Beauty & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Jul 19th, 2017 2:56 pm

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

  • Total votes: 170. You have voted on this poll.
Yes
 
87
51%
No
 
25
15%
Pizza is yummy
 
58
34%
Deal Addict
User avatar
Oct 1, 2011
4371 posts
509 upvotes
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 ?
Deal Addict
User avatar
Oct 1, 2011
4371 posts
509 upvotes
guang34 wrote:
Jun 1st, 2017 12:03 pm
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 ?
My degree of myopia was less than 6 diopters so I would have been classified as "low risk for haze" in the studies I have read. In addition, I read that modern PRK (eg something like SmartSurface technology) results in smoother post-ablation surfaces which further decreases risk of haze...and that even severe cases of haze from early PRK clinical trials had many of them heal and go away on their own over time.

Therefore, I requested that MMC be skipped for me but Dr. Lin did not seem to like the idea. He specifically asked me what concerned me about it, and I don't like that I read it crosslinks DNA in endothelial cells and damages them permanently, a non-regenerating set of cells (as far as we know right now.) He replied that the way he applies it won't touch the endothelium. So...I backed off, not without lingering doubts but I didn't want to argue with my surgeon! Heh.

So, for < 6.00 corrections...
- the risk of haze is low
- it seems haze, if it occurs, can be only temporarily much of the time
- modern PRK techniques, technology and healing protocols (eg bandage contact lenses) seem to have reduced risk of haze further

- MMC may increase risk or degree of post surgical eye dryness
- the long term consequences and exact mechanism in eye surgeries are still unknown
- if haze does occur, it can always be treated with another lasering and MMC then applied

I didn't like the benefit vs risk comparison. But...I got it done.
Member
Oct 6, 2015
461 posts
233 upvotes
guang34 wrote:
Jun 1st, 2017 12:03 pm
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 ?
MMC was used on me. @peanutz evaluated the literature a lot more extensively, as much of it is well above my bio-medical knowledge base (I'm a physicist/engineer by training, I think peanutz has a healthcare background!).
- if haze does occur, it can always be treated with another lasering and MMC then applied
At the potential (and likely) risk of a refractive shift, as is typical with PTK. Plus another few months on steroid therapy which elevates your chances of developing cataracts apparently. And glaucoma if you're a steroid responder.
Therefore, I requested that MMC be skipped for me but Dr. Lin did not seem to like the idea.
A nomogram adjustment would have been additionally required. MMC apparently alters the course of post-procedure regression.

Having said that, there is a Dr. in Germany who works very closely with Schwind, and has a procedure video of a ~20s-ish German female, a -5.75 or so, where MMC was not used on Youtube. So if you're really, really wanting to avoid MMC, but still want the Schwind SmartSurfACE process, Dr Diego de Ortueta doesn't do MMC on routine lower myopia cases and claims pretty good results.
Newbie
May 31, 2017
3 posts
peanutz wrote:
Jun 1st, 2017 1:54 pm
My degree of myopia was less than 6 diopters so I would have been classified as "low risk for haze" in the studies I have read. In addition, I read that modern PRK (eg something like SmartSurface technology) results in smoother post-ablation surfaces which further decreases risk of haze...and that even severe cases of haze from early PRK clinical trials had many of them heal and go away on their own over time.

Therefore, I requested that MMC be skipped for me but Dr. Lin did not seem to like the idea. He specifically asked me what concerned me about it, and I don't like that I read it crosslinks DNA in endothelial cells and damages them permanently, a non-regenerating set of cells (as far as we know right now.) He replied that the way he applies it won't touch the endothelium. So...I backed off, not without lingering doubts but I didn't want to argue with my surgeon! Heh.

So, for < 6.00 corrections...
- the risk of haze is low
- it seems haze, if it occurs, can be only temporarily much of the time
- modern PRK techniques, technology and healing protocols (eg bandage contact lenses) seem to have reduced risk of haze further

- MMC may increase risk or degree of post surgical eye dryness
- the long term consequences and exact mechanism in eye surgeries are still unknown
- if haze does occur, it can always be treated with another lasering and MMC then applied

I didn't like the benefit vs risk comparison. But...I got it done.
Thanks for sharing. I'm considered a low myope as both my eyes are less than -6 diopters. Based on what I read, using the older PRK modality, the risk of haze is lower for low myopes thus I was thinking with the current lasers, the risk of haze should even be lower.

