Quick Update:
The optometrist believe her eyes are improving after pregnancy. We'll see if she achieves 20/20 results after the next visit.
For those asking what questions they should ask their doctors, I cannot help you on that. Please read through the entire blog, educate yourself further with additional research and you will know what questions to ask. My advice may not fit your circumstance. Don't take anyone's advice wholesale and temper it with your experience and research.
Update 12/21/12: For those that I have gone through the surgery, please send me your updates in the comments. I will create a new post with your experience. I believe your experiences will be helpful for others on the fence.
Wednesday, November 28, 2012
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: http://www.scotthyver.com/vision/wavefrontlasik.shtml). 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.
-----END POST-----
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: http://shapirolaser.com/public/blog/270213.
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.
Wednesday, July 18, 2012
July Update
Just a quick update here for those who are still following this.
Her eyes have not changed. She's still not able to see the last line on the chart perfectly. The doctor believes it's because she may be bloated from her pregnancy. We'll have to see if it improves after pregnancy but I have a feeling she may need to get a touch up work done next year.
She doesn't need glasses and can see fine. However, she probably doesn't even realize she can and should see much better.
Good thing we didn't go to LA to save some money. The follow up check ups and the aggravation of travel plus having to pay for the rework would have defeated any cost savings.
Her eyes have not changed. She's still not able to see the last line on the chart perfectly. The doctor believes it's because she may be bloated from her pregnancy. We'll have to see if it improves after pregnancy but I have a feeling she may need to get a touch up work done next year.
She doesn't need glasses and can see fine. However, she probably doesn't even realize she can and should see much better.
Good thing we didn't go to LA to save some money. The follow up check ups and the aggravation of travel plus having to pay for the rework would have defeated any cost savings.
Tuesday, June 12, 2012
LASIK and loss of near sighted vision
KD, thanks for the ongoing blog. I am seeing more evidence that one gains back his far vision and the expense of short distance (reading) vision. I have a coworker that just had the lasik surgery about 3 months ago. His vision was pretty bad prior to the surgery but he could read without his glasses up close really well. Post correction, he is now very happy with seeing the clock on the wall and things at distance but tells me that the food on his dinner plate is no longer clear. Reading or computer work is pretty much impossible for him.Is your coworker over 40? Did he/she have LASIK with either a wavefront-guided or optimized system? I'm curious to know more about this.
I currently wear contacts to correct -3.75 in one eye and -4.0 in another and have no problem reading small print. Making out my finger print pattern is about as fine as i can see with my contacts. With no contacts I can see even better close up. My big worry is close up vision getting worse than i have now with contacts. What do you think?
I am under pressure to do the surgery this year because I signed up for 5K FSA for this year prior to doing the proper homework on the procedure. If i don't do the surgery, i lose the money :(.
In my small sample size of individuals who had LASIK, no one has reported this. However, that doesn't make it non-existent. In my research, I've came across occurrences of this. For many with nearsighted, it takes a while for the muscle in the eyes to adjust. Here is another thread where users reported issue that eventually cleared up. Here's an experience that or may not be similar to your friend's. Then again there are these two who still had blurred vision at 5 months.
I wish I could tell you that LASIK is perfect and you have nothing to worry about. If that were the case, you wouldn't need to research into it. Unfortunately, LASIK is a type of surgery and there are possibilities of complications. The human population is not uniform and there are slight variations in individual's physical attributes. There will always be a percentage of the population whose eyes react differently to the surgery. I wish I can tell you that your LASIK surgery will be perfect and there will be no complications. However, that's not necessarily true. Even my wife's surgery is not perfect even though she's thrilled with the results so far. As far as I know, her vision is not 20/20 but she doesn't have blurred close up vision.
You should discuss your concerns with your doctor and make the best decision you can with the information available.
What I can tell you is that like you I was concerned about the implications of LASIK surgery gone wrong. I was the one that did all the research. The more I read about horror stories, the more I was hesitant to tell my wife to go through with it. Well, she didn't care and was very gung-ho about it. She was going to do it regardless the potential complications. Ignorance is bliss.
What I recommend is that if you're not comfortable with it, then don't let the money be a consideration. It's better to lose the $5000 than to be pushed into surgery if you're not comfortable with it. For my wife, she could barely see without her contacts so the surgery was worth it and the decision to have LASIK was an easy one. For someone who has good vision nearsighted, it's a more complicated matter and only you can answer that after discussions with your doctor and your family.
References:
http://www.healthboards.com/boards/lasik-eye-surgery/900495-post-lasik-near-vision-blurry.html
http://www.healthboards.com/boards/lasik-eye-surgery/731500-post-lasik-despair-blurred-vision.html
http://www.healthboards.com/boards/lasik-eye-surgery/833757-my-lasik-tale-long.html
http://www.healthboards.com/boards/lasik-eye-surgery/870134-four-months-post-lasik-blurred-vision.html
Thursday, June 7, 2012
FSA
In 2013 the flexible spending account will be reduced by half to $2500. However, it's still possible to use all two year's worth of FSA for LASIK if you plan ahead. Now, this is only possible if your enrollment date is the normal late year enrollment. If it's midyear enrollment, you may be out of luck.
The trick is that by law, FSA spending can be spent up to three months into the next year. For example, 2012 FSA money can be spent up to the middle of March 2013. Therefore, it is possible to combine your $2500 from 2012 and $2500 from 2013 for a grand total of $5000. Normally, you would have two debit/credit cards for the FSA. The practice can just split the charges in half, one toward the 2012 card and the other onto the 2013 card. The only downside is that you wait until Jan 1 2013 before you start your procedure. There's no need to rush. Spend that time and research more about LASIK (and check with your clinic to see if they can split the charges. It should be no problem).
Reference: http://en.wikipedia.org/wiki/Flexible_spending_account#Plan_year_grace_period
The trick is that by law, FSA spending can be spent up to three months into the next year. For example, 2012 FSA money can be spent up to the middle of March 2013. Therefore, it is possible to combine your $2500 from 2012 and $2500 from 2013 for a grand total of $5000. Normally, you would have two debit/credit cards for the FSA. The practice can just split the charges in half, one toward the 2012 card and the other onto the 2013 card. The only downside is that you wait until Jan 1 2013 before you start your procedure. There's no need to rush. Spend that time and research more about LASIK (and check with your clinic to see if they can split the charges. It should be no problem).
Reference: http://en.wikipedia.org/wiki/Flexible_spending_account#Plan_year_grace_period
Tuesday, June 5, 2012
June Update
This is just a quick update for those still following this. I've been quite busy and almost forgot about this blog. If you're researching LASIK, I suggest you go through the archives and read it.
Here is a fairly recent study between VISX and Wavelight. There is also an ongoing Stanford study between the two technologies. I'm starting to think that other than HOA, there is really no significant differences between the two of them. If you are clearly in the camp that believe the two technologies are equal, then Dr. Bindi's iFS150 and the Allegretto Wave are clearly the two best combined technologies. Bear in mind that the VISX S4 IR has the largest market share and the longest used laser in the United States. The Allegretto Wave, due to it requiring only a 1 phase (no wavescan check up) is clearly gaining ground. I believe it is the most popular in Europe and around the world. Dr. Bindi and Hyver both switched to the Allegretto Wave. It's no surprise because the less time spent between patients means more eye balls can go through the machines which means more profits. I'm not saying that's a bad thing, but the 1 phase pre-check up with one less machine may eventually win out. VISX used to dominate the market but now I see all these new Laser Centers popping up and they go with Allegretto first as it's a more economical model than the VISX.
The wife is really happy with her results so far. I'm not. She doesn't want to redo her eyes even if she doesn't hit 20/20 because she's "happy with it." For the money she spent, I'm going to make sure she goes back if her vision isn't perfect (or as perfect as the guarantee contract states which is 20/20). She's going to get another check up in July to see if there are any issues delaying her healing.
This is one of the reasons why you want to get your eyes done locally. Most people get great results the first time, but just in case you fall within the 5-10% where complications occur, you want your doctor local and have a guarantee that it gets fixed. However, if you're interested in saving money, I know for a fact that you can get the Allegretto Wave laser in Los Angeles for half the price of the doctors up here in the Bay Area. For some people $2500 is a lot of money and my advice can be thrown right out the window. Just be careful. The doctors here will reject you if your eyes are not ready. I'm not too sure about those other guys. Educate yourself before you make the commitment!
By the way, if you have questions, post it in the blog. If I no one is reading this, I may not continue to update it. Let me know if you guys are still reading this.
References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198407/
http://clinicaltrials.gov/ct2/show/NCT01454843
Here is a fairly recent study between VISX and Wavelight. There is also an ongoing Stanford study between the two technologies. I'm starting to think that other than HOA, there is really no significant differences between the two of them. If you are clearly in the camp that believe the two technologies are equal, then Dr. Bindi's iFS150 and the Allegretto Wave are clearly the two best combined technologies. Bear in mind that the VISX S4 IR has the largest market share and the longest used laser in the United States. The Allegretto Wave, due to it requiring only a 1 phase (no wavescan check up) is clearly gaining ground. I believe it is the most popular in Europe and around the world. Dr. Bindi and Hyver both switched to the Allegretto Wave. It's no surprise because the less time spent between patients means more eye balls can go through the machines which means more profits. I'm not saying that's a bad thing, but the 1 phase pre-check up with one less machine may eventually win out. VISX used to dominate the market but now I see all these new Laser Centers popping up and they go with Allegretto first as it's a more economical model than the VISX.
The wife is really happy with her results so far. I'm not. She doesn't want to redo her eyes even if she doesn't hit 20/20 because she's "happy with it." For the money she spent, I'm going to make sure she goes back if her vision isn't perfect (or as perfect as the guarantee contract states which is 20/20). She's going to get another check up in July to see if there are any issues delaying her healing.
This is one of the reasons why you want to get your eyes done locally. Most people get great results the first time, but just in case you fall within the 5-10% where complications occur, you want your doctor local and have a guarantee that it gets fixed. However, if you're interested in saving money, I know for a fact that you can get the Allegretto Wave laser in Los Angeles for half the price of the doctors up here in the Bay Area. For some people $2500 is a lot of money and my advice can be thrown right out the window. Just be careful. The doctors here will reject you if your eyes are not ready. I'm not too sure about those other guys. Educate yourself before you make the commitment!
By the way, if you have questions, post it in the blog. If I no one is reading this, I may not continue to update it. Let me know if you guys are still reading this.
