Trudi asked

Hello Dave,
I had my eyes lasered in Dec 2009. My prescription was SPH -4.50 & -5.00. My left eye (which had the worst prescription) is perfect! I have had enhancement surgery on my right though as a slight astigmatism remained. I had enhancement surgery (using the LASEK method this time round) 4 wks ago and the vision is not yet as good as it was after the first surgery, before the enhancement. I am beginning to think I should have lived with the result I had after the first surgery and been grateful. Do you think my eye will heal to at least what it was after the first surgery?

Also, I have regular post-op check-ups with various different opticians (dependant on who’s in on the day of my app) and each tells a different story about healing and drops. I have been told that keeping the eyes wet with blink drops is *very important* to aid healing. I have also been told by another optician that I only need to put drops in when my eye feels dry. What is your view?
Thanks.

Trudi, for the lubrication, I would recommend regular instillation rather than just when they feel dry. The nerves are lasered during the treatment and see the eye is somewhat insensitive for a while, so you may not be aware of some dryness and so not lubricate. Aim for 4-6 times a day over the next couple of months. I prefer the preservative free version (you can buy e.g. Blink or Refresh over the counter at Boots) which will be less irritant with regular usage over an extended period. These are the ones in individual droppers. One vial should last you a day, one drop in each eye every 3-4 hours.

For surface laser correction (PRK/LASEK) the full result can take months to fully settle and the vision is often a bit off at 4 weeks post-op. You should find it will settle more over the next 4-8 weeks.

For LASIK laser eye surgery safety, there are 3 things you must look for when you plan to go ahead. This LASIK safety trio means a more accurate result and the safest procedure we know of today:

1. Choose a blade-free all laser LASIK technique – using the latest femtosecond lasers means no blade is used in the surgery. Check with any clinic you talk to that they can offer blade-free LASIK – if they can’t then they are out of date and should be avoided.
2. Wavefront-based LASIK is a must today, so make sure you go for that option. For example, at FOCUS Laser Vision we only do wavefront treatments so that is taken care of. At other centres such as Optical Express, do not choose their non-wavefront option.
3. Get the safety and reassurance of NHS consultant corneal specialist surgeons to do your treatment – the three laser eye chains do not offer this for the great majority of their treatments. Premier centres like Moorfields Eye Hospital, Centre for Sight and FOCUS Laser Vision do.

If you read yesterdays post you are up to speed on wavefront technology. OK, so far so good. It seems wavefront correction improves quality of vision after laser eye surgery. And indeed clinical trials confirm that vision results are much better after laser makers added the ‘wavefront‘ upgrades to their machines.

For example, the American made VISX lasers, used at all Optical Express laser clinics, have much better results when using their wavefront upgrade from 2002. I would not recommend having laser eye treatment today in 2008 without choosing the wavefront package on that system.

Wavefront laser eye surgery - is it the whole truth?

So now you want ‘wavefront‘ in your laser eye treatment! Of course, as the results are better. But when laser manufacturers introduced ‘wavefront’ they actually bundled in other improvements which may account for much of the jump in results! They just didn’t tell you. Why? Because it is complicated to describe all these improvements to someone who isn’t familiar with the technology – such as you, the patient!!

And honestly, I bet the sales people at most clinics talking on the phones who want to sell you a consultation don’t really understand it either! However, they have been trained to explain the wavefront part only, as something like this… “we take a scan, a unique fingerprint, of your vision and the use that fingerprint to perfectly correct your vision“. Go on, call them and check it out!

But for you, as a patient or customer, don’t really care about which part of that technology is helping you the most, you just want great vision, right?

So don’t let clinics blind you with science about wavefront scanners, wavefront maps, measuring hundreds of points of light or how much better their scanner is than other clinics scanners. It is usually marketing spin! Take it all with a pinch of salt.

However, you should choose the ‘wavefront option’ because within that package are the big improvements in laser eye treatment over the past several years. The success of surgery may actually be less to do with the true wavefront technology that has helped astronomy, but rather other improvements that may be confusing to patients but get wrapped up in the marketing of wavefront LASIK.

We come back to ethics again here. Is it ethical for some clinics to still sell ‘non-wavefront’ laser eye surgery technology that was replaced back in 2002?

For my own clinic, we do not offer non-wavefront treatments at all. None at all. I want every one of my patients to have the benefit of the newer laser eye surgery results. So we made it very affordable. In fact, we charge less for wavefront LASIK than other clinics do for their ‘entry level’ lower price non-wavefront LASIK. Really.

That’s my plug for FOCUS done! So, do choose wavefront but don’t pay more than you have to!

To recap from earlier this week, there are two ways you can upgrade your laser eye treatment: (1) upgrading on the quality of the final vision (you will see better afterwards) and (2) improving the safety and accuracy of the laser eye surgery. These are upgrades on what used to be the best treatment only a few years ago, which is known as non-wavefront LASIK and using a blade device to cut a thin flap in the surface of the cornea (the clear window at the front of the eye).

Upgrading on (1) involves paying for what is called ‘wavefront‘ laser eye surgery over ‘non-wavefront’.

Upgrading on (2) means getting rid of a metal razor-type blade in favour of a laser for the first part of the LASIK treatment (lots of names here… blade-free, dual laser, femtosecond, Intralase, Ziemer, Z-LASIK).

Kay’s questions have been about: is it really worth it to pay more? The short answer is that, yes, you should always look for ‘wavefront’ laser eye treatment. But why?

Well, the reason for this is not as obvious as laser eye clinics may tell you!

Wavefront refers to a technology adapted from astronomy which allows better resolution and clarity when looking at images of space. The principle is to remove tiny imperfections of focus, rays of light that are not getting focused properly and which cause blurriness, glare or hide details. Let’s look at an example from astronomy. In this image you can see how a blurry image of a star was improved though wavefront technology to reveal in fact two stars, known as a ‘binary star’.

'Wavefront' laser eye surgery can improve quality of vision

These imperfections of focus (known usually as aberrations) are not corrected by glasses. They are still there even after putting on your glasses or contact lenses. So after correcting your prescription fully and getting clear vision, you can still have imperfections in your vision which are usually more obvious at night.

Check back tomorrow for the next installment and the full answer on whether it is worth it to pay more  in order to get the best vision results (at most clinics – not mine, I add, FOCUS Laser Vision! – we don’t charge extra for you to get wavefront correction! In fact we charge less for wavefront surgery than other clinics do for their non-wavefront treatments).

See you tomorrow!