I don't really like the benefit vs risk comparison as well but I think I will ask my surgeon on this if based on his clinical practice, is the chance of having haze very low for my case even without MMC provided I am really meticulous with protecting my eyes from UV exposure and with some Vitamin C ?

I also found papers indicating correlation of UV exposure and late onset haze and correlation of intake of Vitamin C to prevent haze.

Correlation between ultraviolet radiation level and the incidence of late-onset corneal haze after photorefractive keratectomy - A Stojanovic, TA Nitter - Journal of Cataract & Refractive Surgery, 2001
Ascorbate prophylaxis for corneal haze after photorefractive keratectomy - A Stojanovic, A Ringvold, T Nitter - Journal of refractive surgery, 2003

Otherwise, i think I will wait until the next technology for refractive correction, which is Photorefractive Intrastromal Cross-linking (PiXL) is established in the next few years as PiXL can correct low myopia without any lasers at all.
Newbie
May 31, 2017
3 posts
burnt69 wrote:
Jun 1st, 2017 2:28 pm
MMC was used on me. @peanutz evaluated the literature a lot more extensively, as much of it is well above my bio-medical knowledge base (I'm a physicist/engineer by training, I think peanutz has a healthcare background!).



At the potential (and likely) risk of a refractive shift, as is typical with PTK. Plus another few months on steroid therapy which elevates your chances of developing cataracts apparently. And glaucoma if you're a steroid responder.



A nomogram adjustment would have been additionally required. MMC apparently alters the course of post-procedure regression.

Having said that, there is a Dr. in Germany who works very closely with Schwind, and has a procedure video of a ~20s-ish German female, a -5.75 or so, where MMC was not used on Youtube. So if you're really, really wanting to avoid MMC, but still want the Schwind SmartSurfACE process, Dr Diego de Ortueta doesn't do MMC on routine lower myopia cases and claims pretty good results.
I'm actually an engineer by training. From what I read, it seems like haze can be treated, by using MMC at a higher duration with some laser modality or mechanical methods but I feel that was kind of self-defeating since I would like to avoid MMC in the first place if possible.

I did found some anecdote from Dr Diego de Ortueta I believe, stating that in his practice, his risk of haze is <1% without MMC. Can't remember where I seen this before. Unfortunately, I'm based in Singapore thus I will have to look for Dr Jerry Tan. It's not practical for me to fly to Germany.
Member
Oct 6, 2015
461 posts
233 upvotes
guang34 wrote:
Jun 2nd, 2017 4:24 am
Unfortunately, I'm based in Singapore thus I will have to look for Dr Jerry Tan.
A bit pricey, and only does one eye at a time apparently, but I believe he was one of Dr.'s that was part of the original SmartSurfACE clinical trials. Claims to do mostly "Corneal Wavefront" which is Schwind's version of topography-guided ablation. Should go well!

The only thing at this point that still bothers me about the Schwind is that they don't have published data on final post-surgical visual acuities. While with other laser platforms that have gone through FDA approval, you have nice tables of visual outcomes. For instance, Alcon/Wavelight's topography-guided "Contoura" takes 15.7% of the patients to 20/10 within a year after LASIK. The Schwind "should" be similar (or better, esp. with transPRK), but there's simply no public data.
Deal Addict
User avatar
Oct 1, 2011
4371 posts
509 upvotes
@guang34

Ah! Singaporean and might be able to visit Dr. Jerry Tan...I am definitely curious if he would skip MMC for you! Because if he does, I think that would be awesome.

As part of my own regimen (pieced together with PLEC's own instructions plus our readings/discussions from RFD)--I am planning on wearing sunglasses when outdoors 95% of the time anyway, even past the 3-6 month period (100% of the time in the 3-month post-op period.) Naked eyes need shielding from UV exposure, period.

I've also made sure to get regular vitamin C intake. I opted for Vitafusion Vitamin C gummies (quite tasty and a treat on their own anyway.) Anytime anyone has healing to do, vitamin C intake is crucial.
guang34 wrote:
Jun 2nd, 2017 4:17 am
Otherwise, i think I will wait until the next technology for refractive correction, which is Photorefractive Intrastromal Cross-linking (PiXL) is established in the next few years as PiXL can correct low myopia without any lasers at all.
I waited, too, until I found the procedure and the benefit/risk ratio that I was comfortable with. I DO NOT REGRET WAITING.

