I am very near-sighted, with significant astigmatism in my left eye.

My Optima Toric contact lens prep is

Left
bc 8.6 sph -7.25 cyl -1.25 ax 155

Right
bc 8.6 sph -7.25 cyl -1.25 ax 015

I am not doing well with these toric lens. I have very poor close vision with them and they are uncomfortable. My eyes get dry often. I do still have quite good distant vision with these Toric. I see 20/20 with them.

I have been wearing regular glasses to correct my astigmatism and basic (non-toric) soft contacts for 20 years successfully. In general, before I went to Toric, I had good close and distant vision, with good day and night vision. I saw 20/20 after correction.

I'm East Asian so do I necessarily have small pupils? Do East Asians have less risk with lasik?

What is Wavefront? Am I a good candidate for Wavefront?

Should I wait for more reliable technology?

I'm 48 and since 2003, need to wear +1.25 for reading.

I could get lasik.

Or I could go back to wearing glasses over regular soft contact lens. For reading I would need to correct my astignatism and likely +1.25 with regular glasses. I likely will see 20/20 also.

Try monovision now, if you like it, this can be an option for lasik. Wavefront lasik is FDA approved to -6 diopters glasses. Whats your glasses pescription? Perhaps -9 or very near that(due to vertex distance) However the big question is: How much do you want to reduce your dependancy on glasses? Do you like wearing contacts? What are your expectations? Not everyone ends with 20/20, especially severe myopes, they often regress.

I think your first course of action should be to go back to your current doctor and be refitted for contacts. It would appear that either you are now overcorrected and are slightly hyperopic (farsighted, longsighted), or that your previous contacts undercorrected you and made you slightly myopic (nearsighted, shortsighted), which would help with near vision.

Ace mentioned monovision and that may be an appropriate option for you. We have a detailed article at http://www.usaeyes.org/faq/subjects/monovision.htm

To learn about wavefront and why you may need it, visit http://www.usaeyes.org/faq/subjects/wavefront_custom_lasik.htm

At age 48 your ability to focus on objects near is probably severely compromised. Rather than a cornea-based surgery like LASIK, you may be better served with Refractive Lens Exchange (RLE, http://www.usaeyes.org/faq/subjects/rle.htm). RLE has its own set of limitations, so investigate this technique closely.

East Asians do not seem to have any unique problems with refractive surgery. The only limitation may be due to a slightly smaller “orbit” – the eye socket. It may be necessary for the doctor to use a slightly smaller microkeratome to accommodate a smaller orbit or if you have deep-set eyes. This should not present a problem for most patients.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

My regular glasses prep is quite similar to my toric contact lens prep

Also about -7.00 , not -9.00.

>My regular glasses prep is quite similar
>to my toric contact lens prep
>

>Also about -7.00 , not -9.00.

I woulda thought thered be a big difference due to vertex distance, maybe toric contacts have been adjusted based on glasses? I do know my regular -4 contacts correct me as much as my -5 glasses. My mom wears -5.5 (non toric)contact and -7.5 for monovision and her glasses pescription is about -8 and -9 one eyes undercorrected for near, the other slightly overcorrected for far

However the big question is: How much do you want to reduce your dependancy on glasses? Do you like wearing contacts? What are your expectations? Not everyone ends with 20/20, especially severe myopes, they often regress.

The above is one to ask yourself. If you will be disapointed with less than 20/20 dont bother, stick with contacts and glasses.

"Something very important to understand is that not all aberrations are reduced with custom wavefront or wavefront optimized LASIK, PRK, LASEK, or Epi-LASIK. In fact, in all refractive surgery procedures, wavefront or conventional, HOA tends to increase. This is one of the reasons that the FDA has approved the use of wavefront-guided ablations, but has not specifically approved any laser to actually treat and reduce HOA. Our organization distributed a special Advisory Memorandum regarding this issue. See FDA HOA Advisory."

