appointment with my ophthalmologist tomorrow (who
had the surgery himself) and will be getting an opinion from at least
one other doctor.
Just gathering opinions from all sides, even the kooks.
Thanks,
ac
| |
| Ragnar 2005-09-28, 9:43 am |
| From what you say, you should have LASIK done, but you didn't mention
your age. If you are over 50 and have lost your natural accomodation,
you might as well go for some type of iol instead.
I'm going to pick on LVI yet again today... I have seen LVI take very
very elderly patients and do PRK on them. That is insane. I wouldn't
be surprised if the patients they were doing PRK on already had
cataracts.
That is not unlike doing a penile implant on a 90 year old man - which
is done much more often than you would guess.
On 27 Sep 2005 14:07:06 -0700, "art_classmn" <art_classmn@yahoo.com>
wrote:
>Hello,
>
>I considered LASIK a few years ago and passed. Most of the reason I
>passed was due to the fact that I see fine with glasses or contacts and
>did not want to risk good vision with surgery.
>
>I have astigmatisim in one eye and am very nearsighted (-7) in both
>eyes and was worried about my chance of successful outcome.
>
>I was wondering if anyone had any input on how LASIK technology has
>progressed in the past few years.
>
>I am getting very tired of contacts and glasses and have been getting
>headaches and irritated eyes while wearing contacts lately. Everyone I
>personally know who has had LASIK surgery has been thrilled with their
>outcome, but none of them had as bad of vision as I do.
>
>I have a consultation appointment with my ophthalmologist tomorrow (who
>had the surgery himself) and will be getting an opinion from at least
>one other doctor.
>
>Just gathering opinions from all sides, even the kooks.
>
>Thanks,
>
>ac
| |
| serebel 2005-09-28, 9:43 am |
|
art_classmn wrote:
> Hello,
>
> I considered LASIK a few years ago and passed. Most of the reason I
> passed was due to the fact that I see fine with glasses or contacts and
> did not want to risk good vision with surgery.
>
> I have astigmatisim in one eye and am very nearsighted (-7) in both
> eyes and was worried about my chance of successful outcome.
>
> I was wondering if anyone had any input on how LASIK technology has
> progressed in the past few years.
>
> I am getting very tired of contacts and glasses and have been getting
> headaches and irritated eyes while wearing contacts lately. Everyone I
> personally know who has had LASIK surgery has been thrilled with their
> outcome, but none of them had as bad of vision as I do.
>
> I have a consultation appointment with my ophthalmologist tomorrow (who
> had the surgery himself) and will be getting an opinion from at least
> one other doctor.
>
> Just gathering opinions from all sides, even the kooks.
>
> Thanks,
>
> ac
Over the last few years the technique has improved vastly. More
borderline cases are now ruled out if the surgeon doesn't feel
comfortable with the individual. That comes also with experience. At
-7, your outcome would be more predictable than say four or five years
ago. Bottom line, it's much better now.
SErebel
| |
|
|
| art_classmn 2005-09-28, 9:43 am |
| Thanks for the note - I am 38.
| |
| art_classmn 2005-09-28, 9:43 am |
| Hi Glenn,
It's been a while since I read that FAQ. Thanks for the link!
ac
| |
| art_classmn 2005-09-30, 1:16 pm |
| Thanks,
My optometrist (I misspoke in my original post, I did not see my
ophthalmologist) referred me to a Minnesota Eye Consultants in Edina,
MN. I believe they have merged with TLC and they are listed on your
website. I also got more specific information about my correction:
Right eye -7 with mild astigmatism
Left eye -5.5 with "a lot" (opto's words) of astigmatism. I need to
be out of my toric lenses for three weeks before going in for an exam.
My optometrist mentioned that Intralase may be a good option for me
given my correction.
We'll see.
ac
| |
| Glenn - USAEyes.org 2005-09-30, 1:16 pm |
| One of the surgeons with Minnesota Eye Consultants is certified by our
organization and all of them are well known in ophthalmic circles.