When in doubt, wait (or never), especially when it is an optional cosmetic procedure.

Having said that...PiXL may be the next "big" thing (or something else), but even if it sounds better and safer, etc. you don't really want to be part of the first batch of guinea pigs. So let's say the horizon for availability of the technology is 2 years. Shouldn't you wait at least 2 years more after the first few patients? That is something to consider.
Jr. Member
Mar 6, 2013
142 posts
15 upvotes
burnt69 wrote:
May 31st, 2017 2:20 am
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



Dr. Stein, of course, being local to you in Toronto.
Thanks for the information! I'm looking into it in more detail now.
Sr. Member
Aug 21, 2005
892 posts
376 upvotes
Toronto
Hello! I'm considering having refractive correction done soon. I'm located in Toronto and have been told anecdotally that having my procedure in Toronto would be fine, but after skimming this thread, it seems like the procedure at PLEC is much more advanced/superior? I've skimmed/filtered through the last 30-40 pages and I know a lot of information about both LASIK and PRK are well documented, but I was hoping someone could help me find the following information as I'm having trouble sifting through it again...

1) Why is LASIK considered outdated and how has modern PRK evolved and "fixed" issues which the old PRK... Are there any particular risks of getting PRK over LASIK? What empirical evidence (links?) that demonstrated that trans-PRK with SmartSurfACE is the best thing out there? I've been debating between CCV and flying out to PLEC... Or doing PRK at say, TLC/Bochner?

2) This is targeted towards people like peanutz, did you find the extra time/effort/expenses flying to Vancouver for PLEC was worth it? and would it be good to fly the day after surgery, or would there be any further benefit to taking the time off and stay in Vancouver for Day 5 so they can remove the bandage, look at the healing with expert eyes, and replace the bandage if necessary? Has scheduling post-surgery care been troublesome at home and do you ever have to return back to PLEC? I know burnt69 had spoken to this somewhere in the thread, but centres such as TLC and Bochner have corporate discounts that make their practice enticing... Is PLEC that much better and with less long-term complications? (I've had multiple friends insist these other places are more than OK and flying out to Vancouver is overdoing it...)

3) How much time off would I require post-surgery to rest? My lifestyle has me on/around the lake quite often and I'm worried about how long I need to take off to ensure I don't have complications from possible infection, etc. with lake water getting into my eyes (would 5 days off be enough? A week? More?). I was hoping to do it by the end of August, but would it be that much safer to wait until the winter when I'm not on the lake at all?

4) burnt69, when you went on vacation not too long after surgery, did you have any issues? Not sure how long after surgery to wait until travelling (sorry, weird question).

TLDR: I'm very interested in flying Toronto>Vancouver to do Trans-PRK at PLEC (burnt69 and peanutz have been selling it well!), but overall I just don't have a full grasp of what I'm walking into... Thanks in advance!
Deal Addict
User avatar
Oct 1, 2011
4371 posts
509 upvotes
@lynn24 Glad you've been doing lots of research! Don't do anything unless you are personally comfortable. I would prefer that we get a new laser eye surgery thread anyway, since this original one is long and old. Technology has improved since its inception.

Maybe even PRK with its own thread.

My first consult with LASIK left a lot of concerns and worries and I felt like I was being a little pushed into it by the first clinic (LASIK MD) I visited 5 years ago; in fact, when I asked to speak to the surgeon directly to have some questions answered, the front staff literally booked a surgery. I am very glad I walked away then, as guilty as I felt about taking up the SURGEON's booked surgery time--he was in uniform--but honestly I did not consent to it.
lynn24 wrote:
Jun 25th, 2017 5:41 pm
1) Why is LASIK considered outdated and how has modern PRK evolved and "fixed" issues which the old PRK... Are there any particular risks of getting PRK over LASIK? What empirical evidence (links?) that demonstrated that trans-PRK with SmartSurfACE is the best thing out there? I've been debating between CCV and flying out to PLEC... Or doing PRK at say, TLC/Bochner?
I do not consider LASIK "outdated", per se. Most laser advances and upgrades that are being applied towards PRK apply to any LASIK as well. Many people still opt for LASIK, and even LASIK has improved in the past 5 years.

