My eyes!

[fernj1975]

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Has medical school ruined my eyes? I had absolutely perfect eyesight before starting med school and now I'm freaking nearsighted. This is truly disheartening. I feel as if I have aged considerably along with my thinning hair. All of this has occurred since starting medical school. I wonder if it's possible to survive medical school with intact eyesight? Not only did I just spent $300 on getting a pair of glasses but I have to somehow come to grips with the fact my eyes are not what they used to be.

 

[Jaded Soul]

Consider yourself lucky if you made it to med school without becoming nearsighted earlier. It's not the end of the world. You'll learn to live with it.

 

[Buck Strong]

Yeah, i can't see crap anymore, I'm considering moving to the front in lecture, but that would make me an even bigger dork....definitely getting laser eye surgery at some point...

 

[Galaxian]

How much does lasik cost nowadays. I am soooo ready to have it done. I'm sick and tired of contacts, especially when you get drunk and fall asleep wearing them, and then they get melted onto your eyeballs! And don't get me started with glasses. Man!

 

[Buck Strong]

about 3k-5k i think, you can find cheaper ones, but from what i've heard, they pretty much practice on you, or have older equipment

 

[jbish]

Hold out for the lasik until you have your M.D.....lots of docs offer "doctor discounts." My mom got a discount on her lasik and recent plastic surgery. Good times!

 

[ItsGavinC]

Originally posted by Buck Strong
about 3k-5k i think, you can find cheaper ones, but from what i've heard, they pretty much practice on you, or have older equipment

Probably not that much, if you do your homework. You can find a reputable doc who has done LOTS of procedures, and only charges $600-900/eye if you search around a bit.

If money is really tight, then make a small vacation out of it.

For example, I had a friend who found a great doc in San Diego, so he flew out there to have the procedure done. Roundtrip airline tickets were only $68 for him, and he had the procedure done for cheaper than anything in the local area. Most comforting to him, however, was the state of the equipment and the sheer number of procedures that the clinic had performed, as well as the rate of complications, etc. following the procedure.

 

[Docgeorge]

The only bad thing I hear about lasik you end up with halos (a possible complication of lasik) you can kiss your surgery career good bye.

 

[Caffeinated]

Dear refractively challenged med students,

Trust me, you are not alone in your adult onset myopia. My credentials: 4 years of optometry school, optometrist x 3 years, now a first year med student.

The big question that most people with adult onset myopia ask is "did studying ruin my eyes?" The answer is "no, not really." There are 2 components to the nearsightedness that you are experiencing:

1. First, the ciliary muscle (the smooth muscle that controls the shape of the crystalline lens) can go increase its tone (or a spasm) after you spend lots of hours behind the books. This is called pseudomyopia. Eventually this relax itself back to a normal state. You can take measures to prevent this spasm by taking visual breaks (sometimes called "visual hygiene") or by wearing reading glasses. The reading glasses reduce the amount of work that the ciliary muscle must do, thereby preventing the spasm. But reading glasses are not a panacea; with certain visual conditions it can make eye strain worse.

2. True myopia is an increase in the axial length of the eyeball. Can excessive near work cause the eyeball to actually grow? Yeah, maybe, probably. This doesn't happen to everyone, but some people seem to be predisposed to it. Does this mean that you will end up with coke bottle lenses? Not likely. Adult onset myopia usually doesn't progress like the childhood type.

Those of you who are now a little nearsighted probably have one or both of these mechanisms in play. After the first few years of med school are under your belt, the pseudomyopia component will likely dissipate. Most refractive surgeons won't touch you until your refraction is stable for at least a year or two.

Keep in mind that this advice should not substitute for the advice of an eye doctor who has actually examined you.

 

[driedcaribou]

Wow Caffeinated.. thanks for the highly informative post.

Do you know anything about Laser PRK?

 

[Caffeinated]

There are 2 main "flavors" of refractive surgery being done today: LASIK and PRK. There are other procedures and technologies in the works, but these 2 are the most popular these days. Both procedures involve using a laser to ablate corneal stromal tissue to alter the corneal refractive power. The difference between the 2 procedures is how you get access to the stroma. LASIK involves creating a hinged flap of tissue, and the flap is replaced after the laser work is done. As you can imagine, this corneal flap sort of serves like a "living bandage." The healing time for LASIK is quicker and less painful than PRK. In PRK the stroma is exposed by creating an abrasion that removes the epithelium. After the surgery, the abrasion re-epithelializes. This can be quite painful. The spectrum of pain that patients have reported to me range from a mild "annoying gritty feeling" up to "this is worse than childbirth" pain.

Some patients are candidates for both procedures, some are only candidates for one or the other (and some people may not even be a candidate for refractive surgery at all). Each procedure has it's own risks. There is some evidence to suggest that the flap created in LASIK is susceptible to being dislodged months to years later by shearing forces (e.g., a twig or finger in the eye), whereas the re-epithelialized lesion in PRK is thought to be more tightly adhered.

Keep in mind that I am not a surgeon, and I have not kept up on the latest info as much over the last few months. Nevertheless, I hope this helps.

 

[driedcaribou]

I've read up on LASIK and PRK and know the information you've written but thanks for taking the time to write down and share what you know.

It was my understanding that most PRK is done by the surgeon scraping away the epithelium first before using a laser to burn away the cornea... I could be wrong though which is why I'm asking.

I am curious if using a laser to take away the epithelium and cornea is now standard practice because I know some places locally that do that and my friends who have gotten it done are quite happy with the surgery.

