LASIK - A Smart Transition Move or Not?

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Bananacarrot's picture
Bananacarrot
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LASIK - A Smart Transition Move or Not?

 

http://www.scribd.com/doc/46440409/Waxler-Petition-FDA-Stop-LASIK-6Jan11

So, I've seen LASIK recommended as a potentially smart move to make in preparing for the future.  Obviously contact lens may become more expensive and difficult to come by.  (Glasses seem a little more difficult to predict, but my guess is it won't be as much of a challenge to attain them - and easier to stock up on a few pairs now.)

I myself considered getting LASIK, and was actually all set to do it with my appointment scheduled, until I came across the information contained in the above link - the Waxler Petition. Just to give you a little background, Morris Waxler was the chair of the FDA when LASIK was originally approved. Now he is coming out with claims that the stats on the risks of the procedure were deliberately skewed at the time of approval, and wants to repeal approval due to the number of adverse events being reported. The risks delineated in the Waxler Petition definitely made me think twice about my decision - so it seemed important to share. In addition to the risks - even if all goes well with the procedure - there are no guarantees that your corrected vision will last.  For me personally, I just don't hate my glasses enough, or feel worried enough about access to glasses in the future, to make it worthwhile to accept the potential of these risks. 

Don't get me wrong - I don't want to get slammed by a bunch of irritated people who have had LASIK and loved it. I myself have spoken to at least 20 people who have had it and love it - even if they experienced some of the adverse effects.  I think it is probably quite successful for most people.  However - I do think it is important to consider all the information available before getting a significant procedure on your eyes. If any of the potential longterm effects do surface down the road, it seems very possible that the medical care needed to address them may no longer be available.

 

albinorhino's picture
albinorhino
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LASIK

Just my opinion. . . Realize that  your eyes are going to change as you age. My wife and I are 60 years of age. About 7 years ago my wife elected to have the LASIK procedure done to produce mono-vision--one eye for reading, one for distance. She still experiences dry eye, and for the first couple of years had dificulty with night vision caused by a halo effect around light sources. She now wears glasses nearly full-time, especially for reading and driving. My perspective at the time of her procedure was that I only have two eyes and I can see fine with corrective lenses--near-sighted. And I can remove my glasses and clearly focus on close objects. My vision is slowly becoming more far-sighted, and my optometrist estimates I'll have 20/20 vision about the age of 80.

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joesxm2011
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lazik, eye doctor, cheap glasses

My eye doctor has decidedly recommended against LAZIK, but I always wondered if it was because he makes so much money selling me glasses.  He wears glasses himself, so I guess he does not want to do it personally.

I can't remember if I read it on this blog or on survivalblog.com, but one guy suggested this place to buy lots of cheap glasses to have spares on hand for now and later.

http://www.zennioptical.com

For example, now, what do you do if you broke your glasses while out and needed to drive the car home?  A cheap pair stashed in the car would solve that problem.

My eyes seem to change every year as I am getting older.  I have been toying with the idea of predicting the trend and getting a series of cheap glasses arranged in the direction my vision is moving.  It would be a real drag after TEOTWAWKI to have your glasses slowly get more and more out of focus until you are basically blind.  The same goes for breaking or losing your only pair.

Another thing that I worry about is that if I am ever in a close range violent confrontation the glasses will probably be the first to go, hopefully without jamming shards of glass into my eyes.  It seems that glasses are a definite tactical disadvantage in that sort of situation. 

Joe

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Retha
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lasik

 My brother had lasik in his early 30s, his doc told him he would probably see some changes with age and lasik would last about 20 years or so.  He's 40 now, and his sight is good.  He is very happy with it.  I was thinking about doing it too, just a little apprehensive about lasering around the eyes!

Tim_P's picture
Tim_P
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 I've been thinking about

 I've been thinking about doing PRK myself.  It's an external procedure and does not leave a flap that could later dislodge like Lasik.  My thought is similar to yours.  Contacts are easy to live with now, but in 10 years, could be difficult to come by.  Glasses have a lot of disadvantages too.  Having your eyes trimmed now might make sense in the long run.

Tim

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 That report says that 43%

 That report says that 43% of patients will be wearing corrective lenses 6 to 12 months after surgery, and about 1 in 200 face blindness.

On those statistics, I think anyone would be mad to consider Lasik.

jpitre's picture
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LASIK

 My understanding is that at altitude (10,000+) - mountain climbing, for instance - expect to partially or completely lose your sight until returning to lower elevation. 

Some years back I considered having the proceedure done, however after finding that sight is severely degraded at altitude, I decided against doing it. 

