Your thoughts on Laser Eye Surgery

[backrow]

I am currently an MS3 who can get corrective surgery done for free (I'm in the military). I am wondering what all of you think about having either LASIK or PRK done at this stage of my medical training and your thoughts of the PROS/CONS of the various procedures.

I have visited two civilian surgeons in the past (I was thinking of paying for it myself) and both have said I am a good candidate.

Some Hx:
Prescription: -5.5 diopters (not sure if that's the correct terminology)
Currently wear Focus Night and Day contacts (wear them for thirty days straight and then toss them)
I love these contacts compared to the others I have had in the past due to the ease of use and no taking in/out at night.

Any thoughts you have would be greatly appreciated and if you could include your level of training in your response that would help me gauge the credibility of the answers. Thank you.

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[glacayo]

First thing I would do is NOT wear your contacts for thirty days straight.
I hope your not sleeping in them.
We need to know your corneal thickness, pupil diameter and have your cornea scanned.

there are many factors to consider before refractive surgery...

find out some of that info and then we can talk

Stones

MD
PGY3

 

[JudoKing01]

Now I'm no opthalmologist, lol....but I know people who have contacts where you are supposed to wear them for 30 days straight. That's what my optometrist told me anyway. Is that not true?

 

[VA Hopeful Dr]

First thing I would do is NOT wear your contacts for thirty days straight.
I hope your not sleeping in them.

It was my understanding the the whole point of Focus Night and Day's was their ability to safely be worn for a solid month without taking them out. Possibly due to the comparitively astronomically high Dk value, I wouldn't know.

Not qualified to give any advice about laser, just thought I'd throw that little bit in there.

 

[backrow]

First thing I would do is NOT wear your contacts for thirty days straight.
I hope your not sleeping in them.
We need to know your corneal thickness, pupil diameter and have your cornea scanned.

there are many factors to consider before refractive surgery...

find out some of that info and then we can talk

Stones

MD
PGY3

So you're saying even though Focus advertises these as to be slept in for thirty days straight I shouldn't? My understanding was they had a crazy high oxygenation level or something (I really need to learn the terminology for this field). I have been in these for over a year now without any problems. (In fact these contacts are probably the only reason I haven't had the surgery yet)

As for the other things. I'll have to get my medical record from the base, I had my corneas scanned (at least I think I did) by my optometrist at home. The result was a color picture of my eyes with varying levels of thickness shown (is that what you're looking for?)

Thanks for your response, but in all honesty I wasn't necessarily looking for specific advice for me, although that would be great too. I was more looking for general thoughts on the different procedures and whether the risks are too high and side effects too great.

I was under the impression that alot of opthalmology residents were waiting until after they completed residency b/c their own fear of possible bad outcomes and the loss of the ability to practice medicine. Has anyone heard this too?

 

[Redhawk]

"I was under the impression that alot of opthalmology residents were waiting until after they completed residency b/c their own fear of possible bad outcomes and the loss of the ability to practice medicine. Has anyone heard this too?"

I know I feel that way, but ophtho is one of the few specialties where very sharp vision is necessary. A "successful" procedure with a 20/40 outcome would be pointless because I'd have to wear glasses/contacts anyway. If I were going into something less visual, such as internal medicine, I might consider it.

Just curious, if you love your current contacts so much, why plop down the money and take the risk (however small) of a surgical procedure? Btw, I don't have specific stats, but while the silicone hydrogel lenses can be worn for extended periods of time, it does increase your risk for bacterial keratitis and ulceration to some extent as you might imagine. I'm getting ready to switch to those lenses but will most likely take them out each night unless I'm on call.

MD, soon to be pgy-2.

 

[backrow]

I know I feel that way, but ophtho is one of the few specialties where very sharp vision is necessary. A "successful" procedure with a 20/40 outcome would be pointless because I'd have to wear glasses/contacts anyway. If I were going into something less visual, such as internal medicine, I might consider it.

Just curious, if you love your current contacts so much, why plop down the money and take the risk (however small) of a surgical procedure? Btw, I don't have specific stats, but while the silicone hydrogel lenses can be worn for extended periods of time, it does increase your risk for bacterial keratitis and ulceration to some extent as you might imagine. I'm getting ready to switch to those lenses but will most likely take them out each night unless I'm on call.

MD, soon to be pgy-2.

1. Good point on the 20/40 "success". I'm leaning towards a surgical subspecialty, so I'd probably have to wear glasses too if that's what I ended up with.

2. Only reason I am considering the surgery is because the military provides the surgery at no cost. They don't, however, cover the cost of contact prescriptions or the contacts themselves.

3.Another good point, I should probably start doing this too.

 

[scott McGregor]

1. Good point on the 20/40 "success". I'm leaning towards a surgical subspecialty, so I'd probably have to wear glasses too if that's what I ended up with.

2. Only reason I am considering the surgery is because the military provides the surgery at no cost. They don't, however, cover the cost of contact prescriptions or the contacts themselves.

3.Another good point, I should probably start doing this too.

Backrow--First, the Night and Day silicone hydrogels have been approved for 30 day wear. This is based on oxygen delivery (reduced risk of neovascularization). However all the inherent risk of infection, ulcers, edema, etc are still present. One is still always safer to remove them nightly....period. As to having LASIK eye surgery, it has shown itself to be a quite safe procedure, with extremely good visual outcomes. However, it is not without risk either. One of the main qualifers for having surgery is inability to wear contacts. If you are happy and comfortable in your contacts, (and with silicone hydrogel you have the option of occasional extended wear), to recommend LASIK is hard to do. I worked in a practice that has done more LASIK procedures than any practice in the US. I saw literally thousands of happy successful LASIK patients. However, I am a contact lens specialist (OD) connected to a corneal surgery group and I also have seen what happens when LASIK goes badly. Because the post-op cornea becomes oblate (flat or concave) instead of its normal prolate (convex) shape, fitting the post-op cornea with contact lenses requires very special reverse geometry lenses and outcomes are varied. Often the LASIK-gone-bad procedure creates irregular astigmatism that can only be visually fixed with gas-perm (hard) contacts. Granted the risk is very small, but it can be very hard to deal with bad outcomes. Risk is risk. Patients that I saw with 20/40 vision merely had an enhancement (repeat) LASIK procedure and got much better visual outcomes. Again the risk factor is that one must have enough corneal thickness after the first LASIK to have an enhancement procedure. Again though the risk is unbelievably small, can you accept the consequences if it goes badly when you are happy and comfortable in contacts now?? Remember that LASIK providers are very careful to offer a procedure that will "reduce your dependency" on glasses or contacts---noone ever says "eliminate" your need for glasses or contacts to achieve optimum vision. That said , I still recommend LASIK to any patient who is a good candidate AND is having problems wearing their contacts.