Beauty & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Apr 28th, 2017 10:42 am

Poll: Mid twenties a good age to get it done?

  • Total votes: 159. You have voted on this poll.
Yes
 
81
51%
No
 
23
14%
Pizza is yummy
 
55
35%
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Oct 1, 2011
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burnt69 wrote:
Feb 1st, 2017 2:50 am
The PLEC staff weren't enthusiastic about me not filling the pain prescription when I queried them on its necessity, but I made a judgement call :).
Haha! I brought my steroid drops from the faxed Rx's sent to my Toronto pharmacy, but I also didn't fill the T3. They kept insisting that they would provide me with the Rx in Vancouver if I ended up needing it as well, which thankfully I didn't.

Something like pain is really hard to predict. However, when I got my wisdom teeth taken out over a decade ago, the oral surgeon also told me to take ibuprofen around the clock for 3 days. I ended up filling the T3 script "just in case" back then and didn't end up needing them then, either.

So I just made sure I took the ibuprofen around the clock (every 4-6 hours) for 2 days post-op as PLEC advised. When you pre-emptively prevent swelling and pain, it is better controlled than waiting for the pain to occur and then trying to chase it. The patient instruction sheet also said to use regular Tylenol tabs around the clock...but the recent article I read within the last year stated that if therapeutic doses of ibuprofen (or some other standard NSAID like naproxen) alone isn't enough to relieve pain, there was no evidence for Tylenol + ibuprofen helping much more. So I skipped buying the regular Tylenol tabs, too. Grinning Face With Smiling Eyes (I pretty much never take plain Tylenol...)
Last edited by peanutz on Feb 1st, 2017 3:21 am, edited 1 time in total.
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burnt69 wrote:
Feb 1st, 2017 2:50 am
Part of the pre-op evaluation is to evaluate for dry eyes. If you show up at the clinic for surgery with dry eyes, this may be disqualifying, may interfere with the wavefront scan, or may cause the Dr. to prescribe punctal plugs where they ordinarily would not be necessary. Proper hydration is important and you may not be in a good state of bodily hydration coming off an early morning transcon flight.
Oops...this probably happened to me, as I didn't give myself adequate time to sleep the night before surgery day. My eyes were really sensitive and dry...like poorly-rested eyes are, when they did some of the testing. :(
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Oct 6, 2015
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peanutz wrote:
Feb 1st, 2017 3:21 am
So I just made sure I took the ibuprofen around the clock (every 4-6 hours) for 3 days post-op as PLEC advised. When you pre-emptively prevent swelling and pain, it is better controlled than waiting for the pain to occur and then trying to chase it. The patient instruction sheet also said to use regular Tylenol tabs around the clock...but the recent article I read within the last year stated that if therapeutic doses of ibuprofen (or some other standard NSAID like naproxen) alone isn't enough to relieve pain, there was no evidence for Tylenol + ibuprofen helping much more. So I skipped buying the regular Tylenol tabs, too. Grinning Face With Smiling Eyes (I pretty much never take plain Tylenol...)
Lol, I didn't take any pain medication the day after, but proceeded to have 8-10 strong self-serve drinks at the airport waiting for my flight in the YVR Domestic Maple Leaf Lounge (which for men at least, has a very nice semi-private washroom mirror setup to instill your drops and is kept much cleaner than a typical airport washroom!). Lol. Never mix pain medication (esp. not Tylenol!) and alcohol, BTW. Didn't hurt my recovery one bit as far as I can tell, but the eye dryness definitely was a lot worse the day after :(.
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Yar...you don't want to take much alcohol with ibuprofen or other NSAIDs, either...it's hard on the stomach!
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Jan 30, 2017
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5 upvotes
thanks for the reply :)
what does the optometrist do for pre and post-op?
About the prescription, do you have to go the pharmacy to fill it up or you can just get it from PLEC ?
May I know what's your prescription and the quote that PLEC gave you?
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Oct 6, 2015
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bogummy wrote:
Feb 1st, 2017 5:22 am
thanks for the reply :)
what does the optometrist do for pre and post-op?
About the prescription, do you have to go the pharmacy to fill it up or you can just get it from PLEC ?
May I know what's your prescription and the quote that PLEC gave you?
Pre-op, your optometrist does the traditional 'refraction'. Retinal imaging with dilation. Eye pressure test. Slit lamp exam (for tear film, cataracts, and other diseases). Cycloplegic refraction (special drops that paralyze the eye so it can't change its focus!). Corneal thickness (pachymetry). Overall health questions.

