Health & Wellness

[Merged] laser eye surgery

  • Last Updated:
  • Jan 15th, 2019 10:54 pm

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

  • Total votes: 280. You have voted on this poll.
Yes
 
147
53%
No
 
40
14%
Pizza is yummy
 
93
33%
Newbie
Jan 5, 2012
16 posts
4 upvotes
Brampton
Daskva wrote:
Dec 16th, 2018 9:26 am
I wouldn't do it until the doctors who do these surgeries will correct their own eyes and stop wearing glasses:

https://static01.nyt.com/images/2018/06 ... &auto=webp

Its like going to a dentist with bad teeth lol

Check out Bill Gates or Warren Buffet, they almost always wearing glasses. Another good signal to do the surgery would be when they stop :)
In no instance did any of the doctors tell me I will never wear glasses again, and in fact NVISION was straight in telling me due to how high my prescription is, I have a 20-30% chance of needing an enhancement in 6 months. Secondly, as we age our eyes lose the ability to change their own shape for near focus, so everyone eventually requires reading glasses, which is in the fine print of all the material I've received in consults so far. Third, I'm having refractive surgery because I want to go into law enforcement, which has a minimum uncorrected visual acuity requirement of 20/40. I am 20/800. Fourth, why do I care if the PR people of the richest men in the world want to cultivate a certain look anyways? And finally, Dr. Machat has done 600 procedures on other doctors. As to why refractive surgeons themselves usually don't get the procedure? 1 in 1000 develop high order aberrations, 1 in 3000 develop severe complications, 1 in 100,000 develop infections. These surgeons see the actual people who develop complications, which affects their own risk-taking endeavours, and also if Joe-somebody has blurry vision /corneal haze, they might not even notice. If you have corneal haze as an opthamologist, you arent ever removing another cataract. It's about being informed about risk.
Deal Addict
Oct 6, 2015
1428 posts
758 upvotes
Daskva wrote:
Dec 16th, 2018 9:26 am
Check out Bill Gates or Warren Buffet, they almost always wearing glasses. Another good signal to do the surgery would be when they stop :)
Those individuals are presbyopic and hence would need some sort of correction, whether for reading or for distance.
Jr. Member
Dec 17, 2009
103 posts
35 upvotes
vancouver
Endeav wrote:
Dec 16th, 2018 12:05 am
So I've learned a bit more since my post, and had a few more consultations. I went to TLC Mississauga, who didn't have an optometrist on site the day I went (why book me for a consult then...), and requested I come back in a week for another consult. In short, they felt like a LASIK Mill, felt very non-personal, and they did not know much about the specifics of my ICL inquiries. The optometrist I spoke to didn't know much about night vision outcomes for PRK and ICL, and their sales Rep at the end flat out said they don't do ICL for someone my age if PRK or Lasik is available. Actually, I spoke to Dr. Tayfour today at NVISION and he said Dr. Dean Smith at TLC Mississauga did ICL once, 10 years ago, and hasn't done any since, after the TLC person said Dr. Smith did their ICL procedures.

I met with Dr. Tayfour today, who as far as my research goes, owns the Lasik clinic in Windsor and was the first in Ontario doing Lasik at all. He's renown for cataract surgery and so it makes sense he does ICL at NVISION. I had a consult with Dr. Tayfour who also did a white-to-white measurement of my eyes today, though I haven't decided yet on ICL vs PRK. The white-to-white involved numbing drops and devices to clamp my eyes open while he placed a measuring decide on my eyes, measuring for ICL's later if I opt for them, which would happen February 2nd, and if I didn't get white-to-white measured today, he'd measure in February and do the surgery in March.

His opinion, which was a little different from my research, was that ICL would give the best outcome of course, but that he would do Lasik instead of PRK on someone with my prescription (roughly -9 each eye), due to issues of corneal scarring with PRK, though this I believe is because he's been in the field so long that his experience with the early generations of PRK probably did have those outcomes, and he hasn't done surgeries on the Schwind Amaris with Smartsurface platform.

More relevant is that my eyes have a keratometey value of 41D, whereas normal eyes are closer to 45. I saw papers and general agreement that going below 35D would have bad visual acuity outcomes. Dr. Tayfour said my post PRK keratometry would be 31, very far below the safe standard for good night vision acuity. I did see estimates of 0.7D of flattening per diopter of visual acuity correction, which instead puts me at around 34-35, but he's probably being conservative.