MinnEye had recently acquired the Intralase femtosecond laser to be
able to create LASIK flaps with a laser rather than a mechanical
microkeratome. This may be a good option for you, but expect an
additional cost and you may need to travel to one of their other
facilities for surgery.
You may want to visit both
http://www.usaeyes.org/faq/subjects..._intralasik.htm and
http://www.usaeyes.org/faq/subjects...ustom_lasik.htm
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.
| |
| Ragnar 2005-09-30, 1:16 pm |
| I don't consider intralase a good thing. It should only be used if
you have thin corneas or very large pupils or a very high Rx. From
what I see below, you don't have any of those things.
The basic problem of Intralase is that it allows a much thinner flap
to be made, and a thinner flap is not a better flap. PRK has no flap
at all, epi-lasik (LASEK) has an ultra thin flap. The flap is a good
thing, and to be useful, it has to have a substantial thickness.
Also, the intralase flap is extremely difficult to lift when doing
enhancements. In fact, I'm not so sure it can be lifted. A new flap
may be necessary.
On 28 Sep 2005 10:57:53 -0700, "art_classmn" <art_classmn@yahoo.com>
wrote:
>Thanks,
>
>My optometrist (I misspoke in my original post, I did not see my
>ophthalmologist) referred me to a Minnesota Eye Consultants in Edina,
>MN. I believe they have merged with TLC and they are listed on your
>website. I also got more specific information about my correction:
>
>Right eye -7 with mild astigmatism
>Left eye -5.5 with "a lot" (opto's words) of astigmatism. I need to
>be out of my toric lenses for three weeks before going in for an exam.
>
>My optometrist mentioned that Intralase may be a good option for me
>given my correction.
>
>We'll see.
>
>ac
| |
| Ragnar 2005-09-30, 1:16 pm |
| I'd like to see results of Intralase flaps made to a standard
thickness instead of a thinner than microkeratome flap. The intralase
is usually abused in that it CAN make a thin flap and that is what
surgeons do with it.. making the flap too thin to be most effective.
On Wed, 28 Sep 2005 18:38:50 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>One of the surgeons with Minnesota Eye Consultants is certified by our
>organization and all of them are well known in ophthalmic circles.
>
>MinnEye had recently acquired the Intralase femtosecond laser to be
>able to create LASIK flaps with a laser rather than a mechanical
>microkeratome. This may be a good option for you, but expect an
>additional cost and you may need to travel to one of their other
>facilities for surgery.
>
>You may want to visit both
>http://www.usaeyes.org/faq/subjects..._intralasik.htm and
>http://www.usaeyes.org/faq/subjects...ustom_lasik.htm
>
>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.
| |
| Glenn - USAEyes.org 2005-09-30, 1:16 pm |
| The primary difference between a flap made with Intralase and one made
with a mechanical microkeratome is the universal thickness of the
Intralase flap. An Intralase flap is planar, whereas a mechanical flap
is meniscus with thin edges, thicker mid periphery, and thinner
center.
Additionally, the Intralase flap thickness is reliably predictable. If
you say 100 microns, it is going to be 100 microns plus or minus about
ten microns. Mechanical flaps are not as predictable.
In most circumstances the variable in thickness of the mechanical flap
is not an issue, but with a thin cornea it may be.
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.
| |
| Glenn - USAEyes.org 2005-09-30, 1:16 pm |
| The problem with PRK, LASEK, or Epi-LASIK is that if more than about
6.00 diopters of correction is attempted, there is a higher
probability of corneal haze than with LASIK or IntraLASIK. That higher
probability can be mitigated with Mitomycin C, but then you are adding
a strong medicine that would not be necessary with LASIK or
IntraLASIK.
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.
| |
| Ragnar 2005-09-30, 1:16 pm |
| You overlooked the two important points that I made. An intralase
flap is difficult, if not impossible to lift, so a new flap must be
made in enhancements. And the big big problem with Intralase is that
surgeons make the flaps thinner than they should for the best results.
The surface of the cornea regenerates quite a bit, the deeper stroma
do not regenerate at all. You don't want ablated tissue regenerating.
