My wife and I are trying to decide where to go for her eye surgery. We have two doctors to choose from and here are the main things that are different. Both doctors are very competent, nice, successful etc but they have different technologies and therefore different prices...

Doc #1
VISX Star S3
Microkeratome for the flap
$3000

Doc#2
VISX Star S4
IntraLase for the flap
$4000

The dilemma is that my wife's eyes are REALLY bad. I am not a doc so my terminology is going to be all wrong but I think you will understand. She is -12.?? in both eyes with a +4.?? astigmatism. Her corneas are 560 microns thick. Doc #1 told us that the microkeratome will cut approx 100-130 µm for the flap, then the laser takes approx 14 µm per unit of negative badness (technical term) meaning that the laser will take approx 170 µm (14*12). That leaves a total of 260 µm left, worst case. He said that you have to leave at least 250 µm to be able to do it which she can take but with only 10 µm to spare. This doesn't leave much room for error or possible future enhancements.

My thought was with IntraLase that they could take a thinner flap and have it be extremely accurate reducing the risk of not having much cornea left after it is all done. Also Doc #2 has the latest in the VISX lasers and I always like the latest and greatest if I can get it, but does it matter? I want to make sure that she is getting the best results but don't want to spend an extra $1000 if I don't have to.

I am having trouble deciding if the extra grand is needed because I don't know enough about all of the technologies. The money isn't really an issue but I also am not in the habit of just throwing away $1000 if it isn't justified. Can you all throw around some opinions of what you think I should do? or other questions I should ask? or any other wisdom you might want to share?

To be honest...I do believe in the technology...both of the VISX S4 and Intralase (over a metal microkeratome). But...the prescription is extremely high. Your wife may benefit from a phakic intraocular lens followed by a treatment for her residual refractive error.

The 250 rule, but the way is theoretical. I personally recommend staying closer to 275 or even 300 microns...so a thinner flap is helpful if you are going with LASIK.

Also, intralase avoids certain flap complications.

I hope this helps. These are just my personal opinions on these topics. I should add that in my practice, I prefer Epi-LASIK with MMC prophylaxis for patients with high prescriptions - as this avoids thinning the cornea and works very nicely. But my top level of treatment is about -11 or so...so it would depend if your wife's prescription was written in plus or minus cylinder. Do you have a copy of her prescription that you could type into the computer?

Thank you

Bill Trattler,MD
Miami, FL

I found the copy of her prescription and I will just type it in exactly as it looks on the paper because I don't know what any of it means.

Her contacts are Sunsoft Multiples and the prescription for them says:

...........R...........L
------------------------
BC.....89........89
SP....-750....-800
CY....-175....-175
AX.....010.....175

Here glasses prescription is about a year old but it says:

Rx........Sph.........Cyl.........Axis
OD......-10.00.....-2.50.......10
OS......-10.00.....-2.25.......170

I am 100% positive that the LASIK consultation told us that she was -12.?? in both eyes so I am not sure why the numbers are not matching but I am sure there is a reason.

Thanks for all your help. Upon further research and a Q&A session with the doc I think I am definitely leaning toward the IntraLase over the blade. They did tell me that they were still leaning toward a 110 µm flap with the IntaLase but were confident that she would be okay for any touch ups, and they expected to have one 3-6 months down the road.

The worry I have with the blade (Microkaratome or epi-LASIK) is since her eye is sooo "egg-shaped" any kind of mechanical device will not be able to accurately adjust to that and won't cut the flap perfectly. A computer can adjust and therefore make a perfect flap. Please don't get me wrong, I am not disagreeing with what you said, just trying to talk though my logic when I think about it.

I have also read that some people don't recommend this at all for someone with such a high prescription because she could have regression later and possibly halos at night. In our opinion that is fine. Right now if she loses a contact or breaks her glasses, she is basically immobile, which is not safe, and she also sees halos now. Even if this procedure cut her prescription in half she would be ecstatic and we would consider it a success. My expectation is that since she is only 24 now she will have to have contacts or glasses later in life but her life will still be significantly changed by this even then, and in a good way.

Could her eyes have gotten worse in the last year? I would get refracted at a few places to be safe. -10 with astigmastim thrown in and were talking like 20/1600 uncorrected! This is more than three times worse than my -5. Trattlers opinions have valad points, especially reguarding IOLs Those may be less risky for your pescription and egg shaped eye/cornea. You might still need a thin pair of glasses but this is far better than your thick ones. Your uncorrected vision should/could improve like 20 times or more! Even I am unhappy with my 20/400 to 20/500 uncorrected vision. I am seriously considering intacs myself. Good luck with whatever you decide