Separating Lasik into two procedures

[bobjenkins29]

I have some conditions that are risk factors for Lasik, including Blepharitis, Large Pupils, and mild Dry Eye. I already see starbursts and holos in my glasses and contact lenses. The reason I want to get Lasik is because I have grown intolerant of my contact lenses.

I'm 26 and my prescription is -5.25 with -1.25 of astigmatism

I recently went for a consult and the doctor suggested that due to these risk factors, it might make sense for me split the surgery into two parts: 1) correct my astigmatism fully and correct -3 using wavefront. 2) See how I respond to that. 3) If I respond well I can come in again and have the remaining -2.25 done. According to the doctor, side effects increase exponentially the more you correct.

I'd love to hear other people's thoughts on this strategy.

[Guest]

I'd run away from ANY form of refractive surgery as far and fast as you can... you already have mild dry eye, and LASIK very likely could make it worse... I had almost the same rx as you when I had LASIK, and I, too, had it because I couldn't tolerate contact lenses. However, unlike you, I did not have dry eye prior to surgery, and was not already diagnosed with blepharitis.

However, I was unlucky, and despite having no official risk factors (like YOU do), I ended up with the severely dry eyes - I cannot tolerate the computer for long (if I had to use a computer for my job all day, I'd be on disability right now), I don't read books anymore because my eyes are too dry for it (I use audiobooks instead), I used to play video games a lot and now I can't because my eyes are way too dry. And the real kicker? Now not only can I still NOT wear contact lenses, but I wear goggles pretty much 24/7 - and the goggles are ugly as all hell too. Granted, I have a custom pair of goggles that looks much better, but those are only for wearing in public to avoid the embarrassment of wearing my better-protecting goggles that I wear at home.

I can't swim unless I wear goggles to protect my eyes from the water - and I used to love the water, was close to being a certified lifeguard once upon a time - water NEVER bothered my eyes pre-LASIK. And, there is the issue of my eyeballs sticking to my eyeballs every night - so you know how when you wear glasses you wish you could see the numbers on the alarm clock when you wake up? Well, I suppose technically I can now that I have "perfect" vision, but since my eyelids are stuck to my eyeballs, I can't open them to SEE those numbers anyways (at least not until I ever-so-carefully unstick them... at my worst, this would sometimes take a very long time to do.

The doctors can't fix me... so I'm stuck this way... probably forever. Was LASIK worth it to me? Hell no. It's destroyed the damned good quality of life I had before, and replace it with a nightmare.

I've adapted, and have managed not to get permanently depressed over this... but many have, and many will in future. Don't risk becoming one of them... even if you're not depressed, living like this sucks compared to living a "normal" life like you did before.

Are you married yet? Still single? I couldn't imagine trying to date like this... (Thankfully, I was already married when this happened to me... so I've never had to deal with trying to date and appear "normal" and attractive while fighting this degree of dry eye... )

Anyhow, only you can decide if you hate wearing glasses enough to risk all this... but I know prior to my surgery, my surgeon said that since I was properly screened, there was no way I'd end up with permanent dry eyes from LASIK, and most certainly not severe dry eye like what I have. Not sure what yours has told you, but just wanted to make sure you know that no matter how hard they try to give you a good outcome, crap happens, and they can't always fix it.

If you want to know more about exactly what it's like living with eyes this dry, feel free to ask here or PM me.

Oh, and lastly, although I spent 4k on my LASIK, the expenses didn't end there... I currently spend over FIVE THOUSAND dollars each and every year to maintain my eyes in a tolerable state. Tolerable meaning not in pain every minute, but still greatly disabled by the state of my eyes compared to a normal person. Can you afford that if this happens to you? Can you afford to be unable to work full time because your eyes would hurt too badly if you do? Worst case, do you have a good disability plan at work?

Since I've tried everything else, the next thing I'm going to try will be heading to Boston next year for scleral lenses to protect my eyes - the out of pocket cost for me? I anticipate it to be just about 10 k (I could shave about a thousand dollars off that if I stayed in a lower cost place for my accommodations... but still, even at 9k, that's a lot of money)

Consider spending the money you would have spent on LASIK on a kick-a$$ pair of glasses that makes you look amazing. Splurge. Seriously. Do it. You see all those models in the eyeglasses ads that look incredibly attractive even in glasses? Buy yourself a pair that makes YOU look like that and you won't miss having LASIK.