I'm scheduled to meet Dr. Machat on Monday for another consultation, and if he says I can do PRK, I do it on Dec 20. Dr. Tayfour did recommend I speak to Dr. Machat about night vision concerns, and any other PRK concerns I have. If my corneas were not flat, combined with my high RX, I would definitely have the PRK done, but I want Dr. Machat's opinion on what my night vision outcome will be, and if he recommends ICL, I'll be going that route.

I did mention the deal they have going on with LA fitness and refer a friend discount, I didnt name anyone and May, the advisor, dropped the price from 5100 to 4600 immediately.
They didn’t mention anything about my keratometey, maybe I should ask them next time. Thanks for mentioning this.
Only three clinics in Vancouver are offering RLE, so not many choices. Price is from $6200 to $7000 here.

I opt out prk, because prk can’t correct my astigmatism and make my dry eyes symptoms worst, also I will have presbyopia sooner.
between ICL and RLE, more trend to RLE. But still concern the night vision and retainal detachment.
Newbie
Dec 18, 2018
5 posts
2 upvotes
Alright team. First off, I want to thank the OG contributors to this thread - there is so much solid information here and it really made my laser consultation journey easier. After reading through the many pages of this thread, I am looking for some input.

I went for consultations at LASIK MD, Bochner, Herzig and NVISION. I have narrowed it down to two clinics - Bochner and NVISION. I only qualify for PRK. At this point, I'm not sure who to choose. Bochner has the reputation (not sure if this is because of all the advertising that they do) but NVISION has the technology. That is not to say that Dr. Machat isn't as experienced as Dr. Stein, but for me, the selling factor for NVISION is the technology.

Any thoughts on who I should choose? Is Dr. Machat as qualified as Dr. Stein? Are all doctors relatively the same at this point and the technology is the game changing factor?
Newbie
Jan 5, 2012
16 posts
4 upvotes
Brampton
embuttercup wrote:
Dec 19th, 2018 9:47 am
Alright team. First off, I want to thank the OG contributors to this thread - there is so much solid information here and it really made my laser consultation journey easier. After reading through the many pages of this thread, I am looking for some input.

I went for consultations at LASIK MD, Bochner, Herzig and NVISION. I have narrowed it down to two clinics - Bochner and NVISION. I only qualify for PRK. At this point, I'm not sure who to choose. Bochner has the reputation (not sure if this is because of all the advertising that they do) but NVISION has the technology. That is not to say that Dr. Machat isn't as experienced as Dr. Stein, but for me, the selling factor for NVISION is the technology.

Any thoughts on who I should choose? Is Dr. Machat as qualified as Dr. Stein? Are all doctors relatively the same at this point and the technology is the game changing factor?
I don't believe you could say one surgeon is more qualified than the other, but if you are going to get PRK, I would not get anything other than SmartSurface TransPRK. You could check reddit /r/ lasik where a bunch of people always recommend SmartSurface over anything else, telling most American posters to go to PLEC or NVISION.

You could get sit down consults with both surgeons. I spoke to Dr. Machat for 40 minutes for a consult, and the clinic was pretty much closed - didn't shoo me out or rush me or anything. He told me based on the profile of my eyes, to do LASIK even though I did all my research and prep for PRK, and eventually ICL, but I'm going to have LASIK done by him today.

Why do you only qualify for PRK by the way?
Newbie
Dec 18, 2018
5 posts
2 upvotes
Endeav wrote:
Dec 20th, 2018 9:20 am
I don't believe you could say one surgeon is more qualified than the other, but if you are going to get PRK, I would not get anything other than SmartSurface TransPRK. You could check reddit /r/ lasik where a bunch of people always recommend SmartSurface over anything else, telling most American posters to go to PLEC or NVISION.

You could get sit down consults with both surgeons. I spoke to Dr. Machat for 40 minutes for a consult, and the clinic was pretty much closed - didn't shoo me out or rush me or anything. He told me based on the profile of my eyes, to do LASIK even though I did all my research and prep for PRK, and eventually ICL, but I'm going to have LASIK done by him today.

Why do you only qualify for PRK by the way?
I agree about not being able to say one surgeon is better than another, which is why I'm leaning more towards the tech that each clinic has.

I only qualify for PRK because my corneas are too thin to do LASIK.
Deal Addict
Oct 6, 2015
1428 posts
758 upvotes
embuttercup wrote:
Dec 20th, 2018 9:26 am
I agree about not being able to say one surgeon is better than another, which is why I'm leaning more towards the tech that each clinic has.