Pre-op, PLEC does topography, refraction, wavefront, slit lamp, and eye dominance testing. As well as chart verification and confirmation of informed consent.

Post-op, your optometrist checks to see if there's any residual prescription (in most people there will be, at least initially, as they tend to overcorrect in anticipation of regression during healing). Slit lamp to check for dryness and for healing. Eye pressure test (this is important especially since you're on steroids). The optometrist also removes the contact lens inserted at surgery.

Prescription eyedrops are FML, and Betoptic S. FML is a steroid to improve healing quality. Betoptic S protects against the side effect of higher eye pressures that *sometimes* occurs when using FML and can cause glaucoma. Artificial tear drops (they have a brand they recommend, but you can probably use any preservative-free brand) are to be taken regularly. They also prescribe Acuvail, which is a pain relieving drop to be used on the first and 2nd day. FML and Betoptic have to be bought from a pharmacy. They supply the Acuvail, and an initial supply of the artificial tear drops. They also prescribe an ointment called "Lacri Lube" for overnight use.

Also, they prescribe Omega-3 capsules to be taken prior and post surgery, as well as swimming goggles. And there's a prescription for a few tablets of Ativan, Gravol, and Tylenol with Codeine which can be optionally filled at a pharmacy. They want you off eyedrops (especially VISINE) at least a month prior to surgery. If you need eyedrops for dry-eye or other conditions, they tell you a specific brand to use, or to get a documented prescription from your Dr.
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For an estimate of price (ONLY an estimate--they take into account several factors after receiving your optometrist's pre-op testing notes), the transPRK procedure on "virgin eyes" around -5 to -6 prescription correction with mild astigmatism could range from $3500-3900 from PLEC. I believe for lower prescription/non-astigmatism cases it can go as low as $3100 and for more complicated cases like $4100 or more, depending...this was the range they gave to me when I first contacted them by e-mail. They can't give you an individual quote without the tests from the optometrist sent over.

If you're set on LASIK, I don't think you need to go to PLEC (because the flap that covers over the ablation surface acts as a smoothing blanket), but I personally strongly favoured PRK and I was only going to do PRK there. The smoother ablation of the SmartSurface software is what helps with the faster visual recovery with decreased pain, and also decreases risk of haze development. Dr. Lin was pretty cute when he proudly said that he wrote the algorithms for the SmartSurface software--and this has been adopted by a number of other clinics around the world. I would guess that these clinics would NOT be paying for the licensing fee (or purchase price) if this was simply a one-man-show marketing trick.

Prescriptions need to be filled yourself (two FML bottles, one bottle of Betoptic-S. Optional prescription for 3 tabs Ativan 0.5mg at bedtime if needed for sleep; Tylenol #3 a few tablets.) Non-Rx recommendations are Fish oil capsules to start at least 1 week before surgery (2000mg twice a day with food--I bought Jamieson Select), and Advil and Tylenol.

You can choose to have the prescriptions faxed to a Toronto pharmacy before you go to Vancouver (but of course, you MUST remember to bring them with you!) or simply get the prescription from PLEC the day of surgery. There will be the small variable of a pharmacy wait time when you get it filled in Vancouver.

PLEC office provides you with: ciprofloxacin (antibiotic) eye drops, and the Acuvail as well as a few preservative-free lubricant drops.

The preservative-free lubricant drops they recommend are Refresh Optive / Refresh Optive Fusion (NOT Refresh Optive Advanced, which contains polysorbate 80, which is kind of a surfactant and I have read on other laser eye surgery clinic websites that they do NOT want patients using this.) The active ingredients of Refresh Optive Fusion are carboxymethylcellulose and glycerin.

Now since I'm a dork...before the surgery I picked up a box of GENERIC Refresh Optive from the U.S. Smiling Face With Sunglasses There is an Equate-brand (from Walmart) preservative-free drops that contain carboxymethylcellulose and glycerin as the active ingredients.

