Beauty & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Dec 16th, 2017 9:22 pm

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

  • Total votes: 200. You have voted on this poll.
Yes
 
103
52%
No
 
29
15%
Pizza is yummy
 
68
34%
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Sep 12, 2015
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burnt69 wrote:
Jan 29th, 2017 1:34 am
SmartPulse is just a software program that causes the Schwind AMARIS lasers (750s, 1050rs) to do things with the pulses to create a smoother surface post-laser ablation. When combined with transPRK (basically PRK, but with laser removal of the epithelial layer), it is marketed as "SmartSurfACE", referring to the procedure being a 'surface' procedure (as in PRK).

The theory is that a smoother surface results in higher "off-the-table" visual acuity (ie: 20/25 in my case), and faster healing time due to that smoother surface. transPRK itself improves healing times by reducing the epithelial wound to be precisely the size of the laser treatment, with regular/rounded edges rather than the irregular edges that alcohol or mechanical abrasion would cause. "in theory" visual outcomes are claimed to be slightly better due to the whole procedure taking about 40 seconds and the corneal stroma not drying out. But there's not really any good studies to prove that -- only anecdotal comments from an opthamologist or two that the AMARIS algorithms "reduce coma" or leave an undetectable post-treatment cornea. Hard, at least for the layperson (which I am), to distinguish if that's just marketing speak, or really has meaning!

It doesn't completely close the 'gap' with LASIK recovery-wise, but it makes PRK an awfully lot more palatable to those who otherwise would be looking at many weeks of disability. Which has been the traditional detraction of PRK in the first place.
Just curious to see why you didn't consider crystal clear vision instead of flying to Vancouver?

Thanks
Sr. Member
Oct 6, 2015
902 posts
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Androidmarshmellow wrote:
Jan 29th, 2017 1:48 am
Just curious to see why you didn't consider crystal clear vision instead of flying to Vancouver?

Thanks
I live much closer to Vancouver, Dr. Lin is a world-reknowned 'rockstar' in his field of refractive surgery (been doing it since 1989 and actually invented SmartSurfACE/SmartPulse), and obviously CrystalClear doesn't have the technology. I know nothing of CrystalClear other than what's on their website, so I can neither endorse nor de-endorse them. I can only point out that they have a laser that is capable, in theory, of being upgraded to the technology, but as peanutz researched, they have not. Apparently he/she (peanutz) travelled to Vancouver as well recently for treatment with Pacific.

My impression is that the latest laser platforms, such as the Schwind Amaris, take a lot of the guesswork out of treatment planning and allow even a novice surgeon to achieve great results "straight out of the box". But the overall treatment algorithm is something to consider. This includes not only the decisions the surgeon makes for the laser treatment itself, but also the measurements that go into the treatment (wavefront, manifest and cycloplegic refractions, topography measurement, amongst other information gathering and screening such as corneal thickness), any required pre-treatment for dry eye, the intraoperative pain management regimen, and of course, post-procedure medication and followup.

I was briefly considering flying to Seoul or even Estonia, to undergo considerably less expensive treatment on the same laser platform, but realized that being so far away from my care providers, and coordination with my after-care optometrist would have been dramatically more difficult. I doubt I will need a follow-up appointment in Vancouver since my recovery is going well, but if I do, I have the financial capacity to get on a plane and go to one. I would not recommend undergoing this type of surgery if it stretches you so much financially that you wouldn't be able to, if legitimately necessary, afford to go to a re-treatment or appointment if necessary.
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burnt69 wrote:
Jan 29th, 2017 1:57 am
I live much closer to Vancouver, Dr. Lin is a world-reknowned 'rockstar' in his field of refractive surgery (been doing it since 1989 and actually invented SmartSurfACE/SmartPulse), and obviously CrystalClear doesn't have the technology. I know nothing of CrystalClear other than what's on their website, so I can neither endorse nor de-endorse them. I can only point out that they have a laser that is capable, in theory, of being upgraded to the technology, but as peanutz researched, they have not. Apparently he/she (peanutz) travelled to Vancouver as well recently for treatment with Pacific.

My impression is that the latest laser platforms, such as the Schwind Amaris, take a lot of the guesswork out of treatment planning and allow even a novice surgeon to achieve great results "straight out of the box". But the overall treatment algorithm is something to consider. This includes not only the decisions the surgeon makes for the laser treatment itself, but also the measurements that go into the treatment (wavefront, manifest and cycloplegic refractions, topography measurement, amongst other information gathering and screening such as corneal thickness), any required pre-treatment for dry eye, the intraoperative pain management regimen, and of course, post-procedure medication and followup.

