How much safer are contact lenses and orthoK than lasik or laser surgury?

Some people(wont be giving names) have stated the risks of contact
lenses. They are correct but I argue that the risks are tiny compared
to the risks of lasik. Both options will reduce your dependancy on
glasses but contacts, including orthoK will achieve the goal safely,
effeciently and with much less risks. I dont think they should even be
arguing against contact lense based correction when its the far safer
and also non-permaent choice of vision correction. If something goes
wrong with contacts, you can go back to glasses with no ill effects, no
permaent effects. With lasik, there is no going back to your
pre-operative pescription. You are stuck with whatever lasik gives you.
Of course glasses is the safest but contacts are safe enough that many
millions wear them, even 12 year olds have been known to wear them! Of
course children are more likley to get complications because they dont
take as much responsability. There will be reports of complications
from contacts and orthoK because so many people wear them that a few
will turn up with bad luck. I see much more reports of lasik
complications. Life is all about risks and how you manage them. I am
going to take the very small, calculated risk with orthoK to reduce my
dependancy on glasses.

 

Sounds like you've answered your own question.

Dom

 

Dear All,
I`m writing to You, in the name of our club, hoping that You will join
us in humanitarian action "RIDE BICYCLE AGAINST DRUGS, ALCOHOL AND
VIOLENCE". After January 1., 2006. this action will become program
named "WHEEL OF ENJOYMENT". This program is supported by Ministry
of health Republic of Serbia, Ministry of labour, employment and
social policy Republic of Serbia and Ministry of education and sport
Republic of Serbia.
Program "WHEEL OF ENJOYMENT" also includes actions "Cancer is
hard, Friendship is easier" and "Diabetes has its enemy"
dedicated to people with cancer and diabetes.
Bicycling club " SIRMIUM BIKE INTERNATIONAL" from Sremska Mitrovica
is promoter and initiator of this program. Beside bicycling
promotion, this program`s goal is to build Rehabilitation center for
addiction diseases, too.
After January 1., 2006. our multiethnic bike team will ride again
across Serbia and districts of Kosovo.
In Jun 2006. we will ride trough Europe with same goal to pay
attention on existing problems of addiction diseases, cancer and
diabetes.
We invited great number of economic subjects in country and abroad, to
join us in this program giving their support.
We asking You, too, to join us and to give us your support or to
direct us to competent humanitarian, financial and medical
institutions.

Sincerely,


President of bicycling club

"SIRMIUM BIKE INTERNATIONAL"

and program`s coordinator
Mr. Kamenko Vladisavljevic

 

Dear All,
I`m writing to You, in the name of our club, hoping that You will join
us in humanitarian action "RIDE BICYCLE AGAINST DRUGS, ALCOHOL AND
VIOLENCE". After January 1., 2006. this action will become program
named "WHEEL OF ENJOYMENT". This program is supported by Ministry
of health Republic of Serbia, Ministry of labour, employment and
social policy Republic of Serbia and Ministry of education and sport
Republic of Serbia.
Program "WHEEL OF ENJOYMENT" also includes actions "Cancer is
hard, Friendship is easier" and "Diabetes has its enemy"
dedicated to people with cancer and diabetes.
Bicycling club " SIRMIUM BIKE INTERNATIONAL" from Sremska Mitrovica
is promoter and initiator of this program. Beside bicycling
promotion, this program`s goal is to build Rehabilitation center for
addiction diseases, too.
After January 1., 2006. our multiethnic bike team will ride again
across Serbia and districts of Kosovo.
In Jun 2006. we will ride trough Europe with same goal to pay
attention on existing problems of addiction diseases, cancer and
diabetes.
We invited great number of economic subjects in country and abroad, to
join us in this program giving their support.
We asking You, too, to join us and to give us your support or to
direct us to competent humanitarian, financial and medical
institutions.

Sincerely,


President of bicycling club

"SIRMIUM BIKE INTERNATIONAL"

and program`s coordinator
Mr. Kamenko Vladisavljevic

 

I think the only statistics that matter are those dealing with visual
morbidity, i.e. what is the probability that wearing a contact lens, or
undergoing LASIK will cause permanent decrease in visual function.
Traditionally, this has meant loss of visual acuity on the Snellen
chart.

We know what those numbers are for contact lenses, because the subject
has been studied exhaustively for years, with several large-scale
population studies. Currently, there are ongoing post-market studies
involving the new silicone-hydrogel lenses. We do not have information
of the same quality for LASIK or for orthokeratology. We do NOT have a
good handle on the infectious keratitis rate for overnight OK.

DrG

 

Ace--did you read this?

 

I assume infectious keratitis is treatable (and cureable) with
antibiotics. A poor LASIK result is something you'll have til you die.