Also, our eyes tend to get more dry as we age... you're in your twenties now, how much more dry will they be 60 years from now? As you are now with no refractive surgery, probably tolerably dry...maybe annoying, but tolerable. If you have LASIK, that will likely compromise the ability of your eyes to make tears... will that tip you over the edge to be in great pain/discomfort from it in old age?

Sorry this is sooo long, but I have so much regret over what LASIK has done to my life that I wish SO badly that I'd splurged on those glasses instead... I know that just because LASIK did this to ME, doesn't mean it will do this to you... but still, you already have some issues with dry eyes, so that increases your risk for worse problems after LASIK... just please think about it long and hard...

Good luck with whatever you decide.

[Rebecca Petris]

I have some conditions that are risk factors for Lasik, including Blepharitis, Large Pupils, and mild Dry Eye. I already see starbursts and holos in my glasses and contact lenses. The reason I want to get Lasik is because I have grown intolerant of my contact lenses.

Rather a crapshoot if you ask me. Mild dry eye is presumably the reason you're growing contact lens intolerant and lasik is well known to exacerbate dry eye.

I recently went for a consult and the doctor suggested that due to these risk factors, it might make sense for me split the surgery into two parts: 1) correct my astigmatism fully and correct -3 using wavefront. 2) See how I respond to that. 3) If I respond well I can come in again and have the remaining -2.25 done. According to the doctor, side effects increase exponentially the more you correct.

Don't even consider it without a second opinion. I found this proposal (2 separate surgeries) startling. I have not heard that proposed even for a much higher Rx in recent years. (Yours really isn't that high. Lasers are approved for far higher.

I can totally understand the concern about wanting to see 'how you respond' because healing rates vary so much that it is questionable whether you would come out 'plano' after surgery. But what I can't begin to understand is what possible advantage you can have in a two-step procedure?! Other than failing to achieve the desired refractive result what side effects are they worried about that there wouldn't already be risk of introducing in the first surgery anyway? Is two diopters less of spherical correction going to significantly reduce your risk of dry eye or any optical side effect? I'd be very surprised if there's medical literature supporting this but if there is I'd be interested to see it. My thinking would be that looking at two surgeries instead of one means introducing more, not less risk. For example epithelial ingrowth is supposed to be 3x more likely to occur after a flap re-lift than after a primary surgery where the flap is first cut, and some people get dry eye after a flap lift who didn't get it after the original surgery.

P.S.

According to the doctor, side effects increase exponentially the more you correct.

I appreciate the point s/he's trying to get across but to pick nits, I don't think this is quite accurate. There are risks associated specifically with flap creation (or re-lift, as mentioned) that are wholly independent of the amount of correction being attempted, and while vision quality risks and under/overcorrections increase with (a) higher spherical correction (more myopia), (b) higher cylindrical correction (more astigmatism) and (c) hyperopic corrections, the percentages are all documented in the FDA approval documents for the individual lasers... I don't really think the curves can be described as exponential.

[Gabriel]

Listen to these ladies and take it as serious as you can. This is a terrible bad idea. This procedure can make your quality of life horrible. No one understands what this is like until you're living it. Before I had lasik and serious dry eyes I didn't even have an idea what dry eyes could be like. Worst thing I've ever done.

[bobjenkins29]

Thanks for the replies. SAAG, I'm sorry to hear about your situation. Did you have a good surgeon? I've read many articles online describing lasik complications but I've never read about anything as bad as what you're experiencing.

The thing for me is, this isn't really about the inconvenience of contacts or glasses. I already have a reduced quality of life because as I said I don't tolerate contacts well (feels like saran wrap in my eye after many hours of wear, and they get blurry periodically). I also hate wearing glasses because I see poorly in them compared to my contact lenses unless I tilt them forward 35 degrees (so the stick parts rest on my middle head as opposed to my ears) which looks ridiculous. I've been to multiple doctors and they said they can't do anything about that and I'll just always see worse in glasses than contacts. This is why I feel like Lasik might be worth the risk.

