Beauty & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Nov 20th, 2017 9:13 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
808 posts
413 upvotes
Aznsilvrboy wrote:
Nov 10th, 2017 6:20 pm
Hmm...speaking of warranty, I forgot to ask Pacific Laser about theirs, if any. Does anyone know? Not that I'm considering it at the moment, but just curious.
The representations made by PLEC on their website (which you certainly could access through archive.org indefinitely) are extremely vague, other than free re-treatment in the first year (but not before 6 months), and a "facility fee" (but no doctor fee) thereafter for life.

The real 'problem' arises if there were to be a disagreement between you and the Dr. as to the necessity of a re-treatment. Eligibility criteria is never discussed. The lack of negative online feedback indicates to me that refractive surgeons (PLEC being no exception) are fairly generous with their re-treatments if legitimately in the interest of the patient.
How does this level of astigmatism affect you? Do you need glasses to correct? I don't recall, how far out from surgery are you?
Its no problem to walk around with 0.5D or even 0.75D of astigmatism. Those levels will reduce final visual acuity. Could be the difference between 20/10 and 20/15, for instance.
Newbie
Oct 22, 2017
16 posts
15 upvotes
i went through some of my research links that i found when i was researching PRK and here's one that i think is quite useful for anyone considering PRK.

http://www.schwind-smartsurf.de/en/

This is the tech that Dr. Lin (Vancouver - PLEC) and Dr. Machat (Toronto - CCV/Nvision) are using. I think they are the only places in North America? Is that right? I can't find anyone in the US?
Sr. Member
Oct 6, 2015
808 posts
413 upvotes
JustinLaw wrote:
Nov 14th, 2017 10:15 am
i went through some of my research links that i found when i was researching PRK and here's one that i think is quite useful for anyone considering PRK.

http://www.schwind-smartsurf.de/en/
Yes, Schwind (laser manufacturer's) marketing site. Unfortunately because the technology is so new, they don't have a lot of decent peer-reviewed data to 'prove' that the SmartPulse ablation algorithm produces lower pain scores, etc.

But what really clinched it for me was the claim of PLEC that of 700+ patients treated in their initial trial, barely over a dozen required any narcotic analgesia beyond that of simple Tylenol and Ibuprofen, and never any post-procedure topical anesthesia. For PRK, that's amazing. Even then, I had anticipated a lot of discomfort and pain that didn't actually end up happening. I actually went shopping in the afternoon right after my procedure at No Frills and MEC (amongst other places) and out for dinner with friends in the evening. All day I was thinking, "when is the pain going to kick in", but it never happened.

This is the tech that Dr. Lin (Vancouver - PLEC) and Dr. Machat (Toronto - CCV/Nvision) are using.
And Dr. Holland (Vancouver - PLEC). And a clinic in Edmonton, a clinic in Calgary, and a clinic in Winnipeg. At least that I'm aware of.
I think they are the only places in North America? Is that right? I can't find anyone in the US?
The laser isn't licensed in the US, so nobody is using it in the US per US Federal law.
Last edited by burnt69 on Nov 14th, 2017 12:07 pm, edited 1 time in total.
Jr. Member
Jan 2, 2011
144 posts
25 upvotes
Hi guys,

I need your help. Lasik MD was only clinic that did not want a dilated eye exam from my Optometrist. However everyone else did. Should this be cause for concern?

Also found out LASIK MD Mississauga uses Alcon EX500 and Nvision uses Scwind Amaris 750.

Is one any better than other?