Jim

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I'm considering LASIK

 The thought of having my peripheral vision back, plus true colors not shaded by lenses are attractive thoughts to me as are the ideas of easier sports and waking in  the morning.

I'm still in the gathering stage, but leaning towards the procedure.

robie robinson's picture
robie robinson
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weighing in

on this subject is now neccessary since the boss is in condideration. I've been an Optometrist for 25yrs, and have seen the evolution of refractive procedures.  If i had significant myopia, greaster than 2 diopters, and astigmatism less than 50% of my total ametropia, all of which less than an algebraic equivalent of 7.5diopters i'ld have the procedure. My caveats are family or personal history of connective tissue disease either degenerative,inflammatory or autoimmune; women with pregnancy in their future may also want to tip toe.

Robie,father,farmer,optometrist

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mainebob
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Rejected Surgery 10 years ago and still reject...

I'm 61 now and 10 years ago *almost* got the eye surgery for my lifelong nearsightness... Tried contacts... too much trouble...
and for about 15 years have been using "progressive lenses" in my glasses....(bifocal/trifocals without lines)
They work great.  Very important to be properly  fitted if you go with progressives...
be sure to have two separate measurements by two different people to be sure.

My objection to Lasik/etc surgery was that I would not be able to see up close... as one gets older, one's internal eye lenses
do less focusing... I can read and do close up work without glasses...   The surgical correction would make it necessary
for me to do wear reading glasses...  and I didn't like the one near and one far eye surgery option... I love my stereo vision!  Also
I feel there is a level of protection with glasses... even just walking thru the woods and getting slapped or poked by branches...
or doing mechanical work...carpentry etc... or anywhere out and about.   

Another consideration and alternative to progressive lenses are the http://www.superfocus.com/ glasses that you 
can adjust on the fly.... I haven't tried these yet... and they do get high praise...

Sometimes dads say things that can hurt...even when in jest...   My dad told one of my seven sisters that her glasses
"Wiped that stupid look off your face"....  It has stuck with her for a couple of decades...
until the popular culture "forced" her to contacts.   As a guy, I'm not so vain... and/or  perhaps glasses
make me look smarter...   No matter... getting extra glasses is a great idea... especially since my perscription was
unchanged at my last visit with a 3 year interval.

-MaineBob... That Nurdy guy with glasses!  HA!
 

 

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ccpetersmd
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A Timely Question

I have been considering LASIK/PRK as well, for the same reasons. I have had fairly mild myopia (nearsightedness) since I was a teenager, but this gradually worsened in middle age, to the point where I now wear glasses when driving, etc. My near vision remains fine (my arms have not gotten shorter when reading), which is of particular concern given my occupation as a surgeon. In addition, I commonly wear loupes, or surgical telescopes, during many of my procedures, and they are fitted for my current (now normal) near vision, so I was concerned about the possible effects of LASIK/PRK on my near vision. However, my 82 year old father, who has had severe myopia and astigmatism throughout his life, recently had corrective surgery, and is delghted to have left his (several pairs of) glasses behind. My father does have some problem with glare and sensitivity to light after his procedure, which is a common complaint, but he isnot terribly bothered by this.

I spoke with one of our ophthalmologists just a few weeks ago. He used to do LASIK in his practice, but recently abandoned it due to issues unrelated to the procedure itself. His comments gave me pause. He said that my near vision (again, which is now normal) would be adversely affected if I underwent LASIK/PRK, and that I would likely require reading glasses (no big deal) and new loupes (a bigger deal, as they cost several thousands of dollar apiece). He also mentioned that if I shoot/hunt, my ability to sight might be affected. He suggested that I could have the procedure done in one eye only, for distance vision, maintaining one unoperated eye for near vision; alternatively, I could have the procedure done on both eyes, but wear a contact lens in one eye for near vision. Overall, it sounded like more of a mess than I had expected.

I am still contemplating the procedure, however, and plan to speak with another ophthalmologist friend who is very well known locally, and who still does these procedures. Data gathering, as Chris said...

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Lasik and PRK - My Experience and Suggestions

Hi all,

Just some lay persons experience with PRK and Lasik.  I am not a DR, so take this as my opinion from having gone thru both procedures with limited sucess.

I had PRK on one eye and lasik on the other about 15 years ago.  Neither eye turned out exactly right and my vision has only been correctable only by HARD PRK  contact lenses since that time.  As I have looked at various times to see if medical science has caught up with my complictions from the surgery, I have learned a few things about the complications from the surgery.  Some can be avoided, others not.

