LASIK for bad eyes?
June 19, 2012 7:52 AM   Subscribe

I am very nearsighted, and have an astigmatism in both eyes. I checked out LASIK 10 years ago, and was told that it hadn't developed enough to make it safe/effective for a person with my conditions. Has the state of the art improved with regard to laser correction of severe nearsightedness with astigmatism? Are there new techniques that could work better than LASIK?

Background: I have worn glasses since I was 4, switching to contact lens in junior high school. Without my contacts, I am nearly legally blind, and my glasses are so thick (plastic or glass lens) that they impart a funhouse-like curvature to my vision. My vision with contacts is very good, but I am constantly worried that I'll develop some side-effect of the contacts (like a corneal scratch) or conjunctivitis which will require that I wear glasses (which practically limit me to the house, as my job is almost all reading and writing).

I'm posting this to AskMF in the hopes of hearing both from persons with expert knowledge and those with personal experience of correction of severe nearsightedness and astigmatism. While I understand that it is possible to apply LASIK to persons with my conditions, it is the reliability and safety of the procedure that concerns me -- any significant chance of a degradation in my vision would be too much. With that said, even an improvement that could bring my eyesight back to the level where it could be effectively corrected by eyeglasses would be worth it.
posted by seventyfour to Health & Fitness (17 answers total) 18 users marked this as a favorite
Make an appointment with a LASIK surgeon and find out. I'm sure the state of the art has advanced somewhat in the last decade, but no one here is going to be able to give you an accurate read on whether that means anything for you and your eyes.
posted by valkyryn at 8:04 AM on June 19, 2012

My mother was legally blind without her glasses- sever astigmatism in both eyes and was ended up with early cataracts. She had the surgary done about five years ago and now only needs reading glasses for very small print. She did have to go to a specialist in Atlanta, GA- though.

really, you'll need to talk to a doctor and most likely a couple doctors (her first two doctors told her nothing could be done) to get good solid information about your particular situation- but it's not out of the realm of possiblities.
posted by Blisterlips at 8:07 AM on June 19, 2012

My regular eye doctor advised me against the LASIK because of my extreme astigmatism and myopia - he said I would have significant loss of night vision. He mentioned something about lens implantation instead, and said we could discuss it a few years down the line. (I am not getting anything implanted in my eyes, ugh no no no.)
posted by elizardbits at 8:15 AM on June 19, 2012 [1 favorite]

Agree with the first two posters. It might or might not be possible/worth it. I had LASIK for bad astigmatism and near-sightedness a year ago, but it took about 3 months, and visits to 4 different doctors, before I was in a position to make a decision.
posted by facetious at 8:24 AM on June 19, 2012

I think actress Mila Kunis was blind in one eye and they were able to restore her sight by popping a lens in.

So definitely make an appointment with a well-reviewed ophthalmologist.
posted by discopolo at 8:29 AM on June 19, 2012

Make an appointment and find out. It doesn't cost anything.

FWIW, I have bad astimatism in both eyes and went for a LASIK consultation last year. They said that I'd have longer recovery time than most people and they'd have to use a different kind of laser. The longer recovery time (4 days?) was not okay for me.
posted by k8t at 8:35 AM on June 19, 2012

Best answer: Oh, and if your eyes are as bad as they sound, you may need to resign yourself to doing this in several stages. My aunt, who has terrible vision, had this done a few years ago. She had like four procedures or something, and I think they did one eye at a time, so that's two each. Basically, they do some, give the eye time to adjust and heal, then do more. LASIK is basically slicing up your cornea, so some healing time in there is no bad thing, especially if you're trying to do a more drastic correction.
posted by valkyryn at 9:05 AM on June 19, 2012

Best answer: Research intra-ocular lens insertion. I went for a LASIK / LASEK exam last weekend - astigmatism in one eye and extreme myopia in both - and this was the surgery they recommended. At ~$4,000 it was a bit more than I planned on spending, so I'll be checking out a second opinion.
posted by chrisinseoul at 9:33 AM on June 19, 2012

Best answer: Beyond about 6-8 diopters, LASIK and related procedures won't restore you to normal vision*. I had ~11, with ~1 diopter of astigmatism.

The alternative surgery, which has only been allowed in the US for about a decade, is ICL. It's been practiced elsewhere for longer, and like many such procedures, was developed outside the US' strict AMA jurisdiction (though by a US doctor). My surgeon was the most experienced on the Eastern seaboard, and because of an irregularity in my eye structure, the operation was supervised by someone from Visian - so I felt pretty safe about it. 4 years later, it's great; no problems.