I got my first consult in 2012, and LASIK MD was heavily favouring LASIK. They said PRK was the older, less-advanced choice, and that it came with a lot of discomfort, infection risks, less reliable corrections (and more risk of regression), longer recovery, risk of haze, etc. My independent research at the time made my mind determined to want PRK even back then, but the risk and incidence of post-PRK haze turned me off. My choice then was NEITHER - I would stick to my glasses, at least unless something else changed.

What recently changed my mind was that laser ablations with the SmartSurface tech have proven to result in smoothed out post-surgical surface, and haze has become better understood as to causes/preventative measures, including Mitomycin C application, bandage contact lenses, supplements before/after surgery, etc.

Old PRK = larger zone of removed epithelium = more discomfort/pain, longer recovery, less clear vision until about 2 weeks?

TransPRK with SmartSurface = can see from Day 1 (maybe some mild blurriness on days 3-5 though). I had a single moment of stinging the day of, after a 2-hour nap, which went away when I put in lubricant eye drops. My brother said he woke up one day after a nap, 1.5 months after surgery, and felt some grittiness. On a scale of 1-10...level of pain was 1-2 (very mild.) Little pain. Statistically it seems that people reach 80-100% vision quality quicker than Old PRK, too (but still takes a while; in my case, around the 2.5 month mark.)

TransPRK with SmartSurface references (lol, if I worked for a clinic I'd make sure their website has all the medical articles linked!):
http://www.eye.net.au/media/88004/smart ... ochure.pdf --> this is an ad brochure, but it shows a nice electron microscope image of smoother ablative surface with SmartSurface.

http://ophthalmologytimes.modernmedicin ... n?page=0,0 --> here is a 2-part article that interviews Dr. Ortueta. I really like his very conservative approach (doesn't even use MMC on virgin eyes!)

As for direct scientific articles, I'd sort of have to dig back to some old posts which would take up a lot of time (or to re-Google them), but they are around. The main takeaway point is that old PRK and new PRK with SmartSurface seem to have similar safety and final results...but the EARLY recovery phase is a lot faster and more comfortable with the newer transPRK+SmartSurface tech (note that regular transPRK without SmartSurface still has a slower early recovery.)

Even Dr. Machat's office (CCV) admitted that SmartSurface has these early-phase benefits, and they do not have SmartSurface for their Schwind Amaris yet. They e-mailed me to say that currently the majority of their patients still opt for LASIK, so the SmartSurface benefit which is mostly for PRK was not of major benefit for their operations.

If I didn't believe in the TransPRK + SmartSurface, I would have flown out to Coal Harbour in Vancouver, which I think has the best economical pricing for ordinary PRK, like half the cost of TransPRK + SmartSurface at PLEC, or regular PRK in Toronto.

PRK has higher risk of infection, and early recovery pain, than LASIK due to lack of flap. For individuals with certain skin/healing/autoimmune diseases such as lupus, rheumatoid arthritis, collagen vascular disease, etc., PRK is risky (perhaps even riskier than LASIK)--PRK places a higher burden on a patient to be able to regrow skin in a healthy way.
lynn24 wrote:
Jun 25th, 2017 5:41 pm
2) This is targeted towards people like peanutz, did you find the extra time/effort/expenses flying to Vancouver for PLEC was worth it? and would it be good to fly the day after surgery, or would there be any further benefit to taking the time off and stay in Vancouver for Day 5 so they can remove the bandage, look at the healing with expert eyes, and replace the bandage if necessary? Has scheduling post-surgery care been troublesome at home and do you ever have to return back to PLEC? I know burnt69 had spoken to this somewhere in the thread, but centres such as TLC and Bochner have corporate discounts that make their practice enticing...
- The procedure you choose is a personal decision. There are still many people (my mother included) for whom PRK is scary and not worth the risk, we don't know what will happen to me in 30-40 years. There are also shocking rare stories of certain people who were left with chronic pain, light sensitivity, etc.

I do not wish to scare you, but I do feel that it is my duty to inform you of the worst possibility (even if very small), because YOU might be that 1/10000 or whatever statistical person who gets afflicted.

Stephanie Holloway: http://www.dailymail.co.uk/news/article ... lying.html (post-PRK, young woman, blue eyes, permanent light sensitivity so severe it hurts and eyes get very red.)

