Lasik candidates beware

Ken Ibold said:
Lasik is a topic comes up from time to time, so I thought I would post this cautionary tale for anyone contemplating putting their baby blues (or browns) under the knife.

http://www.newsobserver.com/front/story/721249.html
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Lasik is not performed with a knife. It is done with a laser.

RK: Radial Keratonomy is done with a knife. I had that surgery many years ago. It has almost 40 years of data behind it now. Lasik was new when I set out to get my eyes done and did not trust a new method so went with RK. I have been very happy with mine. Although as my eyes have aged I do need reading glasses form time to time. But that is not a side affect of the procedure, just of age.
 
smigaldi said:
Lasik is not performed with a knife. It is done with a laser.

RK: Radial Keratonomy is done with a knife. I had that surgery many years ago. It has almost 40 years of data behind it now. Lasik was new when I set out to get my eyes done and did not trust a new method so went with RK. I have been very happy with mine. Although as my eyes have aged I do need reading glasses form time to time. But that is not a side affect of the procedure, just of age.
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Yes, I had RK done myself (twice on each eye due to the need for extreme correction) in 1984/85. I was using "knife" in a figurative sense.
 
I wear bifocals that are basically clear on top, but I need the bottoms to read. I wear them all the time. Wearing glasses is a PITA, but, it would have to be a very extreme circumstance before I would let anyone at my eyes with a laser.

My mom had me so paranoid as kid that I was gonna " put an eye out", that now that that I reached adulthood with both intact, I figure it's best to just wear the glasses and put up with it.

Mike
 
Lasik doesn't correct everything, which could explain why some Lasik doctors wear glasses. That's sorta like saying you're a poor pilot because you're driving you car on vacation.

Still, it's statistics like this that scared me away:
article said:
Food and Drug Administration records of clinical studies show that six months after the surgery, up to 28 percent of patients complained of eye dryness, up to 16 percent had blurry vision and up to 18 percent had difficulty driving at night.
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JohnR said:
Lasik doesn't correct everything, which could explain why some Lasik doctors wear glasses. That's sorta like saying you're a poor pilot because you're driving you car on vacation.

Still, it's statistics like this that scared me away:
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The thing that strikes me is that the Lasik marketeers talk about "successful outcomes" without making it clear that what they consider a successful outcome is far short of perfect vision. Most of them consider a successful outcome to be one in which the patient has 20/40 at the end. That's barely enough to get a drivers license or pass a Class III. And that's best corrected. The common discomfort outcomes are routinely ignored by providers and not considered when defining "success."
 
I had a business partner that did Lasik early on. His night vision was essentially ruined; at least as far as flying was concerned. He couldn't judge the depth of light on an approach or landing. We went up several times and I just had to take over the controls on short final; he couldn't judge where to round out to land.

That's one reason I'm still "Mr. Bifocals!"

Best,

Dave
 
When I first got RK I was essentially night blind for about 3 months. I could not even drive. But after a year I was fine. My vision is really good and stable. The only time I notice a change is after scuba diving. Then it is great! I am 20/25 in my eyes and the pressure from being underwater changes the eye shape and I can get better than 20/20. However, a few hours later I am back to normal.
 
Well I guess I'm a lucky one. 5 years now, and vision is still 20:10 in both eyes individually. I wore semi-coke bottles before with astigmatism in one eye. They told me I'd have dry eyes for 6 mo to a year, they told me my night vision would take 6 mo to a year to get back to normal and it did. Realistic expectations about the side effects are important.

That said, I took care in choosing my surgeon, and paid quite a bit more than the in-and-out factories.

I could not be happier. I was constantly losing contacts in the water (waterskiing), fogging glasses while doing outdoors activities, breaking glasses, losing prescriptions sunglasses, etc.

Tim
 
Troska said:
Well I guess I'm a lucky one. 5 years now, and vision is still 20:10 in both eyes individually. I wore semi-coke bottles before with astigmatism in one eye. They told me I'd have dry eyes for 6 mo to a year, they told me my night vision would take 6 mo to a year to get back to normal and it did. Realistic expectations about the side effects are important.