"It has been shown, however, that CustomVue, CustomCornea, and Zyoptix increase HOA less than conventional ablations. This is also true of Wave Light. HOA may increase no matter what you choose, but it will probably increase less with wavefront. Because HOA is likely to increase, if your natural HOA are already elevated, refractive surgery may elevate them farther and cause poor vision. In this situation, it may be that no corneal-based refractive surgery is appropriate."

I am going to have a free wavefront exam tomorow. just to see what they say. But it seems that I would try monovision with regular non-toric soft contacts, and wear regular glasses to correct my astigmatism.

I think I'd holdout for a few more years and see if technology gets better still.

You are getting a free evaluation, let us know how it went and give whatever info you get so the doctors here can further comment. Include your corneal thickness, pupil size, topography and refraction. Have you read my previous threads? Im puzzled about your contact vs. glasses pescription, they dont add up due to vertex distance.

As for wavefront, it greatly reduces HOA's. You are correct in that it also creats new HOA's but I think of it as going 10 steps forward and one step back. I have seen most people improve line(s) of BCVA from wavefront and most report their night vision improved.

I am in agreement with you that im also waiting for lasik technology to improve. I dont even know if youll be a candidate for wavefront with your pescription

I'm right handed, and I prefer to kick with my right leg.

Does it also mean that my right eye is the dominant one?

The link on RLE, the last one, doesn't work.

Thank you very much.

Hand dominance does not necessarily indicate eye dominance. To learn how to test eye dominance, visit http://www.usaeyes.org/faq/subjects/dominant.htm

The bulletin board software included the parentheses and period in the link. Try http://www.usaeyes.org/faq/subjects/rle.htm

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

The doctor told me today that my right eye is dominant.

Thanx

I just came back from an exam. The doctor is Charles Manger III of Saddleback eye Center in Laguna Hills CA; I actually got to speak with him for about 5 minutes.

To my disappointment, it did not appear to be a CustomVue exam.

However, I did find out some important facts.

My pupils are 4mm when constricted and 6.5mm when dilated.

My cornea is "535" and "540". He said they are thick enough for me.

Topograghy is described as "no problem".

He did test my vision and it is still 20/20 after correction.

He said that monovision would likely not work well for me because my myopea is too strong. May be, as I read his printed reasons, it is also because my work is mostly indoor at the computer screen.

He claims a success rate of over 99%, defined as 20/15, 20/20 or 20/25 after surgery.

He said that pupil size is not a problem, not anymore and he gave this website:

http://www.osnsupersite.com/default.asp?ID=2011

He claims to be in the top one percent of lasik surgeons.

It would be All-Laser without blade to cut the cornea. He wants $3,900 for both eyes.

Any comment?

PS

He said that he always put the patient on CustomVue before surgery, and most of the time he follows CustomVue. However, he sometimes elects to deviate fron CustomVue and uses his experience instead, especially if CustomVue deviates too much from traditional test results.

did you get a manual refraction? what did it come out to(pescription) and how much of the 20/20 line were you able to read without guessing or missing? Thats a very good BCVA if it was with the phororaptor and minus lenses because were talking -8 to -9 diopters which makes the 20/20 line considerabily smaller.

are you a candidate for true wavefront lasik? What about epi-lasek to save cornea and not need a flap? What did he say reguarding enhancements?

If monovision isnt for you and you use the computer alot, you may want to ask him to undercorrect you by -1 in each eye to ward off reading glasses and also greatly reduce the chance of overcorrection. Instead if you get "overcorrected" you might be plano instead of -1

My glasses are about two years old.

He said that they are still quite correct for me. Is this what you mean by manual refraction?

I did have to guess a little on the 20/20 line. May be I am between 20/20 and 20/25 after correction with glasses.

When I had my torics on, on the following up visit two years ago, the OD said I was 20/20.

It is unfortunate that I can't wear these Torics for more than six hours or so. Close vision becomes very poor after four hours of wearing the Torics, and after six hours my eyes would be irritated. May be I should check to see if another brand of toric would work better for me. I have tried two brands.