Dr. Michael Brouwer (he had LASIK) - permanent chronic (nerve) pain in eyes.
https://zembla.vara.nl/nieuws/dry-eyed

In the last year I downgraded my work obligations from full-time to part-time and I set my own schedule, so the longer recovery did not affect me. Totally worth it for me to fly out to PLEC, I only wish I'd known they had it in 2014. Other standard laser eye surgery options did not meet my personal risk/reward thresholds.

- PLEC recommends that people fly back out the day after surgery, after their 1-day post-surgery checkup in the morning. This is because as the eyes heal, the baby epithelium may start to blur vision between 3-7 days after surgery and it would be harder to navigate travel. However, if you have someone to assist you, then I suppose if you really wanted you could stay for the 5 days and have PLEC remove the bandage contacts and check out your eyes. It wasn't worth it to me, my hometown optometrist has been wonderful and I'd rather be relaxing and healing up at home. :)
lynn24 wrote:
Jun 25th, 2017 5:41 pm
Is PLEC that much better and with less long-term complications? (I've had multiple friends insist these other places are more than OK and flying out to Vancouver is overdoing it...)
Since transPRK+SmartSurface is so new (came out in 2011-2013 or something), we don't really know "if it's that much better or has any less long-term complications." There is no one who's had it done and can tell us what differences there are after 20-40 years. Maybe it's not any better after all.

Personally, for ME, a neurotic, 'fraidy-cat, mild astigmatism and ~-5.5/5.75 myopia (considered low-moderate), I was never going to get LASIK. I was borderline on regular PRK, leaning towards no (otherwise I would have had PRK done in 2012). Maybe for some people who are worry-free, Vancouver and PLEC is overdoing it. For my personal risk standards, it was my ONLY option in Canada, even if someone offered me free LASIK or PRK elsewhere in Canada, I wouldn't have done it.

If my brother told me he was going to save some bucks and do LASIK, I would have thrown a temper tantrum. If he said he'd do ordinary PRK, I think it would be a bit uncomfortable but I couldn't tell him for sure that it would be less safe or inferior to transPRK+SmartSurface.

I can't tell you for sure that LASIK is worse, I just don't believe in it, and a lot of other opthalmologists don't, either. With PRK we do lose a circular section of Bowman's membrane (in the ablative zone), that is guessed to contribute to mechanical strength and stability, or possibly even acts as a barrier in cell or chemical migration...in LASIK the Bowman's is still there, just with a gap after the flap creation.

Some proponents of SMILE therefore say that theoretically, it is better than either PRK or LASIK. They leave the Bowman's layer intact and there is no flap. I didn't like the imprecision of the forceps having to dig around for a lenticule, etc. and if it didn't produce the results we wanted then they would do PRK anyway, so. I didn't like SMILE much.
lynn24 wrote:
Jun 25th, 2017 5:41 pm
3) How much time off would I require post-surgery to rest? My lifestyle has me on/around the lake quite often and I'm worried about how long I need to take off to ensure I don't have complications from possible infection, etc. with lake water getting into my eyes (would 5 days off be enough? A week? More?). I was hoping to do it by the end of August, but would it be that much safer to wait until the winter when I'm not on the lake at all?
- I'd recommend a week off minimum for any kind of PRK.
- If you have a job that is very intense on the eyes and/or hectic, then probably 2 weeks minimum. I'm a pharmacist and have worked in all kinds of work environments, some of them really really hectic and non-stop for up to 12 hours straight (I mean, not even reliable meal breaks or other breaks), constantly looking at screens or scripts. It would have been 2 weeks minimum advised for me, but gladly took like 4 weeks off anyway since I can dictate my schedule.

If you're around summer lakes a lot, you'd need to be wearing UV eye protection anyway, such as sunglasses or goggles. The risk of infection in the eyes is not that high after 7 days when the epithelium has settled in. It's more imperative that you'd need UV protection on constantly in the first 3 months when outdoors (and preferably more anyway.) You can do it in August, if you like, and are able to UV-protect your eyes.
Member
Oct 6, 2015
461 posts
233 upvotes
lynn24 wrote:
Jun 25th, 2017 5:41 pm
1) Why is LASIK considered outdated and how has modern PRK evolved and "fixed" issues which the old PRK... Are there any particular risks of getting PRK over LASIK? What empirical evidence (links?) that demonstrated that trans-PRK with SmartSurfACE is the best thing out there? I've been debating between CCV and flying out to PLEC... Or doing PRK at say, TLC/Bochner?
In a nutshell, they do a much better job at pain management and haze management than they did in the past. The main risk of PRK over LASIK is haze. edit: @peanutz has covered a few more risk factors, which apply in those specific situations, but historically PRK's downside has been the possibility of haze and a longer healing time versus LASIK.