That said, I took care in choosing my surgeon, and paid quite a bit more than the in-and-out factories.

I could not be happier. I was constantly losing contacts in the water (waterskiing), fogging glasses while doing outdoors activities, breaking glasses, losing prescriptions sunglasses, etc.

Tim
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Good for you Tim! My former business partner was a bit ...ugh....shall we say tight. Went to one of the big places that did a lot of advertising and had a big promotion in process! One could say, he may have gotten what he paid for.

Best,

Dave
 
michael Killacky said:
My mom had me so paranoid as kid that I was gonna " put an eye out", that now that that I reached adulthood with both intact, I figure it's best to just wear the glasses and put up with it.
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Me too.

My opthamologist/eye surgeon who use to specialize in fixing vision correction screwups wears glasses. I figure if a specialist in the field is wearing glasses, that should be the end of the discussion right there. He said as a general rule, the only exception is when surgery/vision correction is the best solution to a more insidious problem. Generic blurry images, go with glasses/contacts.

Besides, glasses act as first stage eye protection by default. I know it's saved me from putting my eye out numerous times.
 
The ophthalmologist who has cared for my eyes the last 7 or so years suggested LASIK. This past February I took his advise. The only regret I have is that I didn't have it done sooner.
​
 
I am 5 1/2 years out from Lasik and still see 20/15 uncorrected with absolutely no adverse effects.

I worried for three years before I finally got up the nerve to do it. Not worried about a true disaster, which is exceedingly rare, but worried about the so-called minor complications, such as night glare which might affect my flying. None of which materialized.

Ken, I think 20/40 is successful, albeit not ideal. Many of us couldn't see the clock next to the bed. Or read a book more than ten inches away. If you go from needing glasses 100% of the time to needing them substantially less, I would call that a good result.

Jon
 
4CornerFlyer said:
Ken, I think 20/40 is successful, albeit not ideal. Many of us couldn't see the clock next to the bed. Or read a book more than ten inches away. If you go from needing glasses 100% of the time to needing them substantially less, I would call that a good result.
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Before I had RK, the eye chart I would get was basically "which way is the big E facing?" I was blind as a bat. Had it twice on each eye, and I don't really regret having done it. However, knowing what I know now I would not do it again. I was in my early 20s and VERY risk tolerant at the time. A friend I recommended it to nearly went blind. My best corrected vision afterward was 20/40 in each eye. Stayed that way for 20 years before I had to go to bifocals in order to read the morning paper and pass my Class 3.

Sure there are lots and lots of people who had great results from Lasik and all the other incarnations. However, the number for whom the best outcome is lousy is much greater than the "industry" lead you to believe, and you should go into it armed with the harsh reality. THAT's why I posted this.
 
I'm the guy who sent the 35 year old ATP wanting correction to the busy opthalmologist....with al the cautions. He came back a few days later to the front window to say, "hey, Dr. S-ch-- wears GLASSES!
 
As much as I'd love to get rid of my glasses, particularly since I started wearing bifocals a year ago, I'm still pretty paranoid of eye surgery of any kind. There still just too many bad results experienced.

I'd want to see it as easy and risk-free as removing tonsils. Then, you spend the day eating ice cream and enjoying the view of a cute nurse or two.

My AME told me yesterday it's likely I'll end up with trifocals in a couple years. It's just a fact of life. This last prescription was made with the near-vision set a good 24 inches out to facilitate computer use and instrument panel use, particularly glass panel. My previous prescription, I found myself raising my lenses to view the smaller details on the panel at night. These work out great as of my last night flight.

So, it's eye glasses for life. Or, a miracle. :)
 
KennyFlys said:
I'd want to see it as easy and risk-free as removing tonsils. Then, you spend the day eating ice cream and enjoying the view of a cute nurse or two.
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Having one's tonsils removed is one of the more dangerous operations. There are better results these days with heart bypass surgery than with the tonsilectomy. I know a guy who died on the table having his tonsils removed.

Also it is not recommended to eat a lot of ice cream after having the procedure. The soft dairy foods will coat the throat and make it feel better but that can cuase a higher risk of wound contamination.
 