[Rebecca Petris]

bobjenkins29,

Don't fall for the 'logic' that says those of us with complications had less than great doctors. It isn't true.

The thing for me is, this isn't really about the inconvenience of contacts or glasses. I already have a reduced quality of life because as I said I don't tolerate contacts well (feels like saran wrap in my eye after many hours of wear, and they get blurry periodically). I also hate wearing glasses because I see poorly in them compared to my contact lenses unless I tilt them forward 35 degrees (so the stick parts rest on my middle head as opposed to my ears) which looks ridiculous. I've been to multiple doctors and they said they can't do anything about that and I'll just always see worse in glasses than contacts. This is why I feel like Lasik might be worth the risk.

I understand where you are coming from. Life was rather similar for me before LASIK.

But in addition to the points I raised above about multiple surgeries increasing risk, please do your homework on the question of what vision you are likely to achieve in a best-case scenario after surgery. (Single surgery, let's say.)

WHY do you not see well with glasses? If you don't know, please find out and let us know.

Under normal circumstances, LASIK can not be expected to give you better vision than you currently have with GLASSES. If a doctor says it will, walk out and don't look back. This is an inappropriate claim to make. Is it POSSIBLE under certain circumstances, yes, probable, no. Consult a reputable corneal specialist to whom you've made it clear they won't be profiting from you other than this single consultation.

I would also encourage you - just for comparison's sake - to look into the possibility of specialty contact lenses. There have been many advances in recent years with large gas permeable lenses that vault, or partially vault, the cornea making it possible in some cases to have more comfort and safety with contacts than with a classic soft contact on a dry eye. This is the technology I would have waited for had I know.

[Guest]

Thanks for the replies. SAAG, I'm sorry to hear about your situation. Did you have a good surgeon? I've read many articles online describing lasik complications but I've never read about anything as bad as what you're experiencing.

He was one of the most expensive guys in town at the time, and my impression was that he was the most experienced of them all. I was also under the impression that at the time, his equipment was top of the line. Believe me, I would have paid triple the price if there was an even better guy in town... but he seemed to be the best, so I chose him.

None of the on-line articles talk about people like me in detail. They all say generic stuff like "dry eye" may occur after surgery etc, but they fail to quantify that by saying how BAD it could be. I read endlessly about LASIK prior to having it done, and the HOW BAD is it possible for post lasik dry to be is the one question that I couldn't get an answer to (other than anecdotal reports in forums and blogs). So I asked my surgeon if it was true that this can happen (ie. people like me I've read about in forums etc.), and he said no way would that happen to a properly screened patient. Well, surprise! It did! -->me<--

This is why I feel like Lasik might be worth the risk.

Just as long as you know as you weigh the risks that LASIK might worsen your already dry eyes to an intolerable state. Trouble is, it's hard to find stats for what percentage of people end up with severely dry eyes post lasik... I'm not aware of any studies looking at that in great detail... maybe Rebecca has seen something along those lines?

[Ahmed]

Bobjenkins,

The only way that suggestion of a partial correction would make sense to me is if you are over the age of 45 and want to retain some near vision after surgery, this would be called mono vision.

I would advise a second opinion, or an explanation of why not to treat the whole amount.

Ultimately you have to find a eye care professional you trust and listen to them.

regards,

Ahmed.

[Gabriel]

I know if I was one of the lucky ones after lasik I wouldn't think this way but I'm not. For me comfort comes before perfect or almost perfect vision any day. I have 20/15 vision in both eyes and would take my glasses back any day. I couldn't tolerate contacts before lasik, maybe my eyes wear a little on the dry side. If they were I didn't know. Man, you have to make up your mind yourself but you are hearing this from people that know how painful your eyes can feel. Not to mention the emotional rollercoaster that goes along with it. Good luck to ya.

[jimi51]

Not only would I echo SAAG but let me tell you, I also had what is called PVD's where the gel inside your eye detaches from the retinas, I now have horrible, permanant floaters and constant flashes where I have to be dilated to check for retina detachments every so often. My dry eyes have not got better one bit in the nearly three years since LASIK and yes I had a "top" surgeon who at 6 months washed her hands of my problem. I wish I was lucky enough to have had these wonderful people on this board steer me away, if you think your life is difficult now wearing glasses, try living our lives! When you go to bed at night thinking about ways to have your eyes removed due to the pain, you know you made a mistake. Do not do it!!

