Hi, I am a 24-year old female with high myopia (-10 to 11) and a slight astigmatism (my contacts don't correct for it and I don't even notice it). My glasses are really thick and heavy so I wear soft contacts for most of the day, but I am really sick of the constant irritation I experience with them and would love to get LASIK. I went for my first consultation recently and the surgeon was cautiously optimistic about my prognosis.

Here are my data:
Prescription:
-10 with -1.25 astigmatism R eye
-11 with -1.5 astigmatism L eye
Pupil diam.: 7 mm R eye, 6.5 L
Corneal thickness: 622 um R eye, 627 L

Because of my high myopia, it's more likely I'll need an enhancement and I have a higher risk of serious problems like corneal ectasia. However, since my corneas are very thick, the doctor felt I was still a good candidate (he estimated I should have about 320 um of cornea left over after surgery using a 6mm ablation zone). The doctor said my risk of corneal ectasia was something like a 1 in 10,000 chance I'd need to wear RGP lenses or 1 in 100,000 chance I'd need a corneal transplant- these odds are higher than for most people, but still very low. Does anyone know where I could check on such statistics?

Another problem is that my pupils are a bit large, giving me a higher risk of halos, starburst, etc. Should I try to find someone who uses a 7 mm ablation zone (instead of 6), or would that be riskier since it would require more cornea to be removed (I've calculated I'd only have ~250-280 um left, which wouldn't leave room for an enhancement)?

I'm going to at least 2 more consultations, and would like to get the opinions of as many doctors as possible. Would you consider me a good candidate for LASIK, or is it too risky? Also, should I get a 6 or 7 mm ablation zone? Should I get Intralase to minimize the flap thickness? I know Intralase can have a whole suite of its own complications. Also, if any similar patients have undergone LASIK, I'd really like to hear about your experiences.

Also, I'd really appreciate some feedback on doctors in my area- since I'm a riskier patient, I'd really like to find a top surgeon. I live in Suffolk County, Long Island (Pt. Jeff). The surgeon I saw was Dr. Zweibel- I liked him a lot but am concerned because he hasn't done any procedures on such a myopic patient. I have 2 other consultations coming up with Drs. Basilice and Hufnagel, because I wanted to choose among several doctors. I also made an appointment with Dr. Donnenfeld, who's pretty well-respected, but I don't think he'd be the best choice because he's almost 1.5 hours west of me (plus I really didn't like that another dr. in the office would perform the consultation, and I have to wait 2 months for the appointment!). Does anyone have feedback on Drs. Zweibel, Basilice, or Hufnagel, or have any other good doctors to recommend in LI?

Thank you!

I forgot to mention- my prescription has been stable for 7 years, so even though I am young, that's not so much of a factor.

Do any of your surgeons use the Allegretto Wavelight laser? You could have a 6.5 pupil setting and it blends out nicely to a wider pupil zone without taking off too much tissue to avoid glare and halos. If your corneas are actually as thick as you state you should do OK although you still have the risks you mentioned.
Leonard Friedman MD Washington DC............

The statistics you are being told regarding the probability of ectasia are from studies presented by Richard Lindstrom, MD, Dr. Trattler who operates this website, and others. The rate of ectasia in large populations of LASIK patients is reported between 1 in 10,000 and 1 in 20,000.

Decades of study and even the FDA have determined that if a healthy cornea has at least 250 microns of tissue remaining untouched, ectasia is not a risk. More is always better and sometimes people with less do fine, but 250 is the “standard”.

I would be very concerned with the combination of an optical ablation zone that is smaller than your naturally dilated pupils and high myopic correction. This combination has been shown to cause night vision problems such as halos around light sources and starbursting. These night vision problems can be bad enough to keep you from driving at night and require other modifications to your normal activities. You may want to read http://www.usaeyes.org/faq/subjects/lasik_pupil_size.htm and discuss this further with your doctor.

Because a larger ablation zone would require more tissue removal, you may want to utilize a surgeon who will create the LASIK flap with a femtosecond laser (Intralase) rather than a mechanical microkeratome using a metal blade. The Intralase has greater accuracy and would be able to create a thinner – but stable – flap. This will increase the amount of residual tissue that remains untouched.

Regression is pretty much a certainty. There are two ways to deal with expected regression. One is to deliberately overcorrect you into hyperopia (farsighted, longsighted) vision with the expectation that regression will bring you back to plano (no refractive error). The problem is that nobody knows exactly how much anyone will regress. You may end up hyperopic (a real problem if/when you are over age 40) or slightly myopic but not enough to risk enhancement surgery. Another technique would be to initially correct you to plano, let you regress, then do a planned enhancement surgery to resolve all regression. Both techniques are valid and both have their own set of risks. You will want to discuss this plan with your doctor before any surgery.