I determined I am going for all laser Lasik. I can't take chance of not having 20/20 later rather than sooner. Cornea was measured 560 from one source to 580 at another. Pupils at slightly larger than 7mm.
Sr. Member
Oct 6, 2015
808 posts
413 upvotes
learsid wrote:
Nov 14th, 2017 12:40 pm
I need your help. Lasik MD was only clinic that did not want a dilated eye exam from my Optometrist. However everyone else did. Should this be cause for concern?
A retinal exam is part of every comprehensive eye exam, but may not be strictly 'required' for corneal refractive surgery.
Also found out LASIK MD Mississauga uses Alcon EX500 and Nvision uses Scwind Amaris 750.
Is one any better than other?
For LASIK (as opposed to PRK -- the Schwind clearly is superior for PRK because of its transPRK w/SmartSurfACE capability), mostly depends upon how they're used. The EX500 can do a type of ablation known as T-CAT (sometimes called "Contoura"), which is roughly equivalent to Schwind's "Corneal Wavefront". Now whether you need such or not, or if the surgeon will offer or not is something that you might want to discuss with them. If the goal is just 20/20, practically anything will work. If you want to be, for instance, a 20/10, then your chances are better with the topography-guided procedures on either laser. Of course, even if they make your corneas "perfect", you might not still end up as a 20/10, but the better centered and matched the treatment is to your actual topography, the better the outcome is likely to be in getting you to your theoretical "best" visual acuity.
I determined I am going for all laser Lasik. I can't take chance of not having 20/20 later rather than sooner. Cornea was measured 560 from one source to 580 at another. Pupils at slightly larger than 7mm.
Thick corneas. I'd just caution you, there's a lot more to vision, particularly night vision, than "just" 20/20. I had 20/20 a week after my procedure, but there's no way I could have driven at night, for example.
Jr. Member
Nov 21, 2014
186 posts
80 upvotes
Atlantic
Is NVISION in Toronto offering Smartsurface now? They upgraded their machine?

What do you guys think about the surgeon? Compared to PLEC?
Sr. Member
Oct 6, 2015
808 posts
413 upvotes
EasyCompany251 wrote:
Nov 15th, 2017 12:57 pm
Is NVISION in Toronto offering Smartsurface now? They upgraded their machine?

What do you guys think about the surgeon? Compared to PLEC?
Dr. Machat has an impeccable public reputation, even going so far as to testify against the "LASIK industry" in the early 2000s in response to a lawsuit filed by a patient disabled by a certain manufacturers' laser's inadequately sized treatment area. You can Google the details, but he basically set off an earthquake in the industry as until then, nobody else was willing to step up and tell the truth about lasers that were injuring people with large pupils.

Dr. Lin's claim to fame is actually fixing patients who were injured, and he did a good amount of the technical "leg-work" involved with such; a good chunk of the patients he treats are from previously botched surgeries done elsewhere. He basically invented SmartSurfACE, and does a lot of laser treatment of Keratoconus patients as well.

Dr. Holland (PLEC) not only treats patients with the laser, but also does other procedures at a local hospital. Some of these treatments, such as corneal transplants, and cataract procedures, may benefit highly from subsequent laser treatment.

And yes, two posters to this thread have confirmed the upgrade at Dr. Machat. For virgin non-diseased eyes, I see no reason to pick one over the other -- whichever is more convenient.
Deal Fanatic
Mar 22, 2004
9021 posts
583 upvotes
Mississauga
burnt69 wrote:
Nov 15th, 2017 1:34 pm
Dr. Machat has an impeccable public reputation, even going so far as to testify against the "LASIK industry" in the early 2000s in response to a lawsuit filed by a patient disabled by a certain manufacturers' laser's inadequately sized treatment area. You can Google the details, but he basically set off an earthquake in the industry as until then, nobody else was willing to step up and tell the truth about lasers that were injuring people with large pupils.

Dr. Lin's claim to fame is actually fixing patients who were injured, and he did a good amount of the technical "leg-work" involved with such; a good chunk of the patients he treats are from previously botched surgeries done elsewhere. He basically invented SmartSurfACE, and does a lot of laser treatment of Keratoconus patients as well.

Dr. Holland (PLEC) not only treats patients with the laser, but also does other procedures at a local hospital. Some of these treatments, such as corneal transplants, and cataract procedures, may benefit highly from subsequent laser treatment.

And yes, two posters to this thread have confirmed the upgrade at Dr. Machat. For virgin non-diseased eyes, I see no reason to pick one over the other -- whichever is more convenient.
So these three Doctors are the best of the best to go with at their respective clinics?
Sr. Member
Oct 6, 2015
808 posts
413 upvotes
radeonboy wrote:
Nov 15th, 2017 2:05 pm
So these three Doctors are the best of the best to go with at their respective clinics?
I think you would find many professionals in the industry speaking very highly of all three surgeons if you were to ask them. All three have done quite a bit of publishing as well in the technical journals relating to laser eye surgery.

