I went to have LASIK consultation recently, here is the result, need your opinion please.

left eye: -7.50, 8mm purpil, 519 cornea
right eye: -7.00, 8mm, 531

Doctor requires me to do IntraLasik+wavefront (CustomVue), and it will be a two-step procedure (6-8 months apart).
Cost: around $5000 both eyes

Thank you.

There are a lot of questions that you will want the doctor to answer. First of all, why does the doctor expect that you will require a two-step process and what, exactly, will be the two steps?

It may be that the doctor expects your corneas to regress and is preparing you for probable enhancement surgery at a later date. It may be that the doctor does not believe his technique/technology has the ability to correct you with one surgery. Discuss this at length.

Your pupil size is a very real potential problem and this may be one of the reasons the doctor is planning a two-step process. The Visx S4 CustomVue laser in wavefront-guided mode is only able to provide a full correction 6.5mm wide. That means that from 6.5mm to the 8.0mm of your pupil size, your corneas would be undercorrected. This can contribute to night vision problems including halos and starbursting from light sources. See http://www.usaeyes.org/faq/subjects/lasik_pupil_size.htm for details about pupil size issues.

To get around this limitation, the doctor may be planning to do an initial surgery in conventional ablation mode because it can accommodate a larger treatment zone, then do a second wavefront-guided procedure to "fine tune" the correction and attempt to reduce aberrations caused during the first surgery. Again, you need to discuss your doctor’s surgery plan at length.

You have the combination of high myopia (nearsighted, shortsighted) vision and large pupils. You would not be an "ideal" candidate for refractive surgery, however if planned carefully it may be possible that you can have the results you desire. You need to have a serious discussion with your doctor about what to expect. If the doctor says you may have halos at night, my recommendation would be to run, do not walk, to the nearest exit.

I know some doctors would disagree with my run away response, but the most you can expect from refractive surgery is the convenience of a reduced need for corrective lenses. To achieve that convenience, all patients must accept some risk. It may be that when all details are considered, your risk is greater than your comfort level.

For details on the Intralase femtosecond laser microkeratome flap, visit http://www.usaeyes.org/faq/subjects/intralase_intralasik.htm

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

The part about a "two-step procedure" also has me wondering what your doctor means. Glenn's complicated explanation makes sense, except that the ablation zone for the VISX Star S4 laser, in either conventional or wavefront mode, max's out at a 6.5 mm optical zone plus a transition zone of ~1.5 mm, for a total ablation zone of ~8.0 mm, of which about 6.5 mm is optically effective. In addition, the S4 in wavefront mode already does most of the ablation in conventional mode, and just polishes off the last of the ablation (and the higher-order aberrations) in wavefront mode. So, I don't think Glenn's scenario holds water. Now, "IntraLasik + wavefront (CustomVue)" is, of course, a two-step process, in that (1) the flap is created with the IntraLase laser, then (2) the ablation is done in CustomVue mode on the S4 laser. However, these events are generally contiguous, and the whole thing takes about 10 minutes per eye. It is true that to really minimize higher-order aberrations a few docs create the flap, then let the eye settle down for about a month, then they lift the flap and do the ablation. But even in this (rare) scenario the wait is about 30 days, never 6 to 8 months. So, it's a mystery. Perhaps, all your doc means is that you have to be out of your (GP) contact lenses for 6 to 8 months before he can perform LASIK on you. That, of course, would make sense. But other than that, I have no idea what he means. Ask him to clarify this point. As to glare, I agree with Glenn. You have a fairly high script, and with 8 mm scotopic pupils and a 6.5 mm central ablation zone, even with a wavefront ablation and the Stiles-Crawford effect helping somewhat, you can expect some very noticeable post-op GASH. Unfortunately, there is really no good way to simulate the effects of GASH before surgery, and some docs make is sound like it's just a little bit of "glare." Believe me, it can be a whole lot worse than that. Read some of the posts under "Night-time problems with LASIK" to get some idea of how problematic it can be. GASH is a very subjective thing, and even with your obvious warning flags (high script, huge pupils) it is impossible to predict how much GASH you would end up with. You might end up with acceptable nighttime vision; you very well might not. Are ya feelin' lucky?

