Help me decide

Discussion in 'Optometry Archives' started by Randy Smith, Sep 23, 2003.

  1. Randy Smith

    Randy Smith Guest


    I have been considering surgery to correct my (approximatly) 2.00-2.50 diopter
    astigmatism. I can't recall my exact presciption but the astigmatism is the
    only correction in it. I am 40 years old and can function without my glasses
    or contacts if I squint.

    I don't like glasses.

    I have tried soft toric lenses and RPG lenses. I had problems with both
    including alergy to most every preservative used. I don't like the idea of
    having to be tied to having a few bottles of cleanser and saline and a lens
    case and a glasses case (just in case) everywhere I go and having to
    remember which bottle is fresh. You get the picture... I feel that
    contacts are a pain in the butt and the solutions I have to use are
    expensive and don't last long.

    I have tried ortho-K but the doctor warned that I shouldn't expect much of
    a result since its more for myopes and that my astigmatism was on the
    margin for showing any improvement. He was right.

    So now I'm left with 3 choices:

    1. Stay with what I'm using which is nothing.
    2. Get some glasses and be thankful I have eyes at all.
    3. Some sort of surgery.

    Choice 3 has issues, namely:

    a. My understanding is that LASIK is for myopia and hyeropia and actually
    induces some astigmatism. I also don't like LASIK because it is so invasive
    and I don't want dry eyes or halos.

    b. Wavefront LASIK is interesting but too new AND we are back to the dry
    eyes and halos again.

    c. RK is out because it involves incisions in the focal area. (read
    starbursts at night)

    d. Presbyopia is right around the corner.

    SO. I'm looking at AK (Astigmatic Keratotomy) or perhaps Limbal Relaxing
    Incisions and have some questions.

    I. Are AK and LRI the same thing?
    II. How accurately can these procedures reduce astigmatism? In
    other words, is this an iterative process?
    III. Its still surgery, so what side effects are expected?
    IV. Is there any other surgery that corrects astigmatism mostly with
    minimal side effects?

    Thanks for any information.
    Randy Smith, Sep 23, 2003
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  2. Randy Smith

    Otis Brown Guest

    (Randy Smith) wrote in message
    Dear Randy,

    Re:> Thanks for any information.

    The FAA requirement is for less than 2 diopters of astigmatism
    and 20/20.

    Therefore you are "legal" on those terms.
    Cylinder lenses will of couse make your distant vision sharper.
    Do you pass the DMV 20/40 level test.

    There are many on this site who would be VERY HAPPY
    to be able to see with out glasses. Count your blessings.
    Eventually, in another 5 to 10 years you are going
    to need +1.5 diopter lenses for reading. Age takes
    its toll.

    I would never get lasik for the circumstance you
    describe. Too much (permanant) risk for too little
    gain. If you were 20/300 the story would be different.

    The other methods (AK) will probably run $1,000 or
    so. Your choice -- but at least very low risk.
    AK is like Ortho-K, but the goal is to "remold" the
    cornea to take out the astigmatism. The problem?
    Stop wearing the AK lens, and the astigmatism returns.

    LRI (I think) means cutting the cornea with a laser to
    shape the cornea to take out the astigmatism. Permanent
    (mostly) but with the attendant risks of the laser proceedure.

    That is the best information I have.




    Your Doctor was right.
    Otis Brown, Sep 24, 2003
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  3. Randy Smith

    Dr. Leukoma Guest

    (TomKopan) wrote in
    Perhaps it would be good for this person to know what your center's results
    were with mixed astigmatism (sphere and cylinder of different signs). My
    hunch would be that the results aren't as predictable as doing simple
    myopia or compound myopic astigmatism.

    Dr. Leukoma, Sep 25, 2003
  4. Randy Smith

    Otis Brown Guest

    The person asked for general advice from the group. Cutting
    the retina involves a certain degree of risk. Are you
    suggesting NO RISK. If so -- say so.
    The person involved apparently passed the DMV eye chart.
    If she had 6 diopters of astigmatism, then perhaps
    Lasik would be OK. As always -- that is her

    Then that is wonderful. And not doubt the right
    decision for you. Indeed, I have friends who
    have done the same thing. But of couse
    the issue is with the risks if you
    pass the DMV test. I stated my opinion
    as an engineer, and she understood it that



    Dear Tom,

    I have made statements about the effect the minus lens
    has on the focal status of the natural eye.

    These are NOT MEDICAL STATEMENTS. I have always
    identified myself as an engineer, not an optometrist.

    In fact I never wish to "practice" optometry -- and
    you understand the reasons. I could never put
    a minus lens on the eyes of the public, without
    FIRST discussiong the effect the minus lens has on
    the natural eye.

    Only after the person had reviewed these facts,
    should he use the minus lens.

    From my long friendships with ophthalmologists,
    and my experience with the FAA requirements, I can
    post these items. You are free to contradict
    them as you see fit. The intelligence of
    the reader can decide the issue.

    Medicine (and optometry) are the practice of
    opinions. When "experts" contradict each other
    (concerning the prevention of a situation),
    then the person involved should hear both
    sides of the story -- not just one side.

    After careful review, he might well decide to
    use the minus lens -- it is sooo easy and quick.
    But then there would be no doubt about
    who was responsibile for the long-term
    effect and consequence of using that minus lens.