That results in unpredictable regression.
Also, the laser for doing the intralase is not only not the same laser
as the lasik laser, it is often in a different ROOM. With LASEK, the
flap must be put back in place within 30 seconds, or you might as well
just throw that flap away. It will result in hazing and slough away.
I'd like to see how fast they can move a patient from one laser to the
other... I bet if LVI had intralase, they would do both flaps first..
then move to the lasik laser. Those ultra thin flaps are almost
entirely water, and by the time they get put back in place, they are
somewhat dehydrated.
On Thu, 29 Sep 2005 03:09:39 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>The primary difference between a flap made with Intralase and one made
>with a mechanical microkeratome is the universal thickness of the
>Intralase flap. An Intralase flap is planar, whereas a mechanical flap
>is meniscus with thin edges, thicker mid periphery, and thinner
>center.
>
>Additionally, the Intralase flap thickness is reliably predictable. If
>you say 100 microns, it is going to be 100 microns plus or minus about
>ten microns. Mechanical flaps are not as predictable.
>
>In most circumstances the variable in thickness of the mechanical flap
>is not an issue, but with a thin cornea it may be.
>
>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.
| |
| Ragnar 2005-09-30, 1:16 pm |
| Neither of us should really be commenting about LASIK vs LASEK vs PRK
vs IntraLasik, etc. It should be left to the surgeons (who would
pick the microkeratome LASIK as their primary choice). Unfortunately,
there are a lot of less than scrupulous surgeons around, and if t hey
have an intralase laser, they are sure to push patients into utilizing
it whether or not it is appropriate for them. If a surgeon is lazy or
not highly skilled, or have an obsolete/cheap laser system, they would
tend to push PRK on their patients.
One quack who had a flap melt problem (probably due to improper
post-op medication) who recommends PRK vs 600 other lasik surgeons
should make a prospective patient think.
On Thu, 29 Sep 2005 03:11:48 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>The problem with PRK, LASEK, or Epi-LASIK is that if more than about
>6.00 diopters of correction is attempted, there is a higher
>probability of corneal haze than with LASIK or IntraLASIK. That higher
>probability can be mitigated with Mitomycin C, but then you are adding
>a strong medicine that would not be necessary with LASIK or
>IntraLASIK.
>
>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.
| |
| Glenn - USAEyes.org 2005-09-30, 1:16 pm |
| I disagree with your premise that a flap made with an Intralase
femtosecond laser is impossible to lift for later enhancement surgery.
It is true that Intralase flaps are more difficult to *start* to lift,
but once the surgeon has manipulated the tool under the edge, the flap
lifts like any other lamellar interface.
All stromal tissue in the area between the bottom of Bowman's layer
and the top of the endothelial layer is about the same. It makes no
difference if that is 10 microns below or 100 microns below.
There is a time delay between femtosecond laser flap creation and
excimer laser ablation, however the flap is not lifted during this
brief period. There is virtually no exposure to atmosphere. Other than
inconvenience, the amount of time from when the Intralase flaps are
created and when the lift/ablation occur is inconsequential.
Although thinner flaps can be less stable, the 100 micron planar
Intralase created flap remains stable.
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.
| |
|
| Until recently I had been a lifelong Twin Cities resident and I can
tell you that Dr's. Lindstrom & Hardten at MN Eye Consultants are the
big names in the area. I know that Dr. Hardten has had lasik himself
and Dr. Lindstrom was the first to offer lasik in MN. I can't speak
for the other Docs on their staff, but if you are working with one of
these two you are in good hands.
| |
| Ragnar 2005-09-30, 1:16 pm |
| There's some good points! That's rare for this newsgroup.
But still, the intralase method costs considerably more, and the
results are no better than with a microkeratome, and in most cases
seem to be a bit worse as far as haze is concerned. It could be that
the problem is not the tool, but the practitioner. Those who use it
often don't use it appropriately, and those who would be able to use
it properly prefer to use microkeratomes - which they have the skill
to use.
On Thu, 29 Sep 2005 14:33:50 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>I disagree with your premise that a flap made with an Intralase
>femtosecond laser is impossible to lift for later enhancement surgery.
