Beauty & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Dec 16th, 2017 8:10 am

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

  • Total votes: 200. You have voted on this poll.
Yes
 
103
52%
No
 
29
15%
Pizza is yummy
 
68
34%
Sr. Member
Jun 7, 2007
551 posts
113 upvotes
Richmond Hill
JustinLaw wrote:
Nov 26th, 2017 10:08 am
Hi, when did you go for your consultation?

I know before the Nvision name change happened the warranty was different but after the name change it's now free for life. I think maybe you misheard her? They did specifically tell me that if you don't do your annual checkups with your optometrist then yes you will have to pay the $500 per eye fee, but so long as you do them it's free for life for touch ups/enhancements.
Ok, I will confirm with her again next week. I believe she might be incorrect in her policies, as she's new. I went last monday on the 20th. I was able to receive a friends referral -$100 off. Thanks :)
Newbie
Aug 6, 2012
4 posts
Oakville
Wondering if anyone had experience getting laser eye surgery after giving birth/breastfeeding? How long did you wait? Thanks!
Newbie
Oct 22, 2017
21 posts
17 upvotes
You should be stable before proceeding but I'm sure it can be upto a year depending on how your physiology changes but I'm no doctor.
Newbie
Dec 1, 2017
11 posts
3 upvotes
I'm getting Wavefront Lasik, choosing between Lasik MD and Bochner, and have several concerns (let me know if you think another clinic would be better!). For background, I'm at a -8 on one eye and -9 on the other (though not sure):
1. Lasik MD said I won't be able to get 20/20 vision in one eye while Bochner mentioned I could get it in both, however, only Lasik MD dilated my eyes (eyes have been sensitive since). Who should I trust?
2. Equipment/Technology: I read a couple of pages back that Bochner's technology is not as state-of-the-art as other clinics, but Lasik's MD tech page didn't specify what technology they have, just the brands, and it says it varies location to location. Does anyone have more information (I'm looking at downtown Toronto location for Lasik MD)
3. Post operative care: both clinics mentioned that I would get a lifetime enhancement plan, but talking more to Lasik MD they said that's only possible if I get a $90 exam every two years, not sure about Bochner though.
What do you guys think? Any opinion on which clinic to go to? Both surgeons have done 80k+ surgery.
Newbie
Dec 1, 2017
11 posts
3 upvotes
I'm getting Wavefront Lasik, choosing between Bochner and Lasik MD (open to other suggestions), and have some concerns. For background, my eyes are around -8 and -9:
1. Getting 20/20 vision: Bochner said I should get 20/20 vision on both eyes, while Lasik MD says can only get it in one of my eyes. Lasik MD dilated my pupils but Bochner did not - who should I trust?
2. Equipment: I read on a couple of pages back that Bochner's technology, while new, is not the newest state-of-the-art equipment. I couldn't find more information on Lasik MD's equipment. How much does equipment matter?
3. Post operative care: I'm getting a lifetime enhancement plan for both, but it turns out Lasik MD needs me to get a checkup every 2 yrs for $90. I couldn't find any information for Bochner. Anyone has experience with either of the clinics and would you recommend them?
Sr. Member
Oct 6, 2015
897 posts
435 upvotes
tgreen2017 wrote:
Dec 2nd, 2017 2:50 pm
I'm getting Wavefront Lasik, choosing between Bochner and Lasik MD (open to other suggestions)
Dr. Machat and SmartSurfACE??
, and have some concerns. For background, my eyes are around -8 and -9:
Pachymetry (corneal thickness) starts to really become an issue at such prescriptions with LASIK. Such limitations at your prescription are mostly avoided with PRK.
1. Getting 20/20 vision: Bochner said I should get 20/20 vision on both eyes, while Lasik MD says can only get it in one of my eyes. Lasik MD dilated my pupils but Bochner did not - who should I trust?
With a proper procedure and full correction with a modest amount of overcorrection, no reason why you shouldn't hit 20/20. LasikMD might be proposing to undercorrect you, due to corneal thickness limitations, or they may be more modest in their expectations, ie: not wanting to make promises they can't keep.

A proper retinal exam, including dilation, is always part of the pre-op, but the fact that Bochner did not perform such in their preliminary exam shouldn't be held against them as such will be performed at the full pre-op. As @peanutz has commented earlier, LasikMD is perhaps more aggressive in getting people from their first visit into the laser chair than other clinics, so they invest a little bit more in the pre-qualifying exam than other clinics.
2. Equipment: I read on a couple of pages back that Bochner's technology, while new, is not the newest state-of-the-art equipment. I couldn't find more information on Lasik MD's equipment. How much does equipment matter?
If you have large pupils (ie: blue or green eyes typically) or if you want a transPRK procedure (ie: SmartSurfACE), it can make a significant difference.
Newbie
Dec 1, 2017
11 posts
3 upvotes
My corneal thickness is at 600 (not sure what unit it is, but the doctor said it's usually 530), and my pupils are at 7 (again not sure what the unit is, but apparently it's average). I do not want to do PRK, it's just picking the best place to get my Wavefront Lasik. I have brown eyes.
Sr. Member
Oct 6, 2015
897 posts
435 upvotes
tgreen2017 wrote:
Dec 2nd, 2017 7:37 pm
My corneal thickness is at 600 (not sure what unit it is, but the doctor said it's usually 530), and my pupils are at 7 (again not sure what the unit is, but apparently it's average). I do not want to do PRK, it's just picking the best place to get my Wavefront Lasik. I have brown eyes.
The problem with the -9 eye is that some surgeons adhere to a rule where they don't want to take more than 1/3rd of the cornea's thickness.

