Beauty & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Nov 16th, 2017 3:25 pm

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

  • Total votes: 196. You have voted on this poll.
Yes
 
100
51%
No
 
29
15%
Pizza is yummy
 
67
34%
Sr. Member
Oct 6, 2015
790 posts
398 upvotes
toaster5 wrote:
May 30th, 2017 7:03 pm
Would PRK be a better option?
It may be. A hyperopic patient has a relatively higher chance of regression and needing a re-treatment. PRK, without the flaps, makes that an easier and less risky process.

For hyperopia, you may also want to look at a topography-guided treatment, something that not that many outfits offer, but may be relevant to ensuring optimal treatment in your case.

https://www.reviewofophthalmology.com/a ... to-its-own
Hyperopia. Hyperopes often achieve better outcomes when treated with a topography-guided refractive procedure. “In my opinion, topography-guided ablation is the equivalent of a successful treatment in hyperopes,” says Dr. Kanellopoulos. “For many years we’ve advocated using topography-guided ablation in all hyperopic eyes because they tend to have significant angle kappa. Topography-guided ablation treats on the cornea apex by default; that’s usually the position of the visual axis.”

Dr. Stein agrees. “We do a high percentage of our hyperopic PRK and LASIK using topography-guided procedures, and we’re getting better refractive outcomes,” he says. “I think you’re going to see a lot more of this down the road.”
Dr. Stein, of course, being local to you in Toronto.
Deal Guru
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Oct 3, 2006
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Toronto
I scheduled to have my optometrist remove the bandages 5 days after the PRK surgery. Is that too rushed or is it fine?
Newbie
Sep 11, 2007
2 posts
Toronto
I am 55, and I would like to have the "AMARIS Custom PRK " procedure at Crystal Clear Vision with Dr. Machat. Did anyone go through it and could share their experience.

Thank you,

dg
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Oct 6, 2015
790 posts
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Aznsilvrboy wrote:
May 31st, 2017 12:50 pm
I scheduled to have my optometrist remove the bandages 5 days after the PRK surgery. Is that too rushed or is it fine?
5 days is all right -- in the rare event that it is not fully healed over, they will install a new lens and ask you to return a few days later. Just keep in mind that shortly after the removal, eyesight can go downhill a little bit as the newly exposed surface is rough. So you might want to keep that in mind if you're driving to the clinic. Night driving is very sketchy for the first 2-3 weeks as well.
Sr. Member
Oct 6, 2015
790 posts
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dg_102 wrote:
May 31st, 2017 12:55 pm
I am 55, and I would like to have the "AMARIS Custom PRK " procedure at Crystal Clear Vision with Dr. Machat. Did anyone go through it and could share their experience.
AFAIK, the Schwind Amaris laser at CCV is in storage per a previous post to this blog. So it might not be available. Confirm with Dr. Machat's office directly. Dr. Machat, as of the most recent inquiries, does not have the "SmartSurfACE" firmware on his particular Schwind Amaris laser. So the procedure, assuming transPRK, will be identical to what I (and @peanutz ) described of our experience in Vancouver, except the recovery will take considerably longer visual-acuity wise.

At the age of 55, you have a few decisions to make. Monovision versus other presbyopic treatment algorithms vs full distance correction (and reading glasses). And you might want to look into your family history concerning cataract development. For example, my 62-year-old aunt had PRK surgery when she was 54 or so, but needed cataract surgery when she was 60. In hindsight, she should've just had cataract surgery, with a refractive adjustment, at the age of 54 instead of undergoing dual procedures.

I'd talk to your optometrist about arranging a contact-lens based monovision trial, and of course, whether laser surgery, rather than "clear lens extraction" (ie: early cataract surgery) is right for you.
Newbie
Sep 11, 2007
2 posts
Toronto
Thanks for the quick answer @burnt69. I have been using glasses since I was 10. Two years ago I did start using progressives, wasn't too happy with them. Now I went back to using two pairs, computer and distance, reading is almost not needed. I do not have any cataract history in the family but it is something to keep in mind. I was looking at PRK because I am playing sports and I read about issues with the flap.