Not to say that other surgeons aren't good as well, but there's definitely some reasons why prospective PRK candidates might want to seek out SmartSurfACE, particularly if they want to minimize their recovery time.
Jr. Member
Jan 2, 2011
144 posts
25 upvotes
Thanks guys for the info. What I have found in this process has been that all the clinics prefer LASIK if you are a candidate for it. Even Dr. Machat at his clinic does mostly LASIK.

The smartsurface PRK is indeed better than prior PRK but it is no means better than LASIK as it also has complications that can arrise.

LASIK is more costly for a clinic as it uses another laser to cut the flap or the blade. This is the surprising part as with normal business practice you would think they would try to push the cheaper method (PRK) but it is not the case.

The clinics I went to for consult said all said the same thing. Basically they do LASIK for about 80% of their procedures.

Even though Dr. Machat in the past spoke out against LASIK... their clinic recommends it over PRK. They don't openly say they recommend it but no clinic openly said for me to do PRK and they didn't even talk much about PRK unless I asked for it.

That being said if you are willing to be patient with PRK than this new technology is intriguing and worth strongly considering. But the medical professionals really had a hard time saying it is better than LASIK.

Smartsurface PRK is definitely easier for the doctor and basically hands off. I'm sure it is cheaper for PLEC than LASIK is and that is partly why they do that as their primary method.


On aside note I called LASIK MD why they didn't dilate my eyes on my consult or require it before exam date like the other 3 Clinics I visited. They said they don't for people under 45 or non-diabetic or appear to have healthy eyes. But said if I want to come in and get it anytime before my surgery I can. Which is what I am going to do.
Newbie
Oct 22, 2017
16 posts
15 upvotes
+1 for Dr. Jeff Machat. He really does know what he's doing. His clinic is very nice (not that it matters but definitely made me feel great that it was in a very nice part of town and looked beautiful inside). They definitely spent the time to dot their eyes and cross their t's :)

ok but seriously, i'd pretty much say the same. PLEC or CCV/Nvision are the places to do it. These places are top notch. Don't discount experience as it's the difference between giving you what you asked for and educating you on why what you want is not necessrily going to be the best way to achieve your best possible outcome (visual accuity) or any complications that you may have. A lot of this is gained by seeing and performing eye surgeries. I think Dr. Machat is at something like 75000 and he's done something like 600 doctors. I don't know the details of the other 2 doctors at PLEC but im sure they are very very exprienced. I personally beleive in paying a premium for their experience (Over LASIK MD who had cheaper prices when i went in for a consult) but exprience is and was more important to me.
Sr. Member
Oct 6, 2015
808 posts
413 upvotes
learsid wrote:
Nov 15th, 2017 2:43 pm
The smartsurface PRK is indeed better than prior PRK but it is no means better than LASIK as it also has complications that can arrise.
Such as? Haze, delayed re-epithelization, and steroid-related complications appear to be the only risks that are unique to PRK. I picked PRK because:

1) No flap to ever dislodge.
2) Lower risk of ectasia (although not really a risk at my age/prescription/corneal thickness).
3) Ease of re-treatment if ever necessary.
4) No application of pressure to eye, ie: no chance of suction-related injury, induction of floaters, etc.
5) Less probability of aggravating my already marginal dry eyes (was diagnosed with marginally dry eyes as a teenager and almost not eligible for contact lenses).
6) Higher probability of getting me to 20/12 or 20/10 due to a single-part cornea and no intrastromal refractive discontinuities.
LASIK is more costly for a clinic as it uses another laser to cut the flap or the blade. This is the surprising part as with normal business practice you would think they would try to push the cheaper method (PRK) but it is not the case.
PRK requires more follow-up, particularly because of the necessity of monitoring eye pressures associated with steroid therapy. PRK has more patient complaints of discomfort or fluctuating vision. LASIK/PRK are, for most patients, elective cosmetic procedures, and there is a historical tendency for doctors to "give the patients what they want".
The clinics I went to for consult said all said the same thing. Basically they do LASIK for about 80% of their procedures.
Even though Dr. Machat in the past spoke out against LASIK... their clinic recommends it over PRK. They don't openly say they recommend it but no clinic openly said for me to do PRK and they didn't even talk much about PRK unless I asked for it.
To clarify, I believe Dr. Machat testified in a court case with respect to lasers at the time which were not engineered to treat a large enough area, and hence, left susceptible patients to occupationally disabling night vision. I'm not aware of any public statements of his on the LASIK vs. PRK debate.
Smartsurface PRK is definitely easier for the doctor and basically hands off. I'm sure it is cheaper for PLEC than LASIK is and that is partly why they do that as their primary method.
In their practice, there are also other considerations. For instance, when re-treating a prior LASIK, RK, or treating a keratoconus patient, the transepithelial PRK approach has some significant advantages, namely, no need for mechanical manipulation of the cornea, and a very high correspondence between the prescribed treatment and the delivered treatment as the epithelium acts as a mask over irregular corneas.