 

True, although the keratitis often leaves you with a nasty (and vision
robbing) scar that will also be with you forever (or until you get a
corneal transplant).

I'd guess that more serious damage, as measured by loss of acuity, has
occured from such ulcers than has occured from LASIK. But one thing is
for sure, far more LASIK patients are glad they had it than not. And I
must add that most post-ortho K people I've seen think they wasted their
money, and I've agreed with that assessmment in every single case.

To be balanced, I admit I have one patient who wishes he'd never had
LASIK. Although he went from -8.00 to 0.00 and gets 20/20 after standard
LASIK then wave front secondary, he hates his night vision and claims he
is now a hazard driving at night. I'm counting on his pupils get smaller
as he ages (yes he has used Alphagan, but still is not a happy camper).

w.stacy, o.d.

 

But, this happens in only 13% of ulcer cases. Probability dictates
that they will occur peripherally and off-axis most of the time.
Without taking you through the calculations, the probability of vision
loss from sleeping in a conventional hydrogel lens is 0.026% per year.

Sure wish you had numbers to back-up your guess, Dr. Stacy. Looking at
the clinical trials, we might come up with an educated guess of from
0.5% to 1%. If you divide 0.5 by 0.026, you get something like 20
years. But, even this statistic is moot, because most patients don't
sleep in their lenses, in which case the probability of an infection is
reduced by a factor of 5 or 10, in which case 20 patient years becomes
100 or 200 patient years.

No contest. Contacts win.

DrG

 

Only 13%? That's quite a few. I wasn't trying to blame them all on
contact lens wear for sure.

I think there are a few million LASIK recipients who might argue with
you on that, as most of them went to LASIK because they didn't like
contacts for one reason or another. But you're right, I have no numbers
to back me up, just my patient base which includes 40 or 50 LASIK
patients and a couple thousand CL wearers.

w.stacy, o.d.

 

Really? That's 13% of 1/500, or 0.026%. That qualifies as "quite low"
in my vernacular.

The subject was "safety," or so I thought. Obviously, if they were
happy in their contacts, they wouldn't be motivated to have LASIK.
This just motivates ME to do a better job at keeping my contact lens
patients happy, just so that they won't be tempted to trade the SAFETY
of contact lenses for something more risky. I think there is another
underlying factor that we eye docs don't want to talk about, and that
is the hassle of wearing contact lenses includes that "pesky" annual
eye exam. I think that successful LASIK patients actually believe that
they have less need for eye examinations, when the exact opposite is
true. They have a greater need for continued care, especially for dry
eye.

DrG

 

Actually, (and here I go again, guessing based only on my experience and
what I've heard/read), I'd guess that fully half the people who have
had LASIK were quite happy with their contacts. They just liked the
idea of not having to buy contacts, solutions, etc. (in addition to the
CL evaluations), the idea of waking up with clear vision, the idea of
less dependence on the CL or SRx "crutches"; plus, a lot of them just
succumbed to the advertising, the "coolness" of having the surgery
(keeping up with the Joneses), etc.

w.stacy, o.d.

 

I would actually agree with you on all of the above. A good contact
lens patient is an ideal LASIK candidate. Those with contact
lens-related pathology probably have a higher incidence of dry eye,
high prescriptions, etc., which make them less than ideal LASIK
candidates. Therefore, you can expect the LASIK marketers to target
those patients.

I'm not sure what's so cool about having a resected cornea, though.

DrG

 

You probably also don't see what's cool about sky diving or bungee
jumping, either?

bill

 

I guess if having a resected cornea is necessary for said activities,
then no. About as close as I have gotten to such daredevilish behavior
is skiing the olympic downhill run at Snowbasin, Utah, and a little
rock climbing at Smith Rock....while wearing contact lenses, of course.

DrG

 

I don't recollect ever seeing a sky diver without goggles...
Not sure about bungee jumpers but I have seen a bunch
that do wear goggles.

Point is that I agree about the relative inconvenience of
contacts relative to (successful) surgery but I don't consider
the very infrequent necessity for protective eye gear (that
you wouldn't normally wear as part of it. Swimming, maybe.

-Quick

 

I have never found contact lenses to be an inconvenience, except when I
was in high school and struggled with hard lenses, and I am not about
to push my luck with an elective surgery. Especially when I don't feel
that my lifestyle is being compromised.

The original point had to do with the relative safety, i.e. what are
the chances I am going to lose some vision if I get surgery vs. if I
stick with contact lenses, not which is preferable.

DrG

 

"Ace--did you read this?"

