Hi-
I'm looking in to LASIK and have a very complicated prescription which consists of being far sighted with astigmatism. I've been to two lasik docs in the DC area. Dr. Boutrous of the Eye Center and also Milennium Laser (a TLC afilliate).

1) Does anyone have any info on either of these doctors?

2) I am a commercial aviation and rely on glasses 100% of the time. I must correct to 20/20. I know that I may correct to 20/30 or less w/ lasik but I would have to have glasses or contacts to make me see 20/20 for flight physicals.

Is there anychance after the surgery that i would not be able to see 20/20 even with glasses / contacts?

3) I hear mixed astigmatism correction is new (far sighted w/ astigmatism) Are there any numbers associated with success? What common issues are out there assoicated with my type of problem.

Thanks to anyone who can assist. Blue Skies-
Andrew

you have a difficult pescription plus you must get 20/20 as well. Your carreer depends on that. I would hold off the lasik for the present.

Thanks for the reply... Can you give me some reasons why to hold off? Both places (The Eye Center and TLC/Milennium) have said that I should have no problem seeing 20/20 with glasses.

How does one narrow down the choices between doctors? Supposedly these two are the best in my area.... (Boutrous and Whitten)

If you lose a line of vision, youll lose your career. If you dont end 20/20 youll be back in glasses anyway. I cant stop you from lasik, but for you, theres alot riding on getting 20/20 and no one can guarantee that. Wont it be a better idea to wait till you retire? By then, there will be newer technologies out and much less to risk.

Everyone assumes some small risk of compromised vision when s/he undergoes refractive surgery, Andrew. In your case, this risk is greatly increased because (1) you have a relatively difficult Rx to treat, and (2) your career is riding on a good outcome. You don't give your exact Rx, but any mixed hyperopic astigmatism is somewhat challenging to treat. You may get a good result; you may not. Certainly, your odds of a good result (UCVA 20/20, w/low induced HOA's) are significantly less than with a regular spherical myopic Rx. With your Rx, (1) the chances are very high that you would be correctable to a good quality 20/20 with RGP contact lenses after LASIK (though you might not be able to comfortably wear them for extended periods). (2) The chances are lower but still good that you would be correctable to a good quality 20/20 with spectacles or soft contact lenses after LASIK. And (3) the chances are about 50/50 or so that you would have a good quality UCVA of 20/20 after LASIK. So, if you feel you can pass the necessary flight tests, and perform your flight duties well wearing RGP contact lenses that might be uncomfortable, then IMO you can consider LASIK. Otherwise, I would think long and hard about the risks. You have a lot riding on the outcome.

Bryce Carlson

All-
Thanks for the replies. So from what you guys are telling me it's a risk to go with LASIK at this current time based on my prescription. Understand.

So then why are two different LASIK firms telling me that my surgery should not be an issue... 20/25 and even 20/40 is fine by me. I've worn glasses since the 3rd grade and am turning 30 this week. As long as I can see 20/20 with glasses and both docs have said no problem!

Whats going on here!

Again- Thanks for your imput.
Andrew

Andrew,
It would be helpful if you could give us your exact Rx. Commenting on anything else is not productive.
Leonard Friedman MD Washington DC

Sorry all- I thought I had posted this already...

OD: +2.75 -2.75 178
OS: +2.75 -3.75 170

Does this shed any light on anything?
Andrew

Thanks for posting your Rx's. You are almost all cylinder. That is, you are plano or close to it along the horizontal meridians, and quite hyperopic (in the +3 D to +4 D range) along the vertical meridians. You have hyperopic with-the-rule astigmatism in your OD eye, and mixed hyperopic with-the-rule astigmatism in your OS eye (due to -1 D of myopia along the horizontal meridian). Your Rx's are within the FDA approved range for several of the popular lasers. So, although you do have somewhat challenging scripts, there is no doubt you can be treated. I stand, however, by my previous assessment of your odds for a satisfactory outcome. One thing you need to understand is that visual acuity (20/X) is one thing, visual quality is quite another. The odds are very high that (perhaps with thin glasses) you will end up with 20/20 visual acuity. But what about visual quality? With your Rx's you are at elevated risk for post-op issues such as glare, monocular diplopia, ghosting and diminished contrast sensitivity. Glasses and soft contact lenses do little to correct these problems. The only reliable correction is often RGP contact lenses, which may, or may not, be comfortable to wear on your post-op eyes. So, given your occupation, if I were you, I would investigate very closely these issues of post-op visual quality, rather than focusing exclusively on post-op visual acuity.

Bryce Carlson

They hope you still end up a correctable 20/20 after lasik. You might still be but with RGP contacts. The fact youll be happy with 20/40 is a relistic expectation, but your career demands 20/20 so if you dont get that, youll STILL wear glasses or RGP contacts. How long can you wait? There may be better and new procedures in the future with less risk. In the meantime, dont you think its more important to enjoy your career than see better without glasses?

Ace has given you the ultimate conservative safe answer. There is risk with every procedure we do.
Tiger Woods took the risk and got by and is happy. That does not mean you will be assured of success. (his Rx was not mixed astigmatism but was a higher risk due to high myopia.) Your Rx is not way out of the ordinary so you should do well but no one can promise you that you won't have a problem. Sorry I can't be more reassuring.
Leonard Friedman MD Washington DC