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!

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. =)

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.

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

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.