There may be an obvious answer to this, but I'll ask anyway: If Wavefront LASIK removes more microns per diopter of correction than regular LASIK, and assuming you'd want to preserve as much corneal thickness as possible, for high levels of refractive correction why wouldn't a Wavefront procedure first correct most of the error in the regular fashion and then use custom ablation on only say the last diopter of correction? Thanks.

I think I have a similar question.

The first doctor that I went to for a LASIK evaluation said that he could perform Custom LASIK (one step), but that it was possible there wouldn't be sufficient tissue remaining to do an enhancement afterwards if necessary. Alternately he could do a conventional LASIK treatment, which would require less tissue, but would have an increased probability of needing an enhancement and possibly having night vision issues.

A second doctor said that due to my corneal thickenss and prescription level that he would perform the procedure in two steps. First a conventional LASIK treatment to correct the majority of my prescription. Then about 3 months later he would retreat with Custom LASIK. Since the Custom procedure removes more tissue per diopter than conventional, he explained operating in this manner would result in less tissue loss (since the Custom would only be used for the small diopter correction).

Both doctors would be using VISX CustomVue with Intralase. Experience and reputation for both doctors were very similar (very high). Price was also essentially identical.

My question is: What will be the end difference in two eyes, one that under went a full Custom treatment and the second that had this two stage Custom? It doesn't seem possible to me that the two stage process can end up with the same results as the one stage without removing the same amount of tissue.

From what ive read, ive seen high myopes get wavefront for their enhancement after getting standard lasik for most of their pescription. Of course IOLs are popular and may be the better route for high myopes in some cases, especially if your corneas are too thin. They are also great for clear lens extraction if you are over 50.