>It is true that Intralase flaps are more difficult to *start* to lift,
>but once the surgeon has manipulated the tool under the edge, the flap
>lifts like any other lamellar interface.
>
>All stromal tissue in the area between the bottom of Bowman's layer
>and the top of the endothelial layer is about the same. It makes no
>difference if that is 10 microns below or 100 microns below.
>
>There is a time delay between femtosecond laser flap creation and
>excimer laser ablation, however the flap is not lifted during this
>brief period. There is virtually no exposure to atmosphere. Other than
>inconvenience, the amount of time from when the Intralase flaps are
>created and when the lift/ablation occur is inconsequential.
>
>Although thinner flaps can be less stable, the 100 micron planar
>Intralase created flap remains stable.
>
>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.
| |
| Glenn - USAEyes.org 2005-09-30, 1:16 pm |
| Most doctors are charging a premium for IntraLASIK over LASIK and the
manufacturer charges a royalty every time the button is pushed. That
does create a financial disincentive for most patients.
There have been three contralateral studies that have shown outcomes
with IntraLASIK to be better than outcomes with a mechanical
microkeratome, however all three doctors are big fans of Intralase so
many are meeting the results with some skepticism.
Even if the visual acuity outcomes are equal, there is a significant
safety advantage with the Intralase over mechanical microkeratome. The
flaps are reliably the thickness desired, they seem to remain very
stable even though they can be thinner, and the "manhole cover" shape
of the edges can reduce the probability of epithelial ingrowth.
Last year Richard Lindstrom, MD presented his negative opinion of the
Intralase at the annual ASCRS meeting, citing cost and time as
factors. This year he has one and claims that neither cost nor time
have been an impediment, and he likes the versatility of the
equipment.
What will probably keep growth of Intralase moderated is that the
results with mechanical microkeratomes are now quite good and many
doctors are moving more and more patients toward surface ablation.
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.
| |
|
| Well, you've gotten an opinion from 'Ragnar' aka Christopher Roiland,
unemployed
and obsessed with proving to himself and others that what he did to his eyes
with refractive surgery
was really an 'OK thing'.
Actually it's not OK. Refractive surgery harms every eye.
First there's the Emory university study showing that every post-LASIK
cornea has
pathology.
http://www.ncbi.nlm.nih.gov/entrez/...4873&query_hl=5
CONCLUSIONS: Permanent pathologic changes were present in all post-LASIK
corneas. These changes were most prevalent in the lamellar interface wound.
These changes along with other pathologic alterations in post-LASIK corneas
may change the functionality of the cornea after LASIK.
Then there's the fact that refractive surgery actually *induces* distortions
in your cornea
that can't be fixed by glasses. That's why visual quality is sometimes poor
after LASIK
and patients complain that they have lost their former 'crisp' vision that
they once enjoyed
with glasses or contacts.
Think your eyes are sore and irritated now? Wait till you lose more than 40%
of your corneal
nerve density, the nerves responsible for the comfortable wetting of your
eye! Sore irritated
eyes BEFORE LASIK are a huge red flag for you NOT to have the surgery.
The Mayo Clinic studies show nerve loss greater than 40% at the 3 year
point. So much for
recovery at 6 months!
http://www.ncbi.nlm.nih.gov/entrez/...5047&query_hl=1
Department of Ophthalmology, Mayo Clinic college of Medicine, Rochester, MN
55905, USA.
CONCLUSIONS: Both subbasal and stromal corneal nerves in LASIK flaps recover
slowly and do not return to preoperative densities by 3 years after LASIK.
The numbers of subbasal nerves appear to decrease between 2 and 3 years
after LASIK. The orientation of the regenerated subbasal nerves remains
predominantly vertical.
Do you want to have a 'structurally compromised cornea'?
http://www.ncbi.nlm.nih.gov/entrez/...1714&query_hl=1
I have had several LASIK patients tell me that they 'Just want their old
life back' and would give anything to undo the surgery. You can't undo
refractive surgery, it's permanent, harmful to your eye and has long-term
eye health consequences. For example, when you're older it will be harder to
get a correct prescription for your cataract surgery implants.
