Laser or Lasik eye surgery questions

Anybody against people getting laser or lasik eye corrective surgery to correct vision? I been thinking of getting this for myself for years, but always back out for fear of complications. Anybody have complication stories? Maybe they have something new on the market? Thank you in advance for your posts.

 

There is a basic fact of life which applies doubly to any cosmetic
surgery - you don't get something for nothing.

 

You may want to post your question at the alt.lasik-eyes newsgroup.
There is a small, but very vocal, group who had complications and they
will be sure to give you all the horror stories, real and imagined.

You also may want to visit our organization's website. We try to stay
objective about refractive surgery and are neither cheerleaders nor
naysayers.

Remember that the most refractive surgery can provide is the
convenience of a reduced need for corrective lenses. To achieve that
convenience you must accept some risk. Only after a comprehensive
examination from a competent doctor and a full discussion of your
individual circumstances can you determine if the potential risk
outweighs the potential benefit based upon your own needs,
expectations, and values.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

 

Do you have a particular view on contact lenses? Particularly the
day/night ones?

I have a fairly strong prescription, and had real problems with
contacts in the past. But with the new materials used, all I need to do
is take a drop of lubricant each morning, and I'm good for the week.

For me, this affords me more than enough convenience, without the risks
involved in the laser surgery.

I have personally known a few people who have had laser procedures, and
none of them have regrets. But for me, the day/night contact lens
option is more than a fair trade-off: one night a week where I have to
wear glasses (while the lenses are being cleaned) and a drop of
artificial tears to get things lubed up in the morning, and I'm good as
gold, without the risks of complications and the pain.

 

I think you're referring to the Ciba Night and Day cl's. This lens, as
well as any contact lens worn on any type of an extended wear basis,
still has a risk factor. I'm just finishing up treating an individual
who did in fact develop a nasty corneal ulcer with the Night and Day
contact lense. So the risk of infection and complications do exist.

There is obviously risk involved with Lasik but careful pre-operative
work-ups, to eliminate those who are not good candidates, is the
key to increase your odds of success. It seems that many of the
patients I see who had less than desirable results were those who
shouldn't have had the procedure done in the first place.

frank

 

You are quite correct in concluding that sleeping in silicone-hydrogel
contact lenses presents less probability of long-term visual morbidity
than any type of refractive surgery.

DrG

 

Was this ulcer central, paracentral, or peripheral? Was there any
necrosis involved, and did you culture it? Or, was it a sterile
peripheral infiltrate? Also, did the patient develop halos, diplopia,
glare, or dry eye as a result? Will the patient be able to wear
contact lenses or eyeglasses in the future?

Of course, hindsight is always 20/20.

DrG

 

I'm curious - was there something about this person's 'routine' which
made them more susceptible to the problem? Or in other words, can these
ulcers occur in anyone equally with no regard to their behavior or lens
cleaning/disposal schedule?

 

This was an 1.3 mm ulcer(not infiltrate), mid-central, with moderate
surrounding stromal edema along with an anterior chamber response.
She was placed on Zymar q 1 h with tobrex ointment at night.
Last seen,the ulcer was 90% resolved with a taper of her meds.
I'm not sure where you're heading
with your last few questions other than not realizing that
corneal ulcers can indeed be serious.

frank

frank

 

It's great that your patient is getting better with the meds. Most
ulcerative keratitis patients do. Also, most of them get better
without sequellae. Although ulcers can occur with continuous wear
lenses, the risks of that occurring are 1/500 per year with hydrogels,
and about 1/3000 per year with silicone-hydrogels. About 13% of those
will have visual sequellae. I think that if you crank the numbers, you
will conclude that the visual morbidity of sleeping in contact lenses
is less risky than that of having LASIK.

That's where I was going.

DrG

 

This was an 1.3 mm ulcer(not infiltrate), mid-central, with moderate
surrounding stromal edema along with an anterior chamber response.
She was placed on Zymar q 1 h with tobrex ointment at night.
Last seen,the ulcer was 90% resolved with a taper of her meds.
I'm not sure where you're heading
with your last few questions other than not realizing that
corneal ulcers can indeed be serious.

frank

 

An interesting footnote to this though was that this patient
did not come in right away when her symptoms first came up.
The provider who fit her with these cl's, according to this
patient, supposedly told her that these cl's were 100% safe.
Obviously I take that with a grain of salt but just wonder
that she was still lulled into a fales sense of security
regarding overnight usage.

It's always been my contention that the majority of those patients
who have had complications with lasik were those who were not
good candidates in the first place(large pupils, thin corneas, etc).
Complication rates for lasik seem to be all over the place
depending upon the studies. I think Glenn would have a good
feel for the actual numbers.

frank

 

I hate that.

In retrospect, many of them no doubt were. But, why weren't they
screened out?

Glenn may have a feel for the numbers, but I would prefer not to have
to rely upon anybody's "FEEL." I'm not even sure about his
methodology. I would like to see real, hard, statistically robust
numbers like those we have for contact lens complications, and see them
published in a journal like the Lancet. Unfortunately, that will never
happen.

DrG

 

To increase the likelihood of ulcer, keep the lens in when it hurts.
That is probably the best way to get the process going.

Better still, sleep with it on and feeling uncomfortable. You need to
have a break in the cornea epithelium and a bacteria to invade that
space and grow there. Not having adequate oxygen flow, like older
non-silicone hydrogel lenses will also help. To get the break in the
epithelium, allow the lens to stick onto the cornea and then try to
remove it, or at least rub your eyes. A particle of debris, like sand, a
piece of hard, dry dandruff or even an eyelash stuck under the lens will
do it. A torn lens or dirty, deposited lens will do it, too, so don't be
to meticulous about cleaning it. Now you need to add some bacteria. That
can come along with the eyelash or debris, or you could put a dirty
finger in your eye and rub it. Perhaps have someone cough or sneeze
directly in your face. You could also introduce the bacteria by not
properly disinfecting the lens between uses---even better is to store
the undisinfected lens in an unclean storage case.

OK, now you have the recipe for a cornea ulcer. Remember, though, you'll
need to leave the lens on your eye have it be bothersome and ultimately
painful if you want the bacteria to have a chance to do some damage.
Leave that lens in and don't seek medical attention for at least a day
or so.

That's the recipe for a cornea ulcer. I'll add that there are some
people who do indeed do everything just right and nevertheless get an
infection. This probably has to do with a problem in the tear chemistry
not providing normal antibacterial action or an otherwise compromised
immune system. But again, prompt treatment is important.

--LB, O.D.

 

What LarryDoc described can be filed under the heading of "self-abuse,"
or "lack of common sense."

Unfortunately, I don't think I could predict if or when a patient will
have an "incident." What I DO know is that the integrity of the
epithelium must typically be compromised in some way before a bacterial
ulcer can develop. We also know that compromised epithelium is caused
by low oxygen permeability. The new standard for oxgyen permeability
for overnight wear is now proposed to be a minimum DK/t of 125. This
is in the range of "most" silicone-hydrogel lenses.

DrG

 

Ah, good - in other words, throw common sense out the window.