Brad

[bobjenkins29]

FYI, you guys convinced me - I'm putting it off at least for a year. I realize that the reason I'm not tolerating contacts is that my dry eyes may be more severe than I previously thought. Would you guys recommend restasis as way to maybe help me tolerate contact lenses better?

Oh and I think I'm going to go for some TAG Heuer glasses. Very stylish.

[Guest]

Would you guys recommend restasis as way to maybe help me tolerate contact lenses better?

I suppose in theory, if the Restasis improves your dry eye enough, maybe wearing contacts would be feasible... but you won't know unless you try it... have you asked your doc about it? What did they say?

Oh and I think I'm going to go for some TAG Heuer glasses. Very stylish.

Awesome!

[poppy]

I have some conditions that are risk factors for Lasik, including Blepharitis, Large Pupils, and mild Dry Eye. I already see starbursts and holos in my glasses and contact lenses. The reason I want to get Lasik is because I have grown intolerant of my contact lenses.

I'm 26 and my prescription is -5.25 with -1.25 of astigmatism

I recently went for a consult and the doctor suggested that due to these risk factors, it might make sense for me split the surgery into two parts: 1) correct my astigmatism fully and correct -3 using wavefront. 2) See how I respond to that. 3) If I respond well I can come in again and have the remaining -2.25 done. According to the doctor, side effects increase exponentially the more you correct.

I'd love to hear other people's thoughts on this strategy.

I think you are looking at your problem the wrong way. You can't tolerate contacts because you have bleph. and dry eye. You should be seeking proper treatment for the bleph and dry eye, that may enable you to tolerate your contacts again without the need for a risky surgery. And if your bleph. and dry eye is "untreatable" before surgery, you certainly aren't going to be able to treat it afterwards.

[Hopeful2]

Anyone considering refractive surgery should read over this advice, posted on d'eyealogues (laser my eye):
What would have helped to have known pre-op:
1. Dry eye...one surgeon told me the average duration of dry eye syndrome was 2-3 months. Tell us that for some individuals, eyes are permanently drier after lasik, and what it's like to live with dry eye. Since dry eye affects nearly every patient to some extent, I think every patient should receive dry eye couseling.
2. I would have liked to have known that nearly all lasik patients lose some contrast sensitivity and that some of this loss may be permanent.
3. I would have liked to have known the impact large pupils can have on night vision. I would have liked this information presented with picture simulations.
4. I would have liked my surgeon to admit there are risks in lasik beyond the surgeon's control and that healing can be unpredictable.
5. I feel it is very important to discuss with patients that they will lose approximately 1/3 of the strength of their corneal stability in the creation of the lasik flap and the risk this poses for ectasia.
6. I think that for people in and approaching their 40's a simulation with lenses of what it would be like not to be able to see their watch or read something in their hands if overcorrected is a necessity. There are advantages to being nearsighted later in life (compensates for some presbyopia) and these should be discussed with patients.
7. I would have liked to have several days to a week to study my informed consent materials. They were shoved in my face minutes before surgery.
8. I would have liked to have been provided a copy of the post-op instructions before surgery so that I could have known what to expect.
9. All prescriptions should have been made available ahead of time so that I would not be in the position of going to a pharmacy while I was supposed to be keeping my eyes shut.
10. I would have liked to have known that some patients have difficulty working on the computer for quite some time. This is a major job disruption.
11. I would have liked to have a more complete list of possible negative outcomes. Some people have problems with depth perception, focusing and reading. We should know all know this up front.

I sure wish I had read a list of concerns like this prior to my surgery! I would have bought myself several pairs of fancy glasses instead. Not mentioned on the list, depression over a poor outcome is very real . . .

Be informed. . . inform others.

[Rebecca Petris]

FYI, you guys convinced me - I'm putting it off at least for a year.

So glad to hear it. Good for you!!! Thanks for letting us know. Taking some time to focus on your ocular surface health, who knows what all you might learn in the process... And enjoy those glasses!