I still don't know if I should have Lasik done soon. May be I worry too much, but there are still a few big quesions.

Would the cornea after lasix still allow the eye to produce enough lubricant?

Are my cornea really thick enough for my degree of myopia? 535 and 540 are average, I was told.

My dilated pupil of 6.5 is a bit larger than average, but not really large.

I will be going to another exam on Monday, at least to double-check on the critical measurements.

May be I would try monovision with regular extended wear soft contact first, and wear thin glasses to correct my astigmatism, as I had for 15 years.

Thanks at lot

>My glasses are about two years old.
>

>He said that they are still quite
>correct for me. Is this what
>you mean by manual refraction?

manual refraction is determining your pescription with a phororaptor and using lenses "is one or is two better" Your current pescription may not neccessairly be the same as your 2 year old glasses pescription. It is important for you and your opthomalogist to know exactly how much refractive error to laser away.

>I did have to guess a little
>on the 20/20 line. May be
>I am between 20/20 and 20/25
>after correction with glasses.

makes sense. Glasses minify the 20/20 line, but besides that theres other reasons such as high order aberrations. I have been tested as between 20/25 and 20/30 with a -5.5(left) and -5(right) lense but I have more high order aberrations than some people.

>When I had my torics on, on
>the following up visit two years
>ago, the OD said I was
>20/20.

contacts give better BCVA than glasses, especially with high pescriptions because they dont minify.

>It is unfortunate that I can't wear
>these Torics for more than six
>hours or so. Close vision becomes
>very poor after four hours of
>wearing the Torics, and after six
>hours my eyes would be irritated.
>May be I should check to
>see if another brand of toric
>would work better for me. I
>have tried two brands.

reading glasses should help with close vision as it does for me on the rare occasional im wearing contacts. I stick to glasses because I can just take them off to see clearly from near.

>I still don't know if I should
>have Lasik done soon. May be
>I worry too much, but there
>are still a few big quesions.

Dont rush yourself into anything. Ask all the questions you want to us and doctors. I also have looked into lasik and knew about lasik for about a decade. I knew about RK before that as well.

>Would the cornea after lasix still allow
>the eye to produce enough lubricant?

dry eye is a concern and if you are experiencing dry eyes now, you may want surface ablation, IOLs or nothing. If your overly concerned about dry eyes, you may want epi-lasek which doesnt make a flap so therefore reduces incidence of dry eyes. I for one if I get lasik, itll be epi-lasek(or perhaps PRK, no flap for me!)

>Are my cornea really thick enough for
>my degree of myopia? 535 and
>540 are average, I was told.

based on your -7.25 contacts, your manifast refraction should be -9 or near that due to vertex distance. My manifest refraction is/was -5.5 and -5 but I see fine with -4 contacts, however my old -4 glasses are slightly blurry. This is also evidenced in my friends, their glasses pescription is always higher than their contact pescription!

>My dilated pupil of 6.5 is a
>bit larger than average, but not
>really large.

That shouldnt be a problem as long as you get an ablation zone of 6.5 or larger. My pupils however are 8 to 9mm so this poses a serious challenge and one reason im not rushing into lasik.

>I will be going to another exam
>on Monday, at least to double-check
>on the critical measurements.

thats a great idea. Be sure to also get a manifast refraction using the phororaptor. Theres cycoplegic refraction but thats usually for hyperopes that accomodate part of their pescription.

>May be I would try monovision with
>regular extended wear soft contact first,
>and wear thin glasses to correct
>my astigmatism, as I had for
>15 years.

Thatll work as an alternative to toric contacts. Remember that lasik can also correct your astigmastim.

As for undercorrection, theres no reason why one or both eyes can be undercorrected if you prefer near vision and hate the idea of reading glasses. Youd only need a thin pair of glasses for driving.

I read that if a surgeon follows CustomVue, he can't undercorrect. This option is not offered.

I read that if a surgeon follows CustomVue, he can't undercorrect. This option is not offered.

It is possible for most lasers to be "turned down" by a small percentage. The variable is not great.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.