There's not a lot of 3rd party academic research on Schwind's implementation of transPRK versus the competition since its pretty new at this point. But the manufacturer's studies indicates that it has substantially faster re-epithelialization time and lower pain scores than the earlier Schwind transPRK, or alcohol-assisted PRK.

2) This is targeted towards people like peanutz, did you find the extra time/effort/expenses flying to Vancouver for PLEC was worth it? and would it be good to fly the day after surgery, or would there be any further benefit to taking the time off and stay in Vancouver for Day 5 so they can remove the bandage, look at the healing with expert eyes, and replace the bandage if necessary?
Its day 3 and 4 that are the worse. I could have stayed in Vancouver until the bandage contact lens removal (on day 5 or later!), but I don't think I would have wanted to venture out of my hotel room. So why waste the $150/day it was costing me when I could have stayed a few extra days prior to the surgery. I flew home the day after the surgery. Getting around Vancouver to the airport was no big deal on the Canada Line.
Has scheduling post-surgery care been troublesome at home and do you ever have to return back to PLEC? I know burnt69 had spoken to this somewhere in the thread, but centres such as TLC and Bochner have corporate discounts that make their practice enticing... Is PLEC that much better and with less long-term complications? (I've had multiple friends insist these other places are more than OK and flying out to Vancouver is overdoing it...)
No, I've never returned to PLEC. All my after-care was handled by an optometrist where I live, and I pay her for each visit. I don't believe there's any meaningful long-term difference in a PRK done at Bochner, versus one done in Vancouver. The difference is short-term outcomes, the first month or two, and the sort of pain you might experience after the procedure.

https://members.optometrists.bc.ca/BCAO ... lation.pdf

Page 26: 765 consecutive cases treated with SmartSurfACE transPRK, only 11 actually consumed prescription medication for pain (Tylenol w/Codeine #3). Whereas, with traditional PRKs (like say you'd get at Bochner!), its my impression that patients usually are popping narcotic painkillers like tic-tacs, and even using topical anesthetics for the first 3-4 days.
* Overcorrrections and undercorrections: 765 consecutive case treated and followed for 12 months with new TE PRK SSm algorithm, only 1 case needed retreatment
* Haze: 2% have 1+ haze at 3 months, no 4+ haze. All haze cases resolved with standard FML protocol over 4 weeks, Restasis and lubricants 
* Delayed epithelial healing > 7 days (1%) Changing CL, all healed within 9 days with BSCVA 20/20 
* 2.4% have loss of 1 line or more of BSCVA at 12 months
* Pain: 11 patients needed acetaminophen-codeine


I was 20/20 a week after, and 20/25 minutes after being lasered (good enough to drive!). Night driving was sketchy for the first month. But there's really no prolonged recovery time. Days 3 and 4, my vision was cloudy to such an extent that using a computer was not comfortable.

I'd keep the lake water out of the eyes for a few weeks. PLEC was emphatic that any sort of water, even chlorinated tap water, shouldn't get in the eyes until at least a week, and required the purchase of swim goggles to ensure such.

Surgery middle of January, vacation in Toronto, southern Florida and the Carribean (BVI, USVI) a little over a month later for 3 weeks. No issues. There was a night or two I was too drunk to remember to use the lubricants. I didn't wake up in any pain or anything the next day.
Last edited by burnt69 on Jun 26th, 2017 1:56 am, edited 4 times in total.
Member
Oct 6, 2015
461 posts
233 upvotes
peanutz wrote:
Jun 25th, 2017 10:15 pm
Personally, for ME, a neurotic, 'fraidy-cat, mild astigmatism and ~-5.5/5.75 myopia (considered low-moderate), I was never going to get LASIK. I was borderline on regular PRK, leaning towards no (otherwise I would have had PRK done in 2012). Maybe for some people who are worry-free, Vancouver and PLEC is overdoing it. For my personal risk standards, it was my ONLY option in Canada, even if someone offered me free LASIK or PRK elsewhere in Canada, I wouldn't have done it.
All the stuff about SmartSurfACE and transPRK aside, the big selling point of PLEC, rather than my local outfit (that uses a VISX laser) is that I have big blue eyes with large pupils. And the VISX laser can only properly treat up to a 6mm or 6.5mm optical zone. I needed larger to avoid night vision side effects.

