Wednesday, October 10, 2012

Guided VS Optimized Revisited

Hi KD,

Thank you for your very informative blog! I found this through Yelp and the doctors you considered are the same ones I am getting consultations from. I've read through every post and have really gotten great advice from you.

I went to Dr. Bindi last week, just saw Dr. Manche today and will be seeing Dr. Furlong next week. Dr. Manche highly suggested wavefront-optimized over wavefront-guided and he said that in his clinical studies, any wavefront LASIK will cause an increase levels of HOA, but wavefront-GUIDED has shown to increase it a little less than wavefront-OPTIMIZED which is why he only offers wavefront-guided. I have an average HOA level and in articles that I've read, including your blog, both wavefront types are almost equal.

I'm looking through Dr. Hyver's website and it shows that he offers both wavefront-guided and optimized but suggests guided for patients with higher HOA (which I've consistently read), but also that optimized has a higher rate of seeing better than 20/20 (source: What do you think of this claim?

I'm torn between getting wavefront-guided vs. optimized and I plan to choose my doctor based on the advice you gave that it really comes down to the technology offered.

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In response to your reply on October 5, 2012 4:15PM:

I understand that you're not a doctor and I just wanted your opinion but again, I'd like to thank you for this blog.

Sorry to confuse you with my original post but when I visited Dr. Manche, he did mention that in all of his clinical trials, WFG outweighed WFO and is the reason why he only offers that type, even if you have an average HOA level. This link summed up what Dr. Manche emphasized:

I was conflicted because I read Dr. Hyver's website that I linked and it says that he offers both but I've confirmed that he only offers WFO when I called their office. Anyways, my appointment with Dr. Furlong is this Thursday and I really look forward to it after your review. Thanks again.

Hi Jonathan,

This question seems to crop up once in a while and I figure I may as well make this a post. When you see the doctors, please keep in mind that although they are doctors, their secondary purpose is to make money for their practice. Hey, that's capitalism! For that reason, the Doctors will push their own technology that they adopted. Dr. Bindi and Dr. Hyver will both claim that optimized is the superior solution. Dr. Furlong will claim that guided is superior. That is not to say that any of them are lying, but they are biased to their solution. Now, the interesting thing is that Dr. Manche who has both optimized and guided equipment also recommends guided! I would be more inclined to accept the opinion of someone who has performed both and have available the technology for both.

Dr. Manche, in my opinion, is the most unbiased source. He has conducted multiple studies on this matter and has performed operations with both. Additionally, his opinion is also supported by various studies out there. Keep in mind that the results of those studies do not claim that one is clearly better than the other. The studies do support the fact that guided tend to increase higher order aberations (HOA) at a lower rate than optimized. All LASIK solution increase higher order aberation--there's no way going around that.

For what it's worth, we came to the same conclusion as Dr. Manche and went with guided. My wife did not achieve 20/20 the first time. However, we cannot make any conclusion based on that because she did get pregnant right after having her surgery. My wife also has rather high HOA to begin with as well.  She's a small sample size and there's no correlation or causation because of that. Another reader who went with the same doctor and guided technology achieved 20/15 within a week of her surgery.

I believe you're already leaning toward one over the other the more studies and research you get into. Good luck!

P.S. Even though my wife never achieved 20/20 the first time, she never regretted the decision at all. One of the best thing she did in her life. She will probably return to get it redone once it's determined that she's eligible.


  1. Hi KD,

    Your blog is very helpful. I've seen Drs. Bindi, Hyver, Furlong, and Newman, and can't seem to make a decision. Do you anything know about Newman's technology? He uses the iFS150 and VISX, which is on par with or slightly better than Furlong's. The patient advisor seemed very knowledgeable about it, however, his "car salesman" pitch and pushy demeanor was off-putting. Their price quote was the cheapest out of all the doctors, but their location is an hour away (I went to a closer one for the consultation but they don't do the procedure there). Also he charges $299 per eye for enhancements after 2 years. Just wondering if you have anything to add to help my decision making process. Thanks!

  2. Hi XY,

    If Dr. Newman has the VISX S4 IR and the IFS 150, then he has the best guided technology available. If you're not comfortable with the salesman, ask to speak directly with the doctor. The doctor should be able to answer your questions. That's his job. You will find that the doctors will be far different from the salesman. You should not feel pressured to undergo something that will change your vision forever.

    I can't answer the price versus distance question. That's up to you if it's worth it in order to save the money. Keep in mind that location rent and staff salary is where the differences in quotes come from and not because of inferior technology or doctor's expertise.

    In general, if you have great results from LASIK the first time, there's really no reason to have enhancements after 2 years. When old age sets in, your eyes will get worse regardless. LASIK is there to fix bad vision from childhood and not for decreasing vision from presbyopia.

    Another thing to keep in mind is that the LASIK machines (flap and vision correction) performs the majority of the heavy lifting. The doctor's job is to operate the machine and adjust the machines pre-surgery based on his or her past experiences to achieve the best results. Once you're on the chair, the machine does 90% of the work.

    1. Thanks for your reply! He does have that technology you mentioned. I decided to go ahead and make the appointment, but I'm still nervous about side effects like dry eye and bad night vision. I will ask about pupil size, cornea thickness after surgery, and amount of HOA. What are other questions I should ask or factors to consider?