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%
Jr. Member
Oct 6, 2015
149 posts
49 upvotes
lkt01071 wrote:
Feb 9th, 2017 10:53 pm
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. :(
Yeah there's two distinct issues with blurred close-up vision:

a) The portion of the eye that actually deals with close-up vision is the inner portion. So if you're trying to focus, corneal imperfections during the PRK recovery tend to be exaggerated.

b) If you're near the age of 40 or older, you could be developing presbyopia. I actually think I have a little bit of this going on, as my very close up vision really isn't that good anymore. Its just something you have to accept as a trade-off.
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.
Interesting. I'm actually finding the Refresh Optive Fusion to be a bit on the thin side. But its what 'they' started me on at the Dr's, so I'm reluctant to spend money trying other products. At this point I'm just putting the lubricant drops in, not because I think I need them, but rather, because they are supposed to help with recovery.
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.
Interesting. There's no good online review source for the various drops. But definitely agree that I can put the Refresh Optive Fusion Sensitive drops in at any time, and immediately get back to whatever I need to do. Driving, computer work, etc.

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.
A night-time ointment might help you if that's the case. But I'm not a Dr. Part of the theory of lubrication and the overnight products is to keep the cornea well hydrated so it can heal.
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!
Ouch, PLEC has us off steroids at the 7 week point. The first week has a heavy regimen, week 2/3, 3X daily, 3/4, 2X daily, 5/6 1X daily, and then every other day thereafter for another week as the final taper. The taste of the drops gets into my sinuses and into my throat, so I'm glad to be into the taper at this point. Its kind of crazy, really, how I went from barely being able to put in drops last year (when I got some free sample drops from my optometrist to try just to get the hang of things) to being a total pro at it now, lol.
Newbie
Jan 30, 2017
20 posts
1 upvote
I'm thinking about getting laser eye surgery but I'm still on the fence. I have about -5.00 in both eyes and work with computers for hours every day (and honestly I've been stupid about taking better care of my eyes). I've been in once for a consultation in Vaughn where they did a preliminary examination to determine if laser eye surgery was suitable for me. I was there for maybe 10 minutes and the person working there said, yes, I was eligible for it. I waited a few more minutes, she took me to the office at the back where I met with a (very very young) lady who gave me a small info package and a quote. After my visit, I still wasn't feeling comfortable with it all - first I felt like the clinic I went to had focused primarily on the costs and told me almost nothing about anything else. In retrospect I should have asked more questions but at the time I was feeling a little overwhelmed with the entire process.

My question is I feel like my eye sight gets slightly worse every year. Is this a normal thing or just a result of me spending way too much time working with computers? And if my vision is gradually becoming worse, is eye surgery for me? And if I do end up getting it, (and assume I take better care of them), would it be worth it in terms that I would still have to be working with computers as my job requires?