Buy some really cool glasses and keep your cornea healthy. I wish I had. I
have dry painful eyes and really horrible visual quality. I know guys in
their twenties who are debilitated by refractive surgery. Don't do this. The
chance to go without glasses isn't worth the risks of this oversold and
overhyped procedure.
"art_classmn" <art_classmn@yahoo.com> wrote in message
news:1127855226.398158.215220@g49g2000cwa.googlegroups.com...
> Hello,
>
> I considered LASIK a few years ago and passed. Most of the reason I
> passed was due to the fact that I see fine with glasses or contacts and
> did not want to risk good vision with surgery.
>
> I have astigmatisim in one eye and am very nearsighted (-7) in both
> eyes and was worried about my chance of successful outcome.
>
> I was wondering if anyone had any input on how LASIK technology has
> progressed in the past few years.
>
> I am getting very tired of contacts and glasses and have been getting
> headaches and irritated eyes while wearing contacts lately. Everyone I
> personally know who has had LASIK surgery has been thrilled with their
> outcome, but none of them had as bad of vision as I do.
>
> I have a consultation appointment with my ophthalmologist tomorrow (who
> had the surgery himself) and will be getting an opinion from at least
> one other doctor.
>
> Just gathering opinions from all sides, even the kooks.
>
> Thanks,
>
> ac
>
| |
| Glenn - USAEyes.org 2005-09-30, 1:16 pm |
| "Sue" is yet another of Hanson's aliases...and the issue of what
constitutes pathology has already been discussed in this forum. The
real meaning of pathology just doesn't fit this particular anti-LASIK
zealot's agenda, so he makes up a different one that does.
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.
| |
| Ragnar 2005-09-30, 1:16 pm |
| Glad you mentioned that the 3 studies were with Intralase doctors.
That is kind of like going to an anchovy fisherman and asking t hem
what they think the best pizza topping is.
On Thu, 29 Sep 2005 16:07:45 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>Most doctors are charging a premium for IntraLASIK over LASIK and the
>manufacturer charges a royalty every time the button is pushed. That
>does create a financial disincentive for most patients.
>
>There have been three contralateral studies that have shown outcomes
>with IntraLASIK to be better than outcomes with a mechanical
>microkeratome, however all three doctors are big fans of Intralase so
>many are meeting the results with some skepticism.
>
>Even if the visual acuity outcomes are equal, there is a significant
>safety advantage with the Intralase over mechanical microkeratome. The
>flaps are reliably the thickness desired, they seem to remain very
>stable even though they can be thinner, and the "manhole cover" shape
>of the edges can reduce the probability of epithelial ingrowth.
>
>Last year Richard Lindstrom, MD presented his negative opinion of the
>Intralase at the annual ASCRS meeting, citing cost and time as
>factors. This year he has one and claims that neither cost nor time
>have been an impediment, and he likes the versatility of the
>equipment.
>
>What will probably keep growth of Intralase moderated is that the
>results with mechanical microkeratomes are now quite good and many
>doctors are moving more and more patients toward surface ablation.
>
>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.
| |
| Glenn - USAEyes.org 2005-09-30, 9:52 pm |
| I don't know that surgeons will want to be compared to fish mongers,
but the analogy is somewhat on target.
The normal path of these things is that the manufacturer "leaks" that
good things are happening, a paid consultant provides a study that
affirms good things are happening, a couple more studies from people
who are early adopters and known fans of the device say that good
things are happening, and then finally people who have little bias or
actually don't like the device say good things are happening.
I'm a bit of a cynic, and being cynical is really a part of my job,
but in my opinion the farther down this line you get, the more
reliable the information will be.
I have yet to see where anyone has ever outright lied in a study
created in this process, but it is reasonable to assume that
enthusiasm (even justifiable enthusiasm) can bias their analysis of
the facts. Analysis is the bridge between fact and opinion.
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.
|
| |
|
|