Beauty & Wellness

Post elective laser eye surgery discussion

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  • Oct 31st, 2017 9:55 pm
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Post elective laser eye surgery discussion

I wanted to create this thread for people who have already had a form of laser eye surgery, as the other thread seems to be a more generalized discussion and many of the questions revolve around which procedures/clinics people would recommend and what the processes are.

The purpose is for ongoing care, and future concerns.

As a helpful reference, I believe the following details to be worthwhile (but not necessary) when discussing concerns, side effects, satisfaction, etc.:
- type of procedure (LASIK or PRK being the most common, but also whether there was keratome, femtosecond laser, manual epithelium removal, all-laser, etc.)
- year of procedure
- characteristics of eye before/after (depth of correction, astigmatism, pupil size, etc.)
- any other physiological traits, e.g. age group, tendency for scarring, relevant diagnosed conditions, etc.
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So, as I have talked about in the other thread, I had successful transPRK with SmartSurface on the Schwind Amaris 1050rs in Vancouver in January 2017. I am extremely happy with the procedure.

However, there still seems to be very minimal information when it comes to rates of dissatisfaction, regression, side effects, etc. The reality is that anyone who undergoes laser eye correction has had a physiologically altered cornea, and the long-term side effects are mostly unknown (with new ones coming to the fore as the decades pass.)

http://rksurvivors.com/hype/rk-hype.html

In the above link are ads for the older non-laser elective eye surgery of the 1980's and early 1990s (RK = radial keratotomy) before laser-based ablative techniques such as PRK and LASIK mostly took over the field. The overpromising and the under-reporting of potential serious side effects does not seem to be much different from the marketing we have today.

The most striking was the ad someone preserved from Dr. Yair Karas' practice right here in the GTA. I would guess the year of publication to be 1993-1994 based on his reference to PRK as roughly a 7-year old procedure of the time. His practice was later sued by patients who felt that he ruined their vision without adequate warning of the risks of RK, although I have read of a few patients who thankfully experienced few drawbacks and were able to enjoy their good vision for 25-30 years.

I browsed the site and it seems that many of the early patients who jumped at the opportunity seem to be having earlier than average onsets of cataracts vs. the general population. I am not an expert on the epidemiology but cataract surgery seems to be something that people undergo in late 60's and older. If I estimate that the average age of people who underwent PRK in the 1990's to have been, say, 40 years old...those early PRK adopters might be entering cataract age just now. So in the next decade or so will we see whether PRK or LASIK potentially increases the risk of earlier cataracts.

The biggest factors for cataracts is age and smoking, as far as I could read about it. However, trauma and UV radiation also seem to be potential causes. I consider PRK and LASIK to be intentional, controlled trauma that may possibly cause increased risk of cataracts (or premature cataracts before the age of 65?), and as our corneas are now thinner, we should all be vigilant about protecting our eyes in high-UV conditions for the rest of our lives--not unlike regular people but especially more important for us.
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The other thing, too, is that some early RK, PRK, LASIK patients, as they begin to have other necessary eye surgeries, are finding that the clinics or clinicians who did their elective eye surgeries 20-30 years ago are now closed, or sold their medical files to places that cannot provide exactly what was done on their eyes.

This is making me wonder if I should request my surgical details be provided to me now...
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Oct 6, 2015
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@peanutz , one of the claimed side effects of steroid therapy (associated with PRK, but also prescribed for other inflammatory eye conditions) is early induction of cataracts.

In the 1990s, for example, PLEC claimed:
For best results, steroid drops must be taken several times daily with gradually decreasing frequency for four to eight months
For my surgery (same stats as yours) in 2017, I was on prescription steroid drops for two months. So less exposure to steroid-related cataract risk as someone treated in the 1990s.

Additionally, the steroids themselves used today might be lower in dose and strength. For instance, fluorometholone 0.1% is perhaps less strong than what was used in the 1990s.

Maybe people who get refractive surgery just have lifestyles that are inherently higher-risk for cataracts. For instance, dehydration is an alleged risk factor for early cataract formation. Maybe people who undergo LASIK/PRK travel more to hot places, drink more, smoke more, and get dehydrated more often?
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burnt69 wrote:
Oct 31st, 2017 4:02 pm
@peanutz , one of the claimed side effects of steroid therapy (associated with PRK) is early induction of cataracts.

In the 1990s, for example, PLEC claimed:

For my surgery (same stats as yours) in 2017, I was on prescription steroid drops for two months. So less exposure to steroid-related cataract risk as someone treated in the 1990s.

Additionally, the steroids themselves might be lower in dose and strength. For instance, fluorometholone 0.1% is perhaps less strong than what was used in the 1990s.
These are both very good points. Now we have shorter, better evidence-based durations of steroid therapy, and FML is indeed a milder topical ophthalmic steroid.

The idea also came about when I came across this study:
https://www.ncbi.nlm.nih.gov/pubmed/27163615

Here is another one posted on the lasikcomplications site:
https://www.ncbi.nlm.nih.gov/pubmed/26703483

But, it could just be a correlation...that people who need corrective eye surgeries have other developmental/nutritional/genetic characteristics for somewhat earlier cataracts risk.

Just brainstorming here. Along with reports of very late-onset haze following equatorial vacations (1 year after PRK), I'm trying to encourage my brother to protect his eyes on sunny days, and keep up adequate vitamin C/general good nutrition.

PRK nerve healing is estimated at 2 years, and LASIK is ~5 years. So even after the early stages of healing, we do need to care for our eyes on an ongoing basis.
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The interesting point I read from that study was:
These patients had preoperative CDVA similar to those of patients without previous corneal refractive surgery but were younger and were at higher risk of worse postoperative CDVA, especially if they had preoperative CDVA of logMAR 0.0(6/6) or better.
Basically put, the suggestion is that people who are 20/20 (ie: because of LASIK/PRK) may have cataract surgery, but emerge with potentially poorer vision than when they started.

I theorize this issue could be due to:

a) Problems in calculating the IOL power in post-refractive surgery patients when lensectomy/IOL implantation occurs. Hence, the possibility of 'refractive surprises'. There's been a lot of research done and the calculations are apparently much better these days and should continue to improve as experience grows.

b) Wavefront-guided abberometry-based laser refractive surgery attempting to neutralize lens abberations on the cornea, leaving an abberated cornea which interferes with a 'neutral' artificial lens post-lensectomy/IOL implantation. Topography-guided ablation (ie: T-CAT or Corneal Wavefront) only treats corneal abberations at the time of refractive surgery and hence leaves a truly 'neutral' cornea with no induced abberations to cancel out lens abberations.

c) A higher propensity of post-refractive surgery patients to choose multifocal lenses which sometimes don't produce 20/20 vision (compromising far for near vision), and are very sensitive to centration of the implant as well as centration of the prior laser refractive surgery. Corneal asphericity is affected by excimer laser surgery, and IOL implants may be engineered to work best with corneas that have virgin levels of asphericity. There have been claims that wavefront optimized and topography-guided surgeries preserve corneal asphericity (ie: prolateness) better than older generation platforms that tend towards creating an oblate cornea. So patients treated on such 'modern' platforms may fare better.

So lots of research questions to be resolved. I hope they get it all 100% sorted in the next 30 years. Or better yet, come up with a cataract-preventing drop so I never need more surgery :)

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