[gei]

I agree with TheProfessor. Having permanent surgery performed on your eyes is one thing you don't want to cheap out on. Unless there's a premium for the doctor's reputation but an identical procedure can be done elsewhere for less by a less known but competent surgeon, I would go with the more expensive option.

As I've mentioned, we're talking about clinics using IDENTICAL techniques. Heck many of them are using IDENTICAL lasers. And these are doctors who have performed over 50,000 surgeries each.

The sad thing I've found with lasik research, is that even given the above circumstances, people will often simply choose the most expensive option and assume it's the best. Which ultimately, is nothing but ignorance.

 

[gei]

If a cornera is not thick, most surgeons will prefer the patient have a touch up via PRK.

If the cornea isn't thick you may not have been the best candidate for LASIK to begin with.

As I said before, I have never heard of a patient doing touch up with PRK. Do a search for follow-up stories and you'll see that 90% of them were also done with LASIK. IMO if your cornea was so thin that a follow up with PRK is necessary, then I would have been hesitant to do LASIK in the first place. Chances are you and your brother both had thin corneas (this usually runs in the family). Being "well within the allowable limits" is a very broad statement. Some doctors are fine with 250 microns being left... some prefer at least 400. As you can see there is a major difference.

And therein lies the problem with laser eye surgery.. using MetroMan as an example... people assume these "most expensive" doctors are experts (which they are) and will give them the best advice. As I've said, ultimately it is a business, and they are still out to get your money. They are giving you a biased opinion.

It's quite possible in fact that the "less expensive" doctor would rather have at least 400 microns of corneal tissue left.

After lots of research, and knowing that PRK is a long and painful process, and knowing that I have a 15-20% regression rate, if my only option for a follow-up was with PRK, I might not have made the choice for laser eye surgery in the first place...

 

[MetroMan]

I've been reading up on this in preparation for a possible surgery in 2 years and I chose to also read the bad stories.

I found that the flap that is cut never truly heals. In fact, if you need a touch up, they'll go in and open the flap without having to cut again. Is this true? The places that mention the flap cut to be permanent talk about how this leaves the eye open to infections.

At first, I would think that the tissue would reconnect but given how stable an eye is from birth (it doesn't grow and remains mostly the same throughout life not withstanding deterioration), I'm inclined to believe that the flap is indeed left cut.

 

[gei]

I've been reading up on this in preparation for a possible surgery in 2 years and I chose to also read the bad stories.

I found that the flap that is cut never truly heals. In fact, if you need a touch up, they'll go in and open the flap without having to cut again. Is this true? The places that mention the flap cut to be permanent talk about how this leaves the eye open to infections.

Dude... seriously? Or are you being sarcastic? You think the flap just sits there? How much research could you possibly have done???

Here's some good info:

http://www.usaeyes.org/lasik/faq/lasik-flap-heal.htm

During this period collagen slowly begins to form at the interface between the flap and the underlying stromal bed. This collagen includes fibril infiltrates that extend from the flap into the stromal bed, in effect suturing the flap to the underlying stromal bed. At the conclusion of this process the flap is both "glued" and "stitched" into place, as well as "sealed" and secured by the surface perimeter epithelium and basement membrane. Although still not as strong as an untouched cornea of the same thickness, the flap and stromal bed are nevertheless now very securely bonded together. At this time, any trauma strong enough to dislodge the flap would also do damage to an eye without Lasik.

So no, it never truly heals to be the exact same was it was before... but it's more than sufficient.

Bear in mind a lot of stuff you read online (or even in medical journals) gets out of data very quickly. For example, there was a point in time where laser-created flaps were considered "superior"... but with recent advances in microkeratome technology, this advantage has been pretty much negated:

Newer blade machines have been introduced in 2008 and 2009 that cut thinner flaps to compete with the thin femtosecond laser flaps which should benefit from the better healing seen in sub-120 micron flaps

Some of the stories you are reading are probably from people ages ago who had very thick flaps cut.. using much older technology.

 

[MetroMan]

Dude... seriously? Or are you being sarcastic? You think the flap just sits there? How much research could you possibly have done???

It's a common claim which is why I'm inquiring about it. The claim is that the flap is kept in place by suction maintained by liquid under the flap. There are stories about the flap dislodging due to accidental pokes, makeup brushes, airbag deployment and other types of trauma.

Further, because 70% of nerves are severed from the flap cut, it's said that this affects the production of tears resulting in persistent and sometimes permanent dry eye syndrome.

I'm taking my time to listen to different perspectives, including the negative ones. My eyes are the only ones I'll ever have so I'll be damned if I gamble them by ignoring negative opinions.

 

[gei]

No offense.... but I think you need to do a little (actually make that a LOT) more research.

Yes, the flap is kept in place by suction maintained by liquid under the flap, but that is only the case immediately after the surgery. This is why it's important not to rub your eyes during the first couple of days. It would take a little more than applying eye makeup to dislodge it. I'm only 7 days or so post-op myself and my flap is secure... if I was a woman my doctor would have advised me it's fine to apply eye-makeup and such. I'm still not supposed to rub my eyes vigorously , but I can (and have) rubbed them lightly (ie in the shower), and it's no big deal.