KennyFlys said:
As much as I'd love to get rid of my glasses, particularly since I started wearing bifocals a year ago, I'm still pretty paranoid of eye surgery of any kind. There still just too many bad results experienced.

I'd want to see it as easy and risk-free as removing tonsils. Then, you spend the day eating ice cream and enjoying the view of a cute nurse or two.

My AME told me yesterday it's likely I'll end up with trifocals in a couple years. It's just a fact of life. This last prescription was made with the near-vision set a good 24 inches out to facilitate computer use and instrument panel use, particularly glass panel. My previous prescription, I found myself raising my lenses to view the smaller details on the panel at night. These work out great as of my last night flight.

So, it's eye glasses for life. Or, a miracle. :)
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I've been wearing blended lenses for close to 15 years now. I will not try contacts as I have a problem with the concept of deliberately putting a foreign object on my eyes. My optometrist agrees. As far as working at a computer goes, I have a special pair of glasses where the whole lens is fixed focus at about 24 inches. My blended lenses don't have a large enough sweet spot to get the whole display in focus at once.

When I first got the blended lenses my optometrists warned that they might not work for skiing and other such activities. I haven't had any problems with them. The only activity where I don't wear them is anything to do with being in the water. I don't want to lose them, and I suspect they'd break the seal on a mask for snorkelling or SCUBA diving. My vision is marginally 20/40 uncorrected, so it really isn't a problem then.

RK or Lasik? No thanks. I know what I have now. Not worth the risk.
 
Ghery said:
The only activity where I don't wear them is anything to do with being in the water. I don't want to lose them, and I suspect they'd break the seal on a mask for snorkelling or SCUBA diving. My vision is marginally 20/40 uncorrected, so it really isn't a problem then.
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Are you aware that you can get lenses ground into face masks for SCUBA diving? I'm sure Scott could point you in the right direction. I think being able to see clearly would really increase the enjoyment!
 
gprellwitz said:
Are you aware that you can get lenses ground into face masks for SCUBA diving? I'm sure Scott could point you in the right direction. I think being able to see clearly would really increase the enjoyment!
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I have not seen them ground in but you can easily get them glued in. We sell lots of masks this way and they work really well. If you cannot find a store near you to do it. You can send me your prescription and your mask and I can get it done for you.
 
smigaldi said:
I have not seen them ground in but you can easily get them glued in. We sell lots of masks this way and they work really well. If you cannot find a store near you to do it. You can send me your prescription and your mask and I can get it done for you.
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Thanks for the clarification. I thought it went the other way, but gluing does make a lot more sense given the pressure differential!
 
Ken Ibold said:
Yes, I had RK done myself (twice on each eye due to the need for extreme correction) in 1984/85. I was using "knife" in a figurative sense.
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Actually, the older LASIK procedures use a knife (well the device looks like a glorified cigar cutter to me) to lift a section of the cornea before the laser part. This was the part my wife had complications with. She had redundant corneal epithelial cells and putting the flap back was a little involved. Fortunately I had insisted on the #1 opthomologic surgeon in the area and not the guy running the Lasik kiosk in the mall.
 
gprellwitz said:
Are you aware that you can get lenses ground into face masks for SCUBA diving? I'm sure Scott could point you in the right direction. I think being able to see clearly would really increase the enjoyment!
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Thanks, but my total SCUBA experience is one introductory dive in Hawaii a few years ago and three introductory dives on the Great Barrier Reef last month. And fortunately I can see well enough without my glasses to enjoy it. Now, if I got serious about the sport, that might be another matter.
 
smigaldi said:
I have not seen them ground in but you can easily get them glued in. We sell lots of masks this way and they work really well. If you cannot find a store near you to do it. You can send me your prescription and your mask and I can get it done for you.
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Wasn't it Sea Vision that used to make presctiption lens masks, they even had the color compensating coating. Are they still in business?
 
20/30 with astigmatism, and if things get worse, give me some good eyeglass frames and maybe some transition lenses. No lasers near my eyes. There's a reason for that warning label on them.
 