References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198407/
http://clinicaltrials.gov/ct2/show/NCT01454843
Tuesday, April 10, 2012
4 Months Post Op
One of her eyes are at 20/20 now. However, her other is is not. Furthermore, the doctor has recommended that she keeps using the eye drops due dryness in her eyes. Oh, that lovely time of year where every gets nasty symptoms in their eyes. The doc said that perhaps her pregnancy is making changes to her body that could be causing affecting her vision. Hmm... I don't know how I feel about that. I can't find any studies regarding this although pregnancy is usually a curve ball thrown into most things.
Immediately after surgery, one of the eyes bothered her more than the other. I have a feeling it's the same one that's not at 20/20 yet. I just think it's not healing as well as the other. The doc said they will keep reassessing and determine the results after a year. 20/15 is look pretty low right now. If she doesn't get 20/20 in both eyes, she's going back for round 2 for sure. That lifetime guarantee is looking pretty useful right now!
Immediately after surgery, one of the eyes bothered her more than the other. I have a feeling it's the same one that's not at 20/20 yet. I just think it's not healing as well as the other. The doc said they will keep reassessing and determine the results after a year. 20/15 is look pretty low right now. If she doesn't get 20/20 in both eyes, she's going back for round 2 for sure. That lifetime guarantee is looking pretty useful right now!
Tuesday, March 27, 2012
Results from a reader
I received this note in the comments section and I thought I'd share it via a post. When I first started this blog, I'd hope that the information would be useful for others. I'm glad that this blog has been of use to at least one person. If anyone else has a similar story to share, please send it to me and I'll post it.
Hi KD,
I wanted to stop by and say thanks again for taking time to put this blog together and for answering my questions so quickly. I printed out the questions and brought them with me to my pre-op exam and that helped me get the answers I needed to feel comfortable with surgery.
I thought I would quickly share my experience for others that stop by. So far my experience has been similar to what you described for your wife. I had custom Lasik in both eyes, my prescription was -6.00 in both eyes with a very slight astigmatism in the right eye. Dr. Furlong said they would be removing about 75-80 microns. The Laser /ophthalmic tech named Will was awesome he answered a lot of my questions and quickly replied to my emails and also kept the mood light on surgery day which I really appreciated.
The Procedure:During the procedure everything happened pretty much as you described except my right eye didn’t go completely black when they applied the pressure it was more of a grey. Also to avoid the burning smell that people described I made sure to breathe through my mouth when I heard the clicking of the laser. This worked well. The only part of the surgery that was uncomfortable was the bright light that was on for a few seconds before the laser started.
After Surgery:After surgery my eyes were very light sensitive, they stung and kept tearing. I could barely open them for the drops. The numbing drops they proved helped but only lasted a few min. After using them 3 or 4 times I gave up and decided to try and sleep, which was hard to do. Having the windows covered help with the sleep and light sensitivity. My surgery was around 3:30 pm; I went straight home, straight to bed and tried to sleep as long as I could. After finally falling asleep I woke up around 9pm and my eyes felt much better. The stinging/tearing was gone, but still sensitive to light. I Ate some dinner and went back to sleep.
1 day postWoke up around 8am eyes felt drastically better. Sensitive to light, right eye felt scratchy and it was a bit hard to focus, but vision was clear and functional. At the post op exam they said I was seeing 20/20 but I still saw halo and rainbows around bright lights. I didn’t feel ready to drive but I was able to watch TV look at my phone and go out for dinner but required lots of eye resting in between.
Today is 4 days post-lasik and I’m back at work, I’m still using antibiotics and steroid drops every 4 hours and sleeping with eye shields (which I thought would be uncomfortable but really aren’t bad). Right eye has felt scratchy ever since surgery, haven’t had much trouble with dry eyes but it’s a bit worse today being in the air conditioning at work. Left eye feels normal and I’m using the lubricating drops every hour as directed. I drove a little bit today but its gloomy/raining out so people have their headlight on which means halos and rainbows for my eye which are still a bit light sensitive. Hopefully this gets better as my eyes heal.
Two other things I would mention are my eyes tend to lose focus often and I have the strange urge to take out my contacts.
Thanks Again and Congrats!!!
Congrats!
For having a prescription of -6 with astigmatism and the fact that you are seeing 20/20 the day after, I would declare that a resounding success! I think you stand a good chance of hitting 20/15 by the 6 week check up. If you do, please let me know so I can post your results.
Your experience is a little different as you are seeing rainbows. My wife did not experience the rainbow effect, however she had the exact same light sensitivity. By the way, the contact in the eye feeling and the feeling of scratchy eye is basically symptoms of dry eye. So yes, you are experiencing dry eye symptoms. I hope it clears for you soon as that is the worst symptom of all post LASIK. I should mention that there is a difference between dry eye symptom which everyone gets immediately post LASIK surgery and chronic dry eyes which is what you don't want to get. If the symptom persist...ugh.
I've got good news for you though, my wife's halos has just about gone completely away. I think you can at least look forward to the halos decreasing as well. My wife can read the default font on the new Retina IPAD from reading distance so I hope to see 20/15 for her result this week. If not, then we can chalk her up to being one of the unlucky ones who can only achieve 20/20. =)
Sunday, February 19, 2012
6 Week Post Op
The wife is almost at 20/20. She still misses the D's and the O's. On the bright side, she can make out a few of the letters on the 20/15 line as well. However, those letters are a little blurry still. She still has halos but it's not that bad. She has stopped using the artificial tears awhile back because she just doesn't feel the need. The doctor recommends that she keep using. She said she would but somehow I doubt it very much. It's human nature. She's basically living like a normal person with good vision without being tethered to the glasses, contacts, or tear drops.
I'm actually disappointed that she hasn't hit hit her 20/20 benchmark yet. Then again, conventional wisdom say that it may take up to a year for recovery. Is almost 20/20 at 6 weeks with a -5.25 prescription good or bad? Who knows. Plus everyone heal at a different rate. We'll just have to wait for the 3 month post-op to find out.
I may be disappointed, but she's ecstatic. Being able to see the clock at night and not having to shuffle for glasses is liberating for her. Plus, not having to deal with contacts, losing a contact, and then having one stuck in the eye (which happens regularly for some reason) is another plus. Yes, she would definitely have this procedure again.
We have another surprise: she's pregnant. Of course, most LASIK doctors don't recommend getting pregnant for at least 6 months after LASIK. There goes conventional wisdom.
I'm actually disappointed that she hasn't hit hit her 20/20 benchmark yet. Then again, conventional wisdom say that it may take up to a year for recovery. Is almost 20/20 at 6 weeks with a -5.25 prescription good or bad? Who knows. Plus everyone heal at a different rate. We'll just have to wait for the 3 month post-op to find out.
I may be disappointed, but she's ecstatic. Being able to see the clock at night and not having to shuffle for glasses is liberating for her. Plus, not having to deal with contacts, losing a contact, and then having one stuck in the eye (which happens regularly for some reason) is another plus. Yes, she would definitely have this procedure again.
We have another surprise: she's pregnant. Of course, most LASIK doctors don't recommend getting pregnant for at least 6 months after LASIK. There goes conventional wisdom.
Friday, February 3, 2012
3 Week Post Op Vision Quality
Remember, every individual is different. Just because your experience is different does not mean that there is a problem. Also, don't expect to have the same results because there are so many different factors including pre-op vision, perscription, existing higher order aberration and existing conditions such as dry eye symptoms, etc.
My wife had -5.25 pre-operative prescription. That means that about 80 microns of her cornea was removed. That is not a small number. It's like a minor wound versus a large wound. The minor wound would heal much faster. Most people who have had flawless vision the day after probably had low myopia to begin with. A test of how well the LASIK technology work is not to ask someone who had -1.25 prescription pre op but ask someone who had medium to high myopia. Many of the ecstatic reviews for LASIK by patients who claim they can watch TV in 4 hours and drive immediately the next day are probably from patients with low myopia. Low myopes will have exceptional results with any system even the 10 year old standard NIDEK laser. That's just the way it is.
Sift through the results and compare apple to apple. For patients with high myopia and astigmatism, exceptional results may be rare. However, if you have a low prescription, you should expect to drive the next day with low complications. Temper your expectations based on your individual characteristics.
LASIK is surgery and all surgery requires healing. For my wife, she was able to see the next day and her vision was hovering between 20/25 and 20/20 the day after. That is an outstanding result! However, the halos around light sources were pretty bad. She was not able to drive the first week because the halos were blinding. I am happy to report that she has been driving at night now with no problem. The halos are still there but they are not that bad. Other than the first few days, the halos are not disruptive or blinding.
Most doctors would tell you to expect up to a year for most post-op LASIK complications to go away. My wife is satisfied with the halos right now even if it never goes away. She would gladly trade her practical blindness for a little halo. However, with the vast improvement in the symptom with the halos from the first few days to now, I hope (and expect) that it will totally go away by 3-6 months.
The biggest issue any LASIK patient should worry about is dry eyes. I have minor starbursting naturally occurring in my eyes at night (I never even realized that this is not normal until I researched LASIK). It doesn't bother me. Just like the minor halos is not bothering my wife. However, the one thing that did bother her was the initial dry eye symptoms and the contact in the eye feeling. Luckily for her it quickly went away . She only used one tear drop the last three days, usually when her eyes get tired from reading the computer screen or her files.
My cousin had dry eye symptoms for an entire year. It "sucked" was his words. He had to constantly use the natural tear drops many times a day. My wife did not have dry eye symptoms pre surgery so it didn't bother her post-op either. However, if anyone has existing dry eye symptoms, that person should consider it as it's most likely will get worse.
My wife believes that her color/contrast and close up reading is superior now 3 weeks post-op as compared to pre-opt. You have to realize that her best corrected visual acuity was not that good to begin with. I have a feeling that it was due to her existing higher order aberrations. On the freeway, she previously was able to read signs at half the distance that I was able to even with her contacts. I was able to read signs a few seconds before she can make it out going 60 mile per hour. Her contacts corrected her vision up to a point, but beyond that distance her clarity just collapsed. Now, even with her eyes still healing, she is able to read signs much farther away. As you can see, she's very happy with her results at 3 weeks. She was able to see before with contacts, but she is able to SEE now without it. The quality difference is there, even with the nighttime halos.
