What kinds of laser eye surgery are there? Part 1
There are three main treatment choices for anyone thinking of having laser eye surgery. But which one will be right for you?
The final choice will be determined between you and your laser eye surgeon. BUT, of course, you have the eyes and your surgeon has the expertise so you will be heavily influenced by what the doctor or another clinic staff member says. It will be better to be prepared. With just a little knowledge you can be actively involved in making the right choice.
I will outline the 3 main options to help you have an informed discussion when the time comes to select which approach is best for your individual eyes. After all, you only have one pair so you want to get it right.
You will be overwhelmed at first by all the terminology, treatments and brand names. Don’t worry. There is no need to be blinded by science or some of the frankly misleading marketing information that is out there.
Firstly, whichever of the 3 treatment types (more on these coming in a couple of days in part 2) you go for, you must go for the wavefront option. The wavefront (or custom) technology has made a huge improvement in vision success rates with many more people getting 20/20 sight or even better.
Different clinics use different names for this technology: custom, wavefront, wavefront guided, wavefront optimised, CustomVue.
Many clinics will charge you more for wavefront based treatments over older non-wavefront options. Is it worth it? Definitely.
Back in 2000 when we were doing LASIK without wavefront, the benchmarks for success were getting 65% of patients to 20/20. In 2008 we expect more than 95% of patients to see 20/20 or better. This improvement has come from better technology, in large part from custom or wavefront based corrections.
Also wavefront laser eye treatment will give better vision at night or in low light situations. Patients will notice less halos and glare from light sources such as car headlights. It is like buying a more expensive camera with a much, much better lens.
This is the year 2008, so get the best current technology for your sight correction - you only will have this done once and you will live with the results for the rest of your life. Think about the computer you had back in 2000 and what is now available in 2008 - that is the level of difference in laser technology too. No brainer, really.
If you can’t afford the price, either don’t have it done yet and save up until you can afford it, or think about financing.
So if you go to Optical Express, go for the more expensive CustomVue wavefront version. Without it, the results really are not at a level that is satisfactory in 2008. If you go to Optimax or Ultralase, pay and get their wavefront guided option.
If you go to FOCUS Laser Vision, wavefront is already included in the quoted price. They don’t do any non-wavefront treatments.
Come back in a couple of days to read part 2 where we will finish this post by looking at safety and healing in laser eye surgery.
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Comment by lin crone on 4 July 2008:
there is no mention of astigma’s - is treatment still possible for those and long sight?
Comment by Dave Allamby on 6 July 2008:
hi Lin
Yes we can treat both long sight up to +6.00 dioptres and astigmatism up to 6 dioptres.
The choice of laser is very important when considering laser eye surgery for long sight, as some lasers are better than others in this area. We chose the WaveLight laser partly for its superb handling of these kinds of prescriptions.
Best regards
Dave
Comment by Mrs S.Daniel on 12 August 2008:
After having customVue wavefront Lasik at Optical Express my daughter was left with a minus 1.25 perscription in both eyes down from minus 5.75, they now wish to correct this with Lasek which we are not happy about at all and will not proceed with. Is there a complaints proceedure or a governing body. Any advice would be gratefully accepted.
Comment by Dave Allamby on 12 August 2008:
Hi Mrs Daniel, thanks for the message. I can offer my personal perspective here but of course will be generalizations as I don’t know any details!
I understand from your mail that the result is still under-corrected in both eyes. This certainly does sometimes happen for every clinic and every surgeon. Most patients are at or very close to target, but a small number are either under or over-corrected by the laser treatment and would so require an enhancement to reach the target vision. This seems to be where your daughter is right now.
Most clinics quote around up to 5% chance of enhancement but the reality for most centres is usually a bit less than that with modern lasers. At my clinic we find only about 1-2% of short sighted patients overall need any adjustment. We are still gathering data on this from our dual laser Z-LASIK techique.
So I think in your case that needing some enhancement (which is usually done around 3-6 months after the first procedure for short-sight) is not so unusual, especially as your daughter had a large prescription. The higher the prescription, the higher the chance of enhancement to get the best results.
I would like to know.. is it the fact that an enhancement is needed that you are not happy with, or the fact that LASEK has been recommended instead of a flap lift LASIK approach?
Why would be enhance with LASEK? With large prescriptions there may not be enough corneal thickness remaining to safely retreat with another LASIK approach. It is usually safer in these cases to change to a surface procedure, LASEK, to keep the cornea strong.
Alternatively if it has been a long time since the LASIK flap was made, it may be better to do LASEK on the surface, rather than lifting an old flap.
Both these latter two points really depend on how the eyes are at the last check up.
If LASEK is the best way to go to enhance for your daughter, assuming no other issues, the results are usually very good. There is more downtime compared to LASIK as the eyes will take a few days to heal.
I would suggest talking with your surgeon again to help clarify the decision to retreat with LASEK. He or she can explain the reasons for that approach. Certainly, needing an enhancement wouldn’t be a reason to go through a complaints procedure.
Usually some one-on-one time with your doctor is the best approach in the first instance.
Hope that helps
David