Having gone through a few eye surgeries (not frivolous, emergency) I'd never touch my "good eye" with Lasik, RK, etc. it works - good enough for me. vanity be damned, ditto the PITA issues to deal with. The contact (no s) still works for me but when it doesn't I'll be wearing funky glasses.
 
woodstock said:
Having gone through a few eye surgeries (not frivolous, emergency) I'd never touch my "good eye" with Lasik, RK, etc. it works - good enough for me. vanity be damned, ditto the PITA issues to deal with. The contact (no s) still works for me but when it doesn't I'll be wearing funky glasses.
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I've contemplated LASIK and RK a few times and each time I stick with the contacts.

Deep-winter backcountry activities are not fun with contacts, neither is a long day on the road bike. However, I get peripheral vision without someone hacking into my eyeball.

Contacts are a bit annoying, but, corrected, I see better than 20/20, and no one took a knife to my eye. Win/win!

Cheers,

-Andrew
 
Lasik best thing I have ever spent my money on and would do it again in a second.
You don't know what your missing.
 
I've worn trifocals for 27 years, after bifocals became ineffective for mid-range (instrument panel) work. No regrets, although they seem to get heavier each time the prescriptions are renewed.

KennyFlys said:
As much as I'd love to get rid of my glasses, particularly since I started wearing bifocals a year ago, I'm still pretty paranoid of eye surgery of any kind. There still just too many bad results experienced.

I'd want to see it as easy and risk-free as removing tonsils. Then, you spend the day eating ice cream and enjoying the view of a cute nurse or two.

My AME told me yesterday it's likely I'll end up with trifocals in a couple years. It's just a fact of life. This last prescription was made with the near-vision set a good 24 inches out to facilitate computer use and instrument panel use, particularly glass panel. My previous prescription, I found myself raising my lenses to view the smaller details on the panel at night. These work out great as of my last night flight.

So, it's eye glasses for life. Or, a miracle. :)
Click to expand...
 
gprellwitz said:
Thanks for the clarification. I thought it went the other way, but gluing does make a lot more sense given the pressure differential!
Click to expand...
What pressure differential? If there's much of a pressure differential between inside and outside my mask it hurts like heck and is easily eliminated by letting a little air out my nose.
 
Hmm... this one was only resurrected from 2007. Not too bad.
 
Ghery said:
Thanks, but my total SCUBA experience is one introductory dive in Hawaii a few years ago and three introductory dives on the Great Barrier Reef last month. And fortunately I can see well enough without my glasses to enjoy it. Now, if I got serious about the sport, that might be another matter.
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FWIW, if you have "perfect" vision on the surface, you will be out of focus underwater because water's index of refraction is different than air's. If your eyes are young enough you might be able to compensate but AFaIK prescriptions for dive mask lenses are made with a different focal length than you'd get in your glasses.
 
gismo said:
Yeah, I'm assuming "guest" was just perusing the archives and found something of interest.
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Yup. And you bet I'm going to take a complete and utterly anonymous stranger's advice really seriously on what to do to my eyes.
 
Public Service Announcement:

Refractive Surgery Options (in no particular order):

1.) Lasik
1a) using microkeratome (glorified cigar cutter). Shallow flap is cut with a little 'hinge' on one side left intact. Flap is folded over, laser is used to re-shape cornea underneath the flap. Flap is folded back and sticks to the surface by adhesion.
1b) using femtosecond laser (bladeless lasik). Ingenious laser contraption that can cut off a laserbeam within femtoseconds and fire little 'packages' of light to a specified depth into the cornea. This deposits a lot of energy in one point and vaporizes a thin layer creating a flap, just as the microkeratome would, except that the laser doesn't exert any force onto the cornea making it a bit more controlled.

2.)Photorefractive keratectomy (PRK) or 'surface ablation'.
Surgeon either scrapes off the front layer of the cornea (epithelium) or vaporizes it using the lawser. Then the same laser used for lasik is used to re-shape the surface of the cornea. The epithelium grows back over the course of a couple of days. Advantage is that there is no 'flap' afterwards and that the structural integrity of the cornea (strength) is not compromised. Disadvantage is: Anyone who ever had a corneal abrasion or ulcer knows that it is 'quite uncomfortable' for a couple of days, also vision is impaired during the healing period whereas the Lasik patients basically walk out and drive home.

