Based on my situation, should I get LASIK?

[apham]

Hi everyone,

I have a couple of questions regarding lasik... but first, here's my story:
I never felt like I had dry eyes until 4 months ago. Before that, I've been wearing contact lenses since I was 14 (I'm now 25). I started noticing out of nowhere that my contacts were gradually bothering my eyes more and more, until I decided I could not wear them anymore. I went to the ophthalmologist who said that I have dry eyes due to improper closing of the eyelids when I'm sleeping AND being a contact lens wearer. It's funny how I was able to wear contact lens for so long without ever having to use eye drops.. until it hit me out of nowhere!
I started using regular preservative free eyedrops + the restasis. I felt like my eyes were getting better (but I do feel like they are dry here and there, and I can only wear contacts once a week for about 5-6 hours before they start feeling dry - but not painful). Since they felt better, I went to 3 different lasik consultations w/ 3 different doctors. They each told me I'd be a good candidate because my eyes aren't that dry. schirmer's test was a 10. They also mentioned that if my eyes were dry, it would show up on the cornea topography and i'd have blurred vision.

Here are the questions:

1. Since I've been doing a lot of research, I'm wondering if I should trust these doctors. A lot of people say that someone with pre-existing dry eye would be a terrible candidate. On the other hand, I read a lot of articles online from doctors who say that dry eye wouldn't eliminate the patient as a candidate, but it's important to get it under control. I had consultations with pretty reputable doctors, one having done over 60,000 surgeries. What do you think?

2. I've heard of people with normal eyes that get severe permanent dry eye after lasik. And then I've heard of people with dry eyes who still get lasik and are perfectly fine afterwards. What causes one patient to get permanent severe dry eye while another doesn't have any symptoms? Is this something based on a good/bad surgeon, or does it solely depend on the patient's body and how it heals?

3. Does anyone here have the same problem, where we can't close our eyelids all the way when sleeping? If so, how do you cope with it? I have genteal gel but it seems to evaporate before morning, leaving my eyes kind of dry in the morning.

Thanks in advance!

[Rebecca Petris]

Hi Apham,

Question 1:

Reputable or not, they all make their living from LASIK. If you want an unbiased opinion, go to a dry eye specialist who doesn't do LASIK, or who does very little of it.

By the way... a little math on those 60,000 procedures: LASIK has been FDA approved since 2000 (that is, that's when the earliest FDA approval for a laser for LASIK occurred). 60,000 procedures means a surgeon doing 24 surgeries per day (that is, every 20 minutes for 8 hours), 42 weeks of the year, for the last 12 years, that is, since approval. (210 days times 8 hours times 3 per hour = 5,040 surgeries annually; divide those 60,000 by 5,040 and you get 11.9 years. I've allowed 10 weeks vacation or days when they're not operating.) Of course, they may have started doing LASIK on an off-label basis much earlier but we needn't go there.

A surgeon who does that much surgery is doing NONE of the aftercare. How the heck does s/he even know whether their patients got dry eye or how bad it was? Some poor miserable optometrist is dealing with the aftermath until the patients get fed up and move on.

Question 2.
There is no simple answer to that question. Sometimes we know, sometimes we don't. There are certain risk factors, but if I had a nickel for everyone I know with no obvious risk factors who got it bad, well...

Question 3.
Lots of people. My favorite approach is physical barrier over the eyes at night. That may be anything from a sleep mask to plastic wrap to specialty goggles designed for the purpose. There are some examples in the dry eye shop (link above) but you can also find things locally.

[kanon]

Gosh, based on your history and based on the stories I hear from people on this forum who really suffer a lot with severe dry eye from Lasik, I wouldn't do it. I have severe dry eye (not from Lasik) and it really affects your entire life and is really painful. I just wouldn't risk it...you never know if you are going to get it and there is no cure. But I understand the allure of Lasik! Good luck.

[robster]

If you are already experiencing dry eye then steer clear of getting LASIK done. I had no dry eye problems(so I thought) and had LASIK and have had dry eye problems ever since. I too went for LASIK due to contact lens intolerance(which is one of the main reasons people give for wanting LASIK), little did I know that my contact lens intolerance was likely due to pre-existing dry eye issues. My eyes never felt dry when I wasn't wearing my lenses they sure as heck do now!

