I have no idea what laser is better. Every firm hypes its own as the best and docs seem to hype the ones they use as better than the others. Then I read Dr. Trattler's posts saying there are no clinical differences...that it comes down to the quality of the surgeon. That is the most truthful statement, but the equipment is still important.

I am scheduled for an OD enhancement on 3.1.01. I had regressed from +0.25+0.50X6 post procedure to -1.50+0.50X178. I had monovision done, and my left eye regressed from -1.25 to -2.00, but I am leaving it alone for now. I have 6mm pupils and lots of cornea left (in high-400s).

The first surgery was on a Nidek ec5000, as will be the second. The doctor stated he prefers to cut as little cornea as possible in mod-to-high myopes like myself, necessitating a greater number of enhancements but producing better end results (initial procedure and enhancements combined). The doctor spoke about enlarging the Nidek's treatment zone to 7-7.5mm, with a transition zone further out to eliminate my current night vision and ghosting problems.

But the FDA says the Nidek is approved to a 5.5mm treatment zone, so how can this be done? Can and how can the Nidek be "tweaked" to perform effectively outside its approved range? How reliable are the results? What are the risks/benefits involved? He also has a VISX, and I note it has a 6-6.5mm optical zone. Should that one be used instead?

And what are the definitions of "Treatment zone" vs. "Optical zone" vs. "ablation zone?" Should the treatment zone be larger than the optical zone to minimize GASH?

Thank you for you help on this matter.

Frank if you go to www.islandlaser.com and click on night vision there is pretty good information on this topic.

>I have no idea what laser is
>better. Every firm hypes its own
>as the best and docs seem
>to hype the ones they use
>as better than the others. Then
>I read Dr. Trattler's posts saying
>there are no clinical differences...that it
>comes down to the quality of
>the surgeon. That is the most
>truthful statement, but the equipment is
>still important.

>I am scheduled for an OD enhancement
>on 3.1.01. I had regressed from
>+0.25+0.50X6 post procedure to -1.50+0.50X178. I
>had monovision done, and my left
>eye regressed from -1.25 to -2.00,
>but I am leaving it alone
>for now. I have 6mm pupils
>and lots of cornea left (in
>high-400s).

>The first surgery was on a Nidek
>ec5000, as will be the second.
>The doctor stated he prefers to
>cut as little cornea as possible
>in mod-to-high myopes like myself, necessitating
>a greater number of enhancements but
>producing better end results (initial procedure
>and enhancements combined). The doctor spoke
>about enlarging the Nidek's treatment zone
>to 7-7.5mm, with a transition zone
>further out to eliminate my current
>night vision and ghosting problems.

>But the FDA says the Nidek is
>approved to a 5.5mm treatment zone,
>so how can this be done?
>Can and how can the Nidek
>be "tweaked" to perform effectively outside
>its approved range? How reliable are
>the results? What are the risks/benefits
>involved? He also has a
>VISX, and I note it has
>a 6-6.5mm optical zone. Should that
>one be used instead?

>And what are the definitions of "Treatment
>zone" vs. "Optical zone" vs. "ablation
>zone?" Should the treatment zone be
>larger than the optical zone to
>minimize GASH?

>Thank you for you help on this
>matter.
It sounds like you should benefit from a re-operation. You have asked many good questions and your surgeon should be willing to discuss them with you.

The FDA apporved the Nidek laser for the 5.5 mm optical zone with a transition zone, but LASIK surgeons can enlrage the optical zone in an "off-label" way. Off-label means that the laser is being used in a way that has not been FDA approved. This is very common ( for example, we use many medications to treat different conditions that are approved for some other treatment.)
I do have an important question. Are you currently wearing glasses or contants to treat your current refractive error? As you may know, having uncorrected myopia and astigmatism will cause glare and halos - and if this is the cause, then wearing glasses with your current prescription will eliminate these night time symptoms.
Please make sure that you go over "off-label" use with your own doctor

Best of luck

Bill Trattler, MD
Miami, FL

Thank you for your reply. Yes I am wearing glasses to correct the residual scrip, and when I got them in late October, they cleaned up my night time problems (halos, starbursts, ghosting/multiple images) from a "4" to a "2." Lately, however, they seem to have intensified to a "3" which to me seems like additional refractive error due to regression or ?. When I went to see my doc on 2.5.01, the phoropter showed about a .25 diopter increase in myopia in each eye. The doc said that was unnoticeable, and hardly measureable, but I notice it.

How should I go over the off-label use with my doc? What should I be asking? Does his plan I described in my original post seem logical? It does to me, but I am not a doctor. Thank you!