I have two questions:

1) I currently wear soft contacts with a -10.0 prescription in each eye. Am I still a candidate for the wavefront procedure?

2) I recently turned 37 years of age. I understand that after the age of 40, most people require reading glasses. Will having the wavefront procedure (or the lasic procedure) speed up this process or increase the likelihood of it happening?

Thank you for your time.

Edmond

Thank you for your question. There is a lot of marketing going in to "wavefront". The idea is that wavefront takes a peson's indivudal aberrations in their cornea and corrects these as well as the refractive error.
It turns out that for a person with 10 diopters of myopia - only 1% of your vision problems is due to "aberrations". 99% is due to the fact that you are severely near-sighted. Therefore - even if wavefront was available (which is it not for your prescription) - it would not make much of an impact in your overall result. That is because there is a lot of healing that occurs when there is such a large correction.
So in summary - wavefront is not available for your correction. And even if it was available - it would not make much of a difference in your final visual result.
If your main concern is obtaining the highest quality of vision after surgery - there are a few options

1. Surface laser (PRK/LASEK) uses the same laser as with LASIK, but avoid the flap. This can allow for higher quality of vision, since the LASIK flap can induce aberrations. Aberrations from the LASIK flap are more common in patients with higher corrections (like yourself) as the flap usually ends up with tiny micro-wrinkles. So avoiding the flap can lead to possibly crisper vision.
The downside of surface laser is that the recovery is longer. It takes about 4 days to recover, vs just 1-2 days with LASIK. As well, although the risk of corneal haze has been reduced dramatically with the newest generation of lasers, the use of vitamin C, and avoidance of UV exposure - there still is a small risk of haze for patients with high levels of near-sightedness like yourself.

2. The second option is called a phakic IOL. Basically - a contact lens is placed in your eye premanently. I was fortunate to be an investigator for phakic IOLs for Medennium - and my patients responded very well to the phakic IOL. However, this is a surgery that has risks (just like there are risks with LASIK, PRK, LASEK and any other surgery). The most serious risks include infection and cataract formation.
The one thing in common my patients experienced with the phakic IOL was that they obtained excellent quality of vision. One patient ended up with 20/12 vision (2 lines better than 20/20).
The phakic IOLs are not yet available. However, they should become available sometime in early 2004.

I hope I have helped provide some general information to answer your question. I should also add that patients that are very near-sighted like yourself are more likely to not be a candidate for surgery than someone with only a slight correction - so that it is critical that you get a thorough evaluation as to whether you are a candidate for any of the surgeries you have asked about. The 3 tests that are probably the most important in determining whether you are a candidate are corneal thickness, corneal topography/Orbscan and pupil size.
As well - you should also be aware that if you undergo LASIK, PRK or LASEK - your chance of needing a second surgery (called an enhancement) is higher. This is because patients with higher corrections are more likely to need an enhancement.

I hope I have helped answer your question. Feel free to email me with any followup questions, or just post them below.

Best regards

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

Dr Trattler:

Thank you so much for the prompt and thorough reply. I definately have a great deal to consider. If I understand correctly, for a person with my large myopia, you favor Lasek and Phakic IOL surgery over Lasik. In a scenario where I was a candidate for all 3, would you recommend waiting for the phakic IOL surgery to be approved for the general public?

Also, a close friend of mine had my exact level of myopia and now sees 20/25 with no complications after lasik surgery. Is he the exception to the rule for people that have had lasik surgery with my level of myopia?

Edmond

All 3 surgeries are options:
LASEK
Phakic IOL
LASIK

Each surgery has its risks and benefits. For patients who are candidates for all 3 (in other words - do not have any issues that would make them not eligible for surgery) - all 3 work and will reduce the myopia. All 3 surgeries have a very good chance of achieving 20/20 vision.
Again - the first thing needed is to find out which surgeries are even options for you. For example - if your cornea is thin - LASIK may not even be an option. If your pupils are huge - phakic IOLs and possibly LASIK & LASEK may not be options. If your corneal topography has an y suspcicious findings - then LASIK and possibly LASEK would not be an option. So again - the first issue is to determine which techniques are available.
From there - you would then compare the risks versus benefits for each procedure. The advantage of LASIK is that there is very fast visual recovery. However, there are more things that can happen with LASIK, plus the quality of vision may not be as high as with LASEK or a phakic IOL.
I hope this helps. Please ask me any followup questions.

Best regards

Bill Trattler, MD
Miami, FL

dr trattler:

Once again I want to thank you for your time and assistance. I'm still a little partial to that wavefront procedure. Would you have any idea when it should be FDA approved for use on people with myopia of -10? I believe it is now only approved for use on people with myopia of up to -6.

Edmond

Wavefront provides fine tuning of the laser treatment. Unfortunately - there is a lot of hype, with the results perhaps only being slightly better as compared to regular treatments. I personally have been performing mostly regular treatments rather than wavefront-guided treatments over the past few months, since the results have been pretty similar.
For a -10 correction - the wavefront portion would make up less than 3% of the overall treatment - and the effects would probably be washed out by the overall large treatment. instead, the plan for msot highly myopic patients like yourself would be to first have regular laser treatment and then have an enhancement with wavefront.
Saying it another way - it is unlikely that an FDA study could show that wavefront-guided treatments had any difference in results compared to regular treatments for a patient with -10 - so that it is unlikely to even be an option.

I hope this helps.

Feel free to ask any followup questions

Best regards

Bill Trattler, MD
Miami, FL

FACT:Tiger Woods was a -11 prior to his LASIK surgery, which is in the worst one percent of those with nearsightedness. Tiger was considered to be legally blind without his glasses or contacts. Prior to LASIK surgery, without his glasses or contacts, he would not have even been able to see the ball on the tee.