Random Musing
So why do LASIK patients post op have starbursting and halos? The reason is most likely due to higher order aberrations. As I discussed previous posts, all LASIK procedures tend to induce higher order aberrations. Even people with normal vision has it (I do) and contacts or glasses cannot fix HOA. Even the machines that claim to be neutral (optimized) or corrects it (guided) tend to induce HOA. The fact that her halo issue is diminishing tells me that it is not due to her pupil size at night but due to the higher order aberrations which tend to be highest immediately after surgery. This is the reason why patients with existing high HOA should select a technology that attempts to fix it. That doesn't always mean that it can fix it (or in most cases limit it), but the studies have shown that patients with high HOA tend to have better results post-op with wavefront-guided technology. Optimized technology attempts to avoid creating new HOA but that doesn't mean much--all LASIK procedures tend to create HOA! Here is another study comparing HOA and the technologies. Notice that with the VISEK, 1/3 of patients had reduced HOA while 1/3 had worse even with the attempt to correct HOA. However, with the optimized version 60% of the post-op patients had worse HOA post-op with only 15% having improved HOA. If it can't get better, it should stay the same, not worse! Higher Order Aberration is a hugely important factor that should be a consideration for all patients with high myopia.
http://en.wikipedia.org/wiki/LASIK#Higher-order_aberrations
http://www.eyeworld.org/ewsupplementarticle.php?id=252
My wife had -5.25 pre-operative prescription. That means that about 80 microns of her cornea was removed. That is not a small number. It's like a minor wound versus a large wound. The minor wound would heal much faster. Most people who have had flawless vision the day after probably had low myopia to begin with. A test of how well the LASIK technology work is not to ask someone who had -1.25 prescription pre op but ask someone who had medium to high myopia. Many of the ecstatic reviews for LASIK by patients who claim they can watch TV in 4 hours and drive immediately the next day are probably from patients with low myopia. Low myopes will have exceptional results with any system even the 10 year old standard NIDEK laser. That's just the way it is.
Sift through the results and compare apple to apple. For patients with high myopia and astigmatism, exceptional results may be rare. However, if you have a low prescription, you should expect to drive the next day with low complications. Temper your expectations based on your individual characteristics.
LASIK is surgery and all surgery requires healing. For my wife, she was able to see the next day and her vision was hovering between 20/25 and 20/20 the day after. That is an outstanding result! However, the halos around light sources were pretty bad. She was not able to drive the first week because the halos were blinding. I am happy to report that she has been driving at night now with no problem. The halos are still there but they are not that bad. Other than the first few days, the halos are not disruptive or blinding.
Most doctors would tell you to expect up to a year for most post-op LASIK complications to go away. My wife is satisfied with the halos right now even if it never goes away. She would gladly trade her practical blindness for a little halo. However, with the vast improvement in the symptom with the halos from the first few days to now, I hope (and expect) that it will totally go away by 3-6 months.
The biggest issue any LASIK patient should worry about is dry eyes. I have minor starbursting naturally occurring in my eyes at night (I never even realized that this is not normal until I researched LASIK). It doesn't bother me. Just like the minor halos is not bothering my wife. However, the one thing that did bother her was the initial dry eye symptoms and the contact in the eye feeling. Luckily for her it quickly went away . She only used one tear drop the last three days, usually when her eyes get tired from reading the computer screen or her files.
My cousin had dry eye symptoms for an entire year. It "sucked" was his words. He had to constantly use the natural tear drops many times a day. My wife did not have dry eye symptoms pre surgery so it didn't bother her post-op either. However, if anyone has existing dry eye symptoms, that person should consider it as it's most likely will get worse.
My wife believes that her color/contrast and close up reading is superior now 3 weeks post-op as compared to pre-opt. You have to realize that her best corrected visual acuity was not that good to begin with. I have a feeling that it was due to her existing higher order aberrations. On the freeway, she previously was able to read signs at half the distance that I was able to even with her contacts. I was able to read signs a few seconds before she can make it out going 60 mile per hour. Her contacts corrected her vision up to a point, but beyond that distance her clarity just collapsed. Now, even with her eyes still healing, she is able to read signs much farther away. As you can see, she's very happy with her results at 3 weeks. She was able to see before with contacts, but she is able to SEE now without it. The quality difference is there, even with the nighttime halos.
Random Musing
So why do LASIK patients post op have starbursting and halos? The reason is most likely due to higher order aberrations. As I discussed previous posts, all LASIK procedures tend to induce higher order aberrations. Even people with normal vision has it (I do) and contacts or glasses cannot fix HOA. Even the machines that claim to be neutral (optimized) or corrects it (guided) tend to induce HOA. The fact that her halo issue is diminishing tells me that it is not due to her pupil size at night but due to the higher order aberrations which tend to be highest immediately after surgery. This is the reason why patients with existing high HOA should select a technology that attempts to fix it. That doesn't always mean that it can fix it (or in most cases limit it), but the studies have shown that patients with high HOA tend to have better results post-op with wavefront-guided technology. Optimized technology attempts to avoid creating new HOA but that doesn't mean much--all LASIK procedures tend to create HOA! Here is another study comparing HOA and the technologies. Notice that with the VISEK, 1/3 of patients had reduced HOA while 1/3 had worse even with the attempt to correct HOA. However, with the optimized version 60% of the post-op patients had worse HOA post-op with only 15% having improved HOA. If it can't get better, it should stay the same, not worse! Higher Order Aberration is a hugely important factor that should be a consideration for all patients with high myopia.
http://en.wikipedia.org/wiki/LASIK#Higher-order_aberrations
http://www.eyeworld.org/ewsupplementarticle.php?id=252
Tuesday, January 31, 2012
Yelp!
I use Yelp on a regular basis. I like it so much that I contribute on a regular basis. However, recently, I realized that Yelp can be paid and bought. If you advertise with them, you can bury reviews that may be...mildly critical of the establishments.
Yelp claims they run reviews through anti-fraud filter. Basically, it tries to detect fake reviews and filter them out.
Guess what? Dr. Bindi recently has a prominent Yelp banner on his website. This means that he paid the company for the advertisement. What does this do for him? It pushes 5 star reviews high up and then...bury reviews that may not be exactly glowing. That's fine, they have to earn money somehow.
Interestingly enough, my review got filtered out. Yelp can push unfavorable reviews down, but when they filter out legitimate reviews as bogus, then they stepped into the the realm of shadiness. Now, I ask you, with my active review writing and even with my taking out some of the sharp criticisms, the review still got filtered out. Why? Because I spoke the truth. Unfavorable 3 line reviews are OK, but a balanced and truthful review backed up with research will get filtered out. Nevertheless, my review for Dr. Furlong stays. Am I bogus or not, Yelp? You can't have it both ways.
Did Dr. Bindi after having paid Yelp to promote him requested my review be buried? You decide.
That is so wrong, Yelp. Apparently, you can buy reviews on Yelp or pay to filter unfavorable reviews. This may not be Dr. Bindi's fault, but it may come back to hurt him in the long run. Most Yelp users click on the filtered reviews to get the whole picture sans shady dealings. Having a legitimate review buried is bad for business.
Update 3/22/12: Okay, it looks like it's part of Yelp's funky algorithm. It wasn't part of some diabolical conspiracy by Yelp and Dr. Bindi. The trick is to add some friends and update your profile with your real name and it will eventually get your review out of filter.
Yelp claims they run reviews through anti-fraud filter. Basically, it tries to detect fake reviews and filter them out.
Guess what? Dr. Bindi recently has a prominent Yelp banner on his website. This means that he paid the company for the advertisement. What does this do for him? It pushes 5 star reviews high up and then...bury reviews that may not be exactly glowing. That's fine, they have to earn money somehow.
Interestingly enough, my review got filtered out. Yelp can push unfavorable reviews down, but when they filter out legitimate reviews as bogus, then they stepped into the the realm of shadiness. Now, I ask you, with my active review writing and even with my taking out some of the sharp criticisms, the review still got filtered out. Why? Because I spoke the truth. Unfavorable 3 line reviews are OK, but a balanced and truthful review backed up with research will get filtered out. Nevertheless, my review for Dr. Furlong stays. Am I bogus or not, Yelp? You can't have it both ways.
Did Dr. Bindi after having paid Yelp to promote him requested my review be buried? You decide.
That is so wrong, Yelp. Apparently, you can buy reviews on Yelp or pay to filter unfavorable reviews. This may not be Dr. Bindi's fault, but it may come back to hurt him in the long run. Most Yelp users click on the filtered reviews to get the whole picture sans shady dealings. Having a legitimate review buried is bad for business.
Update 3/22/12: Okay, it looks like it's part of Yelp's funky algorithm. It wasn't part of some diabolical conspiracy by Yelp and Dr. Bindi. The trick is to add some friends and update your profile with your real name and it will eventually get your review out of filter.
Friday, January 27, 2012
1 Week Update
I guess I totally forgot about this blog. Her one week check-up shows that one eye is 20/20 the other is close to 20/20. Now that it's three weeks later, I have no doubt that she can see 20/20 in both eyes. We used the eye chart app for the IPAD and she can easily read the 9th line on it. She can make out only some letters on the 10th line (the 20/15 line).
The day after surgery, every light source had extreme halos. She is seeing some halos still with her eyes which were not there before. However, the halos had lessen more and more every day. The halos if most likely the reason why she's not able to read the 10th line. She can make out obvious letters but certain curved ones still glow too much.
Her dry eye is extremely minimal. She would have to remind herself to use the artificial tear because she often forgets. Her one month check up is coming up. We're still holding out for 20/15 once the halos go away. That could be up to three months away.
Why are we shooting for 20/15? The reason is 20/20 is only average human vision and not "perfect" which is a misconception most people have. 20/15 is very good. True perfect human vision is probably 20/12-20/10. It's very rare to have vision anywhere close to 20/10 but 20/15 is the gold standard for "perfect" human vision.
http://itunes.apple.com/us/app/eye-chart-pro/id364802332?mt=8
http://en.wikipedia.org/wiki/Visual_acuity
The day after surgery, every light source had extreme halos. She is seeing some halos still with her eyes which were not there before. However, the halos had lessen more and more every day. The halos if most likely the reason why she's not able to read the 10th line. She can make out obvious letters but certain curved ones still glow too much.
Her dry eye is extremely minimal. She would have to remind herself to use the artificial tear because she often forgets. Her one month check up is coming up. We're still holding out for 20/15 once the halos go away. That could be up to three months away.
Why are we shooting for 20/15? The reason is 20/20 is only average human vision and not "perfect" which is a misconception most people have. 20/15 is very good. True perfect human vision is probably 20/12-20/10. It's very rare to have vision anywhere close to 20/10 but 20/15 is the gold standard for "perfect" human vision.
http://itunes.apple.com/us/app/eye-chart-pro/id364802332?mt=8
http://en.wikipedia.org/wiki/Visual_acuity
Wednesday, January 11, 2012
Lasik Complications
Isn't it odd that I'm posting about LASIK complications after the procedure was completed? Previously, my wife was so gung-ho about LASIK that she didn't want to
wait (or cared) about the potential complications. Luckily for her, I
actually cared and did all the research for her. Now that the procedure has been a success, I'm not sure what to do with those notes. I might as well share it here.