So -9 * 15 um/D (@7mm OZ) + 100um for the flap = 235um / 600um = 39%

So they'd do that eye as a -8, at a 6.5mm OZ + 100um for the flap = 8 * 12.8 + 100um = 200um = 33%.

Hence, in that eye, adhering to the 1/3rd rule, they won't correct 100% of the prescription.

PRK, in comparison:

-9 * 15um/D (@7mm OZ) + 55um (epithelium, which grows back!) = 190um < 33%.

So PRK gets you a full correction on the -9 eye (they can even plan a bit of overcorrection), a full 7mm optical zone, *and* doesn't violate the 1/3rd rule. LASIK would limit the optical zone (ie: poorer night vision with your 7mm pupils), cuts way deeper into the cornea, and wouldn't even treat your full prescription in that case.

PRK is nothing to fear, especially with the SmartSurfACE transPRK enhancement which incorporates custom treatment of the wavefront and/or corneal topography.
Newbie
Dec 1, 2017
11 posts
3 upvotes
burnt69 wrote:
Dec 2nd, 2017 7:55 pm
The problem with the -9 eye is that some surgeons adhere to a rule where they don't want to take more than 1/3rd of the cornea's thickness.

So -9 * 15 um/D (@7mm OZ) + 100um for the flap = 235um / 600um = 39%

So they'd do that eye as a -8, at a 6.5mm OZ + 100um for the flap = 8 * 12.8 + 100um = 200um = 33%.

Hence, in that eye, adhering to the 1/3rd rule, they won't correct 100% of the prescription.

PRK, in comparison:

-9 * 15um/D (@7mm OZ) + 55um (epithelium, which grows back!) = 190um < 33%.

So PRK gets you a full correction on the -9 eye (they can even plan a bit of overcorrection), a full 7mm optical zone, *and* doesn't violate the 1/3rd rule. LASIK would limit the optical zone (ie: poorer night vision with your 7mm pupils), cuts way deeper into the cornea, and wouldn't even treat your full prescription in that case.

PRK is nothing to fear, especially with the SmartSurfACE transPRK enhancement which incorporates custom treatment of the wavefront and/or corneal topography.
I'm worried about the long recovery time (what is it like usually? I've seen some anecdotal answers), and the 2 surgeons I'm choosing from have done 80k+ laser surgeries, so I'm hoping they don't have the 1/3 rule.
Sr. Member
Oct 6, 2015
897 posts
435 upvotes
tgreen2017 wrote:
Dec 2nd, 2017 9:41 pm
I'm worried about the long recovery time (what is it like usually? I've seen some anecdotal answers), and the 2 surgeons I'm choosing from have done 80k+ laser surgeries, so I'm hoping they don't have the 1/3 rule.
For SmartSurfACE, only 2-3 days of blurry vision during the recovery period, and only 1 day where its too hard to use a computer. I went shopping and worked the afternoon after my morning surgery, and had a nice restaurant dinner with friends in the evening! Moderate ghosting for the first week or two. Night vision good enough for driving takes a bit longer to recover fully than daytime vision.

LASIK, you're typically told to go home after your surgery, keeping your eyes closed (to aid in flap healing). And are given sleeping pills to make you sleep for the rest of the day. So arguably there is more downtime on the front-end with LASIK than there is with SmartSurfACE.
Deal Addict
User avatar
Oct 1, 2011
4943 posts
778 upvotes
@tgreen2017

Perhaps get a third consult at Clearview with Dr. Machat. They can offer femtosecond LASIK, SMILE, or tPRK with SmartSurface. They were extremely honest with me when I asked them about SmartSurface before they got that software upgrade (admitted that it helps with early PRK recovery) and therefore I went to Vancouver. Now that they have all procedures to offer, I think they can certainly give you an honest opinion about expectations and what is the best procedure for you.

At your increased required correction, haze risk with PRK may be slightly higher.
Newbie
Dec 1, 2017
11 posts
3 upvotes
burnt69 wrote:
Dec 2nd, 2017 10:13 pm
For SmartSurfACE, only 2-3 days of blurry vision during the recovery period, and only 1 day where its too hard to use a computer. I went shopping and worked the afternoon after my morning surgery, and had a nice restaurant dinner with friends in the evening! Moderate ghosting for the first week or two. Night vision good enough for driving takes a bit longer to recover fully than daytime vision.