I'm entirely unsure what to do and feel like I'm searching in the dark. Hopefully someone here can share some of their experiences?
I would love to go glasses and contacts-free but at the same time I'm worried. Any advice or suggestions greatly appreciated!
Jr. Member
Oct 6, 2015
149 posts
49 upvotes
Huntress03 wrote:
Feb 10th, 2017 6:16 pm
I'm thinking about getting laser eye surgery but I'm still on the fence. I have about -5.00 in both eyes and work with computers for hours every day (and honestly I've been stupid about taking better care of my eyes). I've been in once for a consultation in Vaughn where they did a preliminary examination to determine if laser eye surgery was suitable for me. I was there for maybe 10 minutes and the person working there said, yes, I was eligible for it.
Do you know what sort of tests were run? With a -5, most patients can have either PRK, LASIK, or even SMILE, but any reputable laser clinic will screen you more extensively for eye corneal conditions such as keratoconus, ectasia, etc., as well as a few other eye health screenings before making a final treatment decision.
I waited a few more minutes, she took me to the office at the back where I met with a (very very young) lady who gave me a small info package and a quote. After my visit, I still wasn't feeling comfortable with it all - first I felt like the clinic I went to had focused primarily on the costs and told me almost nothing about anything else. In retrospect I should have asked more questions but at the time I was feeling a little overwhelmed with the entire process.
If you have any doubts whatsoever, then you shouldn't go through with it. There are many clinics out there, some spend a lot of effort on marketing. Some don't spend any on marketing, and view themselves purely as medical practitioners.
My question is I feel like my eye sight gets slightly worse every year.
Do you see an optometrist for regular eye exams? Has your prescription actually been getting worse? I am thinking that you perhaps should be having the conversation about your suitability for refractive surgery with your optometrist with access to your long-term records. Rather than with a refractive surgeon (or their office staff) who have a vested interest in selling you a procedure. Most optometrists these days have a preferred referral surgeon they deal with and are very interested in being a part of your overall treatment plan through co-management.
Is this a normal thing or just a result of me spending way too much time working with computers?
How old are you? Losing some near sight, due to an inability to 'accommodate' (ie: change your lens' optical power), is a natural eye condition that occurs in the early 40s known as "presbyopia". Other possibilities include developing dry eye disease. This is something you should discuss with your optometrist.
And if my vision is gradually becoming worse, is eye surgery for me?
Laser eye surgery requires refractive stability. If you prescription is changing, you should not have refractive surgery.
And if I do end up getting it, (and assume I take better care of them), would it be worth it in terms that I would still have to be working with computers as my job requires?
I think the important thing is to get to the root cause of your vision problems before rushing into a procedure. Working on a computer alone will not damage your eyes. However, it is my understanding that extensive computer users tend to experience "dry-eye" at a high rate. You might end up being more of a PRK (or SMILE) candidate than a LASIK candidate for that reason. But you really should see your optometrist, get to the bottom of why you are having vision problems, and then, if a refractive procedure is of interest, pursue such accordingly.
I'm entirely unsure what to do and feel like I'm searching in the dark. Hopefully someone here can share some of their experiences?
Read my (and peanutz's) posts in the past few pages. But you really need to get advice specific to your eyes, particularly *why* your vision has been worsening. An optometrist is where you should be starting. Not a surgeon with a vested interest in selling you a procedure.
I would love to go glasses and contacts-free but at the same time I'm worried. Any advice or suggestions greatly appreciated!
It took me 15 years from when I started being interested, to actually going under a laser. Much of the 'delay' was technology-related as I wasn't happy with the technology available at the time. Do as much research as you feel necessary, and don't let any question you have go unanswered.
Newbie
Jan 30, 2017
20 posts
1 upvote
Thank you for replying with so many useful suggestions and information. I'll definitely read a few pages back to the past posts.
I was feeling like the clinic I went to was more invested in making money than actually helping me. I'm definitely going to go to my optometrist and find out more information. The exam they gave me at the clinic was very basic as well, just a simple eye examination to test what my prescription was at and nothing else. I didn't even know they could have run so many other tests. I'm in my early 30s and over the years, my prescription has been getting worse and I'm not sure if this has been normal. (I'll definitely talk to my optometrist about it). I started off about -2.00 in my early teens and now it's more than doubled over the years. I've always attributed the change in prescription to my career but now realize there may be other reasons.
burnt69 wrote:
Feb 10th, 2017 6:52 pm
Read my (and peanutz's) posts in the past few pages. But you really need to get advice specific to your eyes, particularly *why* your vision has been worsening. An optometrist is where you should be starting. Not a surgeon with a vested interest in selling you a procedure.
This is excellent advice. I hadn't even thought of it that way because I thought of the surgeon as only a healthcare professional but now I realize they really do have a vested interest in selling me the procedure. I'm definitely going to speak to an optometrist and see.
Deal Addict
User avatar
Oct 1, 2011
4082 posts
324 upvotes
@lkt01071 Sorry to read that you were switched to PRK right before surgery. I wouldn't feel comfortable too, I like mentally preparing myself for something like that. Not to disrespect your surgeon's medical judgment, but from the marketing end it seems to happen to a lot of patients around different clinics. Maybe clinics don't want to tell patients they are better candidates for PRK and "lose" them to competing clinics that offer LASIK, so they offer LASIK from the beginning and switch to PRK once they have you in. :X

@Huntress03 burnt69 hit it on the nail...you need to make sure your eyes/general health are good and your prescription is stable. For your information...I started needing glasses when I was 12 or 13 and my prescription was already like -1.75 or something at that point. And into my mid-late twenties (I'm around your age too, early 30's) it did steadily get worse. Possibly due to reading computers and papers/books up close too long, but it DID stabilize and my prescription hasn't changed in the last 6 years. It's normal for myopia to get a little worse into your 20's, but it should stop getting significantly worse for a few years before you even think about laser eye surgery. And it's important to rule out other medical conditions that could be leading to decreased vision quality.