The first thing you need to know is that not everyone is qualified for LASIK (or PRK). This is where having a qualified and scrupulous doctor is very important, beyond just selecting the correct technology for your prescription. Ten years ago, there was a money grab with some doctors who was not always looking out for the patient's benefit. Even now, there are still cases of people who angry and upset about their quality of vision after LASIK or felt they were mislead by their doctors. Being able to see without glasses is great, but having star-bursts, halos, and dry eyes could be debilitating.
Therefore, it's not surprising that you are now required to sign the informed consent forms that state all the potential LASIK complications. The problem with the consent form is that it doesn't tell you what, why, or if you are in a higher category of danger for having those complications. It just states that there are complications as a result of LASIK. This is why it's important that you educate yourself first so that you can can ask the proper questions to the doctor and see for yourself and understand why and if you are a good candidate rather than just relying on the doctor's yay or nay diagnosis. Only you can decide if the risks are worth it. Unfortunately, certain individuals are in a higher risk category.
Pupil Size
If you research LASIK complications on the Internet, the vast majority them are due to the doctors not informing their patients that they have larger than normal pupil and pushing them unadvised LASIK procedures. Did you watch the 20/20 special on LASIK regarding double vision, halos and star-bursts? Doctors should turn away prospective patients if they have higher than normal pupil size. The average ablation zone for the laser is 6.5mm. The average pupil size is around 6mm. If your pupil expands at night beyond the ablation zone, that's when trouble starts. Problems such as star-bursts, halos, etc occur due to to the correction zone being smaller than the size of the expanded pupil. This is why most LASIK issues with halos and star-bursts occur at night when the pupil expands. Read this to understand more about problems with large pupils. Most modern wavefront laser attempt to fix potential night time vision issues by creating a bigger blend zone. This may help in some cases but there is no concrete proof that blend zone resolve the problem of having large pupil size! In general, if you have larger than average or larger than the laser's
ablation zone pupil size, the doctor should turn you away. If the doctor
doesn't, your spidey senses should tingle!
Higher Order Aberrations
Large pupils are not always the cause of problems, higher order aberrations can also be the cause of these problems. In an earlier posts, I mentioned that LASIK (and PRK) procedures tend to create higher order aberrations. Wavefront-optimized attempt to limit that whereas wavefront-guided attempts to correct it. Your objective is always to limit higher order aberrations, especially if you already have higher order aberrations, however all LASIK laser and procedures as a by-product create some sort of higher order aberrations.
Therefore it's important to have a wavescan performed to measure the existence and magnitude of it. My wife who had problems with higher order aberrations was never able to achieve great vision pre-op even with her contacts. I have 20/15 vision, but at night I see slight starbursts that is very slight, nothing as bad as the picture shown above. Even with my naturally excellent eye sight, I'm pretty positive that the existing higher order aberrations in my eyes are the culprits for the slight starbursts at night.
This is why some pay more and some pay less for their LASIK procedure. In my opinion, it's ridiculous that some surgeons even offer these as a choice for prospective patients unless they have a very slight prescription, even then I would be wary of not opting for the wavefront solution. Standard LASIK doesn't offer blending zone which is is why some patients in the past who had standard LASIK with average pupil size still ended up with problems of starbursts and halos. If these patients knew ahead of time that the cheaper standard LASIK laser may deliver substandard results for medium to high myopes as well as having a tendency to cause more higher order aberrations, would they choose it or opt for the more expensive option?
Dry Eyes
This is the other biggie. Most doctors today will ask you if you have existing dry eye symptoms. If you already have dry eyes, LASIK may further cause issues and you should reconsider. My cousin who did not have dry eyes pre-op had pretty bad symptoms for close to a year. My wife on the other hand had it for for the first couple days on only one eye. Five days later she is only using artificial tears every four hours or so. You never know. Chronic dry eyes could be a very bad problem. Discuss this fully with your doctor if you have existing dry eyes or the potential of having dry eyes.
Thin Corneas
If you have thin corneas, don't be surprised if the doctor recommend only PRK for you. Early on, some doctors performed LASIK on patients without checking their cornea thickness or pushing the boundary of safety. The result for some were ecstasia due to excessively thin corneas...and of course malpractice suits for the doctors. This is why if you have thin corneas, your doctor will tell you that you are only qualified for LASIK but instead offer PRK. Did you know that there are now advancements in PRK such as LASEK and epi-LASEK where the recovery time is much faster than PRK? So far, I haven't seen any south bay doctors offering this version of PRK. If faster recovery time is desirable, you may want to look for a doctor who offers LASEK.
Hacks
What is a hack? That's an unqualified doctor or one who cut corners in order to save money. It can be anything from reusing microkeretome blades to pushing people to perform LASIK when they are clearly unqualified. If you are on an assembly line, with 20 patients waiting for LASIK from morning until late into the night, the doctor obviously wants to get through each of you quickly. If something as delicate as surgery is hurried, mistakes may occur either through carelessness or tiredness. For example, this one individual waited until 10PM because the clinic overbooked. Not surprisingly, she ended up with problems. Here is this one person who had his vision ruined because the 'doctor' (who knows, this is Peru after all!) didn't calibrate their machine properly. Or then there are cases of people who had LASIK done too soon while their vision was still regressing. So be very careful if the doctor offer the LASIK at an extremely cheap price, you are not able to ask questions with your doctor, you are pushed to have a procedure, you see are waiting 3-4 hours for a consultation, or you show up to your surgery but end up sitting on the floor with the waiting area looking like a refugee camp.
Are you scared yet? Well, if LASIK was that dangerous, I wouldn't have let my wife go through with it. There has been 31 million LASIK procedures performed. The number of satisfied patients outnumber the unsatisfied patients by many factor. Also, many of the complications were a result of doctors pushing unqualified individuals to have LASIK done when they were clearly not candidates for it. Nevertheless, you should still prepare yourself for the possibilities of complications. The doctors we consulted with are all well respected and are careful to screen their candidates. They have their reputation to protect and have been in business a long time for a reason. However, based on the horror stories out there, not all doctors are that conscionable.
The majority of LASIK complications I've read online are due to (a) large pupils, (b) dry eyes, or (c) thin corneas. There are a small percentage with complications that are unrelated to the above three such as flap complications and misdiagnosis of prescription or miscalibration. It is an elective surgery and there are risks involved. Educate yourself before you go for a consultation. Question everything and do not take their answer as gospel. They may be medical doctors but they are also human. Greed sometimes cloud people's decisions.
LASIK is a miracle cure if everything goes right. As with anything involved with the human body, when things go wrong it could go very wrong. So think twice next time you go to Tijuana for the $800 LASIK. It's a decision that will affect you for better or worse for the rest of your life.
Disclaimer: This is my opinion. This should not be considered medical advice.
References:
http://www.realself.com/review/king-of-prussia-lasik-put-disability
http://www.usaeyes.org/lasik/faq/lasik-pupil-size.htm
http://www.allaboutvision.com/conditions/aberrations.htm
http://lasik-flap.com/forum/viewtopic.php?t=850
http://www.realself.com/review/new-york-terrible-pain-sleep-lasik-laser-vision-correction-surgery
http://www.allaboutvision.com/visionsurgery/lasek.htm
http://www.allaboutvision.com/visionsurgery/epi-lasik.htm
http://www.realself.com/review/lasik-brazil
http://www.realself.com/review/lasik-waist-money-canada
http://www.realself.com/review/only-last-few-years
http://www.realself.com/review/lasik-great-dont-do-it-too-young
The first thing you need to know is that not everyone is qualified for LASIK (or PRK). This is where having a qualified and scrupulous doctor is very important, beyond just selecting the correct technology for your prescription. Ten years ago, there was a money grab with some doctors who was not always looking out for the patient's benefit. Even now, there are still cases of people who angry and upset about their quality of vision after LASIK or felt they were mislead by their doctors. Being able to see without glasses is great, but having star-bursts, halos, and dry eyes could be debilitating.
Therefore, it's not surprising that you are now required to sign the informed consent forms that state all the potential LASIK complications. The problem with the consent form is that it doesn't tell you what, why, or if you are in a higher category of danger for having those complications. It just states that there are complications as a result of LASIK. This is why it's important that you educate yourself first so that you can can ask the proper questions to the doctor and see for yourself and understand why and if you are a good candidate rather than just relying on the doctor's yay or nay diagnosis. Only you can decide if the risks are worth it. Unfortunately, certain individuals are in a higher risk category.
Pupil Size
If you research LASIK complications on the Internet, the vast majority them are due to the doctors not informing their patients that they have larger than normal pupil and pushing them unadvised LASIK procedures. Did you watch the 20/20 special on LASIK regarding double vision, halos and star-bursts? Doctors should turn away prospective patients if they have higher than normal pupil size. The average ablation zone for the laser is 6.5mm. The average pupil size is around 6mm. If your pupil expands at night beyond the ablation zone, that's when trouble starts. Problems such as star-bursts, halos, etc occur due to to the correction zone being smaller than the size of the expanded pupil. This is why most LASIK issues with halos and star-bursts occur at night when the pupil expands. Read this to understand more about problems with large pupils. Most modern wavefront laser attempt to fix potential night time vision issues by creating a bigger blend zone. This may help in some cases but there is no concrete proof that blend zone resolve the problem of having large pupil size! In general, if you have larger than average or larger than the laser's
ablation zone pupil size, the doctor should turn you away. If the doctor
doesn't, your spidey senses should tingle!Higher Order Aberrations
Large pupils are not always the cause of problems, higher order aberrations can also be the cause of these problems. In an earlier posts, I mentioned that LASIK (and PRK) procedures tend to create higher order aberrations. Wavefront-optimized attempt to limit that whereas wavefront-guided attempts to correct it. Your objective is always to limit higher order aberrations, especially if you already have higher order aberrations, however all LASIK laser and procedures as a by-product create some sort of higher order aberrations.Therefore it's important to have a wavescan performed to measure the existence and magnitude of it. My wife who had problems with higher order aberrations was never able to achieve great vision pre-op even with her contacts. I have 20/15 vision, but at night I see slight starbursts that is very slight, nothing as bad as the picture shown above. Even with my naturally excellent eye sight, I'm pretty positive that the existing higher order aberrations in my eyes are the culprits for the slight starbursts at night.
This is why some pay more and some pay less for their LASIK procedure. In my opinion, it's ridiculous that some surgeons even offer these as a choice for prospective patients unless they have a very slight prescription, even then I would be wary of not opting for the wavefront solution. Standard LASIK doesn't offer blending zone which is is why some patients in the past who had standard LASIK with average pupil size still ended up with problems of starbursts and halos. If these patients knew ahead of time that the cheaper standard LASIK laser may deliver substandard results for medium to high myopes as well as having a tendency to cause more higher order aberrations, would they choose it or opt for the more expensive option?
