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Lasik Eye Surgery Message Board


Lasik Eye Surgery Board Index


Hoots,

"Corrective" is an extremely vague term. You need to find out for sure what procedure the doctor is talking about. Since he mentioned "glare" and "trails", he is talking about higher-order aberrations of the eye. So most likely the procedure he is recommending is "wavefront-guided" (aka "custom wavefront") PRK. If you get bored reading the next few paragraphs, skip to the end....

The term "higher-order aberrations" (HOA) refers to the way the optical properties of the eye are modeled mathematically with Zernike polynomials. If you look up this term you will see it pictured like a pyramid. At the top are the lower-order aberrations, which are relatively simple and are what conventional glasses and contacts correct for. Below the first three rows are the higher-order aberrations, which become increasingly numerous and complex; they [I]cannot[/I] be corrected by conventional lenses. They have names like coma, spherical aberration, and trefoil. For example, when your doctor mentioned "trails" he could have meant coma (the term refers to a comet-like appearance, i.e. seeing a "tail" coming off of bright objects).

All eyes naturally have a certain amount of HOA because no cornea has a perfectly smooth, regular surface. Wavefront-guided (WFG) procedures attempt to analyze the HOA to provide a more detailed and precise map of the eye to guide the laser correction. In principle, WFG can be used with any excimer laser refractive surgery (Lasik, PRK, LASEK, etc.). WFG [I]may[/I] improve these naturally-occurring HOA. However, when you look at the medical literature, the doctors are really saying that WFG [I]may[/I] reduce existing HOA and [I]may[/I] induce [I]less additional[/I] HOA. So you could still end up with more HOA after WFG.

The bottom line is that even though WFG is superior in theory, in reality there are many factors that can compromise your outcome. These include:
(1) Accuracy of the wavefront scans. How advanced is the aberrometer being used? How well is it calibrated? Is every effort made to ensure optimal scan conditions, which include precise alignment of the aberrometer to the eye and discarding results when you move your eye or blink? Most likely the doctor has delegated these tasks to a staff person with no medical degree - how much do you trust that person to perform an excellent job?
(2) Repetition and stability of the wavefront scans. The eye is a living organ and changes to its aberrometry can occur from day to day. How many quality scans have been taken? What is the variation between them? If they are averaged together, will the result truly be a "best fit" for your eye?
(3) Healing of the individual eye. Every eye responds differently to the laser and heals differently afterward. The surgeon uses a "nomogram", which means that s/he makes assumptions about how your eyes will respond depending on your age, sex, prescription, HOA, and even the temperature and humidity of the operating room. These are statistical assumptions and may correspond very well, or may not, to your individual response. This is why advertisements guaranteeing 20/20 vision are fraudulent. Indeed, after your own surgery, your results will be factored into the nomogram in an attempt to improve its accuracy.
(4) Surgical complications. These are simply too numerous to mention.

I had WFG Lasik in my left eye and WFG PRK in my right eye in May 2011. The procedure was performed by my regular ophthalmologist, who is board certified, has been involved in refractive surgery for 15+ years, and has contributed to numerous medical articles and books. I had no surgical complications, but eight months later I still have halos, starbursts and ghosting, and they have not improved in seven months. True, at my last exam both of my eyes were 20/15, but there was a big f****** streak of light coming off the bottom of the eye chart, as wide as the chart and perhaps a quarter of the height. I do not call that success.

Let me show you how the money adds up:
$3,400 - Surgery
$1,500 - Medical texts on ophthalmology, eye optics, corneal topography, and refractive surgery (for research)
$ 410 - Second opinion on the outcome of my surgery and the benefits/risks of an enhancement (this is for two hours of consultation only)
$ 230 - Pair of iZon custom wavefront-guided eyeglass lenses, to see if this will correct my HOA (not including cost of frames)
$ ? - Pair of custom wavefront-guided contact lenses (if the iZon lenses don't work)

So that's at least $5,540 for now, the vast majority not covered by insurance. Please keep in mind that like you, I thought I was getting the most advanced procedure from an excellent surgeon. My HOA are not so bad that I can't drive at night, but they are very noticeable, upsetting and bothersome. I can't enjoy seeing the city at night anymore. I work in film industry post-production, in a dark environment, so the HOA are quite noticeable and bothersome there as well. I have a difficult time enjoying movies anymore (yes, the Lasik brochure never tells you that halos and ghosting will also occur with reflected light, such as a movie screen or road sign). Some HOA are still visible in broad daylight, by the way (just not as prominent), which the Lasik brochure also won't tell you. I will go back to wearing glasses or contacts in a heartbeat if these WFG lenses work. If not, I don't know what I'll do.

If you are still going to go ahead with the surgery, wavefront-guided PRK is in my opinion the only option. PRK offers several advantages to Lasik. The only disadvantages I've been able to find are:
(1) Removal of the Bowman membrane of the cornea - I still haven't been able to figure out if that's significant or not, but it certainly seems preferable to the Lasik flap, which severs the corneal neurons and creates a structural weakness in the cornea which may be permanent. There are cases of Lasik flaps getting dislocated after trauma as long as seven years post-surgery.
(2) Small risk of corneal hazing in the months after surgery - vitamin C is thought to help prevent corneal hazing, and you should avoid smoking, which depletes vitamin C.
(3) Longer recovery time and more discomfort. Expect pain and an inability to keep your eyes open during the first few days. Depending on the healing time of your epithelial defect, you should plan on not leaving your house on your own for several days and not driving for 1-2 weeks. And if that makes you too impatient, just imagine living with vision problems for the rest of your life....





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