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?
Feb 1st, 2017 5:22 am
Feb 1st, 2017 1:10 pm
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.
Feb 1st, 2017 2:55 pm
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 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 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.
Feb 1st, 2017 3:57 pm
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...burnt69 wrote: ↑Feb 1st, 2017 3:39 pmI 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.
Feb 1st, 2017 4:16 pm
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!peanutz wrote: ↑Feb 1st, 2017 3:57 pmIs 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.
There's some using SmartSurfACE that have completely abandoned the flap procedures. www.ksa.ee for instance.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 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.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
Feb 2nd, 2017 11:47 pm
Feb 3rd, 2017 2:47 am
Feb 3rd, 2017 5:08 am
Feb 3rd, 2017 1:51 pm
Feb 3rd, 2017 1:52 pm
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.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.
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.
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!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
Feb 3rd, 2017 8:02 pm
1) I've read different calculations. burnt69 uses ~20um/diopter...I've also read of ranges of 12-15um/diopter.bumblebeeeee wrote: ↑Feb 2nd, 2017 11:47 pmI'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?
I'm at Day 10 post-op, not at 20/20 yet (haven't yet returned to optometrist to get the testing yet, but I can tell by comparing with my previous glasses or contacts-assisted vision) but seeing slight daily distance-vision improvements. My right (dominant) eye is also recovering slightly slower and I see slight residual starbursting at night still with really bright lights, like some street lamps or certain car headlights. The left eye is seeing better with no starbursts. Mid-range and near-vision is excellent. I am very very comfortable, no dryness or problems, and am functioning like someone who didn't get surgery at all. I am so pleased and I know my timeline is totally within PRK expectations.
Feb 3rd, 2017 9:25 pm
Did you have that conversation with a physician/ophthalmologist of that particular clinic, or were you talking with a patient counsellor or some other form of marketing staff?peanutz wrote: ↑Feb 3rd, 2017 8:02 pm*LASIK MD is the clinic that refused to even discuss PRK with me. It didn't sit well with me. When I said I was worried about keratoconus/ectasia, and eye dryness, they said "Well there are ways to manage those things, with punctal plugs, eye drops, corneal crosslinking..." etc. So it makes me wonder if their solution afterwards is to push patients towards more options and procedures that brings in more money for them.
Feb 3rd, 2017 9:54 pm
It was a conversation with one of the two head surgeons of the centre at the time...but I do want to add the caveat that in my case, he may definitely have been looking out for my best interests in terms of the more difficult PRK surgery + recovery.
Wow that chart is very enlightening and interesting.burnt69 wrote: ↑Feb 3rd, 2017 9:25 pmPRK has a bad reputation I've found. Even my optometrist, initially, had body language almost bordering on horror when I told her I wanted a referral for it (she briefly tried to talk me into a LASIK referral actually!)! But treatment algorithms, Acuvail, and of course, the optimizations inherent in the PLEC method, certainly cut down on the pain/recovery times significantly! It shouldn't be taken for granted that PRK recovery is as easy as it was for us! LasikMD's online medication chart shows they prescribe Dilaudid* for it for Pete's sakes! (for non-medical types, Dilaudid being only second to Fentanyl for painkiller strength, stronger than Heroin even!)
* http://www.lasikmd.com/pdf/post-op-inst ... prk-en.pdf
Feb 3rd, 2017 10:08 pm
After reviewing my documentation (the informed consent form, page 7, item 5.), the 2 week check-up wasn't optional after all for PRK. However, I'm not clear on whether I need a 2 month check-up now.