Under no circumstances would you be considered an “ideal” candidate for LASIK, but you may be an appropriate candidate. Proceed with caution. If you are under age 40, you may consider a phakic intraocular lens (P-IOL) rather than cornea based surgery. If you are over age 40, you may consider Refractive Lens Exchange (RLE) rather than LASIK.

Ultimately, you may find that your best choice is high DK silicone hydrogel contact lenses.

Dr. Thierry Hufnagel is certified by our organization. See http://www.usaeyes.org/surgeons/stahl.htm

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

Thank you both for your quick and helpful responses!
Dr. Friedman- None of the doctors I'm scheduled to see use the Allegretto Wavelight. They all use the VISX Star 4 (and Dr. Hufnagel also has a LadarVision 4000 Flying Spot Laser), but perhaps in Manhattan I'd have more options. Can the VISX be set up to use larger ablation zones? Maybe a 6.5 mm ablation zone and an Intralase flap would work well for me.

Mr. Hagele- Thanks for the refs. on ectasia. I have started looking into the phakic IOLs recently too (yes, I'm under 40) but have some hesitation with those as well. One plus is that P-IOL implantation is reversible, but on the other hand, it still seems pretty new and experimental compared with LASIK. I'll definitely ask my doctors (but am curious to know what others think) about whether LASIK or P-IOLs would be preferable in my case.

One question about night vision- one doctor I talked to suggested that even if I develop night vision problems, they may not be too dehabilitating for me because I'm used to live with them already (I never really noticed I had a problem, but I've recently seen simulations of what glare and starburst are supposed to look like, and realized that's how I've always seen lights at night- apparently it's common for high myopes). I've seen a few studies mentioning that many highly myopic patients who report night vision problems post-op already had them pre-op as well. But I can't help wondering if my pre-existing night vision problems just put me at greater risk for more severe problems post-op. Any info on this? I feel like I'd be fine if I had the same level of problems I do now, but don't know if I'd be happy if they got worse...

The doctors will be able to complete a wavefront diagnostic and determine exactly what higher order aberrations (HOA) you have currently. Over all, all laser assisted refractive surgery increases HOA, however some HOA will increase more than others. HOA increase more with conventional laser ablation than with wavefront-guided ablation.

You may have HOA that is causing the current night vision problems, which you have learned to tolerate throughout your lifetime. If these particular HOA are elevated more, they may put you over the threshold of tolerable problems into intolerable problems. Your doctors will be able to discuss this with you with much more detail when they are looking at your actual aberration diagnosis. You may want to read http://www.usaeyes.org/faq/subjects/wavefront_custom_lasik.htm

Because of the probable increase in HOA with LASIK, a P-IOL may be a better choice, but there are many issues that need to be evaluated and discussed before you can make a decision. P-IOLs should be considered, but only you and your doctor will know if they are appropriate.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

The doctors already have said much of their share. I also was thinking of IOLs which was already mentioned. I do have an important comment on lasik, some doctors wont laser more than -8 to -10 diopters. Your thick corneas are to your advantage and your risks of ectasia are extremely low. Intralase is very popular, my own doctor offers it since about 6 months ago. The advantage of IOLs is much less likley to under/overcorrect you. Youll probably be undercorrected with lasik unless they aim too high and you dont regress enough. If you do decide to stick with glasses, there are new super high index with small frames that should be much thinner than your old glasses. :)

Thanks so much to everyone who has replied. After talking to 3 doctors, reading all your replies, and reading more online, I think I'll probably hold off on having any surgery right now (LASIK or ICL's). I think I will eventually get surgery, but I think ICL's might be the better option for me and I'd like to wait a few more years until the ICL technology is a little more advanced. There's only one ICL approved by the FDA right now, and it just got approval last year. I'm really nervous about the irreversibility of LASIK since I have a much higher risk of night vision problems. Two of the three doctors I saw said I was a candidate for either LASIK or ICL's, but not an ideal one- they strongly suggested holding out for a while. So, I guess I'll have to live with scratchy eyes for a few more years. Fortunately, one doctor told me those high-O2-permeable contacts are now available in my prescription (until last year, they were only available up to -6.00) so I'm going to check on that hopefully I can give those a try.

One more thing- one of the three doctors I saw really didn't seem to think the risks were bad at all, whereas the other two expressed a lot of reservations. I'm not saying either viewpoint was right or wrong, but I'm glad I talked to a few people and got a range of advice. I would strongly suggest to anyone contemplating LASIK or ICL's that you get a few opinions (maybe go to 2-3 consultations- more than that and you might get TOO many opinions). Especially if you're a borderline candidate like me- different doctors may have different opinions so it's a good idea to get lots of information and make a well-informed decision.