--------------------------------------------------------------------------------------

Progress report: My close- and medium-vision is very good. I have a thermometer in my room that I use to "check" the improvements in my far-vision reading. I'm probably not 20/20 yet, 2.5 weeks post-op (no noticeable improvements since the 10 day post-op mark.) I'm staying patient.

---------------------------------------------------------------------------------------

I found a good review of artificial tears from 2014!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124072/

This is the most important chart I got out of it:
https://www.ncbi.nlm.nih.gov/pmc/articl ... th-8-1419/

It looks like Refresh Optive (Fusion, NOT Advanced), Systane Ultra, and Soothe are the best-performing eyedrops. I like Refresh Optive the best because it contains glycerin, the active ingredient also used in Soothe, plus other electrolytes and substances in the formulation like levocarnitine that may help eye/tear health.
Jr. Member
Oct 6, 2015
149 posts
49 upvotes
peanutz wrote:
Feb 11th, 2017 3:39 pm
@lkt01071 Sorry to read that you were switched to PRK right before surgery. I wouldn't feel comfortable too, I like mentally preparing myself for something like that. Not to disrespect your surgeon's medical judgment, but from the marketing end it seems to happen to a lot of patients around different clinics. Maybe clinics don't want to tell patients they are better candidates for PRK and "lose" them to competing clinics that offer LASIK, so they offer LASIK from the beginning and switch to PRK once they have you in. :X
Yeah in my research, there even appeared to be some regional differences. The Vancouver laser eye surgery market has become so competitive that the surgeons, to cut costs and remain competitive, have gravitated towards more PRK. Coal Harbor, mostly PRK. London Eye Centre, heavily PRK. PLEC, basically all (trans)PRK. 3 of Vancouver's highest volume clinics mostly only do PRK. The femtosecond (Intralase) costs $500/procedure more (equipment ownership/maintenance, patient consumables, and per-procedure fees), and that eats right into the profit margin.

Toronto still has much higher procedure prices, so they're not really aggressive in cutting costs by switching to cheaper-to-perform PRK on the patients who are suitable for either.
Sr. Member
May 11, 2008
686 posts
19 upvotes
Toronto
peanutz wrote:
Feb 11th, 2017 3:39 pm
@lkt01071 Sorry to read that you were switched to PRK right before surgery. I wouldn't feel comfortable too, I like mentally preparing myself for something like that. Not to disrespect your surgeon's medical judgment, but from the marketing end it seems to happen to a lot of patients around different clinics. Maybe clinics don't want to tell patients they are better candidates for PRK and "lose" them to competing clinics that offer LASIK, so they offer LASIK from the beginning and switch to PRK once they have you in. :X
Yeah, I thought of that too, but so far they are still the most attentive and communicative compare to others in Toronto. Price was pretty much the best of the 3 and I did not need to pay for flights and hotel. Maybe you were right though since LASIK MD only offered me PRK from the start, but for a different reason. Nevertheless, at least they did not do LASIK on me just to get my business.

I am happier everyday, seeing clearer and vision is definitely getting more stable.
Jr. Member
Oct 6, 2015
149 posts
49 upvotes
Just a FYI here, Novartis/Alcon's "Systane" systane.ca website offers up a $2 coupon for the purchase of any Systane-branded product. The link doesn't work, but if you email them (follow the links to the Alcon.ca website), they will send you printed coupons.

Allergan's "Refresh Optive" (http://www.refreshoptive.ca) line has a $5 coupon if go onto their site, and 'share' their advertising with your friends on Facebook (you can delete the share immediately after you get the coupon if you want!). Otherwise, they have a $3 coupon. Optometrists/Opthamologists also can give you $2 coupons for the Allergan line of "Refresh" products.

