Ask the LASIK guy!

[benjamin801]

Hey, I know guitar playing is what unites us all here, but we all have lives outside of that - hobbies, jobs, etc. I figured I'd open up this thread to share some of my knowledge, if there's any interest out there.

My qualifications: I've worked in the eye care industry for over a decade, and for most of that time I've been at ophthalmology practices that specialize in LASIK and other vision correction surgeries. I'm currently a clinic director at a practice that's routinely named one of the top ten LASIK providers in the United States. While I myself am not a doctor, I know about as much about LASIK, cataracts, lens implants, and other similar surgeries as is possible without being one. I also had LASIK myself in 2007, so I have a patient's perspective as well. In addition, my wife is one of the nurses in our surgery center, so you get a double dose of knowledge here.

So, if there's anything you ever wanted to know about eye surgery but were afraid to ask, fire away! I'll give you the straight, unvarnished truth as far as I know it.

[sleewell]

do they drug you up good? i hate all things touching my eye, even eye drops, so being strapped down and a laser beam or scapel or whatever they use freaks me out.

what is the success rate now for a good dr? if it gets screwed up is it repairable or are you stuck like that?

[benjamin801]

do they drug you up good? i hate all things touching my eye, even eye drops, so being strapped down and a laser beam or scapel or whatever they use freaks me out.

what is the success rate now for a good dr? if it gets screwed up is it repairable or are you stuck like that?

All great questions!

LASIK doesn't use general anesthesia. They typically give you an oral sedative (e.g. Valium) in sufficient quantity that you are totally chill during the procedure and promptly take a four hour nap afterwards, which is by design. I have seen thousands of people have LASIK, including some people so anxious about their eyes that they can't even put in a contact lens, and the overwhelming majority do just fine on surgery day. Incidentally, there are no scalpels anymore in the modern procedure - every step is performed by a computer-guided laser.

Success rate for a good doctor depends on your definition of success. That sounds snarky, but it isn't meant to be. At my clinic, about 97% of patients are seeing 20/20 at the three month mark after surgery (which is generally considered the time frame after which you are "fully healed"). My clinic offers a money back guarantee if we can't get you to 20/25 or better within the first year, and we've never had to honor it. We also offer free touch-ups for life if your vision ever drops to 20/40 (which is the minimum you need to get a driver's license), and less than 5% of patients ever need to take us up on it. It's a pretty predictable and successful procedure these days.

Problems or complications with LASIK are generally repairable, or heal on their own given time, but if you choose your clinic carefully they are incredibly rare these days.

[rear naked]

sweet AMA thread

[sleewell]

cool, thanks Benjamin!!

[sloppy fingers]

I've been told I have thin corneas and my only option would be PRK. I don't have the corneal thickness number handy. How risky is Lasik on thin corneas? I'm a -8 or 9 with about a -1.75 cylinder in one eye.

[benjamin801]

I've been told I have thin corneas and my only option would be PRK. I don't have the corneal thickness number handy. How risky is Lasik on thin corneas? I'm a -8 or 9 with about a -1.75 cylinder in one eye.

Refractive surgery on thin corneas is definitely risky. PRK is safer because, by working directly on the surface rather than creating a flap, it's leaving between 100 and 150 microns of additional corneal tissue (out of an average of 500 microns to start with) undisturbed versus a LASIK procedure on the same person. In most cases, it's a moot point because most people have more than enough corneal thickness. However, with people with thin corneas (which I don't know if you have), high prescriptions (which you most certainly do), or a combination of the two, PRK can be safer. The long-term results from PRK are every bit as good as those from LASIK, but the recovery is longer and kind of painful, whereas LASIK is pretty much pain-free and the recovery is super fast.

