Hello Doctors,

I've previously posted here before and received feedback that I was a decent candidate based on my prescription. After 3 co-workers returned with successful results, I decided to make an appointment. After calling the LasikPlus Vision Center in Dayton, OH, I was told that the FDA would not allow LASIK to be performed because my astigmatism is higher than my myopia and the factor is greater than 3.

Right Eye: -.75 -1.75 = -2.5
Left Eye: -2.0 -2.25 = -4.25

No one seemed to indicate this would be a deterrant before. After calling a second time, and asking if the right eye could be done, they said yes. Can anyone elaborate on this? Can I still have this done somewhere or am I better off waiting for VISX S3? Thank you very much

Bryan,
below is a copy of my previous answer to your question from October 1999. The FDA has approved LASIK for patients with myopia and astigmatism, and your prescription is within the range of what is treatable. So LASIK is an option - but you again have to discuss everything over with your surgeon to find out whether you are a good candidate (we can't say whether you are a good or bad candidate - we can just say whether your treatment falls within the FDA guidelines).
As for the "factor of 3" - every doctor or laser center will have different criteria for what they feel comfortable treating. I have treated patients with a uch higher ratio successfully, although the risk of needing an enhancement increases with increasing levels of astigmatism.
Now - before this week - if you mistakenly said your presciption was " -0.75 of myopia + 1.75 of astigmatism - then it could not be treated and they would be right. But the proper conversion of your prescription into plus cylinder notation is: -2.50 of myopia plus 1.75 diopters of astigmatism. The conversion of minus cylinder notation into plus cylinder notation is: take the myopia and add the amount of cylinder (so -0.75 + 1.75 = 2.50) - so -2.50 is the myopia - and then switch the astigmatism sign from minus cylinder to plus cylinder.
I hope this last section wasn't too confusing.

My last comments are: The FDA just approved hyperopic astigmatism (where there is more cylinder than myopia when written in plus cylinder) for both the VISX lasers and the autonomous lasers. This doesn't really apply to you, but it is added information to show that your prescription is weel within the range of FDA approval. So you just need to talk with your surgeons to find out if you are a good candidate. As well - perhaps you might want to go to a well-established LASIK surgeon in your area rather than a corporate laser center (Note - Dr. Friedman who I mentioned previously is no longer in Ohio).

Best of luck

Bill Trattler, MD
Miami, FL

Old Message:

Posted By: William B. Trattler, MD from Miami, FL at 02:00:29 on 10/24/99
Subject: LASIK

Message:
Bryan,
Your initial numbers are in the range of what can be corrected with LASIK. However, there are more important questions that you need to answer prior to having LASIK, and you should discuss these with your LASIK surgeon. These include expectatations, risks and benefits of surgery. You will also need a complete eye exam by your doctor who will determine whether you can have LASIK.
Dr. Neil Friedman is at the Cleveland Clinic in Cleveland and Dr. Gary Varley is in Cincinatti. Both are fantastic surgeons and good choices to discuss LASIK.
Best of luck

Bill Trattler, MD
Miami, FL

Dear Dr. Trattler,

Thank you very much for your reply....not to beat a dead horse, but just so I have this correct...my toric soft lens prescription

-075 -175 x 160 (right)
-200 -225 x 025 (left)

I would add the sphere and cylinder:

-075 (+) -175 = -250 would translate to 2.5 myopia and 1.75 astigmatism...so myopia > astigmatism for right eye

-200 (+) -225 = -425 would translate to 4.25 myopia and 2.25 astigmatism for left eye? I don't mean to be so particular, but the education will reassure me when I go under the knife..er laser.

Thanks again for the time...Bryan.

Bryan - If you are reading the numbers correctly (and it sounds like you are), you are a candidate for LASIK with present approvals on the Visx S2. You do not need the S3. I would be happy to help you further, even locally in Springfield if you would like.

Gary A. Varley, M.D.
Medical Director of the CIncinnati Eye Institute Laser Centers
Offices and Laser Centers in Cincinnati And Dayton
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