I only qualify for PRK because my corneas are too thin to do LASIK.
Yeah they're both incredibly qualified surgeons. About the only thing I'd say is that PLEC (in Vancouver) probably has the edge if one's case involves something particularly weird or unusual, like corneal disease, or the need for a re-treatment of a previous botched surgery. But if your case is routine, I doubt there's a reason to prefer one surgeon or another. Technology-wise, of course, there are some known and documented advantages of transPRK + SmartPulse (aka "SmartSurfACE") which accelerates the healing time and minimizes discomfort over other approaches. So if you live in Toronto, that probably means Dr. Machat's NVISION clinic by default for PRK. But if Bochner was able to upgrade to similar technology, I doubt there'd be any advantage one way or the other once the clinic was verified to be up to speed..... Certain other previous posters here travelled to Vancouver to be treated but that was significantly due to the technology not being available in Toronto at the time of their procedures. Of course if one is okay with LASIK, then it probably doesn't matter a lot as the advantages of SmartPulse are relatively minimal with LASIK.
Newbie
Dec 18, 2018
5 posts
2 upvotes
burnt69 wrote:
Dec 20th, 2018 10:42 am
Yeah they're both incredibly qualified surgeons. About the only thing I'd say is that PLEC (in Vancouver) probably has the edge if one's case involves something particularly weird or unusual, like corneal disease, or the need for a re-treatment of a previous botched surgery. But if your case is routine, I doubt there's a reason to prefer one surgeon or another. Technology-wise, of course, there are some known and documented advantages of transPRK + SmartPulse (aka "SmartSurfACE") which accelerates the healing time and minimizes discomfort over other approaches. So if you live in Toronto, that probably means Dr. Machat's NVISION clinic by default for PRK. But if Bochner was able to upgrade to similar technology, I doubt there'd be any advantage one way or the other once the clinic was verified to be up to speed..... Certain other previous posters here travelled to Vancouver to be treated but that was significantly due to the technology not being available in Toronto at the time of their procedures. Of course if one is okay with LASIK, then it probably doesn't matter a lot as the advantages of SmartPulse are relatively minimal with LASIK.
Appreciate the detailed response, @burnt69 ! I'm dreading the healing process for PRK because I only get 10 sick days in the year and am planning to take 1 day for the surgery (on Friday) and the following 5 business days - leaving me with only 4 for the rest of the year. I generally don't use them, but it's comforting to have them. So really hoping that SmartSurfACE really does accelerate the healing process ... even if it's slight. I'm not looking to fly to Vancouver for the procedure (even though some people here have considered it!!!!!!!) but appreciate the information regarding PLEC!
Deal Addict
Oct 6, 2015
1428 posts
758 upvotes
embuttercup wrote:
Dec 20th, 2018 11:07 am
Appreciate the detailed response, @burnt69 ! I'm dreading the healing process for PRK because I only get 10 sick days in the year and am planning to take 1 day for the surgery (on Friday) and the following 5 business days - leaving me with only 4 for the rest of the year. I generally don't use them, but it's comforting to have them. So really hoping that SmartSurfACE really does accelerate the healing process ... even if it's slight. I'm not looking to fly to Vancouver for the procedure (even though some people here have considered it!!!!!!!) but appreciate the information regarding PLEC!
If my experience was any indication, you'll probably be able to go back to work early (I figure Wednesday or Thursday for a Friday procedure). Just as soon as you get through the re-epithelialization blur which typically is 2-3 days after your procedure (ie: Monday or Tuesday) and lasts a day. Night driving is the only thing I really couldn't do for ~2 weeks due to the ghosting.
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User avatar
Oct 1, 2011
6313 posts
1451 upvotes
embuttercup wrote:
Dec 19th, 2018 9:47 am
Any thoughts on who I should choose? Is Dr. Machat as qualified as Dr. Stein? Are all doctors relatively the same at this point and the technology is the game changing factor?
No...I don't think all doctors are "relatively the same". In my experience, a professional license or certification only...certifies...a minimum level of education and training. However, it could probably be fairly said that they seem similarly level in terms of expertise, professionalism, knowledge, etc.

Moreover, since not all eye surgeons are trained/experienced on the same laser platforms (not to mention the modern-day bifurcation between doctors and patients who prefer PRK or LASIK)...I would ask for a chat with both surgeons to see how often they are still doing PRK today and what their experience has been between transPRK and more traditional PRK...and how comfortable each seem with PRK in general.