The Schwind Amaris that PLEC uses not only can treat a larger optical zone, but can do a fully custom ablation for the larger optical zone due to the use of topography-guided ablation ("Corneal Wavefront").

There are a few other advantages of topography-guided ablation as well. For instance, traditional wavefront-guided approaches, for instance, shine lasers onto your retina, and measure the reflection using a camera and some math involving Fourier analysis of the impulse response. However the reflection is a function of pupil size and 'accomodation' which changes with the amount of light. Effectively they're measuring something which is a moving target. This introduces error into the laser pattern that they use when an eye is being treated.

The topography-guided approach measures the contours of the surface of the eye, and generates a laser pattern based solely shape of the surface of your cornea. Thus, it can treat very large optical zones and large pupils (such as I have). The treatment doesn't vary based on the amount of light in the room, or one's accommodative state. Thus, the probability of hitting very good visual acuities, particularly at night, are somewhat higher with the topography-guided "Corneal Wavefront" approach than they are with the wavefront-guided approach used by the VISX laser platform. Another laser manufacturer, Alcon/Wavelight, has actually gone through the process of having their laser FDA-approved for topography-guided ablation, and the number of 20/10 outcomes is incredible -- 17%. The Schwind in Corneal Wavefront and SmartSurfACE is likely in the ballpark.

So to have this type of treatment better suited for my large pupils (Corneal Wavefront) + transPRK + SmartSurfACE, plus PLEC's no-nonsense, totally professional approach (no salespeople, no glossy brochures, no fancy website, no financing) available to me for such a low price was amazing. It cost me literally no extra, including travel and follow-up, than my local LASIK surgery place was offering. And since some of the technology was actually developed by PLEC, I got a 'warm fuzzy' by supporting good quality Canadian innovation :).

BTW, I think it ought to be criminal that there's still doctors who are gladly using lasers on large-pupiled patients that are limited to 6-6.5mm optical zones. They're never going to have good night vision, particularly in low-light situations. Another thing that I do is drive in the dark on country roads, and inadequate treatment was *not* an option for me. I read a blog a few months ago of some guy in Vancouver who had it done at one of the cheaper places a couple years ago (turning down PLEC in his comparison shopping process!), and he ended up with poor night vision, halos, etc. because of it, on a VISX laser. Completely unacceptable (to get that problem fixed, he'd probably have to go to PLEC and have an optical zone enlargement done, $5000 later -- some bargain his discount treatment turned out to be!!!)! The ethics of some surgeons completely piss me off. The doctors have to spend a half million, or even a million buying a laser, and then they're basically married to it financially, even if its a total piece of junk or not the best possible tool for the job!
Deal Addict
User avatar
Oct 1, 2011
4371 posts
509 upvotes
I looked a little more into these chronic post-surgical pain cases.

http://bostoneyepain.org/chronic-pain-f ... surgery-2/

Allegedly, chronic eye pain following LASIK or PRK can often be delayed.
Excluding the 15 year outlier, the median delay in the onset of chronic pain following surgery was 1.5 years.
They're not sure exactly what causes it, perhaps aggressive and non-inhibited nerve regeneration that is triggered.

I wonder if, in the future, there will be a preventive regimen of gabapentin/pregabalin, or some other classes typically used in treatment of neuropathic pain.
Member
Oct 6, 2015
461 posts
233 upvotes
peanutz wrote:
Jun 26th, 2017 3:29 pm
I looked a little more into these chronic post-surgical pain cases.

Allegedly, chronic eye pain following LASIK or PRK can often be delayed.
I know this isn't in direct response to what you're discussing (extremely rare cases of corneal pain), but prior to my procedure, I would have headaches so bad that I was hard pressed to stay up much later than 9-10pm in the evening. Without taking OTC pain medication. I believed my wisdom teeth were the cause, and was gradually working towards getting a consult with an oral surgeon for extraction.

After the SmartSurfACE PRK, magically all my headaches disappeared and I haven't needed pain medication for headaches since. When I had tried toric lenses previously, the headaches actually got worse and I switched back to spherical ones, leaving the astigmatism untreated.

Top

Thread Information

There is currently 1 user viewing this thread. (0 members and 1 guest)