Dry Eyes
This is the other biggie. Most doctors today will ask you if you have existing dry eye symptoms. If you already have dry eyes, LASIK may further cause issues and you should reconsider. My cousin who did not have dry eyes pre-op had pretty bad symptoms for close to a year. My wife on the other hand had it for for the first couple days on only one eye. Five days later she is only using artificial tears every four hours or so. You never know. Chronic dry eyes could be a very bad problem. Discuss this fully with your doctor if you have existing dry eyes or the potential of having dry eyes.
Thin Corneas
If you have thin corneas, don't be surprised if the doctor recommend only PRK for you. Early on, some doctors performed LASIK on patients without checking their cornea thickness or pushing the boundary of safety. The result for some were ecstasia due to excessively thin corneas...and of course malpractice suits for the doctors. This is why if you have thin corneas, your doctor will tell you that you are only qualified for LASIK but instead offer PRK. Did you know that there are now advancements in PRK such as LASEK and epi-LASEK where the recovery time is much faster than PRK? So far, I haven't seen any south bay doctors offering this version of PRK. If faster recovery time is desirable, you may want to look for a doctor who offers LASEK.
Hacks
What is a hack? That's an unqualified doctor or one who cut corners in order to save money. It can be anything from reusing microkeretome blades to pushing people to perform LASIK when they are clearly unqualified. If you are on an assembly line, with 20 patients waiting for LASIK from morning until late into the night, the doctor obviously wants to get through each of you quickly. If something as delicate as surgery is hurried, mistakes may occur either through carelessness or tiredness. For example, this one individual waited until 10PM because the clinic overbooked. Not surprisingly, she ended up with problems. Here is this one person who had his vision ruined because the 'doctor' (who knows, this is Peru after all!) didn't calibrate their machine properly. Or then there are cases of people who had LASIK done too soon while their vision was still regressing. So be very careful if the doctor offer the LASIK at an extremely cheap price, you are not able to ask questions with your doctor, you are pushed to have a procedure, you see are waiting 3-4 hours for a consultation, or you show up to your surgery but end up sitting on the floor with the waiting area looking like a refugee camp.
Are you scared yet? Well, if LASIK was that dangerous, I wouldn't have let my wife go through with it. There has been 31 million LASIK procedures performed. The number of satisfied patients outnumber the unsatisfied patients by many factor. Also, many of the complications were a result of doctors pushing unqualified individuals to have LASIK done when they were clearly not candidates for it. Nevertheless, you should still prepare yourself for the possibilities of complications. The doctors we consulted with are all well respected and are careful to screen their candidates. They have their reputation to protect and have been in business a long time for a reason. However, based on the horror stories out there, not all doctors are that conscionable.
The majority of LASIK complications I've read online are due to (a) large pupils, (b) dry eyes, or (c) thin corneas. There are a small percentage with complications that are unrelated to the above three such as flap complications and misdiagnosis of prescription or miscalibration. It is an elective surgery and there are risks involved. Educate yourself before you go for a consultation. Question everything and do not take their answer as gospel. They may be medical doctors but they are also human. Greed sometimes cloud people's decisions.
LASIK is a miracle cure if everything goes right. As with anything involved with the human body, when things go wrong it could go very wrong. So think twice next time you go to Tijuana for the $800 LASIK. It's a decision that will affect you for better or worse for the rest of your life.
Disclaimer: This is my opinion. This should not be considered medical advice.
References:
http://www.realself.com/review/king-of-prussia-lasik-put-disability
http://www.usaeyes.org/lasik/faq/lasik-pupil-size.htm
http://www.allaboutvision.com/conditions/aberrations.htm
http://lasik-flap.com/forum/viewtopic.php?t=850
http://www.realself.com/review/new-york-terrible-pain-sleep-lasik-laser-vision-correction-surgery
http://www.allaboutvision.com/visionsurgery/lasek.htm
http://www.allaboutvision.com/visionsurgery/epi-lasik.htm
http://www.realself.com/review/lasik-brazil
http://www.realself.com/review/lasik-waist-money-canada
http://www.realself.com/review/only-last-few-years
http://www.realself.com/review/lasik-great-dont-do-it-too-young
Friday, January 6, 2012
The Procedure
The entire procedure lasted maybe 15-20 minutes including the prep time. The actual Intralase process completed in 15 seconds per eye. The Excimer laser lasted maybe 30 seconds per eye. In between, the surgeon and three support staff helped did their job. It was fascinating to watch the procedure on the television set.
The scariest part of the procedure and probably the most difficult portion of the procedure for my wife was the cutting of the flap. I think it was mostly psychological. By taking the oscillating blade out of the equation, the biggest fear was also removed. She opted to skip the Valium altogether. It wasn't necessary because to her the laser wasn't as scary as the microkeretome, which is a glorified oscillating razor blade. The anticipation of the surgery was the hardest part for her. The actual surgery was over before she knew it.
The Prep
For the surgery prep, her eye areas were wiped with antibacterial wipes. She donned the the surgical cap to keep her hair out of the way. Afterward they brought her into the surgical room where the Intralase FS and Visx S4 IR machines dominate the room. The room has a glass window to allow family members to view the procedure. There is a television that displays the camerea from the laser's and surgeon's point of view.
Before the doctor came in, the assistant adjusted the laser level so that so that it was level with my wife's head. She told me that the scene from Final Destination 5 kept popping into her head. Bad idea to watch that movie before the surgery. Fortunately for her, that movie made absolutely no sense. Let's see how many things that it got wrong. First of all, she was never left alone. There was always at least two person in the room with her. The laser does not work on autopilot, so it must always be operated by the surgeon. A rogue killer laser was just not possible. The laser has a fail-safe that shuts itself down in case of a malfunction. Furthermore, the laser beam is ultraviolet which is invisible. Heat would cook the surrounding cells. The reason excimer laser works so well is due to its ability for pin-point accuracy without burning the surrounding cells.
The Procedure
When the doctor finally came in, the surgery was ready to begin. My wife was positioned under the Intralaser laser and had the eye clamp positioned to keep the lids from closing. Yes, at least the director of Final Destination got that one right. Multiple numbing drops were applied to numb the eyes. Then they checked her corneal thickness again with an ultrasound device. Finally, they asked the patient her name and birth date. I assume this was to prevent accidental procedure of the "custom" procedure on the wrong patient.
The doctor asked her to look at his forehead in order to position the eye. The suction cup was laid over her right eye. On the TV, it looked like the eyeball got flattened by the suction device. What she saw under the suction cup was a series of white light. She didn't know or felt the Intralase laser cut the flap. On television, I saw the outline of the flap appearing by the changes in a lighter shade of her cornea as the laser cut the outline of the flap. Once the flap was finished, the doctor applied something like tape to keep it closed and then then the process was repeated for the second eye.
Once the second flap was cut, the doctor moved her over to the second machine to start the actual fixing of her vision. He used a surgical device to separate the flap. This piece looked kind of like a dentist's pick as he because it has a needle end to gently separate the flap. When the flap was moved, her vision became blurred and everything became 'bouncy'. That's her description, it was as if her vision was moving. The doctor asked my wife to look at the red light. On the TV, it looked like a circular red target. Imagine the point of view of the Terminator as he's looking at his target with the bracketed heads up display. That's what the red target looked like. When the laser started, there was a zapping noise that sounded like firecrackers going off. It was fairly loud. She told me that her entire vision blacked out at that point. My wife thought they turned out the lights. Except they didn't. Good thing she didn't know what was happening. It was probably more comforting to think that the lights were turned out than knowing that at that moment your eye just shut itself off by the blinding ultraviolet light. She said it smelled like hair burning when the machine was zapping her eyes. The corneal tissues that were responsible for her bad vision were going to a better place, vaporized into nothingness.
Once the process finished, the doctor scrubbed the cornea with a surgical tool with flat side. He reapplied the flap then pushed it down with another tool that was circular in nature. Then he applied a bunch of medicinal drops on her, perhaps antibiotics, steroid and numbing drops. She said once the flap was reapplied she could immediately see clearly albeit with a slight haze. One thing was for sure, it was much better than the pre-op vision. The same procedure was performed on the second eye. After everything was done she just got up and walked to the next room for the post-op consultation where they gave you the shades, the surgical eye cover for the first few nights of sleeping and the schedule of medicine application.
That was it. We arrived around 12:25. The procedure started at 1:05 PM. We left the building at 1:30 PM.
The First Night
Other than some dry eye symptoms on her left eye, everything appeared normal. Her right eye amazingly has no issue, no pain or dry eye. Only her left eye has dry eye symptoms. It was also the eye that required numbing drops the first night due due to the contact in the eye feeling. She describes it as feeling as if something was left in the eye. We were told that this was normal due to dry eye symptom from the LASIK procedure. She's actually lucky as her symptoms are very minor. I guess this is why LASIK is the preferred procedure over PRK. It's almost close to zero recovery time.
The Next Check Up
Her eyes were tested the next as 20/20 and 20/25. The left eye that was bothering her with dry eye is weaker than the right. Her vision is clear other than the haze that covers it. She describes it as kind of like looking through a foggy filter. The interesting thing is that other than the haze, she swears she can see better than she did with her contacts. Her vision is just sharper. I wonder if this was due to her higher order aberrations? Before the surgery, she had poor quality vision even when she wore glasses or contacts. Her distant vision was only half as good as mine. However, one day after surgery, her vision is of better quality than she ever had even with contacts! It's truly remarkable technology and nothing short of miraculous.
We're looking forward to the one week consultation. Hopefully once the swelling and haze go away, her vision will improve even more. She's extremely happy with her decision to have LASIK done. I asked if she had to do it again, would she go through with it? She says yes she would do it again in a heart-beat and that you can't put a price tag on her improved quality of life. Well, there you go. Another LASIK evangelist is born.
The scariest part of the procedure and probably the most difficult portion of the procedure for my wife was the cutting of the flap. I think it was mostly psychological. By taking the oscillating blade out of the equation, the biggest fear was also removed. She opted to skip the Valium altogether. It wasn't necessary because to her the laser wasn't as scary as the microkeretome, which is a glorified oscillating razor blade. The anticipation of the surgery was the hardest part for her. The actual surgery was over before she knew it.
The Prep
For the surgery prep, her eye areas were wiped with antibacterial wipes. She donned the the surgical cap to keep her hair out of the way. Afterward they brought her into the surgical room where the Intralase FS and Visx S4 IR machines dominate the room. The room has a glass window to allow family members to view the procedure. There is a television that displays the camerea from the laser's and surgeon's point of view.