I was briefly considering flying to Seoul or even Estonia, to undergo considerably less expensive treatment on the same laser platform, but realized that being so far away from my care providers, and coordination with my after-care optometrist would have been dramatically more difficult. I doubt I will need a follow-up appointment in Vancouver since my recovery is going well, but if I do, I have the financial capacity to get on a plane and go to one. I would not recommend undergoing this type of surgery if it stretches you so much financially that you wouldn't be able to, if legitimately necessary, afford to go to a re-treatment or appointment if necessary.
Very in depth analysis, thank you. I'm still leaning towards the Vancouver option. The only thing that's stopping me is the trip there and back from Toronto (around $600) plus cost of hotel. If they ever come to Toronto, I would do it in a heartbeat.

Looking forward to your recovery posts
Sr. Member
Oct 6, 2015
902 posts
436 upvotes
Androidmarshmellow wrote:
Jan 29th, 2017 12:16 pm
Very in depth analysis, thank you. I'm still leaning towards the Vancouver option. The only thing that's stopping me is the trip there and back from Toronto (around $600) plus cost of hotel. If they ever come to Toronto, I would do it in a heartbeat.

Looking forward to your recovery posts
Yeah not much to recovery. Other than drops, drops, and more drops. And over the past few days, while vision has been mostly clear, there's been a few transient periods of blurriness.

Remember that laser eye surgery, and the expenses associated with it (ie: travel, prescriptions, etc.) can be claimed as medical expenses.

http://www.theglobeandmail.com/globe-in ... le4264075/
Sr. Member
Oct 6, 2015
902 posts
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Day 14: 20/20 vision as tested by the optometrist. Considering there's some bloggers who got PRK and took 4-5 weeks to achieve this same result, I think I'm doing pretty good.
Newbie
Jan 30, 2017
17 posts
5 upvotes
hello, im also thinking of going to PLEC for eye laser. Do you have to pay more for the smartAce PRK ?
Newbie
Jan 30, 2017
86 posts
13 upvotes
Hey everyone

What does everyone think of laser eye surgery when your 28. The lady at lasik told me your eyesight will turn bad when your 50ish again...I didn't know that
Anyone have any experience with Lasik? There was mention of a referral discount by the lady at Lasik. Can anybody share a referral with me?

Thanks
Sr. Member
Oct 6, 2015
902 posts
436 upvotes
bogummy wrote:
Jan 31st, 2017 3:36 am
hello, im also thinking of going to PLEC for eye laser. Do you have to pay more for the smartAce PRK ?
No. Its basically the 'only' procedure that PLEC does these days from what I can tell. However, PLEC doesn't do coupons, and their quoted price is exclusive of pre-care and after-care (figure $600-$800) , prescriptions, drops, supplements, and ointments (figure another $100-$180). While there are some outfits in Vancouver that will do traditional PRK for quite a bit less. The key here is that I believe you're getting a better quality service with faster recovery times if you go with what PLEC offers, compared to the competition. But I do not hold myself out as an authority as such, and places like Coal Harbor, KingLASIK, and London (Place) Eye Center have hundreds of thousands of satisfied customers as well.

What sets PLEC apart as well is that they are able to treat many cases that the others can't or won't because of their equipment selection, experience, and algorithms. Particularly with respect to previously botched surgeries, keratoconus and other corneal irregularities.

As for SmartPulse/SmartSurfACE, once a center upgrades its equipment to the technology, no matter whether they use it for transPRK, traditional PRK, LASIK, or femto-LASIK, they have no ability to disable it. The laser manufacturer did not want its customers to undergo an inferior procedure simply to extract a few extra $$ from them.
Last edited by burnt69 on Jan 31st, 2017 8:08 pm, edited 1 time in total.
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Oct 6, 2015
902 posts
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Eaglesfan99 wrote:
Jan 31st, 2017 2:20 pm
Hey everyone
What does everyone think of laser eye surgery when your 28.
If your prescription is stable, and you're otherwise eligible, it can be a great thing to have done. When you get into your 40s, you will suffer 'presbyopia' which is an inability to focus on near objects, and will need reading glasses or alternatively, another form of surgery. This occurs in all patients.
The lady at lasik told me your eyesight will turn bad when your 50ish again...I didn't know that
In some people, there is regression, particularly with higher prescriptions. If this is the case and you have adequate corneal tissue, you can have a second surgery. PRK tends to preserve more corneal tissue than LASIK, and with the Intralase procedures, touch-ups and re-treatments typically need to be PRK due to the difficulty of lifting Intralase (femto) flaps.
Anyone have any experience with Lasik? There was mention of a referral discount by the lady at Lasik. Can anybody share a referral with me?
Just tell them that you want the discount anyways if that's the clinic you want to use. Procedure counts and demand is down significantly over the past 5 years, and patients are in the drivers seat.
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Hey Androidmarshmallow:

CrystalClear Vision in Toronto quoted me $4800 all-inclusive for their Amaris 750 without SmartSurface. Prescription was -5.5 and -5.75 with about 1.00 astigmatism in both eyes.

I went to Pacific Laser and had my PRK done on Jan. 25. For 2 nights of hotel (PLEC provided nearby hotels with medical rates--I stayed at the Park Inn by Radisson, about a 12min walk away @ $244 for two nights with their medical rate plus all taxes) + Air Canada Tango flight ($595 and I did not check a bag for such a short trip) + Vancouver meals + local optometrist follow-ups, the total came out to the same price (maybe even a few dollars cheaper) as it would have been if I had stayed in Toronto without the updated/improved Amaris 1050 with SmartSurface.

