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%
Newbie
Jan 30, 2017
7 posts
1 upvote
Is starburst or halo common side effect after laser eye surgery?? Seems like most of the people experienced that after the laser
Jr. Member
Oct 6, 2015
149 posts
50 upvotes
bogummy wrote:
Mar 8th, 2017 2:44 am
Is starburst or halo common side effect after laser eye surgery?? Seems like most of the people experienced that after the laser
Right after, no starbursts, but halos even during the daytime from light sources. The cause is corneal swelling due to the procedure (PRK in my case).

But pretty much completely gone at this point. And starbursting is only for distant light sources distance, not closer-up.

Modern wavefront-guided treatments with appropriately sized optical/treatment zones have eliminated most of the classical starbursting/haloing side effects disproportionately experienced by individuals with large pupils (most often, lighter eyed patients!) treated with the older lasers
Deal Fanatic
User avatar
Oct 3, 2006
9963 posts
519 upvotes
Toronto
Which laser eye surgery clinics and surgeons are reputable in Toronto these days? With so many different types of procedures (PRK, LASIK, SMILE, ???) these days, which one is most recommended?
Jr. Member
Oct 6, 2015
149 posts
50 upvotes
Aznsilvrboy wrote:
Mar 18th, 2017 2:09 pm
Which laser eye surgery clinics and surgeons are reputable in Toronto these days? With so many different types of procedures (PRK, LASIK, SMILE, ???) these days,
Newest technology-wise (and probably most years in the business) likely is Dr. Jeff Machat with his Schwind Amaris 750s. Dr. Stein has also been around a long time, but uses slightly older technology. Dr. Herzig is another one who's been around a long time. If you search this thread, those are the names/clinics in Toronto that come up the most.

Review my and peanutz' previous posts as to why we hopped on planes to Vancouver instead (at a comparable all-in price including flight and hotel room!) to take advantage of a key technological improvement over and above anything available in Toronto. With great results so far (right peanutz???).

Personally I'm a fan of (and selected for my own procedure despite qualifying for the other procedures) PRK. Flap-related complications are impossible, post-LASIK dry eye is somewhat less, and corneal complications are practically unheard of. No suction ring bruising either. If you use the optimizations available from the Vancouver clinic that me and peanutz used, its recovery time is only slightly worse than LASIK, with only 2-4 days of loss of functional (ie: driving-quality) vision. And at least in my case, no need to use strong pain medication either (peanutz supposedly refused even the procedure painkillers, lol!).
Newbie
Mar 19, 2017
2 posts
burnt69 wrote:
Mar 18th, 2017 5:02 pm
Newest technology-wise (and probably most years in the business) likely is Dr. Jeff Machat with his Schwind Amaris 750s. Dr. Stein has also been around a long time, but uses slightly older technology. Dr. Herzig is another one who's been around a long time. If you search this thread, those are the names/clinics in Toronto that come up the most.

Review my and peanutz' previous posts as to why we hopped on planes to Vancouver instead (at a comparable all-in price including flight and hotel room!) to take advantage of a key technological improvement over and above anything available in Toronto. With great results so far (right peanutz???).

Personally I'm a fan of (and selected for my own procedure despite qualifying for the other procedures) PRK. Flap-related complications are impossible, post-LASIK dry eye is somewhat less, and corneal complications are practically unheard of. No suction ring bruising either. If you use the optimizations available from the Vancouver clinic that me and peanutz used, its recovery time is only slightly worse than LASIK, with only 2-4 days of loss of functional (ie: driving-quality) vision. And at least in my case, no need to use strong pain medication either (peanutz supposedly refused even the procedure painkillers, lol!).
I did my consult at CCV this morning and can report that the CCV and Herzig merger is now official. Both are running in parallel (for laser eye correction) out of CCV's Yorkville office (I believe their cataract surgery is happening at Herzig's old location). The Amaris 750s is "in storage" for the next 6mos or so until they move into a new undisclosed location. If you want to see Dr. Herzig you still need to book your consult through Herzig but they are running out of the same office and offer the same procedures (Dr. Machat now does SMILE too but probably/definitely has less XP with it).