Before the doctor came in, the assistant adjusted the laser level so that so that it was level with my wife's head. She told me that the scene from Final Destination 5 kept popping into her head. Bad idea to watch that movie before the surgery. Fortunately for her, that movie made absolutely no sense. Let's see how many things that it got wrong. First of all, she was never left alone. There was always at least two person in the room with her. The laser does not work on autopilot, so it must always be operated by the surgeon. A rogue killer laser was just not possible. The laser has a fail-safe that shuts itself down in case of a malfunction. Furthermore, the laser beam is ultraviolet which is invisible. Heat would cook the surrounding cells. The reason excimer laser works so well is due to its ability for pin-point accuracy without burning the surrounding cells.
The Procedure
When the doctor finally came in, the surgery was ready to begin. My wife was positioned under the Intralaser laser and had the eye clamp positioned to keep the lids from closing. Yes, at least the director of Final Destination got that one right. Multiple numbing drops were applied to numb the eyes. Then they checked her corneal thickness again with an ultrasound device. Finally, they asked the patient her name and birth date. I assume this was to prevent accidental procedure of the "custom" procedure on the wrong patient.
The doctor asked her to look at his forehead in order to position the eye. The suction cup was laid over her right eye. On the TV, it looked like the eyeball got flattened by the suction device. What she saw under the suction cup was a series of white light. She didn't know or felt the Intralase laser cut the flap. On television, I saw the outline of the flap appearing by the changes in a lighter shade of her cornea as the laser cut the outline of the flap. Once the flap was finished, the doctor applied something like tape to keep it closed and then then the process was repeated for the second eye.
Once the second flap was cut, the doctor moved her over to the second machine to start the actual fixing of her vision. He used a surgical device to separate the flap. This piece looked kind of like a dentist's pick as he because it has a needle end to gently separate the flap. When the flap was moved, her vision became blurred and everything became 'bouncy'. That's her description, it was as if her vision was moving. The doctor asked my wife to look at the red light. On the TV, it looked like a circular red target. Imagine the point of view of the Terminator as he's looking at his target with the bracketed heads up display. That's what the red target looked like. When the laser started, there was a zapping noise that sounded like firecrackers going off. It was fairly loud. She told me that her entire vision blacked out at that point. My wife thought they turned out the lights. Except they didn't. Good thing she didn't know what was happening. It was probably more comforting to think that the lights were turned out than knowing that at that moment your eye just shut itself off by the blinding ultraviolet light. She said it smelled like hair burning when the machine was zapping her eyes. The corneal tissues that were responsible for her bad vision were going to a better place, vaporized into nothingness.
Once the process finished, the doctor scrubbed the cornea with a surgical tool with flat side. He reapplied the flap then pushed it down with another tool that was circular in nature. Then he applied a bunch of medicinal drops on her, perhaps antibiotics, steroid and numbing drops. She said once the flap was reapplied she could immediately see clearly albeit with a slight haze. One thing was for sure, it was much better than the pre-op vision. The same procedure was performed on the second eye. After everything was done she just got up and walked to the next room for the post-op consultation where they gave you the shades, the surgical eye cover for the first few nights of sleeping and the schedule of medicine application.
That was it. We arrived around 12:25. The procedure started at 1:05 PM. We left the building at 1:30 PM.
The First Night
Other than some dry eye symptoms on her left eye, everything appeared normal. Her right eye amazingly has no issue, no pain or dry eye. Only her left eye has dry eye symptoms. It was also the eye that required numbing drops the first night due due to the contact in the eye feeling. She describes it as feeling as if something was left in the eye. We were told that this was normal due to dry eye symptom from the LASIK procedure. She's actually lucky as her symptoms are very minor. I guess this is why LASIK is the preferred procedure over PRK. It's almost close to zero recovery time.
The Next Check Up
Her eyes were tested the next as 20/20 and 20/25. The left eye that was bothering her with dry eye is weaker than the right. Her vision is clear other than the haze that covers it. She describes it as kind of like looking through a foggy filter. The interesting thing is that other than the haze, she swears she can see better than she did with her contacts. Her vision is just sharper. I wonder if this was due to her higher order aberrations? Before the surgery, she had poor quality vision even when she wore glasses or contacts. Her distant vision was only half as good as mine. However, one day after surgery, her vision is of better quality than she ever had even with contacts! It's truly remarkable technology and nothing short of miraculous.
We're looking forward to the one week consultation. Hopefully once the swelling and haze go away, her vision will improve even more. She's extremely happy with her decision to have LASIK done. I asked if she had to do it again, would she go through with it? She says yes she would do it again in a heart-beat and that you can't put a price tag on her improved quality of life. Well, there you go. Another LASIK evangelist is born.
VISX S4 IR
One thing that has bothered me and caused me much trepidation was the fact that their website still shows the original Visx S4. I've contacted the doctor, the nurse, the receptionist, and everyone in between for assurance that the laser is the latest Visx Star S4 IR. They all assured me that it is... but yet I was still worried. Why wouldn't they advertise the fact that they have the latest and greatest technology?
Here is the screen shot of the website the name of the machine highlighted in yellow.
How can they convince patients that they are using the latest and greatest when their own website states otherwise? Notice how there is no mention of IR or Iris Registration? This is what the AMO website describes as Advanced CustomVue. Notice the highlighted lettering:
Well, it is the IR. I saw the machine. The website should be updated to show the IR and the Fourier upgrade to help future patients understand that they are using the latest technology VISX Star S4 IR and Advanced CustomVue.
I know it could have saved me a lot of headaches.
(Update 1/9/12: To reinforce our decision of selecting the Visx S4 IR, here is a great comparison of this laser versus other. All of these are facts can be checked via other Internet sources.
The wife is now home resting. We'll see how she feels tomorrow. I'll post more information regarding the procedure later. It was actually relatively painless. The most painful part of the entire surgery was the first part--paying for it! =)
Reference:
http://www.willvision.com/compare-excimer-lasers-2.htm
Here is the screen shot of the website the name of the machine highlighted in yellow.
Well, it is the IR. I saw the machine. The website should be updated to show the IR and the Fourier upgrade to help future patients understand that they are using the latest technology VISX Star S4 IR and Advanced CustomVue.
I know it could have saved me a lot of headaches.
(Update 1/9/12: To reinforce our decision of selecting the Visx S4 IR, here is a great comparison of this laser versus other. All of these are facts can be checked via other Internet sources.
- Widest FDA approval
- Fourier algorithm has the highest resolution for wavefront scan
- Iris Registration and 3D Eye Tracking
- VISX was the original Excimer laser which started this industry
- It is the most proven laser system
The wife is now home resting. We'll see how she feels tomorrow. I'll post more information regarding the procedure later. It was actually relatively painless. The most painful part of the entire surgery was the first part--paying for it! =)
Reference:
http://www.willvision.com/compare-excimer-lasers-2.htm
Wednesday, January 4, 2012
Our Decision
We knew that whichever doctor we decide to go with, we were going to pick the best available technology out there and that's wavefront, be it optimized or guided. We would probably be happy with standard LASIK as well. However, we want the highest probability of the best possible vision coupled with the lowest probability of complications. That's why we pay for the best technology and the best doctor. It's a one shot deal and there's no point in trying to save a few bucks and go with older technology. Our only regret was that we did not max out our flexible spending account. We set aside only $4500! Too bad we started our research and consultation after we had already set our flexible spending account. Our only consolation is that this is $2000 more than the 2013 year max. I wonder if LASIK prices will drop next year once the flexible spending limit gets lowered?
Lifetime Guarantee
This is one of those 'feature' that some LASIK doctors tout. If you read my previous posts, I'm not too keen on the lifetime guarantee, but it's actually not just a gimmick. You shouldn't require it if you're lucky. Hopefully the newer wavefront tech has lowered the enhancement rate, but historically it's been 7%.
All of us want our eyes to be perfect the first time around. For the majority of people out there, a re-treatment after they get it right the first time is very low. If you do receive enhancement, it is likely within the first year.
If you read the fine print, your eye sight must fall below 20/40 or more than -1.0D prescription for them to allow you to "re-do" the eyes. Also, it must be medically advisable. So ultimately it's up to the doctor if they want to deny it for any reason. Doctors can make up pretty much any reason to deny you. I'm sure our esteemed Bay Area doctors would not resort to anything shady like that. However, not all doctors are scrupulous. Just saying.
Another big fine print guarantee buster: presbyopia. This is the inability of the eyes to focus close up as one ages. This condition usually starts in the fourth decade of your life. The "lifetime" guarantee is more like a 10-15 year guarantee. I can see why they call it the lifetime guarantee: the "until presbyopia set in guarantee" just doesn't have the same ring to it does it? All three doctors exclude presbyopia.
Dr. Hyver and TLC has the same conditions. TLC doesn't advertise it, but I've seen the fine prints. 20/40, -1.0, and no presbyopia. Now, Dr. Bindi's advertises his guarantee as Regardless of your level of vision. Really? Even if for hugs and giggles I want him to laser my eyes for fun? Heh. I assume if you wanted to and your vision is 20/30 he'll do it. Big plus for him. By the way, Dr. Furlong has informed me that his practice will offer the enhancement guarantee even if you miss your annual eye check. I'm glad to hear that's the case. The extra requirement of an annual eye exam is unreasonable and something inserted by their bean counters that only serves to undermine their "guarantee".
Of course, it still must be medically advisable, so none of that hugs and giggles please laser my eyes reason. If you have no corneal tissues left, they will likely deny it. I hope they consider PRK over the flap for those instances where the patients have thin cornea left from the previous LASIK procedure.
The guarantee is basically a 10-15 year long or until presbyopia sets in guarantee for all three doctors. The lifetime guarantee is not a make or break perk. All three doctors offer it so it's a wash. I would not select a doctor over this one item. It is good to have for peace of mind in case your eyes decides to change all of a sudden. Unfortunately for us, a small percentage of the population will need this enhancement down the road.
The doctor
Honestly, they all are well qualified and great doctors. Their license records are pristine. However, with the informed consent they require you to sign, you'd think that LASIK is the most horrible surgery in the world. Dry eyes, starburst, halos, blindness--yes blindness! One of the informed consent has that. Talk about covering your butt!
We both like Dr. Bindi. We went to see him a few years back when he turned my wife because we were told her eyes were not stable. I enjoyed communicating with him through Email. If our decision was based on the doctor and doctor alone, we would definitely pick Dr. Bindi. Referral: our aunt had LASIK with him. No issue.