If you have pre-existing dry eye you are only increasing your chances of having post LASIK dry eye issues. My advice to anyone who has dry eye issues is too NOT have LASIK as your chances of having severe dry eye issues afterwords will be increased.

As for the LASIK clinics saying your a "good" candidate that is pretty much what they say to anyone who does not have severe dry eye already(and even some that do). As far as them saying you would have blurred vision if your eyes were really dry that is complete nonsense as many people have severe dry eye without having blurred vision though blurred vision can be caused by dry eye.

Sorry for the rant but if you have LASIK with dry eyes you could be OK but you could also be opening yourself up for a world of hurt. I personally think that dry eye should preclude people from having LASIK but that will never happen as the LASIK companies would lose too much money. As I said earlier dry eye issues(contact lens intolerance) is one of the main factors for many people getting LASIK not knowing that the reason behind there contact lens intolerance is most likely underlying MGD.

[jax8it]

Do not do it! I had lasik on Jan 21 and I have regretted it everyday since then. Like robster, I did not think I had dry eye. I remember I would have to take my contacts out as soon as I came home from work and put my glasses on. I wrote all this on my lasik paper work and I was still the perfect candidate. That stupid surgery has caused pain, depression, and anxiety everyday. I would not wish this on my worst enemy.

[Guest]

Agree with the others... I couldn't tolerate contacts because they made my eyes too dry... multiple docs told me I was "allergic" to the contacts or the solutions. Eyes felt normal as can be if I kept my contacts out. Told all this to the lasik surgeon, he insisted I was a perfect candidate, and all hell broke loose with my eyes once I had lasik.

I wonder if pre-lasik I did not have an "allergy" to the contacts, but maybe some meibomian gland dysfunction or mild dry eye that never got diagnosed.

I think any kind of eye discomfort increases the likelihood that Lasik or other refractive surgury will mess up your eyes and cause lasting symptoms like I, and so many others here, have to deal with. Believe me, Lasik can open up a whole world of hurt eye-wise that you never imagined was possible. And a lot of lasik docs seem in such a hurry to make more money that they ignore this possibility. Don't forget - although a lasik doc may be a doctor who should have your best interests at heart, there is also a lot of temptation to just do more surgeries because it is so lucrative. Not saying they are all evil people, but I think the temptation to make such good money and the numerous happy patients maybe make it easy to delude themselves that people like me don't exist.

[apham]

Hi everyone,

Thank you for your responses. I'm going to my regular ophthalmologist today to get some plugs - hopefully after the plugs I can wear contact lenses again. I just wish I could wear contact lenses without discomfort, then I wouldn't even consider getting lasik done. I think the restasis reached a point where I haven't been seeing much improvement for weeks now.

A big part of me tells myself NOT to get lasik due to all the horror stories of severe dry eye syndrome, but a small part of me is itching to get it done from coworkers and friends' experiences (even the ones who had pre-existing dry eye). I keep telling myself, 'maybe i won't be unlucky,' but I know it's still not worth the risk. I really need to convince myself not to do it, as I've been at the point (4+ months ago) where I had severe dry eye, with a Schrimer's test of 2.. and it was so miserable.

[Guest]

Totally understand the temptation for Lasik... it's powerful! But remember that experience where you were so miserable with a Schirmer's of 2 and imagine being like that forever... odds of that happening to you are higher than the average person because you've already been there I think. Trouble is, no-one can tell you precisely how high your risk of that kind of thing being permenent after LASIK really is... if you do it, just be sure you can live with the worst case scenario... people have done themselves in due to post-lasik complications and you don't want to end up being one of them.

Good luck with the contacts... hopefully you'll be lucky and find a way to wear them... if not, use the money you would have spent on lasik and splurge on a kick-a$$ pair of glasses.

[Rebecca Petris]

I just wish I could wear contact lenses without discomfort, then I wouldn't even consider getting lasik done.

Boy do I ever hear you on that one! Exactly what happened to me. Actually I just had an intermittent problem with contacts in my left eye. I actually liked glasses, but I couldn't see as well with glasses as contacts. That's where I was back in 2001 before I got LASIK.