I too was a borderline candidate for lasik. I was not as myopic as you are, but my corneas are much thinner. My surgeon laid it all out on the line for me regarding possibility of regression and the possibility that I would not have enough cornea for an enhancement and end up needing glasses or bifocals after all. After much soul searching (and after wearing glasses or contacts for 35 years), I decided to go for it. To make a long story short, it was not a quick fix. After about 14 months, one pair of glasses for driving (so much lighter and thinner than my old ones), and two more surgeries on my right eye, my vision is where I want it to be. My right eye is 20/20 or better and my left is undercorrected at 20/40 to help with reading. Overall my distance vision is very close to 20/20. Things like swiming, camping, and working outside in the rain are great now without the anoying glasses. Everyone has to make up their own mind and decide what level of risk they will accept. I guess I wanted you to hear a success story because much of this board is negative.....

Thanks SU. Yeah, I definitely plan to consider some type of surgery again at a later date- I just think I should wait a couple more years. One surgeon I met with told me that he expected the ICL technology to improve over the next few years, and said that LASIK would probably be performed less and less on people with my prescription as the ICLs become more common. He said that even LASIK might improve a little, because a new type of laser that has a curved (rather than flat) ablation zone is being investigated now, and that this might reduce night vision problems. So, I decided to get new classes for now and try to get a trial pair of those high-O2-permeable contacts.

"One surgeon I met with told me that he expected the ICL technology to improve over the next few years"

Would ICLs be good for moderate myopes too? I read about this and they come from -5 to -20. However they only come at 5mm to 7mm sizes so those with larger than 7mm pupils may be out of luck still :( can anyone comment on this?

"and said that LASIK would probably be performed less and less on people with my prescription as the ICLs become more common."

nonwithstanding very large pupils, I can see ICLs definately an alternative for severe and extreme myopes. I was talking to this lady whos -9 and her surgeon said she has too much myopia to be fully treated so shed still need thin glasses. I guess if she had thick corneas all -9 could be treated. ICLs then would be her option. Best thing about them is theres no regression, its like an internal contact lense. Even if she got lasik she could regress without enough cornea for an enhancement and shes the type of person that "must" have perfect vision. I can see ICLs even being an option for -5 or -6 if they have thin corneas and/or dry eyes or if they just dont like the idea of a laser in ther eyes.

"He said that even LASIK might improve a little, because a new type of laser that has a curved (rather than flat) ablation zone is being investigated now, and that this might reduce night vision problems."

This excites me greatly, especially since I have huge pupils(8-9mm) The one limitation of todays lasers is they change a prolate eye to oblate, makes a curved profile flatter. This causes issues at the edges due to the flatness. I also heard a curved profile may increase your odds of 20/20 and beyond vision. In fact I read in an article that the goals is 20/10 by the year 2010! They say more than 50% of patients will experience 20/10 with a fair amount at 20/8! Theoratical limit 20/5! This might not interest someone whos corrected to 20/15, but for guys like me who see 20/30(+) with glasses it matters alot more.

"So, I decided to get new classes for now and try to get a trial pair of those high-O2-permeable contacts."

sounds good, enjoy :) I also got new glasses and they are thinner, smaller and more comfortable :)

Hi Ace,
From what I've learned, LASIK is preferred for most people because it's much less invasive than an ICL (right now they have to make a 6mm slit in your cornea to put in the ICL, and the ICL carries a small risk of serious probs like retinal detachment, cataracts, etc. that don't occur with LASIK). Obviously, your doctor would need to help you decide what's best for you. The doctor who told me about the new technology that might be coming out is Dr. Thierry Hufnagel at Stahl Eye (NYC and Long Island), so if you're interested in these things you might want to talk to him. I liked him- he seemed very knowlegeable and wasn't trying to "sell" me anything.

Hello, I just wanted to tell you I am getting the ICL in 2 weeks on my left eye. My right eye will be done in January. Both eyes are not done at the same time with this surgery. I will report my progress to you if you are interested?

I am -15 in both eyes. I have been having major problems with contact lenses irritating my corneas over the past year. Doctors in my area have trouble finding a high oxygen lens in my prescription. Add to this the fact that I am so tired of sore, dry, red eyes, messing with all the solutions and cases, and being sooo blind without my lenses or glasses on. I have been wearing contact lenses for 30 years. I am 41 yrs old and healthy. My surgery is scheduled Dec 13th. Let me know if you have any questions or are interested in my progress. By the way, I will also need some laser to correct mild astigmatism and I will get that in February.

let us know how your IOLs went. I can understand the fustration reguarding contact lenses. I cant tolerate contacts either but glasses arent too much of a problem for a -5 myope. For high pescriptions, glasses would be very thick, heavy and minify a good deal. What is your BCVA now with contacts?