Would anyone suggest some other facility with the latest equipment?
Member
Jun 22, 2006
246 posts
3 upvotes
toaster5 wrote:
May 30th, 2017 7:03 pm
Would PRK be a better option? I'm not sure . Looking for somewhere in West Toronto/ Mississauga. Anyone with similar astigmatism/hyperopia get it done and have a ballpark cost?
I have the same condition as you (astigmatism, hyperopia), and was considering PRK at PLEC until I caught the most recent burnt69 posts along with statistics. If I'm interpreting them correctly, this kind of stopped me in my tracks that while I am a candidate, I may not be an ideal one.

With the recovery process, lowered % of vision correction right off the bat and chance of regression, I'm wondering if I shouldn't just give extended wear contacts a try.

Previously my contact experience has been brutal but I imagine those weren't fitted by a real professional, and there have been advances since with contacts for astigmatism (Acuvue, AirOptix, seem to be pretty popular).

Huge thanks to burnt and peanutz, the information they provided is invaluable.
Sr. Member
Oct 6, 2015
790 posts
398 upvotes
HoTnickZ wrote:
May 31st, 2017 9:41 pm
I have the same condition as you (astigmatism, hyperopia), and was considering PRK at PLEC until I caught the most recent burnt69 posts along with statistics. If I'm interpreting them correctly, this kind of stopped me in my tracks that while I am a candidate, I may not be an ideal one.
Those statistics are for a single treatment. Multiple treatments can have better outcomes, but hyperopia is more difficult to treat I understand. Additionally the PLEC statistics for hyperopia may be old. A more recent presentation from PLEC indicates that they do hyperopic cases with PRK (SmartSurfACE). So I'd urge caution concerning those hyperopic "LASIK" stats.
Huge thanks to burnt and peanutz, the information they provided is invaluable.
You're welcome, but in your specific case, I'd definitely encourage you to talk with a specialist, whether its Drs Lin or Holland at PLEC, or elsewhere, for more specifics concerning potential treatment outcomes. Also, those website statistics run the whole gamut of hyperopic cases. As I understand, PLEC tends to get a lot of referrals for more difficult cases, even from their competitors, so PLEC's statistics might look worse because they have a wider treatment range than some of the clinics that only treat very routine cases.
Deal Fanatic
Jul 20, 2006
6960 posts
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Ajax
A -12.75 in both eyes, what options would I have in terms of surgery? No sign of caaracts yet and hell of a time getting frames that would hide the thickness of the lenses.
Sr. Member
Oct 6, 2015
790 posts
398 upvotes
bobcat99 wrote:
May 31st, 2017 10:07 pm
A -12.75 in both eyes, what options would I have in terms of surgery? No sign of caaracts yet and hell of a time getting frames that would hide the thickness of the lenses.
With sufficient corneal thickness, you could do PRK. There's implantable lenses, or even early cataract surgery if you're older than your mid 40s. LASIK is almost certainly off-limits. But for people with your sort of prescription, it can be a real home run to be treated.
There's not much out there online except for this which kind of spooked me too (although dated so I'm not sure how valid or if it still holds up)
Well topographic ablation addresses "angle kappa", but yeah, regression still can exist as an issue. They might be able to do corneal cross-linking to reduce the rate of/prevent regression, but that's a pretty new, and potentially controversial indication for cross-linking.
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Oct 1, 2011
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Aznsilvrboy wrote:
May 31st, 2017 12:50 pm
I scheduled to have my optometrist remove the bandages 5 days after the PRK surgery. Is that too rushed or is it fine?
PLEC likes to have their patients take them out 5-7 days after surgery day (some other PRK clinics say 3-4 days...maybe it's because they use different kind of bandage contact and/or steroid drop regimen. Steroid drops slow down healing, but make the healing more "controlled".)

To add to what burnt69 said, PLEC will provide an envelope of instructions to your optometrist to ensure they put in new bandage contacts if the epithelium isn't completely closed by Monday. PLEC instructs that if the optometrist isn't sure, it's better to keep them in rather than prematurely take them out.

I did my surgery on a Wednesday and had my bandage contacts taken out the following Monday morning (5 days later.) My left eye was slightly scratchy afterwards, but not gritty enough that eyedrops didn't soothe it so I believe my epithelium was closed, but barely.

When my brother had his taken out, therefore...I advised that he book his bandage contact lens removal for the afternoon, in case the few hours make a difference in giving more chance that the epithelium is comfortably healed over.

