Beauty & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Mar 24th, 2017 10:09 am

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

  • Total votes: 157. You have voted on this poll.
Yes
 
80
51%
No
 
23
15%
Pizza is yummy
 
54
34%
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Oct 1, 2011
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bumblebeeeee wrote:
Feb 2nd, 2017 11:47 pm
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?
1) I've read different calculations. burnt69 uses ~20um/diopter...I've also read of ranges of 12-15um/diopter.

A microkeratome flap might average ~140um thickness.

A femtosecond/Intralase laser-made flap ~100um. For you, if you opt for LASIK I would ONLY consider a femtosecond laser flap, NO microkeratome due to the human-made decreased precision of flap thickness.

5.25 x 15um + 100um flap = 179um needed (rounded up)

~488 corneal thickness = ~309 residual thickness left.

It looks like kind of a borderline LASIK suitability, although there is the option of corneal crosslinking to strengthen that remaining cornea. Very little room for any potential enhancements in the future. We are also only talking about ectasia risk here...who knows if it also means more corneal nerves severed = higher dryness risk?

*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. :rolleyes:

Maybe you can go to a third clinic and get a consult and make them the tie-breaker.

b) If you were family or friend (or myself) as a candidate, I would prefer PRK. I mean, I still opted for PRK with my -5.75/-5.5 prescription and ~520um corneas.
bogummy wrote:
Feb 3rd, 2017 5:08 am
WOW! Thanks for replying with all those details @burnt69 @peanutz !!
How is the recovery going?
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.

I WILL say that PLEC's final correction was lesser at 5.25 per eye (compared to my glasses Rx being -5.5 and -5.75 as per my optometrist's office.) Maybe with their more precise testing, they calculated that this is what was needed for me. I will follow-up and pepper my optometrists at the 1-month follow-up. I hope I'll get the 20/20 too but if I'm a little under at 20/25 I'll be happy as well.
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Oct 6, 2015
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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. :rolleyes:
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?

PRK 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
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burnt69 wrote:
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?
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.
burnt69 wrote:
Feb 3rd, 2017 9:25 pm
PRK 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
Wow that chart is very enlightening and interesting.

Dilaudid's potency is actually beneficial, and is an excellent choice of opioid pain relief because it produces some of the highest pain relief compared to nausea, itching, and constipation side effects. Its effect is also not dependent on an individual's ability to convert it to its active forms (unlike codeine--which doesn't convert efficiently to morphine in all people and therefore some members of the population get very little or delayed pain relief from codeine, and others get too much/too fast effect) and it doesn't have active metabolites that can vary in their excretion (e.g. if patients are old and/or diabetic, etc. oxycodone clearance will vary which means more risk of overdoing or underdoing the desired pain control.)

What's more interesting is that that chart includes prescribed ketorolac pills for pain relief (a highly analgesic NSAID), plus two different topical anaesthetics. We weren't given any of those. The ketorolac was substituted by PLEC with simple over the counter ibuprofen.

Also, the Systane Ultra in the diagram is the bottle kind, but all PRK patients should really be using a preservative-free lubricant drop. Various preservatives are a little toxic to healing epithelium...there are preservative-free Systane Ultra boxes around these days.

Other than that... the Zymar antibiotic is a great pick for post-ophthalmic surgery.

Edited to add: I just chuckled...maybe that's why your optometrist wanted you to come back for the optional 2-week check-up. Maybe she was curious to see how well you were recovering.
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peanutz wrote:
Feb 3rd, 2017 9:54 pm
Edited to add: I just chuckled...maybe that's why your optometrist wanted you to come back for the optional 2-week check-up. Maybe she was curious to see how well you were recovering.
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.

And maybe those preservative drops are the source of higher pain outcomes with that outfit's PRK? We definitely had none of the topical anesthetics. They inhibit healing. I actually mis-used my Acuvail drops and ran out -- the patient counsellor at PLEC was initially going to give me more, but took them away!

edit: no steroids in that LasikMD regime. I wonder if that is a factor in pain levels as well?
Last edited by burnt69 on Feb 3rd, 2017 10:08 pm, edited 1 time in total.
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burnt69 wrote:
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.
Naw, I noticed the discrepancy and clarified during the next-day checkup. They said they USED to order the 2-week checkup, but removed it since the majority of patients were doing well by the 2-week mark.

You'll have to ask PLEC about the 2-month checkup, which the notes they provided said is an important time to note any rebound haze from stopping the FML steroid drops.