I say this because:
e.g. PLEC mentioned that the overwhelming majority of their patients in the past 3-4 years have done the transPRK + SmartSurface. Like 90%+. What that suggests is that their doctors are extremely comfortable with doing transPRK; but if they were asked on the spot to perform, say, old school microkeratome (blade) LASIK, they may feel a bit rusty at it?

e.g. in 2011 or 2012, I did a consult with LASIK MD in downtown Toronto where I was strongly leaning towards PRK. I told them I don't care about the pain or difficult recovery, I felt it was safer...but they heavily promoted LASIK on me. Even booked a LASIK appointment when I said I just wanted to speak directly with the surgeon LOL. At the time, they were offering microkeratome LASIK as well as the all-laser LASIK...and the surgeon there said I was very suited for microkeratome LASIK, while strongly discouraging PRK. Now I'm not accusing them of being rusty with PRK, but I'm pretty sure that those surgeons there were highly experienced and comfortable with the blade LASIK and therefore possibly influenced their preference.

Hence, I would first choose the procedure, then tailor your questions of the surgeons/clinics you have narrowed your interests down to.
embuttercup wrote:
Dec 20th, 2018 11:07 am
Appreciate the detailed response, @burnt69 ! I'm dreading the healing process for PRK because I only get 10 sick days in the year and am planning to take 1 day for the surgery (on Friday) and the following 5 business days - leaving me with only 4 for the rest of the year. I generally don't use them, but it's comforting to have them. So really hoping that SmartSurfACE really does accelerate the healing process ... even if it's slight. I'm not looking to fly to Vancouver for the procedure (even though some people here have considered it!!!!!!!) but appreciate the information regarding PLEC!
Don't forget that there is always variability in healing...and don't over-estimate the SmartSurface healing rate. If you scrape your knee, it still takes a while for that delicate skin under the scab to heal up to normal, right? There are some processes we just cannot realistically accelerate.

Finally, I do want to point out that my friend may have been an outlier, but she got LASIK done at Bochner in 2012 or 2013 and the recovery in one eye was delayed because (she's not sure how? she thinks she could have disturbed it in sleep) she had to get the flap smoothed down again in one eye around 1 week after surgery. So yeah, 3-7 day recovery was expected...but natural processes have to be given some wiggle room.
Newbie
Dec 18, 2018
5 posts
2 upvotes
peanutz wrote:
Dec 20th, 2018 12:04 pm
No...I don't think all doctors are "relatively the same". In my experience, a professional license or certification only...certifies...a minimum level of education and training. However, it could probably be fairly said that they seem similarly level in terms of expertise, professionalism, knowledge, etc.
I didn't mean ALL doctors, but I meant between big names like Dr. Machat and Dr. Stein, I feel like their expertise in the field are comparable.
peanutz wrote:
Dec 20th, 2018 12:04 pm
Moreover, since not all eye surgeons are trained/experienced on the same laser platforms (not to mention the modern-day bifurcation between doctors and patients who prefer PRK or LASIK)...I would ask for a chat with both surgeons to see how often they are still doing PRK today and what their experience has been between transPRK and more traditional PRK...and how comfortable each seem with PRK in general.
I agree with this. I went to LASIK MD and they couldn't give me an answer when I asked them to give me a ball park figure on how many people do LASIK vs PRK. HUGE red flag (i.e. if these consultants speak to 10 people per day, how many people were recommended for LASIK vs PRK). From speaking with the consultants at Bochner and NVISION, both doctors are well versed in LASIK and PRK.
Newbie
User avatar
Apr 6, 2010
13 posts
My prescription is about -6.00 to -7.00 for both eyes, with -0.50 astigmatism for one eye.
I went to 3 places for consultation and received 3 different suggestions.

Nvision suggested smart surface PRK, as my cornea is about 520 microns (avg is 540-550) thick. For lower prescription, cornea thickness at 520 microns is still good for LASIK, however for my prescription which is relatively high, they would be more conservative hence suggested PRK. Operation will be performed by Dr. Machat.

Bochner suggested LASIK, however due to my small eye opening, the suction cup used in LASIK might not fit. If that's the case, they will switch to PRK. The type of the procedure will be decided on the surgery day. (Cost for both LASIK and PRK are the same). Operation will be performed by Dr. Stein. Bocher's Cost = Nvision + $300

Herzig suggested SMILE, since SMILE is less invasive and my astigmatism is low enough for SMILE to treat. They didn't suggest LASIK or PRK due to invasive procedure and long recovery period. If I'm a good candidate for SMILE, why not SMILE? Operation will be performed by Dr. Herzig. Herzig's cost = Nvision + $1200

Anyone falls into a similar situation as me? What did you choose? I'm in this big dilemma right now. All 3 places mentioned that PRK is possible if I need further enhancement after the first surgery.