PRK represents about 15-20% of our total laser surgeries, and it's a great option for patients like yourself who are not ideal LASIK candidates. If you were in my clinic, we might also suggest ICLs (implantable contact lenses) as an alternative. It's a little more expensive than LASIK or PRK, but it removes no corneal tissue at all, rendering your corneal thickness a non-risk factor for surgery, and it often gives even sharper vision than laser surgery can - it's popular with people like pilots, photographers, and competition shooters.

[ovid9]

I want LASIK. I don't want to pay for LASIK. What do?

Serious question though, is there any extra sensitivity to wind or air dryness long term?

I'm just asking because I'd love to be able to wear normal sunglasses while cycling and not worry about carrying other glasses around.

[sloppy fingers]

I've been told I have thin corneas and my only option would be PRK. I don't have the corneal thickness number handy. How risky is Lasik on thin corneas? I'm a -8 or 9 with about a -1.75 cylinder in one eye.

Refractive surgery on thin corneas is definitely risky. PRK is safer because, by working directly on the surface rather than creating a flap, it's leaving between 100 and 150 microns of additional corneal tissue (out of an average of 500 microns to start with) undisturbed versus a LASIK procedure on the same person. In most cases, it's a moot point because most people have more than enough corneal thickness. However, with people with thin corneas (which I don't know if you have), high prescriptions (which you most certainly do), or a combination of the two, PRK can be safer. The long-term results from PRK are every bit as good as those from LASIK, but the recovery is longer and kind of painful, whereas LASIK is pretty much pain-free and the recovery is super fast.

PRK represents about 15-20% of our total laser surgeries, and it's a great option for patients like yourself who are not ideal LASIK candidates. If you were in my clinic, we might also suggest ICLs (implantable contact lenses) as an alternative. It's a little more expensive than LASIK or PRK, but it removes no corneal tissue at all, rendering your corneal thickness a non-risk factor for surgery, and it often gives even sharper vision than laser surgery can - it's popular with people like pilots, photographers, and competition shooters.

Interesting,I work in a related field, servicing opthalmic equipment, so I'm fairly familiar with IOL's for cataracts and wondered about a similar procedure for regular refractive correction. I'm assumimg it's not too comon yet?

[benjamin801]

I want LASIK. I don't want to pay for LASIK. What do?

Serious question though, is there any extra sensitivity to wind or air dryness long term?

I'm just asking because I'd love to be able to wear normal sunglasses while cycling and not worry about carrying other glasses around.

Long-term dry eye is a possible post-operative complication from LASIK. Short-term dry eye is expected; it happens to just about everyone who gets LASIK, and it typically lasts 3-6 months. Past that, it's still possible but uncommon. If I had to venture an educated guess, I'd say 1-2% of patients find themselves needing drops for dryness past the one year mark. It used to be more common in the early 2000s when blades were still used in LASIK.

Being able to wear normal sunglasses is an awesome payoff from LASIK.

[benjamin801]

Interesting,I work in a related field, servicing opthalmic equipment, so I'm fairly familiar with IOL's for cataracts and wondered about a similar procedure for regular refractive correction. I'm assumimg it's not too comon yet?

Right. The ICL is a phakic lens, meaning it goes in front of the natural lens without removing it as one would in cataract surgery. It sits behind the iris, though, so it's basically invisible to observers. (Earlier ones went in front of the iris, and you could see them. It looked like freaky robo-eyes.)

It's not too common yet (got FDA approval in 2005), but it's growing more common. My clinic is actually one of the two highest volume ICL implanters in the US, and we're still talking just a couple hundred per year compared to the thousands of LASIK and PRK procedures we do annually. A couple of reasons it's less common than LASIK:

- It costs more. LASIK at a good center averages around $2000 per eye, whereas ICL is closer to $3000 per eye.
- It requires an actual surgery center, with sterile field, incisions, and anesthesia, so the little LASIK places in strip malls and such can't even consider offering it.

[ovid9]

I want LASIK. I don't want to pay for LASIK. What do?

Serious question though, is there any extra sensitivity to wind or air dryness long term?