It looks like this:
http://www.ebay.com/itm/Equate-Restore- ... 2372239743

I don't know if this generic is available in Canada yet. But if you have a friend or relative who can bring it over for you, maybe get like 1-2 boxes. Those single-use vials can be capped again so you can actually use them over the course of a day.
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peanutz wrote:
Feb 1st, 2017 2:55 pm
If you're set on LASIK, I don't think you need to go to PLEC
I don't even think PLEC does LASIK anymore. Dr. Lin is on record saying basically that LASIK flaps (and ReLEx SMILE lenticles) suck. And in the Google Reviews of the clinic, there's someone who wrote a nasty review because they refused her LASIK who apparently was LASIK'ed elsewhere. I didn't see anything but the Schwind Amaris 1050rs in the PLEC OR either.
I would guess that these clinics would NOT be paying for the licensing fee (or purchase price) if this was simply a one-man-show marketing trick.
Only 60,000 SmartSurfACE procedures worldwide as of October 2016 (3 million total on the Amaris platform). And literally no procedures in the biggest refractive surgery market in the world, the USA, as the Schwind lasers are not FDA approved.

I'd love to buy stocks in Schwind as I think their machines will eventually replace all of the VISX + Intralase setups around the world, as LASIK is rendered an obsolete procedure. But they're a privately held German company.
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burnt69 wrote:
Feb 1st, 2017 3:39 pm
I don't even think PLEC does LASIK anymore. Dr. Lin is on record saying basically that LASIK flaps (and ReLEx SMILE lenticles) suck. And in the Google Reviews of the clinic, there's someone who wrote a nasty review because they refused her LASIK who apparently was LASIK'ed elsewhere. I didn't see anything but the Schwind Amaris 1050rs in the PLEC OR either.

Only 60,000 procedures worldwide as of October 2016. And literally no procedures in the biggest refractive surgery market in the world, the USA, as the Schwind lasers are not FDA approved.
The FDA is a slow, inefficient behemoth...plus I'm sure there is a slight pressure from other clinics who have older technology who love how slowly the FDA is moving when it comes to reviewing the Schwind Amaris...

I'm still convinced that there must be a place in therapy to offer LASIK. I know that both SmartPulse LASIK and SmartSurface PRK are offered in the South Korean and Singapore clinics that have the Amaris 1050rs. If a patient has higher scarring potential or certain healing defects, inflammatory conditions, etc. LASIK may theoretically be a slightly better option...?

Not totally sure. But all I know is: if I were responsible for choosing the procedure for a family member or close friend, I'd push towards PRK, just as I chose for myself...

Is it quite interesting how probable competitive motivations caused phases where LASIK surgeons kind of maligned PRK referring to old PRK drawbacks... so I am cautious when it comes to ragging on LASIK. I'm just speaking from personal experience. My 2010 LASIK consult had the surgeon just totally dismissing PRK as any kind of option to consider, since with my thinner-than-average, but still normal corneas (~520um) I was an acceptable candidate for LASIK (yet not perfect candidate--not only with my thinner cornea, but also my tendency towards dryness and also my pupils which in darkness dilated beyond the 6mm capability of their laser at the time). I just wanted to be presented with professional pros and cons and that turned me off and away.

Honestly, it seems that from surgeons who offer either of the most advanced PRK and LASIK, we will probably find the most balanced assessment.

I also looked into the SMILE...wasn't a fan of tiny little forceps having to dig into my cornea looking to pull out the lenticule. lol
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Oct 6, 2015
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peanutz wrote:
Feb 1st, 2017 3:57 pm
Is it quite interesting how probable competitive motivations caused phases where LASIK surgeons kind of maligned PRK referring to old PRK drawbacks... so I am cautious when it comes to ragging on LASIK. I'm just speaking from personal experience. My 2010 LASIK consult had the surgeon just totally dismissing PRK as any kind of option to consider, since with my thinner-than-average, but still normal corneas (~520um) I was an acceptable candidate for LASIK (yet not perfect candidate--not only with my thinner cornea, but also my tendency towards dryness and also my pupils which in darkness dilated beyond the 6mm capability of their laser at the time). I just wanted to be presented with professional pros and cons and that turned me off and away.
When I asked about PRK oh say, back in 2004 or so, I was told that I was at the outer range of local clinic's treatment experience, and that haze was a very high risk. They weren't doing MMC though. I asked about the side effects of halos and starbursts with LASIK, and my (former) optometrist (who was pushing the procedure very heavily on her patients with her local referral clinic, angering my mom quite a bit with how aggressive she was selling!) acknowledged the probability of such, but said, "well you already experience those right now so it won't be any different". Not acceptable!
Honestly, it seems that from surgeons who offer either of the most advanced PRK and LASIK, we will probably find the most balanced assessment.
There's some using SmartSurfACE that have completely abandoned the flap procedures. www.ksa.ee for instance.