The good news though is that there really are more and better contact lens options these days and there are more optometrists pursuing them... Wish you the best of luck whatever paths you pursue! Here's to healthy eyeballs

[apham]

Boy do I ever hear you on that one! Exactly what happened to me. Actually I just had an intermittent problem with contacts in my left eye. I actually liked glasses, but I couldn't see as well with glasses as contacts. That's where I was back in 2001 before I got LASIK.

The good news though is that there really are more and better contact lens options these days and there are more optometrists pursuing them... Wish you the best of luck whatever paths you pursue! Here's to healthy eyeballs

I tried asking my optometrist about better contact lenses. He was pretty adamant about how I already have the best ones (acuvue oasys), and didn't suggest anything else. Maybe I'll try browsing around this forum for any suggestions on better contacts. I was also thinking that maybe acuvue oasys was causing discomfort because it simply wasn't for me.. my contacts seem to always sit slightly higher on my eyeball - or is this just a symptom of dry eye?

[sazy123]

Just wear glasses.... I would do anything to have my eyes how they were and i would never wear contacts agian.. I would wear glasses and be happy that my life wasnt ruined!!!!

wEARING CONTACTS WITH DRY EYE IS NOT A GOOD IDEA EITHER.. I CAN MAKE DRY EYE WORSE. THERES RESEARCH OUT THERE.

[jax8it]

Hi apham,

You said that your contacts always sit slightly higher on your eyeball. Has your doctors checked under your lids. I was recently diagnosed with giant papilary conjunctivitis which normally affect contact lense wearers, so I do not understand how I got it since I have not worn contacts in over five months. Anyway, during my research of it I read that one symptom is contacts riding up on the eyeball along with irritation and the contact intolerance. I hope this helps and sorry if this is something that has been checked.
Bianca

[apham]

Hi apham,

You said that your contacts always sit slightly higher on your eyeball. Has your doctors checked under your lids. I was recently diagnosed with giant papilary conjunctivitis which normally affect contact lense wearers, so I do not understand how I got it since I have not worn contacts in over five months. Anyway, during my research of it I read that one symptom is contacts riding up on the eyeball along with irritation and the contact intolerance. I hope this helps and sorry if this is something that has been checked.
Bianca

Hi Bianca,

I've had my eyes checked by optometrists and ophthalmologists and they never said anything about that. I'll try asking my ophthalmologist again tomorrow. I used to have ocular allergies, but I don't have them anymore ever since I used Zaditor. When I flip my lid inside out, I don't see any bumps (indicators of ocular allergies). What does giant papilary conjuctivitis look like under the lid??

[Rebecca Petris]

GREAT tip from Bianca. Strikes a chord. I am convinced (from the problems I still have with my left eye wearing scleral lenses) that I had undiagnosed GPC back in my soft-lens wearing days. I wasn't savvy enough to really push for better diagnosis - I just kind of ignored it and lived with it.

Apham, regarding better lenses: Best is always relative when it comes to contacts. Some have properties or features that are superior to others and it's natural for doctors to develop favorites based on what the majority of their patients are doing well in. But at the end of the day, patients who are not precise averages need optometrists who keep going till they get the lenses that are performing best for them as individuals. So getting a better contact lens experience might even mean some significant legwork to find a doctor who is really motivated to troubleshoot and hunt down the right solution. It is not acceptable for a doctor to simply be satisfied that he's given you the "best" soft lenses based on prevailing opinion/practice when they are so clearly not the best for you personally. I say this because I wish, I wish, I wish I had known it 12 years ago. Keep in mind that soft contacts are not the only solution either. There are hybrids (Synergeyes) and even some of the large diameter gas permeables can sometimes be the right thing.

[apham]

Hello everyone,

I went to the ophthalmologist today, and she said that she wouldn't recommend lasik because I already need plugs + restasis NOW. That means that if I get dry eye after lasik, I wont' really have any options left to cure the dry eye. Anyway, I got plugs put in today (the non-dissolvable kind), and it's really irritating my eyes when I move my eyes a certain way. If i look far to the right or left, I feel like it's poking my eye. Is this normal? Should I have them taken out?

Another interesting thing I discovered today was that there were signs of dryness on my right eye, based on the dye they instill into my eyes. It's funny how the last lasik doctor I visited said that my eyes are in perfect condition...