3.) LASEK another form of 'surface ablation'. Instead of scraping the front layer off, it is softened up using an alcohol solution and pushed aside temporarily. Laser ablation is performed, epithelium (front layer) is slid back in place. Very similar to PRK, not common in the US.

1-3 allow for 'customized ablation', meaning that the surgeon can measure the exact shape of your cornea prior to the procedure and the computer that controls the laser will be able to smooth out existing 'bumps' or distortions (higher order aberrations, astigmatism), often leading to a better than 20/20 result.

4.) Radial Keratotomy (RK). Using a blade, a number of 'spoke' like cuts are peformed on the cornea, the subsequent healing/scarring process re-shapes the cornea in a somewhat predictable manner. Was quite popular in the 80s, has pretty much fallen by the wayside since due to less than optimal outcomes compared with the other options.

5.) Refraktive lens exchange. Basically cataract surgery without a cataract. The natural lens is replaced with a small acrylic lens. Just like cataract surgery, this requires a small cut to open up the eyeball, use of a ultasound probe to dissolve the existing lens and implantation/injection of a acrylic lens. More commonly performed in more 'mature' patients who may come up for cataracts in a couple of years anyways.

6.) Implanted anterior chamber lens. The patients own lens remains in place and additional lens is implanted between the natural lens / iris and the cornea. Uncommon procedure.

7.) Corneal Rings (INTACS). Ring embedded in a channel in the cornea that can be used to re-shape the cornea. Not currently in use in the US.


So, there are a couple of different options, some dating back to the 80s, some fairly recent developments. The innovation trajectory has been steep, most of it developed outside of the US. Some of the stories regarding poor outcomes are related to that trajectory and the fact that early on a lot of people got started in this and it took a while for the wheat to be separated from the chaff.

If anyone considers a refractive procedure, I suggest to go to a surgeon who offers different options AND PAY FOR THE CONSULT. It reduces the likelihood of 'if you have a hammer a lot of things look like a nail' problem. The branches of the US military offer Lasik to their officer candidates. They have high-volume practices at various military facilities. Given that the goverment bears life-long responsibility for the medical care on service related conditions of their active-duty personnel, they have looked at the long-term risk benefit ratio of doing this. There is a reason they settled on customized (also called wavefront) Lasik and PRK.
 
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gismo said:
What pressure differential? If there's much of a pressure differential between inside and outside my mask it hurts like heck and is easily eliminated by letting a little air out my nose.
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I was young and stupid when I made that remark. Now I'm old and stupid! :)
 
I had lasik done about 6 months ago. My eyes aren't perfect today but....

When I went in 6 months ago I was at least 20/600 and according to one doc I was closer to 20/800. When they change your eyes that much there's a lot of "art" involved along with the "science" because of how much they need to burn and the effects of healing.

I'm better than 20/30 and close to 20/20 in both eyes. I need reading glasses (as I did before the surgery) because I'm 50.

I was advised to let my eyes heal for six months and stabilize before getting a new prescription and glasses...I'm picking up my new glasses tomorrow.

It's really nice to know that if I lose my glasses, or if a lens falls out, that I can still function.

My results weren't perfect but compared to 20/800...well, suffice it to say that I'd highly recommend it to anyone. It's the best money I've spent in the last few years.

EDIT: Weilke, you were posting your list as I was composing my above message. I'm curious why PRK isn't listed? I know a few aerobatic pilots who have had that procedure and really like it...never mind...milk in the refrigerator...I can't find that either.
 
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weilke said:
The branches of the US military offer Lasik to their officer candidates. They have high-volume practices at various military hospitals. Given that the goverment bears life-long responsibility for the medical care on service related condition of their active-duty personnel, they have looked at the long-term risk benefit ratio of doing this. There is a reason they settled on Lasik.
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Interesting. I understood that for pilots only PRK was acceptable to them.
 
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