I learned that 20/20 vision is not necessarily the same thing as good vision.  Let me try to explain.  IN one of my eyes, I have less contrast due to haze.  In an exam room, I may be correctible to 20/20 with lenses on my PRK eye, but the letters are not the same depth of black or sharpness  as the other eye due to the haze on the cornea.  The other eye (Lasik) healed with an abnormality where I have a shadow of the letters superimposed on one another.  Technically I can read a 20/20 or 20/30 line with glasses and working at focusing, but with a ghosted image, that is hardly  a quality 20/20 experience as I previously understood 20/20 to be.  I found that confusing as a lay person who didnt know that there existed something like 20/20 vision, but still couldnt  see squat easily.

PRK:

PRK is a less invasive procedure to the structure of the eye in that there is no flap dug into the structure eye, only reshaping the surface of the cornea.I have heard that ( a long time ago) that the millitary pilots are allowed PRK but not lasik because of that.  With Lasik, only the edge of the flap heals, the middle of the incision is still loose.  It is possible for the flap to become dislodged if the eye were to take a blow at some point in the future.

The issue that I had I had with PRK was the development of scar tissue (Hazing on the cornea) which caused my correction to change for several months after the surgery.  Initially I had perfect vision, but that started changing about a month after the surgery.    At the rime, no one seemed to understand what was happening.  

Now it seems to be understood that with PRK, Hazing can occur and it is caused by exposure to bright sunlight in the months following the surgery Maybe this complication can be avoided now, but I would be sure to research how to avoid it as hazing was really common for people undertaking PRK back in the day.

Lasik 

One of the complications of Lasik is dry eye, which occurs when the structure of the cornea does not recover from the damage from the cutting of the flap.  There are structures in the cornea that stimulate/promote tear production.  Those are damaged by the cutting of the flap.  Usually a Lacik recipient will need eye drops for a while after the surgery, which slowly diminshes over time as the eye heals.  Sometimes the tear production does not recover.  As I understand, this is a really painful problem, as without adequate tear production, the eye is not lubricated.  Apparenlty in the worst cases, this is excrutiating, even with the blocking of the tear ducts and adding drops regularly.  Especially at night, when the eye can glue itself shut.    Fortunately, I did not experience this issue with either my PRK eye or Lasik eye.  As I understand this complication is less common with PRK as the internals of the corenea are less disrupted.

 

LasiK and PRK:

One of the more common complications of both surgeries is Ghosting and Halos at night when the pupil expands to let in more light.  If the surgeon is not careful, or doesnt know to check, some patients have pupils that can become wider than the diameter of the surgery area. In that case the light entering the eye at night will be distorted thru the corrected and uncorrected part of the cornea and huge halos and stars will appear around objects at night making for loss of contrast and trouble with night vision and depth perception.  I dont know if this is a routine thing to check for now, but it was not for many of the early years of this surgery.  When I last looked the surgery abut 5 years ago, people were still having bad outcomes  because of this issue.

Lastly, It is important to understand that the lasers still cannot selectively pinpoint specific spots for more or less correction.  So, as in my case, If your eye topography heals wierdly.  IE with a lump or valley in a certain area, the laser cannot just focus on just that one spot during a redo of the surgery.  So there are cases where a redo will not work.   If that happens, it is likely that glasses will no longer correct your eyes properly and you will HAVE to wear a hard contact called an RPG.  This is a really large contact that sits on the white portion of the eye and eliminates high order aberations that glasses cannot.  There are very few DRs in the USA that specialize in fitting RPGs for eyes dammaged via surgery.  I was only able to regain good vision by going to a doctor in Dallas ( DR Gemoules), and he has people visiting him from all over the world, it is that specialized.  I have now spent way more for contact lenses than I ever spent for surgery.

Also understand, if something goes badly, it may be considered too risky to go back in and do corrections.  In my case, my lasik eye is not considered correctible by some DRs, so I cant afford to let them work on the PRK HAZE cornea for fear of making that eye worse.

 

Overall, here are my thoughts.

If the surgery goes well, it will seem like the best decision ever.  I am guessing that 95% of people are happy on a per eye basis.  If it goes less than stellar, it wont take too much of a complication to make you regret your decision.

  If you proceed and need a redo, I would become very conservative, as the surgeon is likely to put you back under the knife for items that may or may not turn out better with a 2nd surgery.  For example if you have ghosting or high order aberations, surgery redo is not so likely to help anything and may make matters worse.

If you are correctible with glasses, stick with them and get some spares for the decline.  I was used to wearing glasses and didnt mind them aside from sports, skiing and the like.  I decided on the surgery because I was young and believed in science and medicine too implicitly.  I had never had much luck with contacts (soft and hard) so the surgery seemed like a no brainer.  That was not true by a long shot.