Yes and my risks are at least 10x lower with overnight orthoK than
lasik. Also if im not satisfied with orthoK such as if it doesnt give
me satisfactory vision I can simply discountinue the procedure and my
pescription will revert back to square one. Lasik is permaent and you
are stuck with the results. I have met many people that wish they could
"undo" lasik and said they woulda tried orthoK instead because orthoK
can be undone.


"I assume infectious keratitis is treatable (and cureable) with
antibiotics. A poor LASIK result is something you'll have til you
die."

Thats correct. Complications from lasik is more serious and permaent
than are complications from contacts including orthoK

"far more LASIK patients are glad they had it than not."

The satisfication rate is 90% but even among those, many said there
were some aspects of lasik that could have been improved upon. One of
my friends is happy with lasik but wishes the night vision was better.
Another wishes she ended with 20/20 but considers 20/30 acceptable and
is still satisfied.

"And I
must add that most post-ortho K people I've seen think they wasted
their
money"

If thats the worst thing that can happen with orthoK, sign me up! With
lasik you stand to lose alot more than just money!


"Although he went from -8.00 to 0.00 and gets 20/20 after standard
LASIK then wave front secondary, he hates his night vision"

This is something us large pupil people worry about. My pupils
certainly are large so theres too much risk of that. My friends have
provided words of wisdom, dont get lasik if your pupils are larger than
6mm or you can give up some or more night vision.


"If you divide 0.5 by 0.026, you get something like 20 years."


So this means someone whos slept in contacts for 20 years is "due" for
a complication on average. I read that overnight orthoK is 5 times
safer than other overnight contacts because your eyes get a chance to
rest and soak oxygen durning the day while they are suffociated for a
week to a month with standard soft overnight contacts. Focus day and
night comes to mind, my optometrist said he gets patients all the time
who develop complications that way. However with orthoK you DONT wear
the contacts for a month strait! Just 8-10 hours a night for 2-5 nights
a week.


"as most of them went to LASIK because they didn't like
contacts for one reason or another"


That is absolutely true. I have a friend I know in person whos like
-4.75 with astigmastim and she hates her toric contacts, they dont give
very good vision, rotate, dry her eyes, irritate them and just are a
pain. She said shes looking into lasik and may have to get it. I just
said research everything about lasik, make sure you are a good
candidate and are well informed and good luck, hope it goes well if you
get it.


"The subject was "safety," or so I thought. Obviously, if they were
happy in their contacts, they wouldn't be motivated to have LASIK.
This just motivates ME to do a better job at keeping my contact lens
patients happy, just so that they won't be tempted to trade the SAFETY
of contact lenses for something more risky."


absolutely true. Of course theres always glasses and many people who
werent satisfied with lasik wish they could undo lasik and go back to
their glasses. I suggest all contact lens wearers take at least one day
off a week to rest their eyes and be in glasses so they can get used to
it. Or they can take their contacts off at home and wear glasses. My
mom only wears contacts when she gets out of the house. Someone whos
worn contacts full time for years is going to need some time to get
used to glasses. Make it easy and get used to glasses now so when you
can no longer tolerate contacts, glasses wont be much of a problem.


"I'd guess that fully half the people who have
had LASIK were quite happy with their contacts. They just liked the
idea of not having to buy contacts, solutions, etc. (in addition to the

CL evaluations), the idea of waking up with clear vision, the idea of
less dependence on the CL or SRx "crutches"; plus, a lot of them just
succumbed to the advertising, the "coolness" of having the surgery
(keeping up with the Joneses), etc."


How true. The pressure is strong when your friends, family and
coworkers are all getting lasik. It becomes the "in" thing. When I was
in Israel lasik was the "thing" for soldiers and I talked to many of
them who say all their fellow soldiers got lasik or are getting it and
they say they want lasik too! In fact glasses are not just an
inconvinence, but a hinderence when you are in the army. Lasik is
encouraged for soldiers and a very large percentage get it.

Many others who get lasik do so because their friends got it and raved
about it and that person feels left out. Sometimes their brother,
offspring or spouse gets it and they want it too! Theres tons of
marketing and hype about lasik. Just about every myope has heard about
lasik. I bet most of them have read about it and thought about it too.
Most people who look into lasik decide its not for them after all.

Its my opinion if you are happy with glasses and/or contacts that it
makes no sense to get lasik just for the sake of it. Its not something
to be done on a whim or taken lightly. Many people regretted getting
lasik for no reason when their resultant vision wasnt as good as they
had with glasses and especially contacts. In fact lasik centers point
out that you arent a good candidate if you are content with
glasses/contacts. Lasik is for those with a strong desire to reduce
their dependancy on glasses. Youd really have to hate glasses to take
the risks of lasik. Youd be much better off going to contacts and
especially orthoK to reduce glasses dependancy and which is what im
doing!