Dr. Hyver was very nice when we spoke to him. However, we're not sure we would pick him based on his high volume, marketing-machine model. Plus, blindness as an informed consent? Come on, Dr. Hyver! Referral: my wife's friend had LASIK with him. No issue.
Dr. Furlong doesn't really market himself other than aligning himself with TLC. Also, he has only one business (that I know of) so you may actually catch him the entire week rather than two days a week. Did you know that Dr. Furlong actually performs more than refractive surgery, like real eye surgery and not the one where the machine does all the work? ;) He also performs cataract surgery and lens implant. He is the only surgeon who was able to detect cataract in my mother's eyes when she went for a LASIK consultation. Referral: our cousin had LASIK with him. No issue.
My aunt who is a nurse had her LASIK with Dr. Ellis (yes, the doctor with the malpractice suit). She isn't happy with the results because she has bad night vision with halos and starbursts which make it difficult for her to drive at night. She said she had custom LASIK with him. I assume that's with the 217z Zyoptix. He's lucky she doesn't exercise her God-given blogging rights as a consumer like me. Oops, too late, guilty by association. Bummer for him. She is the only person I know who claims to not be totally satisfied with her LASIK procedure. I asked her for a recommendation and she mentioned Dr. Furlong because the doctors from her hospital had it done with him. That's a nice endorsement!
The technology
This is the big one. Since we were happy with all three doctors, the real difference is the technology. The studies have shown that wavefront is superior to standard LASIK. I've discussed the technology in length in a previous post. The results were statistically insignificant between wavefront-optimized and wavefront-guided for patients with higher order aberrations below .3 RMS. However, my wife's eyes had .59 and .39 both above that magic number. Ultimately, we have to go with the tech with the higher probability no matter how small it is. With her high prescription and high HOA, the probability of achieving 20/15 is likely not that high. No matter, we have to strive for that level. If she only gets 20/20 then that's OK. However, we do not want to have regrets of not aiming for the 40% rather than the 20% target.
Side-Effects
My wife has come to terms with the side effects. There's always a small chance of something not working out such as dry eyes or halos and starbursts. She is willing to put up with dry eyes and starbursts if it means being able to see 5 feet in front of her and living without the use of contacts or glasses. Her bar is set fairly low. Her unaided visual acuity is somewhere around 20/500. If she can see 20/40 after surgery, she would consider the surgery a success. Of course, we're shooting for 20/15!
By the way, the doctor will prescribe you some brand name drug that cost over $120 for the antibiotics. Make sure you go back and demand they prescribe you an alternative generic like Ciproflaxin. Are the pharmaceutical companies offering them commissions for recommending these brand name drugs? These are not cancer treatment medicine. Get the cheapest antibiotics you can.
Oh yeah you probably want to find out who we chose...
I believe we would probably get great results with any of the three doctors. However, based on the studies, we will go with the doctor and technology that afford us the best probability and possibility for great results: Dr. Furlong.
Look for a future post of the actual surgery and recovery.
References
http://en.wikipedia.org/wiki/Presbyopia
http://forums.anandtech.com/showthread.php?s=3fad80c79cab1c7636affe52a6e55dff&t=78072
http://www.usaeyes.org/lasik/library/lasikplus-warranty.htm
http://www2.mbc.ca.gov/LicenseLookupSystem/PhysicianSurgeon/Lookup.aspx?licenseType=G&licenseNumber=19742
http://www.elliseye.com/san-francisco/lasik_technology_san_francisco/lasik-technology-san-francisco.htm
Lifetime Guarantee
This is one of those 'feature' that some LASIK doctors tout. If you read my previous posts, I'm not too keen on the lifetime guarantee, but it's actually not just a gimmick. You shouldn't require it if you're lucky. Hopefully the newer wavefront tech has lowered the enhancement rate, but historically it's been 7%.
All of us want our eyes to be perfect the first time around. For the majority of people out there, a re-treatment after they get it right the first time is very low. If you do receive enhancement, it is likely within the first year.
If you read the fine print, your eye sight must fall below 20/40 or more than -1.0D prescription for them to allow you to "re-do" the eyes. Also, it must be medically advisable. So ultimately it's up to the doctor if they want to deny it for any reason. Doctors can make up pretty much any reason to deny you. I'm sure our esteemed Bay Area doctors would not resort to anything shady like that. However, not all doctors are scrupulous. Just saying.
Another big fine print guarantee buster: presbyopia. This is the inability of the eyes to focus close up as one ages. This condition usually starts in the fourth decade of your life. The "lifetime" guarantee is more like a 10-15 year guarantee. I can see why they call it the lifetime guarantee: the "until presbyopia set in guarantee" just doesn't have the same ring to it does it? All three doctors exclude presbyopia.
Dr. Hyver and TLC has the same conditions. TLC doesn't advertise it, but I've seen the fine prints. 20/40, -1.0, and no presbyopia. Now, Dr. Bindi's advertises his guarantee as Regardless of your level of vision. Really? Even if for hugs and giggles I want him to laser my eyes for fun? Heh. I assume if you wanted to and your vision is 20/30 he'll do it. Big plus for him. By the way, Dr. Furlong has informed me that his practice will offer the enhancement guarantee even if you miss your annual eye check. I'm glad to hear that's the case. The extra requirement of an annual eye exam is unreasonable and something inserted by their bean counters that only serves to undermine their "guarantee".
Of course, it still must be medically advisable, so none of that hugs and giggles please laser my eyes reason. If you have no corneal tissues left, they will likely deny it. I hope they consider PRK over the flap for those instances where the patients have thin cornea left from the previous LASIK procedure.
The guarantee is basically a 10-15 year long or until presbyopia sets in guarantee for all three doctors. The lifetime guarantee is not a make or break perk. All three doctors offer it so it's a wash. I would not select a doctor over this one item. It is good to have for peace of mind in case your eyes decides to change all of a sudden. Unfortunately for us, a small percentage of the population will need this enhancement down the road.
The doctor
Honestly, they all are well qualified and great doctors. Their license records are pristine. However, with the informed consent they require you to sign, you'd think that LASIK is the most horrible surgery in the world. Dry eyes, starburst, halos, blindness--yes blindness! One of the informed consent has that. Talk about covering your butt!
We both like Dr. Bindi. We went to see him a few years back when he turned my wife because we were told her eyes were not stable. I enjoyed communicating with him through Email. If our decision was based on the doctor and doctor alone, we would definitely pick Dr. Bindi. Referral: our aunt had LASIK with him. No issue.
Dr. Hyver was very nice when we spoke to him. However, we're not sure we would pick him based on his high volume, marketing-machine model. Plus, blindness as an informed consent? Come on, Dr. Hyver! Referral: my wife's friend had LASIK with him. No issue.
Dr. Furlong doesn't really market himself other than aligning himself with TLC. Also, he has only one business (that I know of) so you may actually catch him the entire week rather than two days a week. Did you know that Dr. Furlong actually performs more than refractive surgery, like real eye surgery and not the one where the machine does all the work? ;) He also performs cataract surgery and lens implant. He is the only surgeon who was able to detect cataract in my mother's eyes when she went for a LASIK consultation. Referral: our cousin had LASIK with him. No issue.
My aunt who is a nurse had her LASIK with Dr. Ellis (yes, the doctor with the malpractice suit). She isn't happy with the results because she has bad night vision with halos and starbursts which make it difficult for her to drive at night. She said she had custom LASIK with him. I assume that's with the 217z Zyoptix. He's lucky she doesn't exercise her God-given blogging rights as a consumer like me. Oops, too late, guilty by association. Bummer for him. She is the only person I know who claims to not be totally satisfied with her LASIK procedure. I asked her for a recommendation and she mentioned Dr. Furlong because the doctors from her hospital had it done with him. That's a nice endorsement!
The technology
This is the big one. Since we were happy with all three doctors, the real difference is the technology. The studies have shown that wavefront is superior to standard LASIK. I've discussed the technology in length in a previous post. The results were statistically insignificant between wavefront-optimized and wavefront-guided for patients with higher order aberrations below .3 RMS. However, my wife's eyes had .59 and .39 both above that magic number. Ultimately, we have to go with the tech with the higher probability no matter how small it is. With her high prescription and high HOA, the probability of achieving 20/15 is likely not that high. No matter, we have to strive for that level. If she only gets 20/20 then that's OK. However, we do not want to have regrets of not aiming for the 40% rather than the 20% target.
Side-Effects
My wife has come to terms with the side effects. There's always a small chance of something not working out such as dry eyes or halos and starbursts. She is willing to put up with dry eyes and starbursts if it means being able to see 5 feet in front of her and living without the use of contacts or glasses. Her bar is set fairly low. Her unaided visual acuity is somewhere around 20/500. If she can see 20/40 after surgery, she would consider the surgery a success. Of course, we're shooting for 20/15!
By the way, the doctor will prescribe you some brand name drug that cost over $120 for the antibiotics. Make sure you go back and demand they prescribe you an alternative generic like Ciproflaxin. Are the pharmaceutical companies offering them commissions for recommending these brand name drugs? These are not cancer treatment medicine. Get the cheapest antibiotics you can.
Oh yeah you probably want to find out who we chose...
I believe we would probably get great results with any of the three doctors. However, based on the studies, we will go with the doctor and technology that afford us the best probability and possibility for great results: Dr. Furlong.
Look for a future post of the actual surgery and recovery.
References
http://en.wikipedia.org/wiki/Presbyopia
http://forums.anandtech.com/showthread.php?s=3fad80c79cab1c7636affe52a6e55dff&t=78072
http://www.usaeyes.org/lasik/library/lasikplus-warranty.htm
http://www2.mbc.ca.gov/LicenseLookupSystem/PhysicianSurgeon/Lookup.aspx?licenseType=G&licenseNumber=19742
http://www.elliseye.com/san-francisco/lasik_technology_san_francisco/lasik-technology-san-francisco.htm
Monday, January 2, 2012
The Costs of LASIK
The average costs of LASIK in the San Francisco Bay Area is around 5K after "discount". In general they have a listed price of $5900 then discounts it from there via promotion or insurance. The most annoying aspect of the LASIK experience is the used car salesman aspect where you meet the sales consultant who starts the haggling of the price. Unfortunately, you can haggle with medical expenses and it's a fact of life. You can expect to shave around $1k or so give or take depending on the promotion, the referral, or the "study" special. The "real" price is around 5K give or take $300. In the UK, the practice is even worse where they start very high (£ 5000) and discount up to 50% off.
Breakdown of components of the cost of LASIK:
The surgeon
The doctor's reputation and experience probably make up 50% of the cost of LASIK. Although the machines actually perform the work, it is up to the doctor to program the nomograms based on your prescription. With experienced surgeons, they can use nonmograms to add or subtract from your prescription based on the machine to achieve better based on their experiences of past patients and/or your prescription/corneal/similar eye structure. This is why not all surgeons can give you the same results even though they may use the same technology.
