I'm currently exploring my lasik options, one of which is the possibility of having the procedure done in Canada (where wavefront custom lasik is apparently a reality today) instead of having the older procedure done in Miami (where I live). I'm not planning to rush out have it done next week, but I would like to have it done sometime before Christmas.

My primary motivation for travelling to Candada to have it done is my astigmatism. I've never actually been told that I have irregular astigmatism, but based upon what I've learned this weekend while researching lasik online, I'm practically a textbook case example of it... at least, my left eye is.

Over the past 12 years, I've had four doctors and changed contact lens brands/models four times. Every single time, I ended up with monocular double vision in my left eye with a sharp primary image and a slightly fuzzy lighter image shifted down and to the right. After one, two, or three attempts with different lenses they always managed to eliminate the double vision, but the fact that four different doctors all had the same results on their first try strongly suggests to me that something about my left eye defies conventional logic and consistently misleads everyone into making a wrong choice the first time around. I've been told that I'm EXTREMELY sensitive to axis errors (I think my tolerance is somewhere between +/- 3 degrees). For the record, my prescription stats are at the end of the posting.

Given the rather poor track record my doctors have had with getting my contact lens prescription right on the first try, I'm not terribly optimistic about the chances of lasik getting it right either... at least not without the assistance of wavefront technology.

I can deal with waiting until maybe March or April 2002 to have the procedure done in Miami, but it looks like the FDA is in no hurry to approve it anytime soon. Given that I'm almost 31 and only have about 8 or 9 years left to enjoy life without glasses as it is, I'd MUCH rather just get it done in Canada today than wait another two years to have the same thing done locally (or settle for the older, less sophisticated procedure and face the near-certainty of monocular double-vision afterwards... something I absolutely, positively, could NOT live with. Period).

Am I totally off-base on my assumption that my contact lens double-vision experiences suggest that having traditional lasik done would all but guarantee disaster?

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my stats:

Focus Toric Visitints (June 1999 - December 1999)
Right: 8.9 BC, 14.5 dia, -3.00SPH, -1.75CYL, 010 axis
Left: 8.9 BC, 14.5 dia, -2.25SPH, -1.75CYL, 180 axis

Sunsoft Eclipse Toric (April 1995 - June 1999)
Right: -2.25SPH, -2.00CYL, 180 axis, 8.6BC, 14.5dia
Left: -1.75SPH, -2.25CYL, 175 axis, 8.6BC, 14.5 dia

Note: my astigmatism didn't magically improve between 1995 and 1999... my most recent prescription went with -1.75CYL because that was the highest power available in disposable lenses. I don't have my current glasses prescription available, but I think it's approximately the spherical measurement of my most recent contacts and the cylindrical measurement of my previous contacts (i.e., the worst from both).

Between 1989 and 1995, I wore soft contacts, but had an unhappy experiment with gas permeable lenses in 1991 (I couldn't adapt to them).

A few comments

1. You may not even be eligible for any type of LASIK. keratoconus is a condition where there is alot of astigmatism, and patients with keratoconus can not get LASIK at all, as the cornea is not stable enough for LASIK. So you need to get a corneal topography or see a cornea specialist to rule this out

2. Wavefront LASIK is still in its infancy. There are places in the US to get wavefront LASIK, but the patients in both CAnadaa and the US are still undergoind experimental protocols to see how to best provide wavefront LASIK. There are atleast 7 companies working on their treatments all over the world. The results are promising, but they are still in the begginning. Unless you want to be in a study, you may want to wait and see which wavefront system ends up with the best results. As well, with each group that undergoes wavefront LASIK, the surgeons and companies are refining their data so that the next group will do even better. So you have to decide whether you want to be one of the pioneers, or wait for things to get perfected.

The third consideration is travelling for LASIK. There are siginficant risks to traveling for LASIK. What if you travel, return 3 days after surgery, and get an infection, or a flap slip. Or you have some minor trauma and a flap slip. what if you develop inflammation under the flap, or epithelial ingrowth.
There are alot of things that can happen, so most surgeons recommend that it is best to have surgery in and around where you live (I am not saying 5 miles, but somewhere that you can easily get back to if you have a problem).

I hope this helps. Please feel free to ask a followup question. You may also email me any other questions.

best of luck

Bill Trattler, MD
Center For Excellence in Eye Care
8940 North Kendall Drive; #400E
Miami, FL 33176