Bryce Carlson

Shouldn't this doctor just say: "NO!"
For those who are candidates:
Why would anyone NOT use a most advanced custom wavefront; Why risk inferior eye correction?
According to September 2005 Sky & Telescope magazine, a vertical cut is "superior" to a horizontal cut? Why don't doctors talk more about these risks? A doctor pointed out to me the article stated "may" cause problems, as if that "may" word was some ground to discredit the entire claim? What is the truth? What do studies show? That doctor claims allegretto is the most advanced and best, is that true? He also said a single one time eye drop test will show dryness damage and a history of dryness damage? Is that true?
Again, why would anyone risk these older procedures that do not map and test every known factor? It just shows me how weak the judicial system is to be such a mild threat to opportunists: who appear to me to be getting "their"/its claws into victims for a lifetime of problems and alleged (leading to more alleged cures) cures and expenses, deliberately and negligently.

>The part about a "two-step procedure" also
>has me wondering what your doctor
>means. Glenn's complicated explanation makes
>sense, except that the ablation zone
>for the VISX Star S4 laser,
>in either conventional or wavefront mode,
>max's out at a 6.5 mm
>optical zone plus a transition zone
>of ~1.5 mm, for a total
>ablation zone of ~8.0 mm, of
>which about 6.5 mm is optically
>effective. In addition, the S4
>in wavefront mode already does most
>of the ablation in conventional mode,
>and just polishes off the last
>of the ablation (and the higher-order
>aberrations) in wavefront mode. So,
>I don't think Glenn's scenario holds
>water. Now, "IntraLasik + wavefront (CustomVue)"
>is, of course, a two-step process,
>in that (1) the flap is
>created with the IntraLase laser, then
>(2) the ablation is done in
>CustomVue mode on the S4 laser.
> However, these events are generally
>contiguous, and the whole thing takes
>about 10 minutes per eye. It
>is true that to really minimize
>higher-order aberrations a few docs create
>the flap, then let the eye
>settle down for about a month,
>then they lift the flap and
>do the ablation. But even
>in this (rare) scenario the wait
>is about 30 days, never 6
>to 8 months. So, it's
>a mystery. Perhaps, all your
>doc means is that you have
>to be out of your (GP)
>contact lenses for 6 to 8
>months before he can perform LASIK
>on you. That, of course,
>would make sense. But other
>than that, I have no idea
>what he means. Ask him
>to clarify this point. As
>to glare, I agree with Glenn.
> You have a fairly high
>script, and with 8 mm scotopic
>pupils and a 6.5 mm central
>ablation zone, even with a wavefront
>ablation and the Stiles-Crawford effect helping
>somewhat, you can expect some very
>noticeable post-op GASH. Unfortunately, there
>is really no good way to
>simulate the effects of GASH before
>surgery, and some docs make is
>sound like it's just a little
>bit of "glare." Believe me,
>it can be a whole lot
>worse than that. Read some
>of the posts under "Night-time problems
>with LASIK" to get some idea
>of how problematic it can be.
> GASH is a very subjective
>thing, and even with your obvious
>warning flags (high script, huge pupils)
>it is impossible to predict how
>much GASH you would end up
>with. You might end up
>with acceptable nighttime vision; you very
>well might not. Are ya
>feelin' lucky?

>Bryce Carlson

Thank you guys for your inputs. Sorry I didn't make myself clear in my original message, the reason for 2-step is currently FDA only allows Wavefront to correct up to -650 myopia, with my prescription of -700 and -750, they have to perform a 2-step procedure (650+100)

My biggest concerns are 1.will I have enough conear left after the procedure? 2. high risk for night version problems? I have asked the doctor about these questions, he said every patient was different, it's hard to tell...