Beauty & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Oct 16th, 2017 12:54 pm

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

  • Total votes: 185. You have voted on this poll.
Yes
 
95
51%
No
 
27
15%
Pizza is yummy
 
63
34%
Deal Addict
User avatar
Oct 1, 2011
4683 posts
638 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.
Sr. Member
Oct 6, 2015
636 posts
309 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
697 posts
24 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.
Sr. Member
Oct 6, 2015
636 posts
309 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
4 posts
3 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
9 posts
12 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
Sr. Member
Oct 6, 2015
636 posts
309 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
9 posts
12 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?
Sr. Member
Oct 6, 2015
636 posts
309 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".
Sr. Member
Oct 6, 2015
636 posts
309 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
4683 posts
638 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]
Sr. Member
Oct 6, 2015
636 posts
309 upvotes
peanutz wrote:
Feb 20th, 2017 1:37 pm
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).
Weird. My night short-distance halos seem to be getting better, almost to the point of non-existence. But longer-distance, the starburst/blur seems to be getting worse.

This PRK recovery is a strange thing. And few websites/blogs describe it properly, or really even at all. I think my expectations were calibrated way too high after being delighted with the initial results which were dramatically in excess of my expectations.

On that note, I had to check some messages in bed this morning on my phone, and got into a sort of frenzy when I couldn't find my glasses which are usually stowed in a few very specific spots by my bed! Lol! Then it dawned upon me that I didn't need them.
Newbie
Jan 30, 2017
17 posts
5 upvotes
Is PLEC and Coal Harbour using the same technology for laser eye surgery?
Sr. Member
Oct 6, 2015
636 posts
309 upvotes
bogummy wrote:
Feb 23rd, 2017 12:31 pm
Is PLEC and Coal Harbour using the same technology for laser eye surgery?
No. PLEC uses a Schwind Amaris 1050rs. Coal Harbor uses a B&L Technolas laser, or the Alcon/Allegreto Wavelight EX500.

The 'difference' is the Schwind Amaris supports "transPRK", which is a single step process where the excimer laser removes the epithelium while applying the treatment. When combined with "SmartPulse", this procedure has been called "SmartSurfACE" by Schwind and PLEC.

Whereas with the Coal Harbor lasers, to perform a PRK, the surgeon will use a "well" of alcohol to dissolve the epithelium, removes it manually, and then applies the laser treatment. Basically a traditional PRK.

The Schwind is also slightly faster than the Wavelight EX500 (1050Hz versus 500Hz) at delivering the treatment, but requires more pulses due to its smaller spot size. The difference in treatment time is negligible.

So you probably will recover more quickly visually and have less pain from a PLEC (trans)PRK/SmartSurfACE than you would a Coal Harbor PRK. But it will cost you extra $$$$, give or take, to use PLEC. I don't know what Coal Harbor's fee is (I hear its quite low!), but minimum all-in at PLEC including follow-up care and prescription/non-prescription drops is ~$4000, and that can go higher with a higher prescription.

Dr. Kirzner has done 80k+ procedures. Dr. Lin has done 60k+ procedures, but takes on some incredibly challenging cases with respect to keratoconus patients/botched surgery elsewhere/etc. and has R&D interests with an academic publishing record to match.
Sr. Member
May 11, 2008
697 posts
24 upvotes
Toronto
Week 4 update: Did my 3 weeks post op check early this week, doctor said my eyes are healing perfectly, there are still signs of reshaping so my eye sight will keep improving still.

I could see 20/20 usually in the morning and my close vision is mostly back. Things start to look sharp again. Left eye (with astigmatism) is a little worse than right eye when tested.

Night time vision is worse than day time vision, probably because pupils are dilated at night, seeing more imperfections on the cornea. Some circular lights (such as traffic lights) I would see 2 circles overlapping each other sometimes.

Getting happier everyday. Still taking 2-3 fish oil pills everyday along with multivitamin.

Doctor also changed the schedule of the steroid drops from 4 times a day to 3 times a day in week 4-8, and 2 times a day in week 9-12.

Got more refresh optive drops from the clinic. :)

Top