Personally, I found the bandage contact lenses very comfortable (unlike prescription contacts)...but still, my eyes felt more free and liberated when the bandage contacts came out. I didn't notice decreased eyesight quality.

@HoTnickZ that's kind of you Grinning Face With Smiling Eyes but burnt69 is doing a much speedier and thorough job in answering this thread.


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

I did not research much about hyperopia about it since my case is myopic, before age 40.

**I am not an optometrist** so take what I say with a grain of salt and definitely consult more than one eyecare specialist, or contact PLEC yourself with an e-mail although it seems they are very busy. But I will emphasize that after ~40 years of age, what is commonly called "farsightedness" is presbyopia and typically caused by a loss of elasticity in the focusing tissues (lens) of the eye and is a natural part of aging for almost all people. Just from a conceptual point of view...I question whether any kind of cosmetic laser eye surgery is appropriate for this state. Wouldn't it require some sort of compromise/tradeoff between far-sighted and near-sighted vision?

For those under 40 years, and myopic (such as myself), my eyeball is "too long" although the collagen in my lens is still flexible enough to be able to accommodate near-vision after the surgery to restore my far-vision. Therefore shaving off a little bit of the cornea is a mechanically simple fix that should benefit me even when I'm 70, without much tradeoff.

@dg_102 As you mentioned that you wear progressives, one option is getting the myopic portion of your vision PRK'd and then wearing reading glasses for close vision would be an idea. However, again, burnt69 has already answered you pretty wisely, I'd say. Have a discussion with an eyecare professional you trust, maybe get the opinions of several. Not just for future eye health concerns, but also...just be aware that there are other surgeries out there available today and possibly becoming more available, such as the use of implantable intraocular lenses (IOLs) which is (allegedly) like getting cataract surgery before cataracts...and can be replaced/updated later. It is more expensive and invasive than LASIK or PRK, but again, different circumstances and individual physiology to take into consideration.

I first read about it in this thread on reddit:
https://www.reddit.com/r/BuyItForLife/c ... h=50fed411

And here's a little more about it:
http://optometrytimes.modernmedicine.co ... s-exchange

Finally...I'm sorry to be cynical, but always, always keep in mind the incentives behind the person who might be advising you, even if they seem like the kindest optometrist or ophthalmologist or any other professional. If they are someone who makes the bulk of their money from LASIK/PRK and they do no IOL surgeries (or vice versa...take into consideration IOL surgeries are more expensive), it may shift their bias a bit. I'm not saying those individuals are evil and selfish, but I think part of it is human nature. Make sure to get more than one opinion.

In the short history of cosmetic eye surgeries as far as I could tell... radial keratotomy was all the rage. Then it was PRK. Then people were wild about LASIK. Then LASIK shortcomings reverted to more advances in PRK (such as trans-PRK with SmartSurface).

Here is an excerpt from Michael Lewis' The Big Short:
In the 1990s, the ophthalmologists were building careers on performing cataract procedures. They'd take half an hour or less, and yet Medicare would reimburse them $1,700 a pop. In the late 1990s, Medicare slashed reimbursement levels to around $450 per procedure, and the incomes of the surgically minded ophthalmologists fell. Across America, ophthalmologists rediscovered an obscure and risky procedure called radial keratotomy, and there was a boom in surgery to correct small impairments of vision. The inadequately studied procedure was marketed as a cure for the suffering of contact lens wearers. "In reality," says Burry, "the incentive was to maintain their high, often one- to two- million-dollar incomes, and the justification followed. The industry rushed to come up with something less dangerous than radial keratotomy, and Lasik was eventually born."
Lastly...if you are still keenly interested. "Amaris Custom PRK" at CCV with Dr. Machat does not have the SmartSurface update. The long-term outcomes should be similar to PLEC in Vancouver, but I believe the short-term recovery period could be slightly prolonged and a little more uncomfortable.
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Oct 6, 2015
790 posts
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peanutz wrote:
May 31st, 2017 11:17 pm
**I am not an optometrist** so take what I say with a grain of salt and definitely consult more than one eyecare specialist, or contact PLEC yourself with an e-mail although it seems they are very busy. But I will emphasize that after ~40 years of age, what is commonly called "farsightedness" is presbyopia and typically caused by a loss of elasticity in the focusing tissues (lens) of the eye and is a natural part of aging for almost all people. Just from a conceptual point of view...I question whether any kind of cosmetic laser eye surgery is appropriate for this state. Wouldn't it require some sort of compromise/tradeoff between far-sighted and near-sighted vision?
Well plenty of people do very well with monovision, which is correcting the dominant eye for distance, while under-correcting the (myopic) non-dominant eye. Another strategy is to do a multi-focal ablation, where they essentially create different 'zones' of optical power within the cornea. There's various strategies which are a combination of multi-focality and monovision. The decision making process is a *lot* more difficult than a myopic patient in their 20s or 30s that still has some 'accomodation' available.