LASIK, you're typically told to go home after your surgery, keeping your eyes closed (to aid in flap healing). And are given sleeping pills to make you sleep for the rest of the day. So arguably there is more downtime on the front-end with LASIK than there is with SmartSurfACE.
Interesting! When did you get it, and what are the regression rates/post-operative care like? Would you prefer that over SMILE?


peanutz wrote:
Dec 2nd, 2017 11:52 pm
@tgreen2017

Perhaps get a third consult at Clearview with Dr. Machat. They can offer femtosecond LASIK, SMILE, or tPRK with SmartSurface. They were extremely honest with me when I asked them about SmartSurface before they got that software upgrade (admitted that it helps with early PRK recovery) and therefore I went to Vancouver. Now that they have all procedures to offer, I think they can certainly give you an honest opinion about expectations and what is the best procedure for you.

At your increased required correction, haze risk with PRK may be slightly higher.
Thanks! Just booked a consultation with Clearview - should I specific I want to see Dr. Machat or is it someone else who does the consultation?
Sr. Member
Oct 6, 2015
897 posts
435 upvotes
tgreen2017 wrote:
Dec 3rd, 2017 2:07 pm
Interesting! When did you get it, and what are the regression rates/post-operative care like? Would you prefer that over SMILE?
I'm about a year post-op. SMILE has potential flap complications, a longer recovery time (apparently), is rare in Canada, is difficult to repair if something goes wrong, requires suction on the eye (potentially causing floaters), and does not offer the option of custom treatment. Additionally, because SMILE is so new (compared to PRK which is 25 years old), long term data is not available.

Regression rates should be the same as those for PRK. Depending on your age, your refractive history, and your ability to tolerate such, the surgeon will probably make a modest planned over-correction.
Thanks! Just booked a consultation with Clearview - should I specific I want to see Dr. Machat or is it someone else who does the consultation?
Tell them that you're interested in SmartSurfACE. I don't know if Dr. Machat personally meets with patients in the consultation phase or not, unless the staff detect something out of the ordinary about a specific case that requires discussion.
Deal Addict
User avatar
Oct 1, 2011
4943 posts
778 upvotes
peanutz wrote:
Dec 2nd, 2017 11:52 pm
Thanks! Just booked a consultation with Clearview - should I specific I want to see Dr. Machat or is it someone else who does the consultation?
You're welcome. :) It is a big (permanent) decision, not something to be rushed.

I only spoke with Clearview (Dr. Machat's daughter Paige) over e-mail last year, so I am not sure of how they coordinate consults and communication. I wouldn't necessarily be picky about who does the in-person consultation. I am sure that if you requested that Dr. Machat be your surgeon, or wanted to pass on some questions to him after the consult, they would be happy to relay over e-mail and/or phone.
tgreen2017 wrote:
Dec 3rd, 2017 2:07 pm
Interesting! When did you get it, and what are the regression rates/post-operative care like? Would you prefer that over SMILE?
I know you didn't ask me this question, but this was an option I considered when I chose tPRK + SmartSurface.

a) Allegedly, the smaller the correction, the harder it is to get a clean lenticule extraction in SMILE. In your case it may not be too difficult, but my prescription was a little less than yours.

b) LASIK/PRK uses a kind of UV-based excimer laser that zaps surfaces (PRK in the immediate surface of eye, LASIK on the surface after a flap is peeled back.)

SMILE uses a modified femtosecond laser (non-UV, lower energy--the same kind that creates LASIK flaps) at what is purported to be a less mechanically strong, deeper part of cornea so that the "stronger surface part of cornea" retains more of its tissue for theoretically improved biomechanical strength.

SMILE therefore creates a deeper incision, but smaller overall "keyhole" cut compared to the rounded circumference of a LASIK flap.

One study using mathematical models estimated that SMILE retains 75% of original corneal tensile strength; 68% for PRK and 54% for LASIK.
https://www.ncbi.nlm.nih.gov/pubmed/23820227

Some people also believe that the lower energy zapped by this laser is less disturbing to the eye tissue.

My issue with all this, however, is that this method of correction is only a few years old and we don't know how well this theory translates to clinical truth. There have been rare reports of patients with normal eyes getting post-SMILE ectasia, so this method does not completely preserve biomechanical stability of the eye. (I mean, neither does PRK but the whole point of this more complex procedure was to do better than either PRK or LASIK...)

c) If for whatever reason, SMILE does not go as planned, there are no lenticule re-extraction enhancements available at this time as far as I know. It seems that the majority of re-dos are PRK on top of the SMILE. We don't know further what this does to the biomechanics of the eye, and how well SMILE + PRK compares to simple PRK or simple LASIK.

Dr. Machat's clinic may have better firsthand knowledge of how the surgeries compare to each other.
Sr. Member
Jun 7, 2007
551 posts
113 upvotes
Richmond Hill
I think you guys are mistaking Dr. Machat performing procedures at Clearview, but rather at NVision (formerly Crystal Clear Vision).

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