The cost of the procedure and the time needed off from work are not main issues for me. I'm willing to invest both time and money in my eyes.

Any suggestions are welcome. Thanks in advance!
Last edited by dorayaki on Dec 21st, 2018 3:28 am, edited 6 times in total.
Deal Addict
Oct 6, 2015
1428 posts
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dorayaki wrote:
Dec 20th, 2018 11:22 pm
My prescription is about -6.00 to -7.00 for both eyes, with -0.50 astigmatism for one eye.
Nvision suggested smart surface PRK, as my cornea is about 520 microns (avg is 540-550) thick. For lower prescription, cornea thickness at 520 microns is still good for LASIK, however for my prescription which is relatively high, they would be more conservative hence suggested PRK. Operation will be performed by Dr. Machat.
Anyone falls into a similar situation as me? What did you choose? I'm in this big dilemma right now.
Your numbers are only minorly worse than mine with similar corneal thickness, although I had an enormous pupil size that required a very large treatment (~8.5mm) for 'perfect' night vision. I went with the SmartSurfACE PRK with PLEC in Vancouver. Dr. Machat uses the same technology and for routine cases should not have any differences in treatment outcomes compared to PLEC due to the use of identical equipment. Still seeing 20/10 2 years later. And because my corneas are still over 400um, if I do regress, or if I want another treatment to deal with presbyopia, it shouldn't be a problem.
Newbie
Jan 5, 2012
16 posts
4 upvotes
Brampton
I did LASIK at NVISION today, with the SmartPulse upgrade. Procedure was done at 230, everything went as I had expected - I was considering not taking the offered Ativan but did anyways even though I had no jitters or concerns in the morning. Didn't move at all on the table, didn't feel uncomfortable as the speculum went in and suction was achieved, etc. Procedure was probably 10 mins inside the operating room. They checked my flaps with the slit lamp after about 20 minutes and sent me home.

Car ride I kept my eyes closed but I opened here and there to direct my dad how to get home (Asian driver meme!) and could, to my own surprise, see my phone, though it was definitely blurry. Looking outside (with sunglasses on of course) was uncomfortable only because my eyes themselves were sore, not because of light sensitivity. I went home and knocked out for 5 hours.

As I write this now, I see my phone as clearly as I did pre-surgery, and walking around my house I'd say most things are in-focus and clear. To my more pressing concerns, I definitely see Starbursting and halos around small light sources that were not there before - but I'm looking for these halos since they've been my concern since it all started. I would say my night vision right now is functional, and I'm of rather high hope since I'm about 9 hours removed from surgery and the halos are, I'd rate, 'not bad'.

I don't know if it's cause it was the Schwind platform + Smartsurface or all LASIK ends up like this, but it's 12 am, my eyes were lasered around 240 pm, and currently I feel no discomfort in my eyes, not even dryness. I have never felt dry eye before my procedure, so maybe I do have dry eye now and simply don't feel it. In any case, the soreness is completely gone and my eyes feel like they have any other day of my life.

Day 1 followup at 1 pm today, genuinely curious what my CDVA is right now, but I'd ballpark 20/30
Deal Addict
Oct 6, 2015
1428 posts
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Endeav wrote:
Dec 21st, 2018 12:19 am
As I write this now, I see my phone as clearly as I did pre-surgery, and walking around my house I'd say most things are in-focus and clear. To my more pressing concerns, I definitely see Starbursting and halos around small light sources that were not there before - but I'm looking for these halos since they've been my concern since it all started. I would say my night vision right now is functional, and I'm of rather high hope since I'm about 9 hours removed from surgery and the halos are, I'd rate, 'not bad'.
Typical due to corneal edema (swelling). Should go away.
I don't know if it's cause it was the Schwind platform + Smartsurface or all LASIK ends up like this, but it's 12 am, my eyes were lasered around 240 pm, and currently I feel no discomfort in my eyes, not even dryness. I have never felt dry eye before my procedure, so maybe I do have dry eye now and simply don't feel it. In any case, the soreness is completely gone and my eyes feel like they have any other day of my life.
Sounds typical for a post-LASIK patient. SmartPulse (not SmartSurfACE which refers to SmartPulse + transPRK) doesn't really bring a lot of benefits to LASIK patients, but LASIK does have very quick recovery.
Day 1 followup at 1 pm today, genuinely curious what my CDVA is right now, but I'd ballpark 20/30
Probably 20/20 at next-day follow-up. Most LASIK patients are.

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