Throwing a wrinkle into all of this is the likelihood, in the next decade, of prescription eyedrops becoming available which may reduce/prevent the natural lense from hardening, thus preserving/restoring accomodation. Novartis/Alcon apparently are doing some clinical trials with very encouraging early results.
For those under 40 years, and myopic (such as myself), my eyeball is "too long" although the collagen in my lens is still flexible enough to be able to accommodate near-vision after the surgery to restore my far-vision. Therefore shaving off a little bit of the cornea is a mechanically simple fix that should benefit me even when I'm 70, without much tradeoff.
But you (and I) will probably need reading glasses in our 40s or early 50s (absent those magic eyedrops). The question is whether or not this is tolerable, or if you want to have additional laser treatment, ie: monovision or multi-focality. My brief bout with presbyopia due to temporary PRK over-correction was a lot more disturbing, psychologically, than I thought it would be. I've since regressed, so its much more tolerable now. Having said that, I'd much rather wear glasses for "close-up" stuff, than to be wearing glasses (or contacts) when I'm out riding my bike or playing sports. So the tradeoff is quite acceptable. I'm not so vain that I absolutely would refuse to wear glasses. Heck, if magic drops became available, I don't know if I'd be willing to spend anything but non-trivial amounts of money on them. Or accept being a long-term guinea pig.
In the short history of cosmetic eye surgeries as far as I could tell... radial keratotomy was all the rage. Then it was PRK. Then people were wild about LASIK. Then LASIK shortcomings reverted to more advances in PRK (such as trans-PRK with SmartSurface).
AFAIK, the LASIK/PRK split is still 80/20. I think we were both quite spoiled by SmartSurfACE :).

BTW @peanutz, this is an interesting viewpoint on monovision:
. Sort of along the lines of your quote from "The Big Short", that the opthamological community might be pushing multifocal IOL due to financial reasons, rather than any superiority over monovision with standard IOL's.
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burnt69 wrote:
May 31st, 2017 11:59 pm
Sort of along the lines of your quote from "The Big Short", that the opthamological community might be pushing multifocal IOL due to financial reasons, rather than any superiority over monovision with standard IOL's.
Yes, that is what concerns me. Proceed with caution!

I don't like the idea of monovision. Face With Stuck-out Tongue And Tightly-closed Eyes I'd prefer reading glasses. (Well, maybe the idea could take in the future if I needed it and considered it some more.)
Newbie
May 31, 2017
3 posts
I chanced upon this thread while doing some reading on the TransPRK + SmartPulse technology on the Schwind Amaris platform as I am thinking of undergoing refractive surgery as it seems to be the best in terms of preserving the strength of the cornea and minimal intraoperative complication risk. The only drawback seems to be the longer recovery time. My only hesitation is the usage of Mitomycin-C (aka MMC) to prevent haze. I understand that the current protocol is that most surgeons would apply a 0.02% Mitomycin-C on the stromal bed for perhaps around 15 to less than a minute (depending on surgeon's preference).

While doing further reading up, it seems that MMC is a approved drug used for cancer treatment and is known to be carcinogenic. Although MMC has a long track record in eye surgery such as for treatment of glaucoma and pterygium as you can find published papers in journals dating back around 20 years with short-term side effects and no long term effects, which are well reported, I am hesitating a bit at the thought of using such a drug for an elective procedure as it seems that ophthalmologists are uncertain if there are any long term side effects on the usage of MMC in refractive surgery.

For those who have undergone the TransPRK + SmartPulse or SmartSurface procedure, what are your thoughts with regards to usage of MMC ? Was MMC used for your procedure ?

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