Flaps can under extreme circumstances become wrinkled if you rub your eyes right after surgery (bearing in mind it would take a good deal of force)... or an extreme case you mentioned, like being poked in the eye, or an airbag deployment (again, within a day or two after surgery). But this can be corrected relatively easily with a follow-up procedure... it's nothing too serious.

The severed nerves heal, and rather rapidly. I had dry eyes (expectantly) for about 1-2 days after surgery. Now my eyes are pretty much exactly as they were before. Except of course now I have better than 20/20 vision.

 

[MetroMan]

No offense... but it seems that you haven't done sufficient research before getting the surgery. In fact, the flap is adhered but "trauma or surgical instruments can still dislodge or lift the flap" even at over a year after surgery. Only after 180 days does the flap begin to become an integral part of the tissue surrounding it, although it never returns to its previous strength.

This is not very important in practical purposes for most people but it is in fact a concern to anybody participating in extreme physical sports and activities such as skydiving where the force of wind can dislodge a flap well after surgery.

Like I said before, it's important to read about the possible negative aspects of this surgery. Ignoring them won't be helpful if you fall into a high risk category and don't tell your doctor because you don't know that it's important.

 

[gei]

No offense... but it seems that you haven't done sufficient research before getting the surgery. In fact, the flap is adhered but "trauma or surgical instruments can still dislodge or lift the flap" even at over a year after surgery. Only after 180 days does the flap begin to become an integral part of the tissue surrounding it, although it never returns to its previous strength.

This is not very important in practical purposes for most people but it is in fact a concern to anybody participating in extreme physical sports and activities such as skydiving where the force of wind can dislodge a flap well after surgery.

Like I said before, it's important to read about the possible negative aspects of this surgery. Ignoring them won't be helpful if you fall into a high risk category and don't tell your doctor because you don't know that it's important.

Believe me I've done more than sufficient research. In fact you are quoting an article I pointed out to you in the first place. I am fully aware of the length of time it takes a flap to heal. And I am a big sports guy. Which is why for the next 6 months I'll be wearing protective glasses while playing sports. Not a big hassle and 180 days is not so long. I'll probably avoid skydiving for a year as well (this is not a major concern for me).

 

[MetroMan]

I'm glad that I've waited before considering this. What compelled me to wait was that it's only been around for about 20 years so nobody knows what the long term effects are. Secondly, I felt that the procedure will eventually be perfected and become so routine that contact lenses and even glasses will become relics.

A new procedure is beginning to gain steam: Epi-Lasik or Surface-Lasik. The flap that is created in this new method is on the top most layer which regenerates completely every 3 weeks. The downside is that recovery takes a few days, rather than seeing immediate results but your eyes return to exactly as they were before the surgery -- except for now having perfect vision -- so any possible complications are almost completely removed.

With the advances in the last few years, I think that when I'm ready to get this done in 2 or 3 years, it may be possible to simply sit in front of the laser device and have the procedure done without any cutting at all.

 

[gei]

I'm glad that I've waited before considering this. What compelled me to wait was that it's only been around for about 20 years so nobody knows what the long term effects are. Secondly, I felt that the procedure will eventually be perfected and become so routine that contact lenses and even glasses will become relics.

LASIK has been around for more than long enough to understand the long-term effects. Similar procedures (corneal surgery) have been done since the early 1950s.

A new procedure is beginning to gain steam: Epi-Lasik or Surface-Lasik. The flap that is created in this new method is on the top most layer which regenerates completely every 3 weeks. The downside is that recovery takes a few days, rather than seeing immediate results but your eyes return to exactly as they were before the surgery -- except for now having perfect vision -- so any possible complications are almost completely removed.

People keep saying this. However Epi-Lasik/LASEK is just a more refined version of PRK. It's NOT something that will eventually "replace" LASIK. You don't want people to have to deal with weeks of recovery time for such a trivial operation.

With the advances in the last few years, I think that when I'm ready to get this done in 2 or 3 years, it may be possible to simply sit in front of the laser device and have the procedure done without any cutting at all.

It already is. Sit down, laser creates flap, laser trims cornea, and you're done.

 

[ceaz40]

Google the Hamilton Laser Eye Institute....it's on Upper Wentworth (on the mountain) in Hamilton. I had gone to the Bochner and was quoted $4500. I then spoke with a few people who had it done in Hamilton. I went out for the consultation etc. and had it done.....no problems whatsoever. Great staff. $3000. all in.

 

[SP!RE]

It's a very safe procedure. To argue otherwise is to be in utter denial given the positive reports on the matter.

That said, I think the Herzig Institute is as good as it gets with laser eye surgery

 

[andrewz]

Here what i found -> laser eye surgery

 

[Bayer]

I haven't read the whole thread, but one important thing to remember is that your vision can change considerably with age. For instance, my shortsightedness appeared with I was 25, peaked at 35 and, at 46, is now very slight; additionally, both of my eyes are not changing in the same way. Someone I know had the lasik done and was without glasses for a while, but then her vision changed and she had to get glasses again, on top of losing some of her night vision.