Monday, July 18, 2011


Disclaimer: the following post is by no means a medical recommendation regarding lasik. Every person's eyesight is unique and a consultation and research of your own is strongly recommended if you are considering the procedure. I am saying this so that you can't sue me. Clear? Good. 

This Friday, July 22, 2011, I am going under the knife. Actually, microkeratomes are definitely a thing of the past so no I am not really going under the knife. But I am going under a laser. And on Saturday, July 23, 2011 I will wake up and be able to see for the first time ever without glasses or contacts (obviously not counting my middle school years when I slept in my contacts and started to get some minor neovascularization....). I cannot express how excited and anticipatory (is that a word?) I am about this day!

I have terrible eyesight - there are always people out there better or worse, but for the most part I find myself in the slightly upper average for how bad my eyesight is comparatively. My contact prescription is a -6.75 OS and -7.00 OD and when I was measured during my lasik consultations they found that I was actually more like -7.00 OS and -7.50 OD. I know a lot of people that have gotten lasik and have loved it and said it was the best decision they ever made so why wasn't I jumping on board and getting it? Knowledge.

I had been told by one eye doctor that I shouldn't even consider lasik and that I should investigate implantable contact lenses (ICL's). I was told by my current eye doctor that I might not be able to get to 20/20 with lasik, but that even an improvement to a -1.00 myopia would be life-changing. However, I reason that if I would still have to wear glasses or contacts at a -1.00, then what was the point? Armed with conflicting information I set out to do as any good engineer would do under the circumstances - research for myself and determine what route - ICL, lasik, or nothing - I was most comfortable going forward with.

As a result I went on five, you read that correctly, five lasik consultations. The first place said that I was not a candidate for lasik and they would recommend ICL. The second place said I was a candidate for lasik. The third said I was not and recommended ICL. The fourth place said that I was a candidate for either and would recommend ICL just marginally over lasik. The fifth place said I was a candidate for lasik. Confusing? I thought so too - enter my massive research findings.

Here are the facts I found that helped me to weave through the fog of information:
(1) There are a variety of different FDA-approved lasers being used today, but the two most common appear to the Star Visx S4 and the Allegretto Wave EyeQ. I was able to find a chart that discussed the specifications fo these different lasers and the myopia's that they are rated to correcting. The Star Visx S4 is only rated to a myopia of -7.00 and was the laser of choice at all of the places that recommended ICL over lasik. One of the doctors told me that the Star Visx S4 can correct higher myopias - this was the place that only marginally recommended ICL over lasik. The Allegretto Wave EyeQ laser does not correct for cyclotorsion, but that should only be a concern if you have a high asitgmatism which fortunately I did not. Both laser correct for high order aberations, another important thing to inquire about. However, the Allegretto Wave EyeQ appeared to be advantageous for me over the Star Visx S4.

(2) The calculation used to determine eligibility is a measurement of your cornea thickness minus the thickness of the flap created by the laser (approx. 110 um) minus the amount of ablation necessary to correct your vision. There is no FDA-recommended cutoff and its at the discretion of your surgeon to determine if they believe your cornea is thick enough for the procedure. The two main cutoffs are 250 and 300, the latter being more conservative. There are articles amongst surgeons debating these "cutoff" values in detail, but there is no consensus. Guess what I am? Around 275 in both eyes. Awesome.

(3) The ICL technology has only been around for 10 years. Even though the material is biodegradable and should have no long-term impacts on your body or eyes, no person has had them for 10+ years. I am 25 years old and that contact would be in my eye for at least 40+ years. I pushed one of the doctors in this area and he agreed with me that there is no long-term study on the contacts. He said that if I were in my 40's he would definitely recommend ICL over lasik, but because I was 25 he would be comfortable doing lasik on me if that was the route I chose.

(4) Thickness of the flap - the flap is usually 110 um. Some doctors used 130 um in their calculation to be more conservative in addition to a 300 cutoff. I pointed out this "double dipping" on being conversative with one of the surgeons and asked if he would actually measure the true thickness created on the flap once it was cut before going in for the ablation (in order to know exactly how much he could remove). After giving me a very impressed look he answered honestly saying no he does not. In cases of touch ups where it's more crucial he would, but that otherwise he doesn't and that's one of the reasons he would still be willing to do lasik on me. True, but with a high myopia like mine I would feel more secure if the thickness was actually measured. The final place I am going to do indeed measure the thickness after the flap is cut so the surgeon is positive of the ablation he can remove.

(5) Once I determined that I wanted to use the Allegretto Wave EyeQ, then I stumbled upon another quandary - I was reading on different websites about iLasik and zLasik. Both were advertised as all-laser lasik, but of the two places with the Allegretto Wave EyeQ one advertised iLasik and the other advertised both iLasik and zLasik. At this point I had not been on the fifth and final consultation. I had already been considering a particular location because it was listed on the approved ICL doctors in Houston (which is actually quite small), but I had seen the name elsewhere a couple days earlier - Groupon. That's right people - there was a coupon for lasik and it was going to expire in just three hours and I was actually considering buying it!

I went ahead and started researching iLasik versus zLasik and discovered that it was the technology that was referring to how the flap is actually created. (The previous lasers are excimer lasers used for the ablation portion.) The iLasik or intralase was the American technology which had been around slightly longer than the zLasik, the Swiss alternative. There were no studies on the two types and any information I could find was opinion. The Groupon location though appeared to have both and it provided an opportunity to inquire about the difference.

The deal was only $100 and in the end I decided that the value of information to inquire about the iLasik and zLasik was worth the purchase. I am ashamed to say that I did not make a decision tree, but I knew that's the outcome it would have led to in the end. I went ahead and purchased the deal and was careful not to say in my exam, my paperwork, or where I heard of them that it was through Groupon. I wanted to see for myself what they said about eligibility prior to knowing I had the Groupon. I inquired about lasik versus ICL and got all of my detailed questions answered before being told that they would recommend lasik over ICL, but I could choose to do either.

At the visit I got to meet with the surgeon who would be performing my surgery (I would highly recommend you meet your actual surgeon ahead of time). I asked him my detailed questions about the two lasers as well as the iLasik and zLasik. I was incredibly impressed with his knowledge and found out that he actually has both excimer lasers and had decided to use only the Allegretto from now on because his studies showed that fewer people needed enhancements with the Allegretto laser. I inquired about the iLasik and zLasik and he said that both methods were used and that unless I has loose tissue he would recommend iLasik. He said that at three months the iLasik method has slightly better results, but that the six month mark shows the two methods to be identical.

I was asked twice if I was an engineer and once if I was a medical student because of the questions I asked of the doctors and surgeons. Impressive. In the end, I feel good about my decision to have lasik done and I am confident in the research I did and the final place that I chose to use, despite the amount of teasing I know I will incur when people find out I used a Groupon for lasik...

There was a lot of information in that post! If you are considering lasik and would like for me to talk to you more specifically about lasik I am willing to share all the places I visited as well as pricing, opinion, etc. I would encourage anyone to do some of their own research though and be informed before going on your consultations so that you know what the doctors are talking about. If you are blessed to have eyesight that's not as bad as mine you probably don't need to be as detailed as I was in my evaluations...

I cannot wait for it to be Friday!! :-)

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