I'm pretty bummed as i was really looking forward to learning more about transPRK (and the potential for SmartSurface). Looks like all of the big players in the GTA are only using the VISX platform.
Newbie
Mar 19, 2017
2 posts
Hi guys, I've been lurking on this thread for a while and thank everyone for their comments. It has been very helpful in my research.

I went in for a consult at CCV on Monday (my initial post regarding this is maybe still awaiting approval?). I just wanted to stop by and report that the CCV-Herzig merger is well underway. Both clinics now operate their laser eye surgery out of CCV's Yorkville clinic (but for now you'll still need to call CCV if you want Dr. Machat, and Herzig if you want Dr. Herzig).

Unfortunately, this means that the Amaris 750s is in storage pending a move to bigger digs. I'm pretty bummed since I specifically wanted transPRK (thin corneas and general squickiness about alcohol/manual abrasion of the epithelium.

Does anyone know who the surgeons at TLC Yonge/Eglinton are or have any first-hand experience with them?

Thanks everyone!
Jr. Member
Oct 6, 2015
149 posts
50 upvotes
avix01 wrote:
Mar 22nd, 2017 10:35 am
I went in for a consult at CCV on Monday (my initial post regarding this is maybe still awaiting approval?). I just wanted to stop by and report that the CCV-Herzig merger is well underway. Both clinics now operate their laser eye surgery out of CCV's Yorkville clinic (but for now you'll still need to call CCV if you want Dr. Machat, and Herzig if you want Dr. Herzig).

Unfortunately, this means that the Amaris 750s is in storage pending a move to bigger digs. I'm pretty bummed since I specifically wanted transPRK (thin corneas and general squickiness about alcohol/manual abrasion of the epithelium.
Good to know. Hopefully they'll get that wonderful SmartPulse/SmartSurfACE software put onto it when they get it back up and running out of storage. Many of these 1st generation laser refractive surgeons who have been doing procedures since the 1990s are getting pretty close to retirement age (and certainly becoming wealthy enough in the process!). Its good, from a patient's point of view, that they're amalgamating and looking to bring in younger talent to their practices so that there is continuity of records, care, of quality.

Just as an aside, anyone getting a procedure done should arrange for their pre-op measurements, including "K" values (pre-op corneal steepness) and refraction (spherical and cylindrical), to be supplied to them for long-term preservation in aid of calculating replacement lens power during cataract surgery. Pacific Laser provided this typed onto the back of a business card.
Member
Dec 29, 2009
475 posts
69 upvotes
I've been going through this thread and I do find it helpful. However, like everything there are lots of different opinions and I'm having difficulty figuring out what is what. My basic facts. Late 30's, -6.5 & -7.5 eyes that aren't changing. I'm in Toronto. My health benefits cover 100% of the surgery, so I'm not concerned about cost.

I don't play contact sports, but do spend most of my day in front of a computer. I'm a professional so it's hard to take a week off work to recover.

I'll obviously go and meet with various doctors to ensure my eyes are in good condition for surgery, but I'm interested in going into the meetings with a lot of knowledge to allow myself to have intelligent questions.

The Smartsurface PRK looks promising, but then I see the medication notes for PRK a few pages back which are super strong which leads me to think that PRK is still super painful in the recovery versus LASIK.

My impressions from reading this thread are that beyond recovery time PRK may be preferable. However, the recovery time and pain are significantly worse for PRK than LASIK. Does SmartPRK change the recovery time or pain?

With the knowledge that cost is not an object, what would surgery would people go for?