Here is their wording:
"AT 2 MONTH POST-OP VISIT *KEY VISIT*
The patient should be done all steroid drops at this time. This is the most important check-up for any rebound haze directly after steroids are completed...Send post-op assessment report to our office."
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peanutz wrote:
Feb 3rd, 2017 10:16 pm
Here is their wording:
"AT 2 MONTH POST-OP VISIT *KEY VISIT*"
The patient should be done all steroid drops at this time. This is the most important check-up for any rebound haze directly after steroids are completed...Send post-op assessment report to our office."
Ah yes. In that envelope of instructions to the optometrist which I reviewed and then handed over. Thanks!

But at my 2 week checkup, Betoptic S was discontinued. If you don't get a 2 week checkup, how would they know? Did they check your pressures (air puffer machine) at 1 week? My optometrist didn't check mine till week 2, claiming it wasn't allowed.
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burnt69 wrote:
Feb 3rd, 2017 10:21 pm
Ah yes. In that envelope of instructions to the optometrist which I reviewed and then handed over. Thanks!

But at my 2 week checkup, Betoptic S was discontinued. If you don't get a 2 week checkup, how would they know? Did they check your pressures (air puffer machine) at 1 week? My optometrist didn't check mine till week 2, claiming it wasn't allowed.
No, they did not check my intraocular pressure at 5 days. :razz: I guess there is no real hurry to make patients stop the Betoptic-S, they just happened to tell you it's OK to stop because your pressure was checked and you were fine.

My optometrist's office has a scanner so that's why they handed me back the envelope. I didn't peek at it before they gave it to me. :)
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Apr 3, 2012
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Toronto
@burnt69 @peanutz I really appreciate the thorough responses from both of you. This has been very helpful. I scheduled a third consult at TLC Yonge Eglinton for that exact reason of getting a second, second opinion. I'm still leaning heavily towards PRK as the most suitable option as cost and pain is not an issue (but quality of night vision, ability to have a revision if necessary and because PRK seems to be chosen a bit more frequently for the type of work I'm hoping to transition into.)

Thanks again for taking the time to respond, this entire thread has been an excellent resource.
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Oct 6, 2015
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Just for those reading here, another SmartSurfACE PRK study (this being one of the first that is independent of Schwind company paid consultants) just hit the journals:

http://www.contactlensjournal.com/artic ... 0169-2/pdf

Just a few points from my read:

1) Pain scores are cut from 2.98 to 2.1 straight off the table for SmartSurfACE, 1.78 to 1.02 the next day, and fall to practically zero on the 3rd day.

2) The difference in visual recovery times particularly in the first month is amazing. Patients literally have better vision straight off the table, than patients would have had with the older technology 1 month post-procedure.

If anyone's on the fence about getting PRK, and fears the long recovery time traditionally associated with the procedure, please check SmartSurfACE PRK out. A great "Made in Canada" innovation/technology. As a recent patient of the procedure, I can tell you, my "computer down-time" was literally three days (and my computer has a 14" 1080p screen!).
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@burnt69 I've noticed an increasing trend towards calling the modern, improved PRK techniques as "advanced surface ablation"--one reference I read created the acronym of ASA to differentiate it from the earlier versions that are associated with more discomfort. A rose by any other name...

@bumblebeeeee You're sweet! Good luck. If cost, time, and proximity to Toronto weren't an issue I would strongly recommend Vancouver's PLEC for the trans-PRK with SmartSurface but people have had regular PRK as well and not regretted that choice.

Undergoing this choice has been very recent and close to my heart, and I have a younger brother who has expressed interest in it as well, so the nerding-out exercise is a hobby for me (and I think burnt69 as well.)

The final review for possible excluding health conditions are listed here:
http://www.medscape.com/viewarticle/827454_4

Here's an excerpt:
Another relative contraindication is uncontrolled systemic immune-mediated diseases such as Sjogren's syndrome, rheumatoid arthritis, systemic lupus erythematous, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease (IBD) with arthritis and Behçet's disease. Patients with these conditions may be candidates for LASIK if the disease is controlled with or without medication for over 6 months without any active symptoms or signs confirmed by the treating physician, there is no active ocular complications secondary to the disease and the patient exhibits a normal tear film.
Because I have atopic dermatitis (commonly referred to as eczema) that can flare and go away, I thought about testing for any possibility of, and ruling out lupus. But since I've never had mysterious joint pains or debilitating fatigue, I played my odds and went ahead with the PRK. I don't want to be a scaremonger, but it's just something that I was wary of, since there are some inflammatory conditions that aren't uncommon, and sometimes people are undiagnosed if they have them mildly.
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Feb 4, 2017
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Prk is better and safer than Lasik. Less dry eye and lower risk of keratoconus and ectasia. But visual recovery time is longer than Lasik
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peanutz wrote:
Feb 5th, 2017 4:16 pm
Because I have atopic dermatitis (commonly referred to as eczema) that can flare and go away, I thought about testing for any possibility of, and ruling out lupus. But since I've never had mysterious joint pains or debilitating fatigue, I played my odds and went ahead with the PRK. I don't want to be a scaremonger, but it's just something that I was wary of, since there are some inflammatory conditions that aren't uncommon, and sometimes people are undiagnosed if they have them mildly.
I think a lot of those 'contraindications' are basically throwing the kitchen sink at things, or are along the lines of things to watch out for in the post-treatment medication regime in terms of medication interactions. For instance, eczema is treated with corticosteroids, which is also the treatment post-LASIK/PRK. So a medication adjustment may be in order if one is taking oral steroids for that condition, and also taking intraocular steroids to treat the corneal wound induced by LASIK/PRK.