    Otis Brown, Sep 25, 2003
  5. Randy Smith

    Randy Smith Guest

    I did ask for general advice. I have been lurking on this board for several
    months now and I have yet to see many discussions regarding correction for
    small (some would say insignificant, but annoying none the less) amounts of
    astigmatism. My opinion is that LASIK would be a really big hammer for
    such a small nail. The risks and complications are too great for me to
    seriously consider this. Especially with presbyopia just around the corner.
    I have passed the DMV eye test recently without glasses (only squinting).
    Yeah ME! :) I guess I'm more disheartened to learn (according to Otis) that
    I am now a woman. What am I going to do with all those power tools now?
    Wait...I don't have any power tools. I'm ok then. Does this mean I have to
    start to learn to LIKE to watch Lifetime and the Lifetime Movie Network?
    :) :) :) :) Just having a little fun with you Otis. :) :) :)
    [deletia occured on irrelevent IMHO stuff ]

    I really just wanted to see if there was something out there that I was
    overlooking wrt reducing/eliminating astigmatism. I guess I'll just go
    get some snarky (my daughters will ensure that) glasses and thank the
    good Lord that I can see at all. I can't imagine what someone with a real
    Rx must have to endure.

    Randy Smith, Sep 25, 2003
  6. Randy Smith

    Otis Brown Guest

    (Otis Brown) wrote in message


    Re> The person asked for general advice from the group. Cutting
    Should be: ... cutting the cornea involves a certain
    degree of risk. ...

    Otis Brown, Sep 25, 2003
  7. Randy Smith

    drfrank21 Guest

    otis> The person asked for general advice from the group. Cutting

    Again Otis, the problem is that your knowledge of the
    anatomy of the eye is off, at least in this case:
    the cornea, not the RETINA, is involved in lasik.
    The retina is not involved- and it's certainly not cut.

    You do come across to other posters (especially those who
    are new) as indeed giving advice to situations that are
    beyond your scope as a layperson. If you want to "dabble"
    in the eye/vision fine- but don't mislead posters.

    drfrank21, Sep 25, 2003
  8. You want to see like this the rest of your life? Actually it's worse
    than this because it's in 3 dimensions and changes quickly as the
    pupil adjusts size (frequently depending on light) or the eyes move. Simulations Webpage.htm

    Individual variation means that it is very important to screen people
    beforehand in terms of their ability to deal with the kind of vision
    that Lasik can leave you with. Wouldn't want to do surgery on someone
    with a pre-existing vulnerability to anxiety, depression, any vision
    or eye sensitivity (dry eyes, night or day vision problems, who needs
    good vision because LASIK reduces vision), etc.

    I believe that LASIK is very dangerous. For most people who have had
    LASIK, their likelihood of being injured for life was the single most
    dangerous thing they ever did or ever will do in their entire
    lifetime. Check out my posts, others, and other websites.

    I think this indicates refractive surgery can have serious
    consequences. I wish all the websites had information like this-
    right up front.

    "If you are here, you are probably pretty anxious about your vision."

    "Suffering a personal injury has been rated almost as stressful as the
    death of a close relative. Sometimes the depression, loss of
    confidence, feelings of isolation, self-blame, anger, and other
    emotional responses that some people manifest because of a refractive
    surgery induced complication are more debilitating than the
    complication itself. "

    These are just samples- there are a lot more than this.
    lasik advocate with flap melt, Sep 26, 2003
  9. Randy Smith

    Otis Brown Guest

    I had already published a "correction". Yes, Lasik
    is cornea cutting. For a my background and experience
    (and that of Dr. Stirling Colgate) you can read
    my book on:

    Yes, indeed, I a made a typo.

    Anyone who reads chapter 3 will understand the parts
    of the eye -- as the optics of a box-camera or
    optical bench.

    Otis> See above.
    Otis> I think I have been absolutly clear about
    my statement of the dynamic behavior of the
    natural eye. If a person wishes to learn
    more -- he can listen to our coversations.
    He can then develop his own judgment about
    these various issues -- and a choice he might
    wish to make.

    If you want to "dabble"
    I do not "dabble". Sorry. I present analysis
    and facts concering the eye as a sophisticated
    system. If you wish to state that the eye
    is not sophisticated in the manner -- do so.

    If you wish to affirm the the minus lens has no
    effect on the focal state of the natural eye -- then
    present experimental data to that effect.

    The title was, "help me decide". And so we
    discussed the value of Lasik for improving
    vision that passes the DMV (20/40) level test.

    With our collected analyis she can now form
    here own judgment. I think we have done
    her good service by discussion the
    risk/benifit ratio for her decision.


    Otis Brown, Sep 26, 2003
  10. Randy Smith

    drfrank21 Guest

    (Otis Brown) wrote in message > I had already published a "correction". Yes, Lasik

    Yea, you're still a layperson in the eye care field who likes to dabble.

    COMET study. My last patient yesterday was a college soph
    that I've been seeing since he was in 6 th grade. Guess what?
    Initial exam was -125-25x90 ou. Exam yesterday was -125-50x95 ou.
    Minus lens for about 8 yrs- no increase.Explain that! Oh ,never mind.

    drfrank21, Sep 26, 2003
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