Edit: Is SmartPRK available in Toronto?
Jr. Member
Oct 6, 2015
149 posts
50 upvotes
iherald wrote:
Mar 23rd, 2017 3:44 pm
My impressions from reading this thread are that beyond recovery time PRK may be preferable. However, the recovery time and pain are significantly worse for PRK than LASIK. Does SmartPRK change the recovery time or pain?
Yes SmartSurfACE does significantly reduce the recovery time, and in most patients, reduces pain quite a bit as well. In my case, I walked to the surgery from my hotel in the morning, took a cab back to the hotel around noon, went shopping in the afternoon at MEC and surrounding shops, and had dinner (w/o alcohol) with friends in the evening. The 'pain' that I was 'expecting' never appeared and I slept like a baby. I've had worse "pain" during "bad contact lens days" than I had undergoing SmartSurface transPRK.

Just another note, most surgeons who do "traditional" PRK (either alcohol or brush) provide tetracaine (anesthetic freezing) drops for their patients for use when the pain is particularly severe and doesn't resolve with artificial tears or oral medications. SmartSurfACE doctors don't provide these drops because they're pretty much never needed. In fact, even narcotic pain medication isn't needed in many patients and only minimal quantities are even made available to the patient. This shows the sort of confidence in the consistency of recovery in "SmartSurfACE" not achieved with other procedures.
With the knowledge that cost is not an object, what would surgery would people go for?
Can only speak for my experience, which was SmartSurfACE PRK, using the Corneal Wavefront treatment profile (basically its corneal topography-guided, which has numerous advantages!). I'm the first patient my optometrist (who I use for co-management) has ever seen undergo the procedure, and she's been amazed at the speed of recovery compared to other PRK patients she's co-managed.
Edit: Is SmartPRK available in Toronto?
The only clinic in Canada that is known and verified to do it is Pacific Laser in Vancouver. Dr. Machat at CrystalClearVision could upgrade his laser's software and achieve the better outcomes for his patients, but apparently has not done so yet. But if enough patients ask for it....
Deal Addict
User avatar
Oct 1, 2011
4085 posts
324 upvotes
Regarding transPRK with SmartSurfACE:

- No opioid pain meds for me at any time. Right before surgery, the clinic offers 2 ibuprofen (Advil) tabs + 2 acetaminophen (Tylenol) tabs + Gravol 25mg + (optional, if nervous, 0.5mg lorazepam?); I took the ibuprofen and 1/2 tab Gravol 25mg and refused the others.
- After surgery, they recommend taking regular doses of ibuprofen for the next 72 hours. The only analgesic eyedrops provided were Acuvail (NSAID) only for the first 24 hours.
- I was very comfortable, with almost no pain. There was ONE single moment of a stinging/teary feeling in my right eye after my first post-surgical nap, about 2 hours long...that I would rate at 2/10 Pain on the Pain Scale. It felt like when you get shampoo accidentally in your eyes. Very manageable--I just gently peeped that eye open and put in some lubricating eye drops and it went away.

**I had punctal plugs inserted right after my surgery, I guess the staff noticed that my eyes were quite dry. This may have improved the comfort I felt, and I plan on keeping them in for 6 months to ensure proper moisture in my eyes.** The default is that they are not put in; I don't believe burnt69 had them.

***Please do not confuse the Amaris 750rs as having the same technology as the Amaris 1050rs + SmartSurfACE (currently only available in Vancouver in Canada as far as we know). I have seen electron microscope details of how much smoother the ablation zone on the corneal surface is after the SmartSurfACE compared to traditional PRK...and Dr. Machat's office in Toronto confirms that the SmartSurfACE is of benefit for those having transPRK. It is quite possible that the Amaris 750rs, despite being in the same 'family' of lasers, may still yield a somewhat uncomfortable recovery since they do not have the SmartSurfACE algorithm installed.

From my reading of various online reports (where unfortunately people are not always specific about their year/laser technology for their PRK), burnt69's and my recovery were exceptionally comfortable--I mean, nowhere close to some of the nerve-wracking stories out there. I am ONLY speaking of SmartSurfACE-enhanced PRK, which I really think should be given a slightly different name so people aren't confusing it with the harsher experience of the other kinds of PRK.