I know, a rounding error after you've paid $5000 for surgery and after-care, but every little bit helps.
Newbie
Jan 20, 2017
3 posts
2 upvotes
Huntress03 wrote:
Feb 10th, 2017 6:16 pm
I'm thinking about getting laser eye surgery but I'm still on the fence. I have about -5.00 in both eyes and work with computers for hours every day (and honestly I've been stupid about taking better care of my eyes).
I'm in my late 40's and had Advanced Surface Treatment with Corneal Cross-linking last year to correct my -5.75 in both eyes. And it was a blended correction to help with presbyopia. I no longer require glasses and I work at a computer all day. Long distance vision suffers slightly but that was the trade off with correcting the presbyopia because I didn't want to be needing reading glasses after surgery.
Newbie
Nov 26, 2009
5 posts
2 upvotes
Toronto
This has been a very informative thread...

About 7 years ago, I went for a free consultation at Lasik MD in Montreal. I was recommended the custom wavefront lasik. I never went through with the procedure as I was barely out of school and didn't really have the funds to support this elective surgery.

Fast forward to 2017 and I think I'm ready for this. I do have hyperopia (about +4.00 in both eyes) which makes me doing anything without my contacts or glasses almost impossible. Getting glasses is also a challenge as with this prescription, I am extremely limited in the shape of lenses if I don't want to be wearing coke bottles.

I do understand that with hyperopia, there is a chance I will need glasses again in a few years (perhaps 10 years) but hopefully it won't be as bad as a +4.00 and all I'll need is readers.

Given my research, I'm definately more inclined to PRK than Lasik. I saw the comments about TransPRK and it seems like a really good option that I'd like to explore more. I reached out to PLEC to inquire about the process but i'm curious about other locations.
burnt69 wrote:
Dec 7th, 2016 5:17 am
But aside from a clinic in Toronto using the Amaris 750rs, one in Calgary using a 750rs, and another in Quebec using the 1050rs (all of which have higher fees), Pacific Laser appears to have the most up-to-date laser platform on the market.
@burnt69 , can you provide the name of the clinic in Quebec that performs TransPRK with a 1050rs laser? I now moved from Montreal to Toronto but I have a much better support system in Quebec than in Vancouver so this option might be suitable for me as well.

Dave
Jr. Member
Oct 6, 2015
149 posts
49 upvotes
davemichaud wrote:
Feb 14th, 2017 7:59 am


@burnt69 , can you provide the name of the clinic in Quebec that performs TransPRK with a 1050rs laser? I now moved from Montreal to Toronto but I have a much better support system in Quebec than in Vancouver so this option might be suitable for me as well.

Dave
http://www.chirurgivision.com/ <-- Trois Rivieres (Amaris 750s)
http://www.laservue.ca/ <-- Montreal (Amaris 750s)
http://www.laserprovue.com <-- Rimouski (Amaris 500e)

I may have misspoke if I implied that these places had 1050rs lasers (or I might've forgotten about another clinic). The 500e/750s can run the SmartSurfACE software I am told, only that the eye trackers are slightly weaker, and treatment takes a few seconds longer due to the slightly slower lasers. Please do contact them and find out if any of them have done the "SmartSurfACE" upgrade yet.

As far as 'support system', it really was less of a deal than I thought. I had friends on standby to help me in Vancouver, thinking I'd be basically blinded by the procedure, at least for a few days. But truth be told, I went for the procedure in the morning, cabbed back to my hotel room, and went shopping in the afternoon. No dark rooms or curtains pulled. No clutching bottles of painkillers. PLEC (and I presume most other clinics) make you sign a disclaimer if you come alone, but I was able to use a smartphone and a computer straight after ablation. The key is to fly back/get home on the day after the procedure, not later, and not earlier, as the doctor wants to see you back the next day for a brief checkup!

* Note that my comments may not apply to hyperopic treatments, particularly since a considerable amount of overcorrection (ie: induced myopia) may be required initially to counteract regression. Hyperopia appears to be much more difficult to treat than myopia, so finding someone very experienced with higher hyperopic correction is very important.

* not an endorsement of any of the above outfits as I have done literally no research on any of them. The 'nomogram' (fine individual tweaks to the process) employed by an individual surgeon can be just as important as the physical laser machine used! My personal preference was for a research-oriented surgeon who has a passion for tweaking the inputs/process, not someone who does a gazillion procedures a day at a discount, or a smaller center surgeon who does only a very limited number of procedures to supplement their publicly funded cataract business!
Newbie
Nov 26, 2009
5 posts
2 upvotes
Toronto
Thanks @burnt69, I reached out to LaserVue in Montreal and will let you know.