I also looked into the SMILE...wasn't a fan of tiny little forceps having to dig into my cornea looking to pull out the lenticule. lol
I didn't think SMILE was that bad of a procedure, but the problem was with respect to re-treatment, Basically re-treatment has to be PRK -- SMILE cannot be repeated. And since its so new, its not clear if surgeons have a lot of good re-treatment experience, whether a standard wavefront-guided re-treatment will provide good results, or if there's any weirdness in corneal topography induced by the procedure. Also, there's still the possibility of bacterial infiltration (or epithelial infiltration) into the incision even if its size is dramatically reduced versus LASIK. Even a few epithelial cells dragged into the incision during the lenticel extraction can cause ingrowth.
Newbie
Apr 3, 2012
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Toronto
I've had two consults, one with Lasik MD and one with Herzig.

Herzig told me my corneas were too thin (both sub 500, one 488 I believe), -5.25 both eyes, and refused to do Lasik, offering wavefront PRK instead. However when I went to Lasik MD they seemed confident that wavefront Lasik would be totally fine.

While I'm ok with PRK, I'm finding it difficult to decide if LasikMD's confidence was due to them believing they could safely do it, or if they were simply more interested in promoting it over PRK. With my thin corneas, I'm worried that opting for Lasik will put me in a situation where there's little cornea left if a revision is ever needed. Thoughts anyone?
Newbie
Jan 30, 2017
52 posts
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Hey all what has been your experience with laser surgery firms in Toronto.. went to lasik and they are standing pat with the offer of $4030 for custom wavelength.. spoke with director she kept saying no discount we are reputable brand we price match tho bla bla..

When I said just make it $4000 even they refused :|

What's the cheapest laser eye surgery place I can get a quote so that I can show lasik and they can pricematch??

Any other ideas to get the lasik pricing cheaper

Thanks
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Oct 6, 2015
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Herzig told me my corneas were too thin (both sub 500, one 488 I believe), -5.25 both eyes, and refused to do Lasik, offering wavefront PRK instead. However when I went to Lasik MD they seemed confident that wavefront Lasik would be totally fine.
500 - 5.25 * 20 microns/diopter - 120 (flap) ~= 275um. The official limit is 250um, but most surgeons want 300um. Looks to me (lay person, not a doctor!) that you're probably a better PRK candidate.

edit: a 'theme' I've seen in online comments and reviews is that 'marketing' or 'sales' staff of a clinic will tell a person (with marginal numbers) they can have a "LASIK" procedure based on cursory examination of the file, but when the patient actually talks to the Dr just prior to going for the surgery, they get switched to PRK. A lot of people come to such clinics very demanding to specifically get the "LASIK" and actually think PRK is an inferior procedure. PRK has a more difficult early recovery period, but it is *not* an inferior procedure quality-of-vision-wise 3-6 months post-procedure. I don't find such a practice ethical or professional (for sales staff to be passing judgement on procedure suitability!), but its not surprising that some of the 'chain' centers might engage in it.

edit 2: PLEC took quite a while to get back to me (~10 days), even for my very routine case. Which means that the Dr. likely personally reviewed my file. There was no salesperson or marketing person involved.
WOW! Thanks for replying with all those details @burnt69 @peanutz !!
How is the recovery going?
Almost 3 weeks later, vision is entirely clear (no blurriness anywhere), I tested 20/20 at the optometrist at the 2 week mark, the glasses restriction has been dropped from my drivers license (confirmed with a letter from the DMV), and I will be starting to taper my steroid eyedrops next week. Near vision is perfectly fine, and no light sensitivity (can work all day at a computer or go out in the sun no problem, with sunglasses of course!). Distance vision, particularly at night, still isn't the best, but sharpness continues to improve.

Pre-op starbursts completely disappeared immediately. Night halos continue to improve. No ghosting whatsoever now.
For those who are contemplating between lasik and relex smile like me, I'd advise you to do your own research, and not just solely rely on the words of eye centres. This is a good place to begin: https://www.ncbi.nlm.nih.gov/pmc/?term=relex%20smile
Interesting link with studies. My position is that its just way too early on the technological maturity curve to consider that procedure. And quite frankly, after experiencing how painless and how rapid recovery from a highly optimized PRK procedure can be, it does seem like a lot of risk for not a lot of benefit. Someone else can be the guinea pig!
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