My brother is scheduled next month at Pacific Laser Eye Centre.
Jr. Member
Oct 6, 2015
149 posts
50 upvotes
Good post peanutz. I think people who have never worn contact lenses face a more difficult recovery from PRK than people who, like myself, were 12-14 hour/day contact lens users prior to surgery. Most of the 'horror' stories with PRK, I theorize, come from people who have worn only glasses, never contact lenses. And suddenly are forced to wear the 'bandage contact lens' for a week. So they're 'fighting' two root causes of pain; the ablation itself and that of having a foreign object in the eye in the form of a contact lens.

I know that when I was fitted with contact lenses for my very first time as a teenager, the first few weeks were very problematic getting my eyes adjusted to them. Until the surgery, I had never deliberately worn a contact lens overnight, so I was apprehensive as to how it would feel, especially with post-surgical corneas. But with the lubricating drops and the steroids they give you, it was surprisingly comfortable. Had I known that I could make my contact lens experience so much less annoying by using lubricating drops, I might not have had the surgery, lol!

Your comments about SmartSurfACE are 100% spot on and I agree with them fully :). But I have certainly read of people with minimal pain traditional PRK recoveries as well. The 'straight off the table' visual acuity of SmartSurfACE is pretty much impossible to beat though, which really reduces overall downtime and makes travelling alone for the procedure a piece of cake!
Member
Dec 29, 2009
475 posts
69 upvotes
burnt69 wrote:
Mar 23rd, 2017 5:39 pm

The only clinic in Canada that is known and verified to do it is Pacific Laser in Vancouver. Dr. Machat at CrystalClearVision could upgrade his laser's software and achieve the better outcomes for his patients, but apparently has not done so yet. But if enough patients ask for it....
I emailed Dr. Machat and was told they were not upgrading because they mostly do Lasek.

But I very much appreciate the rest of the information.

Does anyone know of a site that has unbiased information about all the different options? I google questiosn and I always get websites for clinics, which I am hesitatant to believe.
Jr. Member
Oct 6, 2015
149 posts
50 upvotes
iherald wrote:
Mar 24th, 2017 9:46 am
I emailed Dr. Machat and was told they were not upgrading because they mostly do Lasek.
Good. The more people that do this, the better. It will even help his LASIK patients, although not quite as dramatically. Obviously I don't know the commercial terms involved between Schwind and its customers, but upgrading strikes me as such a no-brainer with minimal to no adjustment in treatment planning required by the surgeon.

Does anyone know of a site that has unbiased information about all the different options? I google questiosn and I always get websites for clinics, which I am hesitatant to believe.
Unfortunately you basically have to sort through a lot (and I do mean a lot) of BS, marketing claims, manufacturer and vendor claims. And of course, the anti-LASIK sites, whistleblowers, etc.

When I did this, the 'take-away' message appeared to be that most LASIK complications arise from the flaps. Whether it be the creation of the flap, the actual fact of cutting into the cornea, the actual flap itself, etc. So you're automatically avoiding these complications through PRK.

Once I came to this conclusion, then I had to look at PRK complications and downsides. Another angle I had to look at, as a large pupil owner, is whether the laser and clinic I was interested in actually could appropriately and fully treat me. For the clinic I was all set to book with initially (based on flashy marketing and extremely attractive pricing), the answers I was coming up with were quite inconclusive, but trending towards the negative. I recently found a blog article which details what happens when someone, with large pupils, is treated at the clinic I was interested in using in Vancouver initially:

http://www.isthisyourhomework.com/halos ... prk-lasik/

(one of the busiest clinics in Vancouver (not PLEC!!), and the most popular laser system in the world that they use, and they're still leaving people with night vision side effects due to inadequate optical zones! crazy!)
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