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%
Newbie
Jan 30, 2017
17 posts
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?
Sr. Member
Oct 6, 2015
902 posts
436 upvotes
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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Oct 1, 2011
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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.
Sr. Member
Oct 6, 2015
902 posts
436 upvotes
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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Oct 1, 2011
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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
Sr. Member
Oct 6, 2015
902 posts
436 upvotes
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
6 posts
1 upvote
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
86 posts
13 upvotes
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
Sr. Member
Oct 6, 2015
902 posts
436 upvotes
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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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
902 posts
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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.
Sr. Member
Oct 6, 2015
902 posts
436 upvotes
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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