I am sure that this has been discussed before, but I new to the sight. I have visited to reputable surgeons in my area. Both have told me that I am not a candidate for Lasik due to my corneal thickness. The more experienced surgeon (5+ years)is recommending PRK. The surgeon with less experience (2 years) is recommending Lasek with Custom Wave mapping. The difference in price is about $500 with the Lasek procedure the more expensive one. The surgeon recommending PRK owns his equipment and the one recommending Lasek rents his. My prescription measures -7.0 in each eye with no astigmatism. I have been told that I have pupils on the large side (7?). I am very confused, and I want to do what's best for my eyes. I can afford the extra $500, but I do not want to pay for something that is unnecessary. Please help.

My recommendation is not to select the surgeon based on PRK vs. LASEK. These two procedures are so similar as to be almost the same and your long-term outcome will undoubtedly be the same with either. Even the length of time each doctor has been performing refractive surgery (2 yrs v. 5+ yrs) is not nearly as important as the number of procedures exactly like yours the doctor has performed…and the outcome of those procedures. The 5 year doc may have only performed a handful of PRK/LASEK whereas the 2 year doc may have significantly more practical experience. You may want to use our 50 Tough Questions For Your Doctor at http://www.usaeyes.org/faq/tough_questions.htm

A wavefront-guided ablation can be performed with LASIK, IntraLASIK, PRK, LASEK, and Epi-LASIK. Many studies have shown that a wavefront-guided or wavefront optimized ablation will provide a better result than a conventional ablation. You may want to visit http://www.usaeyes.org/faq/subjects/wavefront_custom_lasik.htm

The issue of the size of your naturally dilated pupil is important and is probably why LASIK and IntraLASIK are not viable. For the lowest probability of night vision problems after surgery, the optical ablation zone needs to be equal to or larger than the naturally dilated pupil in a low light environment. The larger the ablation zone, the greater the amount of tissue that must be removed to effect the same change. Large pupils means more tissue removal and your doctors have apparently determined that there would not be enough untouched tissue with LASIK to keep your corneas stable. You may want to read http://www.usaeyes.org/faq/subjects/lasik_pupil_size.htm

A concern with your high refractive error and a surface ablation technique like PRK or LASEK is an elevated probability of developing corneal haze. This can be mitigated by you taking 500mg of vitamin C twice a day for two weeks before surgery and for at least three weeks after surgery, plus the use by the doctor of Mitomycin C during the surgery. Mitomycin C is strong medicine, but a 7.00 diopter myope (nearsighted, shortsighted) with a large ablation zone would probably need it.

Being doubtful about elective surgery shows that you understand the potential downsides. If after researching these issues and discussing your concerns with your doctors you still have serious doubt; just don’t do it. You can always come back to later and revisit the issue.

Glenn Hagele
CRSQA
http://www.USAEyes.org

I am not a doctor.