If you think you will need someone to help nurse you, or help you navigate, then I guess there would be extra expenses there if they have to travel with you. I went alone. Although your eyes will be blurry, it's not like you can't move around. The flight return should be 1-2 days after the procedure as your vision will be clearest then and start to blur more before it improves. So yes, I booked a flight home the day after surgery, and that also helped to cut down on hotel cost.

I was only 20/30 off the table, so not quite as impressive as burnt's clarity but still good enough to read texts on my phone. In fact, the patient counsellors there asked me to check if I can read it, so that I can also read their paper instructions post-care.

So the only real expense that PLEC cost more than for me to do it in Toronto was the extra day I needed to get to Vancouver before the day of the testing + surgery (i.e. the TIME expense.)

Vancouver's airport is extremely accessible and easily connected by trains to the downtown core. Just buy a 2-zone fare for each ride, down and back. I am very pleased with how easy it was and highly recommend it.

Although, if my younger brother opts to do it as well, I may accompany him because he hasn't traveled by himself as much and may be overwhelmed or nervous, and he's less familiar with the drops and how they work.

**Recovery = I did not fill or use my prescription for the Tylenol #3's. I napped a lot the day of the surgery; went out for a pleasant dinner, had a green smoothie from Whole Foods and listened to podcasts. I had ONE moment of gritty/scratchy/teariness in my bandaged right eye upon awakening from my first nap, but I let the tears wet that eye and slowly opened and that was it. Pain level was...2/10. Light sensitivity was minimal and happened more on Day 4 when I was back home...totally tolerable when my sunglasses were kept on. However, there is the caveat that Dr. Lin inserted temporary punctal plugs on me, because the morning of the tests/surgery I didn't get a good sleep overnight and my eyes were obviously dry.

***I noted when booking my Air Canada flight online that I would be "Visually Impaired". So for the return flight they auto-assigned me a seat nearer to the front where there is more leg room. They also offered me a pre-boarding but I sheepishly told them that I wasn't actually blind, just blurry from laser eye surgery so I would just board with Group 3.

I thought about being super cheap and booking the flight into Vancouver for early morning the day of the surgery (to save on one night's hotel fee), but that's silly. Not only will you be more stressed, but you should allow for the possibility of flight delays. I realize this is common sense, but this is also RFD...so just making sure...I spent that day hiking around Stanley Park and had a lovely dinner at Sushi Bar Maumi.
Last edited by peanutz on Feb 1st, 2017 2:23 am, edited 1 time in total.
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Oct 6, 2015
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peanutz wrote:
Feb 1st, 2017 2:23 am
The flight return should be 1-2 days after the procedure as your vision will be clearest then and start to blur more before it improves.
Very good point. Next day for sure. Day 3 was blurry. It would have been a struggle to navigate if I had stayed an extra day. But by all means, Vancouver is a beautiful city, so no reason why one shouldn't spend a few days prior. There's lots of places to eat on W. Broadway. Granville Island isn't too far away from PLEC. Lots of nice places to eat and drink. I went out and had a light dinner out with friends the evening of the surgery, but since drops are every 2 hours, you probably don't want to go clubbing or be that far away from your hotel. Unlike LASIK, there's no restrictions on keeping your eyes open after PRK. You do not have to drug yourself to sleep right after you get back to your hotel room. I went to my laptop computer and completed an ordinary day of work. Had no light sensitivity on the first or 2nd day (but lots of nice psychedelic halo'ing of lights!).

I booked the Best Western Plus Uptown. It was ~$120/night, about a half hour walk to PLEC (or a $10 cab fare), and there's a midnight SDM right across the street if you decide not to fill your pain prescription and end up needing it. I didn't. :) 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 :).

Agree with peanutz totally, if you go to one of the 'traditional PRK' outfits, with the poor initial visual recovery, it possibly will be considerably more difficult to do it "on your own". You'll likely be fighting more pain (= use of strong painkillers), and have a vision problem which may make navigating the unfamiliar streets more difficult to use the public transit.

Oh yeah, they make you sign a waiver if you don't come with someone. But as long as you look like a competent English-speaking adult, I can't imagine them refusing service for coming without an aide. They do ask your hotel and emergency contact details, of course, just in case.
I thought about being super cheap and booking the flight into Vancouver for early morning the day of the surgery (to save on one night's hotel fee), but that's silly. Not only will you be more stressed, but you should allow for the possibility of flight delays. I realize this is common sense, but this is also RFD
Not only this, but there is a *medical* reason why you shouldn't do a same-day flight arrival. Airplane air (and alcohol if you drink) dries the body out, including the eyes. 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.
Last edited by burnt69 on Feb 1st, 2017 2:50 am, edited 1 time in total.
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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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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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