The lasers have become better over the years ( wavefront topography and so on), but the bodys reaction to the trauma of surgery is still a wildcard that will mess things up sometimes.

If I had found a great pair of hard contact lenses prior to surgery, I would have never needed to consider the surgery. Try that first.  There are not too many DRs that do a great job of fititng lenses.  However, if you find one, hard contacts can be very comfortable.  I can wear my RPG lenses for 20 hours a day and never know they are even in.  If you have the ability go to dallas and have DR gemoules fir you with Hard lenses.  A non surgery eye can be fit very well and will be comfortable beyond your expectations.  My wife did this and her lenses are more comfortable and sharper vison than soft contact lenses or glasses.

Hope this helps some of you.

 

John

 

 

 

 

docmims's picture
docmims
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Thanks John that was well

Thanks John that was well thought out and presented.  I'm 52 with bad diabetes and mild cataracts therefore, the opthamologists won't touch me.  However when my cataracts mature to the point that they need to come out, there are some really nice  lenses that can be implanted during cataract surgery.  Unfortunately they are very expensive (like 2000 bucks range) and not covered by medicare and most insurances.  This may be an option for those of us who will eventually have our cataracts removed.

One of my partners had these implanted about 6mos ago.  I asked him how it was.  He said it was "just like christmas".

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Sept25
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Opinion from a Doctor of Optometry and LASIK patient

I am a practicing optometrist for 20 years and I have had LASIK done on my own eyes 13 years ago. I see patients everyday that ask me about the the procedure. Those patients that have a relatively stable prescription (less than 0.75D spherical equivalent) change over a 3 yr period, have enough a corneal tissue, no corneal conditions that are contraindications, and have otherwise good ocular and systemic health, would be considered good candidates.

In the hands of a good surgeon and you are a good candidate. It really is a good 3rd option along with glasses and contact lenses. In a vastly different world of very limited resources as depicted by our faithful information scout, CM, it is certainly a good safe option for vision correction.

I would advise correcting both eyes for distance and getting some reader glasses for up close for patients close to forty and older, unless you have a successful history of mono vision contact lens wear. Although patients in their mid 50s and later, I would recommend a procedure called clear lens exchange so you don't have to worry about cataracts later on in life.

I personally love the independence from corrective lenses!!! I was a 5.00 D myope. Those horror stories are way overblown. In Canada and US over 7 million people have had it done and an overwhelming majority of people are happy with their decision For most people, the benefits far out weigh the risks. Should consult your own eye doctor first though. Remember the goal of the procedure is to decrease your dependency on corrective lenses, not necessarily eliminate their use all together, all though that does happen a lot.

Good Luck All

Sept25's picture
Sept25
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Opinion from a Doctor of Optometry and LASIK patient

I am a practicing optometrist for 20 years and I have had LASIK done on my own eyes 13 years ago. I see patients everyday that ask me about the the procedure. Those patients that have a relatively stable prescription (less than 0.75D spherical equivalent) change over a 3 yr period, have enough a corneal tissue, no corneal conditions that are contraindications, and have otherwise good ocular and systemic health, would be considered good candidates. In the hands of a good surgeon and you are a good candidate. It really is a good 3rd option along with glasses and contact lenses. In a vastly different world of very limited resources as depicted by our faithful information scout, CM, it is certainly a good safe option for vision correction. I would advise correcting both eyes for distance and getting some reader glasses for up close for patients close to forty and older, unless you have a successful history of mono vision contact lens wear. Although patients in their mid 50s and later, I would recommend a procedure called clear lens exchange so you don't have to worry about cataracts later on in life. I personally love the independence from corrective lenses!!! I was a 5.00 D myope. Those horror stories are way overblown. In Canada and US over 7 million people have had it done and an overwhelming majority of people are happy with their decision For most people, the benefits far out weigh the risks. Should consult your own eye doctor first though. Remember the goal of the procedure is to decrease your dependency on corrective lenses, not necessarily eliminate their use all together, all though that does happen a lot. Good Luck All

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SingleSpeak
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So far so good

 

I'm 54. I started wearing glasses for distance when I was 20. Had Lasik on my right eye about 6 months ago. I didn't like the mono vision due to occasionaly fuzziness. Then I had the left eye done about 3 months ago with only half correction so I would still be able to read. So far I love it. The only time I have any trouble is with very small print like a serial number on the back of a computer. I know reading glasses are in my future but that would happen anyway. My only problem now is finding someone that can Lasik the rest of my body.

SS 

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Hair Transplant

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