Similar with diabetes. Its not an absolute bar to a refractive surgery procedure, but the patient should be evaluated when they are at a normal blood sugar, confirmed by glucometer testing, rather than in a myopia-inducing hyperglycemic state.

Any good refractive/PRK/LASIK surgeon will do a complete medical history, or acquire such information from a co-management arrangement with an optometrist. This may be one of the benefits of using co-management, rather than showing up at an all-inclusive clinic and perhaps, in the rush of it all, not disclosing conditions or medications that may require relevant modifications to the treatment algorithm. I know there's a lot of controversy over whether co-management fully serves the interest of the patient (or is just a marketing tool for high-volume clinics!), but I've been very happy with my optometrist and the feedback provided to her (and myself) from the surgery center.
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May 11, 2008
686 posts
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Toronto
Update after exactly 2 weeks with PRK at clearview...

Vision:
It is getting better and clearer everyday. I don't see any haze at all at this point. I could start driving maybe on day 10. Vision got really blurry again after removing the contact lens on day 5.
I can tell my vision is way better than before in the morning (I had around -1 on both eyes and -1 astigmatism). However it does fluctuates a lot throughout the day. I can literally force myself to yawn to get my eyes wet and I can see super well for about a minute, and get back to blurriness. Interestingly, artificial tears does not provide the same effects.

Feel:
I have had 0 pain and I have taken 0 pain killers after the surgery. Maybe it is due to my low prescriptions?
My eyes were dry occasionally during sleep, I had to use drops to the eyes before opening them when I wake up. Maybe once or twice a week so far.
I was really sensitive to light for the first week or so, by now I don't even need sunglasses outdoor with bright sun light, but I do wear sunglasses as much as I could.
I had originally planned to do LASIK, but final testing shows the "back?" of my cornea had a kind of large gap at the thinnest point. Dr. Kranemann was honest and said he does not want to risk it and offered PRK. The long recovery and blurriness was making me grumpy. I used to have good up close vision with great sharpness but now it's fuzzy still.

Drops: Anti-bacterial, Anti-inflammatory, and steroid drops for first 5 days, after removal of bandage contacts, only steroid drops were needed, 4 times a day for the first month. 3 times a day for next 2 months.

After care: I did not get to see Dr. Kranemann after the surgery so far with 2 post op visits. However Dr. Yu is also a very thorough and nice. She did all the checks and answered all my questions.

Over all: Mixed feeling, most likely due to my expectations were changed last minute. That said I wasn't pressured in any way to change my decision, I just took a week off already and went for it. Given the reviews here so far, I would have done trans-PRK with PLEC if I were to choose again knowing PRK was my only option.
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Oct 6, 2015
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lkt01071 wrote:
Feb 9th, 2017 11:04 am
Interestingly, artificial tears does not provide the same effects.
Are you doing Omega-3 supplements as well? Speaking from experience taking 2000mg twice daily (Jamieson Omega-3 "Select", 4x1000mg capsules daily!) pre-op, this *definitely* helped my eye hydration. Not all Drs recommend it, but I don't see how it could hurt if you're struggling with minor amount of dry eye.
I had originally planned to do LASIK, but final testing shows the "back?" of my cornea had a kind of large gap at the thinnest point. Dr. Kranemann was honest and said he does not want to risk it and offered PRK.
Its good that you had PRK then. Saved you a lot of grief if you were at a high risk of developing a 'buttonhole' due to the topography. You were looking to have an Intralase (femtosecond) flap, right, before you got switched?
The long recovery and blurriness was making me grumpy. I used to have good up close vision with great sharpness but now it's fuzzy still.
Close-up seems to be worse for me than medium-vision. So not entirely unexpected (3.5 weeks out for me!). Strangely after being really clear for most of the past week, I've been getting a bit of a blur :(. PRK recovery is hit and miss, that's for sure!
Over all: Mixed feeling, most likely due to my expectations were changed last minute. That said I wasn't pressured in any way to change my decision, I just took a week off already and went for it. Given the reviews here so far, I would have done trans-PRK with PLEC if I were to choose again knowing PRK was my only option.
Yeah sounds like you've had a rough time of it, and for such a small correction too. Well it does get better!