 

[Caffeinated]

Yes, there are several ways to remove the epithelium before doing the stromal ablation (laser, mechanical, etc). As for the intricacies of which is best, I cannot say. A surgeon would be the best person to ask about this.

Best of luck!

Originally posted by driedcaribou
I've read up on LASIK and PRK and know the information you've written but thanks for taking the time to write down and share what you know.

It was my understanding that most PRK is done by the surgeon scraping away the epithelium first before using a laser to burn away the cornea... I could be wrong though which is why I'm asking.

I am curious if using a laser to take away the epithelium and cornea is now standard practice because I know some places locally that do that and my friends who have gotten it done are quite happy with the surgery.

 

[driedcaribou]

Originally posted by Caffeinated

Best of luck!

Heh, I should've mentioned that the surgery's already been done on me. 😉

It isn't perfect but I didn't expect it to be given how poor my vision was before.

But thanks anyways! 🙂


Vision in dim light isn't as good anymore.

Hope it doesn't affect me as a doctor.

 

[Galaxian]

Hey caffeinated, thanks for all the info man!

I HAD to ask...do you wanna be an ophthalmologist?

 

[carrigallen]

well...I will not add much to what others have already said, except for this:


They often do not recommend performing PRK/LASIK for persons under the ages of 25, since your prescription may still be changing.

 

[Finally M3]

Thank God for featherweight lenses...or I would be wearing coke bottles.

My prescription increased by -2.0 both sides. Whoopee!

PS They are offering LASIK for around $500-800/eye in the SE Michigan/Windsor area...lots of eye docs in the area have been performing it for a while. Hell, you can even go to where Tiger got his done (Tayfour?, in Windsor, I think).

 

[driedcaribou]

I think one thing that I don't hear mentioned that often is that when you get much older, even if you get the surgery, you're going to have to use reading glasses eventually because of presbyopia.

Maybe that's just obvious? 😉

 

[Galaxian]

Just went to the opto's today, she tells me my prescription has increased by 0.75 diopters in 12 years. That's not too shabby apparently, but still, I'm depressed for my poor, poor eyes! No lasik for me just yet!

 

[Caffeinated]

Be careful with the term "much older." At age 30, early 40's suddendly doesn't seem that far off for me! Observe the reaction when you refer to a 43 yo patient as "much older" or even simply "old." They don't like that one bit. As for presbyopia being obvious, it's actually quite difficult to get the non-medical public to understand presbyopia. You don't know how many times I have tried to explain to pre-presbyopic patients that they will need reading glasses in a few years, and they don't believe it.

Originally posted by driedcaribou
I think one thing that I don't hear mentioned that often is that when you get much older, even if you get the surgery, you're going to have to use reading glasses eventually because of presbyopia.

Maybe that's just obvious? 😉

 

[driedcaribou]

Originally posted by Caffeinated
Be careful with the term "much older." At age 30, early 40's suddendly doesn't seem that far off for me!

Oops. Sorry if I offended. You have an excellent point that I will keep in mind.

What is a better term I could use to describe 'older' patients?

 

[indiamacbean]

It's sort of a joke among my friends that med school is making us go blind as we've pretty much all moved to the front of the lecture hall. Anyhow, I was thinking about getting reading glasses to hopefully reduce the pseudomyopia that Caffienated describes. Can I get reading glasses on my own or should I go see an optho? if on my own, should I get a low strength lens? my eyesite was excellent at the begining of school and now am having trouble with my long distance vision. cheers.

 

[Caffeinated]

Originally posted by driedcaribou
Oops. Sorry if I offended. You have an excellent point that I will keep in mind.

What is a better term I could use to describe 'older' patients?

Heh, heh, don't worry. You haven't offended me. I was just passing along a lesson that I have learned from dealing with middle aged folks. In all seriousness, though, people tend to have some anxiety about reaching their 40s. By today's standards, 40 is still pretty young, but people still have some anxiety about it. It may not be readily obvious, and they may joke about being "over the hill." Being a young guy who tends to look even younger than my actual age, I try to remain sensitive to the fact that the 40 somethings don't want to feel "old." So when I explained presybopia to patients, I would simply say "this happens to everyone in their early to mid-40s."

 

[Caffeinated]

Originally posted by indiamacbean
It's sort of a joke among my friends that med school is making us go blind as we've pretty much all moved to the front of the lecture hall. Anyhow, I was thinking about getting reading glasses to hopefully reduce the pseudomyopia that Caffienated describes. Can I get reading glasses on my own or should I go see an optho? if on my own, should I get a low strength lens? my eyesite was excellent at the begining of school and now am having trouble with my long distance vision. cheers.

Technically speaking, you can purchase reading glasses over-the-counter. However the symptoms of blurred vision and eye strain are not specific to the pseudomyopia phenomenon I described. I suggest you have an eye exam from an optometrist or ophthalmologist. You may be wondering "should I seen an optometrist or an ophthalmologist." Well, you could go to either one, as this is one of those things that falls within the scope of either professions. The emphasis of the training for an optometrist is on anomalies of refraction, whereas the emphasis of the ophtho's training is on ocular pathology. Keep in mind that this is a generalization. In short, I'd start with the optometrist.

 

[Caffeinated]

Originally posted by Galaxian
Hey caffeinated, thanks for all the info man!

I HAD to ask...do you wanna be an ophthalmologist?

With my background, I get this question a lot. Ophtho is in my top 3 choices, but as a first-year med student, I haven't had much of a chance to rule out other specialties yet. I think I will know better after I have experienced other specialties. It would seem like a natural progression to go into ophtho, but I am keeping an open mind at this point.