Comments on: cTen, no-touch PRK and LASIK

By: Natasha Vidas

Natasha Vidas — Thu, 01 Dec 2011 00:18:42 +0000

Dear Dr Allamby

I hope this is the right space to ask a question.

I came in to FOCUS on Monday (28th Nov) for my laser eye surgery assessment (the staff were lovely and really helpful). After all the tests I was told that I have 20/12 vision with my contact lens correction, which is something I suspected but wasn’t sure about. The optometrist explained that not all people can see 20/12 no matter how much one tries to correct their vision with lenses – which is something I didn’t know. She said I was quite unusual in that I have a -5 prescription with 20/12 vision (with lens correction). I was told that the statistics for FOCUS and people obtaining 20/12 after surgery was 49%. I am keen to have the surgery done (and have provisionally booked to have it done next Tuesday 6th Dec at 3pm) but I am nervous as I might only end up with 20/20 or 20/15 post-op which is not as good as the vision I currently have with my contact lenses.

I would really value your feedback/opinion on this. I guess I am after a little reassurance, not sure that is possible. One of the main reasons I chose to come to FOCUS was the excellent results reported for 20/20 vision post-op i.e. 100%, I didn’t realise that that might not translate into my vision being as good post-op as pre-op i.e. 20/12.

My other question is, will my corneas be as strong post-op as they are pre-op or does one end up with weakened corneas and if so, what are the implications?

Thank you so much.

Kind regards
Natasha

By: Dave Allamby

Dave Allamby — Wed, 30 Nov 2011 13:41:19 +0000

hi Minhaj, All surface laser techniques improve over 3 months, be it PRK, LASEK, or trans-epithelial PRK. (the term Epi-LASIK is an awful one – just branding to make PRK sound like LASIK). Epithelial regrowth takes about the same time for all techniques, slightly faster for trans-epi PRK as just enough is removed for the treatment zone but no more.
Best regards, David

By: Minhaj

Minhaj — Wed, 30 Nov 2011 11:02:23 +0000

Dear Dave:
First of all thank you very much for guiding me throughout the process. Your expert advice actually went a long way helping me choose the right procedure. Even though i qualified for both with doctor’s consent I opted for No Touch All Laser Epi-Lasik. I’m quite happy with that.It’s been a little over a month now. Doctor said it’ll take about 3 months for my vision to stabilise. I’m just curious to know a little detail about this procedure. Does it take longer time because the epithelium regrowth takes place like layer by layer (eg. 1 micron at a time) or something else? Why is the recovery time longer?
Thanks and Regards,
Minhaj

By: Dave Allamby

Dave Allamby — Wed, 21 Sep 2011 11:48:29 +0000

hi Minhaj
For the latest technology for femtosecond flap creation, the Ziemer LDV Crystal Line (newest model) is in my opinion the clear leader.
For excimer lasers, it depends somewhat on the kind of prescription you have. For short-sight, I would choose the WaveLight Allegretto Eye-Q or either of the Schwind Amaris models, 500 or 750. The Schwind takes away slightly more tissue per diopter, but otherwise the results are the same. If you have a very large amount of astigmatism, the Schwind’s active tracking may be of help. For hyperopia (long-sight), the WaveLight gets the best results, with the Schwind prone to a little more regression in comparison. I personally would not use the VISX for hyperopia treatment.
Hope that helps. David

By: Minhaj

Minhaj — Wed, 21 Sep 2011 11:22:14 +0000

Hi Dave,

Thanks for your advice. This will help me choose the right procedure. But of course with an expert consultation. Since you talked about choosing the latest Technology which of the following you consider the latest-

For Flap Creation

Visumax® femtosecond laser
Intralase® femtosecond laser,
Ziemer’s FEMTO LDV.

For Corneal Ablation

The ALLEGRETTO WAVE@ Eye-Q
VISX STAR S4
Schwind Amaris 750

Thanks & Regards,

Minhaj

By: Dave Allamby

Dave Allamby — Mon, 19 Sep 2011 16:37:09 +0000

hi Minhaj, First of all, you can forget about Relex, Flex, and Smile procedures from the Zeiss femtosecond laser, for the time being at least. Having seen the latest results, they do not yet match what can be obtained from advanced excimer LASIK. Interesting concept though, and we will watch where it goes.
CTEN gives the same results as PRK or LASEK, but just uses the laser to remove the epithelium. You can choose any of these variants, as they will lead to the same outcome. You will want MMC used also if your prescription is moderate to high. I believe the long term safety of femtosecond LASIK and PRK/LASEK/CTEN to be the same, so touch or not doesn’t really matter. If you want a (much) faster recovery and little pain, do choose thin flap femtosecond wavefront (optimised/customised) LASIK. Long-term safety in this respect is about any pre-existing/incipient tendency for the cornea to deform, and this is what corneal topography/mapping is for at your consultation.
Just choose an excellent centre, surgeon and with the latest technology, and discuss your options with the team.
Regards, Dave

By: Minhaj

Minhaj — Mon, 19 Sep 2011 10:48:38 +0000

Hi Dave, if I qualify for both Flap lasik & CTEN which one should I go for? To a layman like me it appears since CTEN doesn’t involve any touch and also doesn’t have the flap creation procedure it is safer in the long run.Please correct me if i’m wrong. Is the post operative vision quality any better or similar? There is yet another new technology called Relex or Flex. What is your opinion on that? Thank You.

By: Dave Allamby

Dave Allamby — Wed, 07 Sep 2011 20:12:09 +0000

yes, same procedure. The outcome is also the same as PRK/LASEK.

By: Minhaj

Minhaj — Wed, 07 Sep 2011 18:26:11 +0000

I think C TEN is the same as “No touch all laser EpiLasik”,isn’t it? Eagle Eye Center in Singapore provides it.