dear Drs
i am a 40 year old female physician. my eye sight is never stable; with a deterioration rate of about -.5 every 2 years or so.
currently my Rt eye is -10 and Lt - 9.5 using glasses. with astigmatism of max -1.75.
contact lenses readings: Rt -9 and Lt -8.5. i have a problem with my Lt eye when using the lenses: i.e gritty sensation and inability to focus while reading. dryness is in both eyes most of the time. some opthalmologists said i cannot have 100% correction with the lasik, while only one said he did full corrections in upto -20 myopia. my question: shall i go for it. what is the risk of complications? and can i completely get rid of the glasses and lenses after the operation?

Some of the questions you raise cannot be answered with the information you have provided. There is also one question that no one else can responsibly answer: should you do it. That is your decision and only you can decide if elective surgery is appropriate.

The most refractive surgery can provide is the possibility of the convenience of a reduced need for corrective lenses. To achieve that convenience one must accept some level of risk. What is an acceptable level of risk is dependent upon the individual. In your case, you have several issues that make you at a higher than normal risk of problems.

Your refractive error instability is an indication of the possibility of something much more problematic than simple myopia (nearsightedness). If the instability has been in the last 1-3 years, it may be due to hormonal changes due to the onset of menopause. It is possible that the natural lenses of your eye are changing due to presbyopia. This too would be relative to the last 1-3 years. Presbyopia is when the natural lens of the eye can no longer change focus from distance to near and when most people need bifocals or reading glasses.

Your very high refractive error may be able to be corrected with LASIK, but this will depend upon your individual circumstances. If your pupils are large and your corneas are thin, you may not be able to have LASIK at all. PRK and LASEK would be pretty much out of the question because of the increased risk of corneal haze, although that may be able to be accommodated.

If you are presbyopic, I suggest you research Clear Lens Exchange (CLE). This is essentially cataract surgery where the natural lens of the eye is removed and replaced with a new plastic or silicon lens. The new lens would be of a power to correct your myopia.

A downside of CLE is that your eyes cannot change focus. You will need reading glasses or you may want to try monovision.

I suggest you read http://www.usaeyes.org/faq/subjects/pupil_size.htm and http://www.complicatedeyes.org/dry_eye_treatment.htm.

Glenn Hagele
Council for Refractive Surgery Quality Assurance
http://www.USAeyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

The risk of post-RS complications is highly correlated with the degree of correction needed. After -6D, the possibility of a serious vision-impairing outcome increases substantially. The higher the correction, the more tissue that needs to be removed and the optical zone will be smaller than a lower prescription would in order to conserve as much tissue as possible. It appears you also have some dry eyes issues; RS is known to exacerbate this condition, some are affected lifelong and there is little ameliorative therapy.

As a physician, you should know that you already have a few big strikes against you from the above information. You should also know there is an inverse relationship between prescription and % of pts. that achieve 20/20, 20/30 and 20/40. And these Snellen measures don't even measure visual quality, which undoubtedly will be worse than vision corrected with CLs or specs with your scrip.

Also, with you being a physician, I am more than a little surprised by some of your questions. Your visual fluctuations need to be diagnosed. You are posing questions about a potentially life-changing procedure on a BB inhabited by people you don't know, which coming from a physician seems somewhat naive. Sorry to be harsh, but it just seems out of character for a highly-trained medical professional. You obviously need to do a boatload more primary research.

Sounds like you've got a little presbyopia going. Get yourself some reading glasses, and use the money you would use for RS on a nice vacation, or maybe some CEUs in the Bahamas.

You need your best eyesight for yourself and your patients. In your case, RS has an enhanced potential to ruin your personal life and professional career. It cannot be undone.