Getting LASIK/PRK during Residency?

[natrimestan]

Hi everyone, I'm going to be starting a radiology residency this upcoming summer. I have pretty terrible vision (~-10, -11) and have been wearing glasses for as long as I can remember. I had always dreamed of getting my vision corrected when I was able to. It's not so much about style or convenience, but the glasses are a lifelong burden that has gotten more expensive, thicker, and cumbersome over time and I genuinely cannot imagine dealing with it forever. After matching to radiology residency, I am more concerned that I will be taking too much of a risk with things like corneal ectasia, blurred vision, decreased contrast sensitivity etc. To top it off, a couple of the ophthalmologists I have suggested that I am not a good candidate (due to increased risk of ectasia), but other ones (equally reputable) have said it can be done. I don't know if I'm crazy for keeping the hope alive after all of that, but I just wanted to get some of your thoughts on whether I should consider any sort of corrective surgery during or after residency? Does anyone have any knowledge or experience of residents in any field who have done this?

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[Fascia Lata]

ICL (implantable collamer lens) is an alternative in cases not suitable for LASIK or other types of laser corneal refractive surgery. This is a phakic lens, meaning that it is a lens that is placed in the presence and on top of your natural crystalline lens. You can find many videos on youtube. It has a favorable safety profile, but still is an intraocular procedure. The problem with laser vision correction in high prescriptions like yours is not only limited to risk of ectasia, but more commonly the poor quality of vision postoperatively, including night vision issues.

 

[OphthoApplicant04]

Have you considered contact lenses? A nice daily like Dailies Total 1 can be comfortable and give you sharp vision.

 

[krukenbergspindle]

Whether or not you are a good candidate probably comes down to how aggressive your lasik surgeon is. I've seen conservative surgeons and aggressive ones. The conservative cornea surgeons I know would not touch your eyes because of your high degree of myopia, which would require a larger, deeper ablation (look up Munnerlyn's formula) and leave a thinner residual stromal bed, leaving your cornea at risk of changing shape and causing irregular astigmatism over time. The more aggressive ones I know will freely operate on anyone as long as they have at least 250 microns of a residual stromal bed. The reality is this 250micron residual stromal thickness number is clinically derived and unviersally used but there are no prospective studies. PRK may be a better option because you would have a higher residual stromal bed. However, as a high myope, you are at increased risk of having decreased vision quality due to spherical aberration, decreased contrast sensitivity and impaired night vision.

Also, getting LASIK will not eliminate your need of glasses forever - possibly just for the next 10-15 years. We lose our ability to accommodate as the years go on, and most people notice the need for reading glasses in their 40s. As the decades wear on, your lens will continue to change in its refractive power, and there is a good likelihood that your prescription will then change again, and you will need additional refractive correction (glasses or contacts) as you develop cataracts.

Then there is the outsize risk of flap dislocation due to trauma, infection, epithelial ingrowth, worsened dry eye etc. As a futureradiologist, you will be looking at screens all day and almost certainly have dry eye already and it will worsen during residency as you look at screens more and as your eylid hygiene suffers. Sure, most people have good outcomes LASIK and PRK, and overall they are very safe procedures. But keep in mind that you'd be taking someone who is likely currently 20/20 and simply annoyed at glasses, and introducing the risk of ectasias and all the other complications above, for an effect that might achieve your goal of being glasses free for at most 20 years.

 

[long]

As long as you qualify for it, ICL is an excellent option and can give you excellent vision. Just find someone who does it regularly.