Does that matter much to 'normal' patients? No. But the fact that they were able to optimize it to reduce pain and make it a very easy single-step procedure is awesome in my view.
On aside note I called LASIK MD why they didn't dilate my eyes on my consult or require it before exam date like the other 3 Clinics I visited. They said they don't for people under 45 or non-diabetic or appear to have healthy eyes. But said if I want to come in and get it anytime before my surgery I can. Which is what I am going to do.
Seems reasonable, its corneal surgery, so the condition of the retina probably isn't terribly relevant. Chemically dilated eyes may interfere with the surgery itself (ie: tracking systems on lasers often use iris features!), so you probably want to do it at least a few days prior if you're going to do that so the drops can fully and properly wear off.
Newbie
Oct 2, 2017
11 posts
6 upvotes
PLEC requires the pre-op with dilated exam be no closer than 4 days before surgery.
Sr. Member
Oct 6, 2015
808 posts
413 upvotes
VinceInSeattle wrote:
Nov 15th, 2017 4:28 pm
PLEC requires the pre-op with dilated exam be no closer than 4 days before surgery.
Yup. Another thing that is important is that nothing touches your eye for a day or two prior as any indentations can affect topography. As can a poor tear film.

https://www.accessdata.fda.gov/cdrh_doc ... 0S012d.pdf
A proper tear film is essential for good topography image of the examination. Apply artificial tears approved by the manufacturer in patients with short tear-film break-up time. Please refer to the ALLEGRO Topolyzer manual for details. Measured eyes must not have had any kind of applanation or indentation during the 12 hours before topography examination, e.g. applanation tonometry or contact pachymetry and contact biometry.] All such procedures must be performed long before or after the topography examination.
This is why I travelled by rail, not airplane to Vancouver to have my surgery, and arrived 2 days in advance. To keep the eyes from drying out affecting measurements.
Newbie
Oct 2, 2017
11 posts
6 upvotes
I had my pre-op exam yesterday with a local optometrist, and based on that, I decided to cancel my scheduled PRK surgery.

I'm 57 and have significant presbyopia. My goal was to get rid of my glasses for running and other outside time. Here in Seattle, "outside" often means rain, and last year we had record rainfall during marathon training. But during the exam, I confronted what it would be like to be corrected for distance vision. I understood already that I would need reading glasses for computer work or reading time. But I thought I would be able to see enough with some squinting and varying distance. After all, now I can either find a focus point with my progressive lenses, or just take off my glasses and bring a pill bottle or my phone close to my face to read any small type. I found there would be no way to compensate for my lack of near vision, except readers. That means I wouldn't be able to read my GPS running watch. Wouldn't be able to change the music on my phone. Wouldn't be able to order at Starbucks and send a text or two after running, unless I carried readers with me. Given that, plus the need to use sunglasses religiously for months and then as needed after that, doesn't look like spectacle independence.

The alternative is monovision (for those who don't know, that means correcting the non-dominant eye for near vision while the dominant eye is fully corrected for far), but many authorities including this optometrist recommend a trial using contact lenses. Not everyone adapts to monovision. I haven't used contact lenses since my 20s and am not willing to go into all the habits of using contacts - when to put them in, take them out, how to clean them, carrying the case at all times, etc.

For right now, I'm going to get a great new set of glasses, and see what develops in refractive lens exchange. Some new IOLs have come on the market lately, reportedly providing great vision at all distances. Much more expensive than PRK though, more like an $8000 adventure, with possible blindness as a complication. Within 5-10 years I may have clinically significant cataracts anyway that would necessitate this approach. It would be ironic to have the best vision of my life in my last years!

I want to thank the posters here for relating their experiences and research. AFAIK the SmartSurface procedure is the tops, and something I would allow my family to do if they needed it. Just isn't right for my particular eyes and goals, but I couldn't find any flaws in the procedure itself. Good luck to all!

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