Hello, I've considered Lasik for some time now; but I would like to get some opinions as to which laser would be best for my prescription.

I've got a couple of different prescriptions that are about 16 months in between them from two different eye places.

The first is O.D. Sphere -4.00, Cylinder, -1.75, and Axis 10(or maybe it's a hundred it's hard to tell from his writing).
O.S. Sphere -3.25, Cylinder -2.00, Axis 72+1/2

The next one done 16 months later in June of last year is: O.D. Sphere -4.50, Cylinder + 1.75, Axis 010
O.S. Sphere -5.00, Cylinder +1.50, Axis 165

These were both done by Optometrists, only the more recent one on the bottom happened to work for an Opthamologist, hence the positive numbers.

I would like to know what laser would be best for my eyes. I know the fact that the amount of astigmatism in my eyes isn't that common. So that makes me a little leary of the VISX which I feel was designed more for the masses without much astigmatism.

I'd also like to know why nobody can make contacts that actually fit my right eye and see well. The second place I went to also does lasik. Well if they can't get my right eye to see well through contacts, why should I trust them with a laser?! And yes they use a VISX(star2)

I must say that I have to have night vision. My job depends on it.

I've heard good things about the Mel 70, the B&L Technolas 217, and the Autonomous(for night vision especially).

So if you had a prescription like mine, what laser would you use?

Randall

Your prescription is actually nothing out of the ordinary and should be able to be treated well with any brand laser. I would stay away from a "broad-beam" laser however, which is advice I would give anyone. I believe there's a higher incidence of central islands with them although I'm sure other drs may dispute this. If nobody can fit you with a contact lens for your right eye that you can see well with, that may be a red flag. You need to have this explored further before having LASIK. It may indicate you have some irregular astigmatism which LASIK currently cannot treat or it may be some other cause. You should get an explanation. As far as your need for good night vision, it is important that your pupil size in dim lighting be measured accurately. If it is 5.5-6 mm in diameter, you can go with most any laser. If it is greater than this, make sure you are treated with a laser that can expand the optical zone. I use a Nidek and an Autonomous and if your pupil size is less than 6.5 mm, I would use the Nidek. If it's over 6.5 mm, I would use the Autonomous

Thanks for your time to respond, Dr. Corwin. My right eye sees o.k. with RGPs, but not well enough in my opinion(I want 20/20 vision!).

I've had problems with the contact slipping, and It seems I can always tell that the contact is in my right eye whereas the left eye always feels comfortable and I see better with it.

I've used two different types of RGPs lately. Some really big ones by the first optometrist, and some really small ones by the most recent optometrist. I used to think that I could see the edges of my contacts, and I'm guessing that's why he put me in really big ones.

I later found out that it was the constant movement of the contact during blinking because the things are weighted for astigmatism and that I was seeing the portion of the contact that didn't have any power in it in the corner of my sight when the contact moved.

The really small RGPs I'm using now are made by Duffens/Langley, and the left sees o.k., it's just the right one that's the problem.

The latest optometrist put my right eye up to the pinhole test, and I could see better. I always thought though you could always see better through a pinhole now matter what though.

Anyway, I've got an appointment with the first optometrist again who used the large contacts. I can see better with those, but they've become irritating to wear, and the second optometrist advised against wearing those even as a backup. I'm going to insist on going back to soft toric lenses though. When I was in the soft torics, they seemed much easier to fit even though they did like to dry out much much quicker than the RGPs.

The optometrists seem to want to keep me in RGPs, since they claim my vision would be better. Well, this may be true, but if I'm going to go ahead and have lasik, I want my eye to start getting back to it's original shape without having to be out of contacts for as long as I would if I stayed with RGPs.

Well I'm getting long winded. If I could get contacts that would enable me to see my best, and didn't have these problems, I'd stick with them; but I have yet to find them.

Thanks again for your reply.

Randall

This is what I would do if you were my patient. I would take you out of your RGP contacts for 2 weeks and have you only wear eyeglasses. I realize you won't see as well with them on but this is only temporary. We need to know what the true shape of your cornea is. It sounds like you are having astigmatism issues with your right eye and the question is, is it just regular astigmatism, irregular astigmatism or an early form of keratoconus. I would then do a topography on you and a refraction. Then come back one contact lens free week later to repeat both tests. I would keep doing this until your topography and refraction are stable. Then I would analyze the data. If you have regular astigmatism, you should be able to be correctable with spectacles to 20/20. If not, we need to look for another, non-cornea cause. If you have irregular astigmatism, I would wait for wavefront technology-assisted LASIK. If you have early keratoconus, do not have LASIK ! If you would like a second opinion, feel free to send me your topographies.

Steven Corwin, MD
895 Canton Rd.
Marietta, GA 30060
(770)-427-8111

Thanks for the time and the additional info.! I'm going back to my first optometrist(well, first since I moved down here) and hopefully he'll see what's going on. I'm not in a real hurry to have lasik.

Thanks again

Randall