To be honest however I am really confused with what exactly is SmartSurfACE.

Reading on various websites, it sounds like SmartSurfACE is the technology that allows the procedure to be performed with a single laser and without alcohol abrasion but that is the definition of TransPRK (at least that's what I understand). So what exactly is this SmartSurfACE improvement?
Jr. Member
Oct 6, 2015
149 posts
49 upvotes
davemichaud wrote:
Feb 14th, 2017 5:37 pm
Thanks @burnt69, I reached out to LaserVue in Montreal and will let you know.

To be honest however I am really confused with what exactly is SmartSurfACE.
"SmartSurfACE" is a trade-mark for a single-step process using Schwind AMARIS laser that includes:

a) transepithelial PRK ("transPRK"). This means the laser ablates (removes/burns) the epithelial layer using a pre-defined profile, prior to the treatment being applied to the stroma. Traditional PRK approaches use either a mechanical brush (like an electric toothbrush), or a polyvinyl alcohol solution applied to the eyeball, with the dissolved epithelium scraped away by the surgeon prior to treatment.

b) SmartPulse technology, which is a laser spot optimization algorithm developed by Schwind and PLEC which optimizes the smoothness of the ablated corneal stromal surface. A smoother surface leads to very rapid visual recovery, lower pain levels, etc. SmartPulse can be combined with all treatments (LASIK, LASEK, PRK, PTK, etc.) but the most useful application of the technology is for surface treatments where there is no flap acting as a surface smoothener.

I would point you to the paper by Dr. David Lin, et al, describing the improvement in recovery time associated with the "SmartPulse" (SPT) technology applied to transPRK treatments:

http://www.pacific-laser.com/wp-content ... y_2015.pdf

In particular, Figure 6 describes the magnitude of short-term visual improvement. Figure 7 represents comparative straight-off-the-table results (I'm a 4%'er, lol) with and without SPT. Figure 8 is 1 month follow-up outcomes.
Reading on various websites, it sounds like SmartSurfACE is the technology that allows the procedure to be performed with a single laser and without alcohol abrasion but that is the definition of TransPRK (at least that's what I understand). So what exactly is this SmartSurfACE improvement?
Yes, that is the definition of transPRK. SmartPulse + transPRK = "SmartSurfACE".
Jr. Member
Oct 6, 2015
149 posts
49 upvotes
Another SmartPulse/SmartSurfACE paper out. This time with 6-month visual acuities, which may very well reflect an improvement to final results:

Advanced Surface Ablation With a New Software for the Reduction of Ablation Irregularities.
Journal of refractive surgery (Thorofare, N.J. : 1995) 33:2 2017 Feb 01 pg 89-95 wrote:A total of 139 eyes in the 750 group and 40 eyes in the SPT group were evaluated. Epidemiological and preoperative refractive data of the two groups were comparable. Uncorrected distance visual acuity improved with time and was significantly better in the SPT group (-0.04 ± 0.61 logMAR for the SPT group vs 0.02 ± 0.78 logMAR for the 750 group) (P < .001). At 6 months, 55% versus 21% achieved 20/16 or better (P = .005) and 90% versus 65% achieved 20/20 or better (P = .019) visual acuity in the SPT and 750 groups, respectively. Corrected distance visual acuity improved with time and appeared to be influenced by group (P = .054), with better results in the SPT group. Coma and trefoil improved significantly with time in a similar manner in both groups.
Moral of the story is that if you're considering treatment with a Schwind AMARIS laser, the improvement with a SmartPulse-enabled laser could very well be permanent. The previous Schwind paper implied convergence of results at the 1 month point, but this new study shows that not to be the case for a significant number of patients.
Deal Addict
User avatar
Oct 1, 2011
4082 posts
324 upvotes
Progress update: Tomorrow I have my 1-month post-op visit. I will post the eye exam results. However, I can already tell that acuity in both eyes is very sharp now; last Wednesday was the start of tapering of FML steroid drops from thrice daily down to twice daily.

I was worried that my right eye would be behind, but it's about the same now as the left eye. I will check for night starbursts later in the week, because sometimes it seemed that the right eye had a bit of it (with left eye having none).

[transPRK with SmartSurface]
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