What brand of artificial tears are you using? Although expensive (but you can find a $5 off coupon at the Allergan website, and they come in packs of 30 as opposed to 24 for "Bion Tears" or similar), PLEC told us to use the Refresh Optive Fusion Sensitive Preservative-Free. Don't know how much difference the brand or type of preservative-free Artificial Tears can make, but some may be better than others.

Are you on any sort of night-time dry eye treatment? PLEC has its patients on "Lacri Lube" which is basically a sort of sterile opthamalic Vaseline for one's eyes overnight.
Sr. Member
May 11, 2008
686 posts
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Toronto
burnt69 wrote:
Feb 9th, 2017 9:47 pm
Are you doing Omega-3 supplements as well? Speaking from experience taking 2000mg twice daily (Jamieson Omega-3 "Select", 4x1000mg capsules daily!) pre-op, this *definitely* helped my eye hydration. Not all Drs recommend it, but I don't see how it could hurt if you're struggling with minor amount of dry eye.
Yeah, I am taking 2 deepsea fish oil capsules per day (1000mgx2) 2 days after the surgery. I think it definitely helped. After hearing from your experience, maybe I should be taking 4x everyday! Clearview said it's great to take omega 3 supplements, but it wasn't mandatory. They recommended to take multivitamins on their post op schedule.
burnt69 wrote:
Feb 9th, 2017 9:47 pm
Its good that you had PRK then. Saved you a lot of grief if you were at a high risk of developing a 'buttonhole' due to the topography. You were looking to have an Intralase (femtosecond) flap, right, before you got switched?
Yeah, I appreciated their honesty. Yes they were offering me intralase flap lasik with MEL90 from Zeiss before. Even the PRK I did this time was bladeless, no microkeratome involved, just not with smart pulses like the transPRK.
burnt69 wrote:
Feb 9th, 2017 9:47 pm
Close-up seems to be worse for me than medium-vision. So not entirely unexpected (3.5 weeks out for me!). Strangely after being really clear for most of the past week, I've been getting a bit of a blur :(. PRK recovery is hit and miss, that's for sure!
Ah! That's too bad but also a relieve that there aren't something wrong with my eye. Everyone seems to talk about distance vision on youtube etc for PRK recovery, no one really talks about close-up for reading etc. I was worried at one point my close-up vision problem was caused by something else. I work with computer 95% of my work time with a lot of text so close-up vision is a must for me. :(
burnt69 wrote:
Feb 9th, 2017 9:47 pm
Yeah sounds like you've had a rough time of it, and for such a small correction too. Well it does get better!

What brand of artificial tears are you using? Although expensive (but you can find a $5 off coupon at the Allergan website, and they come in packs of 30 as opposed to 24 for "Bion Tears" or similar), PLEC told us to use the Refresh Optive Fusion Sensitive Preservative-Free. Don't know how much difference the brand or type of preservative-free Artificial Tears can make, but some may be better than others.
Yeah, just more rough than what I expected. I have been a lot more worse stories on youtube for PRK recovery. :)

I was recommended BION Tears, and they gave me preserved tears (BLINK, SYSTANE ULTRA, Optive Fusion) and preservative free tears (celluvisc) in the post OP package. I didn't really like the celluvisc since it was VERY thick, it is long lasting lubrication but it literally blocks my vision for first 3 minutes lol.

I didn't end up getting BION tears, I got systane ultra high performance preservative free drops for like $14 with 24 packs. Each pack can last me about 6 drops for both eyes. They are fine. Interestingly, I also felt the Refresh Optive Fusion Sensitive drop ( mine has preservatives so I don't use it very often) was the most long lasting and provide best vision.
burnt69 wrote:
Feb 9th, 2017 9:47 pm
Are you on any sort of night-time dry eye treatment? PLEC has its patients on "Lacri Lube" which is basically a sort of sterile opthamalic Vaseline for one's eyes overnight.
Not really, I usually am ok during the night, only some times I feel my eyes can't open after the night and I had to put drops in to open it. Scared to force it open lol. My vision is usually the best when I wake up.

Thanks for the tips and sharing your experience! I am sure I will be satisfied and become a happy man again after the recovery (which according to the steroid drop schedule it's about 3 months). Wished it was shorter or I could skip thorough it though. :P Keep us posted with your recovery road trip too!
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