Did you know your doctor's license is public information? Always use the California Medical Board License Lookup to research your doctor before you make a commitment. Malpractice suits should be a part of your consideration. Paradoxically, doctors with active malpractice suits may not be much cheaper because their malpractice insurance would go up exponentially.
The location
The San Francisco Bay Area in general cost about $1k more than the greater Los Angeles area. Within the LA area, there may be cheaper and more expensive areas. There's a Beverly Hills doctor who charges $6400 per procedure whereas there's another doctor in Koreatown who charges $1200(!!!) for the entire operation. The rent plays a huge factor into location The rent for an office in Koreatown is much less than a huge office in the Santa Clara or San Francisco area with mood lighting and a clean atmosphere.
Make sure you factor in the cost of travel if you are willing to go out of town for your surgery. Do you want the follow up exams? If you travel by plane, it cost at least $150 by plane round trip. By car, it could be half of that but you will lose about 6 hours. How much is your time worth to you? Don't forget to add in cost of hotels as well.
The staff: The more expensive surgeons have a full staff of professionals. Also, some of the more high volume doctors also hire optometrists who performs the follow up checks for them. If you want the surgeon to also be your follow up doctor, make sure you ask ahead of time. Not all surgeons have the time or willingness to actually see you. Interestingly enough, some of the low cost doctors may also be your follow up doctor because they cut back on costs for their staff. The result of these low cost surgeons is that they book more patients per day with less staff to accommodate them. It's not unheard of to wait 2-4 hours to see a Koreantown doctor. Once again, how much is your time worth?
Technology
After the the surgeon, technology should be the second highest priority than you should look at. The $1200 per eye doctor charges based on your prescription. The price goes up as your prescription goes up. Also, the surgeon most likely uses the NIDEK laser. This is an older technology that doesn't offer wavefront technology. It is tried and true but is very old (in terms of LASIK technology). These doctors have already paid back the cost of the LASER. Any new procedure is just gravy for them aside from the annual maintenance cost. The wavefront technology, both optimized and guided carry new costs with them. Also, the manufacturer often charges a per click price. Expect to pay twice as much as what the surgeon pays to the manufacturer per eye. Some surgeons may have the machine on consignment where the per click cost of LASIK is much higher than average.
The femtosecond flap technology can add $500 to $1000 to the LASIK procedure cost. Surprisingly, many patients chose this over the microkeretome. Apparently, a blade to the eye is just not a very popular option even when that option is frequently free. The low cost LASIK are almost always using the blade. The reason is probably that they are not willing to invest in a femtosecond laser if they are going for the low cost market. Did you know that you can go to Koreatown and get LASIK by a surgeon using the Allegretto machine with a microkeretome blade for only $2500?
Some surgeons have a "menu" of prices depending on the technology. For something as important as your eyes, why wouldn't they just offer you the best technology available? Well, some doctors do. One doctor in the Bay Area offers one price regardless of whether you are qualified for PRK or LASIK. He also uses the latest available rather than offer an older laser for a cheaper price.
Advertisement
There's a pretty good chance that Patrick Willis or Tiger Woods did not pay for their LASIK procedure. Additionally, there's a pretty good chance that they got paid for the procedure as well. If you are going to pick a surgeon based on a celebrity, you should be aware that these celebrities probably did not pick the surgeon on their own and that they got paid for their endorsement of that doctor.
The rights for the official 49ers eye doctor? It's probably a paid endorsement deal. Patrick Willis's LASIK surgery?It's most likely PRK and not LASIK. Doctors do not recommend LASIK on individuals who participate in high contact sport. (Update 1/3/12: Apparently, football players can get LASIK if they wear a face mask! Thanks, Dr. Bindi!)
Conclusion
The cost of LASIK varies greatly between surgeons and regions. You should make a decision on LASIK based on the doctor, the technology, then the cost. The low cost surgeon may very well be a good surgeon and low cost doesn't automatically mean low quality. Although, with the lower cost, something has to give. Is it the rent? Is it the advertising budget? Is it the older laser technology? Is it the lack of femtosecond laser? Is it the long wait? Is it the staff who doesn't speak English? Or is it something else like a license censure?
If you are on a fixed income, or if the cost LASIK is beyond your budget, or if your prescription is on the low side, it may make sense to consider the low cost doctors. Keep in mind that 10 years ago, that same laser was performed on patients who are still perfectly happy with the results today.
However, never go into a LASIK procedure on a compromise. If you have doubts about your doctor or your procedure, you should stop. It may cost more down to road to fix a botched procedure than it does for the initial work. Ultimately, for us, it's more about the doctor and the technology. We are willing to pay more for the doctor we are most comfortable with the technology we want. We are still deciding but we will stay with a doctor in the Bay Area.
Disclaimer: I'm a not a doctor. Everything written here is my opinion only. None of what I wrote should be construed as medical advice.
References:
http://www.maloneyvision.com/resources/pdfs/Visx-wavescan-combined-nomogram-v2-regression.pdf
http://www.usaeyes.org/lasik/library/allegretto-lasik-datalink.htm
http://www.revophth.com/content/c/27712/
http://www.mbc.ca.gov/lookup.html
http://www.allaboutvision.com/visionsurgery/cost.htm
Breakdown of components of the cost of LASIK:
The surgeon
The doctor's reputation and experience probably make up 50% of the cost of LASIK. Although the machines actually perform the work, it is up to the doctor to program the nomograms based on your prescription. With experienced surgeons, they can use nonmograms to add or subtract from your prescription based on the machine to achieve better based on their experiences of past patients and/or your prescription/corneal/similar eye structure. This is why not all surgeons can give you the same results even though they may use the same technology.
Did you know your doctor's license is public information? Always use the California Medical Board License Lookup to research your doctor before you make a commitment. Malpractice suits should be a part of your consideration. Paradoxically, doctors with active malpractice suits may not be much cheaper because their malpractice insurance would go up exponentially.
The location
The San Francisco Bay Area in general cost about $1k more than the greater Los Angeles area. Within the LA area, there may be cheaper and more expensive areas. There's a Beverly Hills doctor who charges $6400 per procedure whereas there's another doctor in Koreatown who charges $1200(!!!) for the entire operation. The rent plays a huge factor into location The rent for an office in Koreatown is much less than a huge office in the Santa Clara or San Francisco area with mood lighting and a clean atmosphere.
Make sure you factor in the cost of travel if you are willing to go out of town for your surgery. Do you want the follow up exams? If you travel by plane, it cost at least $150 by plane round trip. By car, it could be half of that but you will lose about 6 hours. How much is your time worth to you? Don't forget to add in cost of hotels as well.
The staff: The more expensive surgeons have a full staff of professionals. Also, some of the more high volume doctors also hire optometrists who performs the follow up checks for them. If you want the surgeon to also be your follow up doctor, make sure you ask ahead of time. Not all surgeons have the time or willingness to actually see you. Interestingly enough, some of the low cost doctors may also be your follow up doctor because they cut back on costs for their staff. The result of these low cost surgeons is that they book more patients per day with less staff to accommodate them. It's not unheard of to wait 2-4 hours to see a Koreantown doctor. Once again, how much is your time worth?
Technology
After the the surgeon, technology should be the second highest priority than you should look at. The $1200 per eye doctor charges based on your prescription. The price goes up as your prescription goes up. Also, the surgeon most likely uses the NIDEK laser. This is an older technology that doesn't offer wavefront technology. It is tried and true but is very old (in terms of LASIK technology). These doctors have already paid back the cost of the LASER. Any new procedure is just gravy for them aside from the annual maintenance cost. The wavefront technology, both optimized and guided carry new costs with them. Also, the manufacturer often charges a per click price. Expect to pay twice as much as what the surgeon pays to the manufacturer per eye. Some surgeons may have the machine on consignment where the per click cost of LASIK is much higher than average.
The femtosecond flap technology can add $500 to $1000 to the LASIK procedure cost. Surprisingly, many patients chose this over the microkeretome. Apparently, a blade to the eye is just not a very popular option even when that option is frequently free. The low cost LASIK are almost always using the blade. The reason is probably that they are not willing to invest in a femtosecond laser if they are going for the low cost market. Did you know that you can go to Koreatown and get LASIK by a surgeon using the Allegretto machine with a microkeretome blade for only $2500?
Some surgeons have a "menu" of prices depending on the technology. For something as important as your eyes, why wouldn't they just offer you the best technology available? Well, some doctors do. One doctor in the Bay Area offers one price regardless of whether you are qualified for PRK or LASIK. He also uses the latest available rather than offer an older laser for a cheaper price.
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There's a pretty good chance that Patrick Willis or Tiger Woods did not pay for their LASIK procedure. Additionally, there's a pretty good chance that they got paid for the procedure as well. If you are going to pick a surgeon based on a celebrity, you should be aware that these celebrities probably did not pick the surgeon on their own and that they got paid for their endorsement of that doctor.
The rights for the official 49ers eye doctor? It's probably a paid endorsement deal. Patrick Willis's LASIK surgery?
Conclusion
The cost of LASIK varies greatly between surgeons and regions. You should make a decision on LASIK based on the doctor, the technology, then the cost. The low cost surgeon may very well be a good surgeon and low cost doesn't automatically mean low quality. Although, with the lower cost, something has to give. Is it the rent? Is it the advertising budget? Is it the older laser technology? Is it the lack of femtosecond laser? Is it the long wait? Is it the staff who doesn't speak English? Or is it something else like a license censure?
If you are on a fixed income, or if the cost LASIK is beyond your budget, or if your prescription is on the low side, it may make sense to consider the low cost doctors. Keep in mind that 10 years ago, that same laser was performed on patients who are still perfectly happy with the results today.
However, never go into a LASIK procedure on a compromise. If you have doubts about your doctor or your procedure, you should stop. It may cost more down to road to fix a botched procedure than it does for the initial work. Ultimately, for us, it's more about the doctor and the technology. We are willing to pay more for the doctor we are most comfortable with the technology we want. We are still deciding but we will stay with a doctor in the Bay Area.
Disclaimer: I'm a not a doctor. Everything written here is my opinion only. None of what I wrote should be construed as medical advice.
References:
http://www.maloneyvision.com/resources/pdfs/Visx-wavescan-combined-nomogram-v2-regression.pdf
http://www.usaeyes.org/lasik/library/allegretto-lasik-datalink.htm
http://www.revophth.com/content/c/27712/
http://www.mbc.ca.gov/lookup.html
http://www.allaboutvision.com/visionsurgery/cost.htm
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