11/28/12 Quick Update

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.

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.

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.

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.

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 :(.

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.

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

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

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

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!