I'm just asking because I'd love to be able to wear normal sunglasses while cycling and not worry about carrying other glasses around.

Long-term dry eye is a possible post-operative complication from LASIK. Short-term dry eye is expected; it happens to just about everyone who gets LASIK, and it typically lasts 3-6 months. Past that, it's still possible but uncommon. If I had to venture an educated guess, I'd say 1-2% of patients find themselves needing drops for dryness past the one year mark. It used to be more common in the early 2000s when blades were still used in LASIK.

Being able to wear normal sunglasses is an awesome payoff from LASIK.

Good to know!

$4k is a lot to swallow, but its one of my near term goals, next 3-5 years. I don't care for glasses, but I HATE contacts (I'm lazy) so man, being able to get rid of glasses for pretty much everything would be awesome.

[marshallnoise]

Great thread!

I have had -1.75 in each eye since I was about 13 and I am now 32. I have worn contact lenses ever since I was 13 and contemplated getting LASIK just to not deal with them. However, I pop in my contacts in about 10 seconds flat (after wiping away the morning goobers) and they last a good 12 hours before I need to pull them cause they dry out.

Is it something I should really consider doing?

[benjamin801]

Great thread!

I have had -1.75 in each eye since I was about 13 and I am now 32. I have worn contact lenses ever since I was 13 and contemplated getting LASIK just to not deal with them. However, I pop in my contacts in about 10 seconds flat (after wiping away the morning goobers) and they last a good 12 hours before I need to pull them cause they dry out.

Is it something I should really consider doing?

You sound as though you tolerate contact lenses well, so there's really no reason to push forward with LASIK as long as you're happy. (On the other hand, since you have a fairly mild prescription and it's been stable for years, you'd probably do great with LASIK too.) Now what will probably happen sometime between now and age 40 is that you'll start finding your contacts dry out faster. That's because your tear glands, which are currently producing plenty of moisture to maintain the 45% or 55% or whatever water content your contacts contain, will start to produce less. It's part of the natural aging process. If you find yourself pulling out your contacts after 10 hours instead of 12, then eventually ripping them out as soon as you leave work because you can't stand it anymore, then that may be a good time to look into LASIK.

Honestly, a big portion of our surgical patients are either people who are losing their contact lens tolerance, or people who just broke a $400 pair of glasses and want to look into their options before they shell out for another pair.

[marshallnoise]

Great thread!

I have had -1.75 in each eye since I was about 13 and I am now 32. I have worn contact lenses ever since I was 13 and contemplated getting LASIK just to not deal with them. However, I pop in my contacts in about 10 seconds flat (after wiping away the morning goobers) and they last a good 12 hours before I need to pull them cause they dry out.

Is it something I should really consider doing?

You sound as though you tolerate contact lenses well, so there's really no reason to push forward with LASIK as long as you're happy. (On the other hand, since you have a fairly mild prescription and it's been stable for years, you'd probably do great with LASIK too.) Now what will probably happen sometime between now and age 40 is that you'll start finding your contacts dry out faster. That's because your tear glands, which are currently producing plenty of moisture to maintain the 45% or 55% or whatever water content your contacts contain, will start to produce less. It's part of the natural aging process. If you find yourself pulling out your contacts after 10 hours instead of 12, then eventually ripping them out as soon as you leave work because you can't stand it anymore, then that may be a good time to look into LASIK.

Honestly, a big portion of our surgical patients are either people who are losing their contact lens tolerance, or people who just broke a $400 pair of glasses and want to look into their options before they shell out for another pair.

Great information! I am pretty much exactly as you stated. Will continue with contacts until I can't stand it anymore. Ha!

Thanks for the service!

[Elessar [Sly]]

Can you fix it so that everyone appears to have Katy Perry's breasts?

[benjamin801]

Can you fix it so that everyone appears to have Katy Perry's breasts?

Yes, but there's an upcharge for that.