The downsides:

1. $5k/eye. WAY more expensive than LASIK. And most insurance considers it "elective".

2. Visian is having some sort of PR scrape with the AMA, and can't get their astigmatic lenses approved. Physically, the only difference is a teensy, invisible difference in thickness on one side. These lenses can't rotate within your eyes, so there's no need to weight them, as with toric contacts. There's no reasonable reason to forbid their sales, but as of last I heard, astigmatic correction requires you visit Canada.

Surgery is painless. Recovery is quick. If I had to redo it every year, I wouldn't flinch (except for the bill!).

*I should also point out that, unless you are born with an abnormally high density of receptors in your fovea, the magnification of a myopic eye beyond ~6-8 diopters may mean 20/20 acuity is unachievable, regardless of correction. I'm lucky that way; no guarantees for you. But it will still get you close, and (unless you have significant astigmatism) able to drive w/o glasses.
posted by IAmBroom at 9:37 AM on June 19, 2012

chrisinseoul: " At ~$4,000 "

Sorry, it was $5k for me, because I chose the doctor I did. Forgot that. Still pricey.
posted by IAmBroom at 9:38 AM on June 19, 2012

valkyryn: "LASIK is basically slicing up your cornea"

And that's another advantage to ICL: the only damage to the eye it involves is a 3-mm cut at the edge of the iris, far from any part you see through. It's 100% reversible, and leaves no scarring to complicate eye work later in life.
posted by IAmBroom at 9:40 AM on June 19, 2012

Just get it, odds of messing up your vision are incredibly low. If you're scared get one eye done and wear contacts in the other until you're sure the first one turned out OK

IMO no price could justify the lifestyle + getting this surgery has had on me (ok to a certain degree)
posted by MangyCarface at 9:57 AM on June 19, 2012

My daughter decided against refractive surgery after an ophthalmologist explained its limitations for a person with severe nearsightedness. If you're considering the procedure, I think it is worth consulting with an ophthalmologist who does not do the procedure, nor have business ties to those who do it, in order to get objective professional advice.

Here are some sites publicizing negative outcomes of Lasik:
posted by Snerd at 10:21 AM on June 19, 2012

My husband I were both in the -8 to -10 range; I had astigmatism in both eyes. We've both done PRK where instead of cutting a flap out of your eye with a laser, the outer surface is dissolved. There's a lower corneal thickness requirement because the dissolution grows back and the flap has a larger required thickness.

In any case, ours both went phenomenally - he's at 20/10 and I'm at 20/15. The down side of PRK is a slightly longer recovery time, but I had the surgery and was back at work the following Wednesday.

Laser vision correction is so amazingly worth it. We ended up using Groupons to get a discounted price and using CareCredit's 0% interest for two years.

Consult a local well-rated place - they can do a free consult to get the go/no-go based on your corneal thickness and other particulars.
posted by bookdragoness at 10:37 AM on June 19, 2012

Best answer: I did some serious research into laser surgery for myself last year. I'm -10 in both eyes, no astigmatism. Everyone agreed that LASIK was out of the question for me - there just isn't enough cornea to slice off to correct vision that bad.

Intraocular lenses were the way to go: minimally invasive, fully reversible, monstrously expensive :-)

But - I ended up not going for it, because (as I discovered) I have a family history of glaucoma. The possibility - slight, but real - that the surgery would upset the pressure in my eyes and cause me to go blind was too risky for me, so I bailed.

How did I find this out? I didn't just talk to laser surgery clinics - I also talked to my family, and underwent extensive tests and consultations with an independent eye hospital before I made my decision. The clinics were predictably gung-ho about everything - because they stood to earn thousands of euros. My family were full of interesting information about my paternal grandmother's and great-grandmother's medical history. The independent eye hospital were super informative and very supportive. Also, extensive eye tests are really weird. The field of vision test in particular was a proper headfuck. And I discovered that my 3D vision is kinda rubbish. No wonder I thought Avatar was rubbish.

In the end, satisfied that I had comprehensively informed myself about the risks vs benefits, I decided that I'd rather have shit eyes than no eyes.

I'll have another crack at it in 5 or 10 years, see if the technology has anything new to offer.

Good luck!
posted by ZipRibbons at 11:14 AM on June 19, 2012 [1 favorite]

Best answer: LASIK patient here-- I spent something like $2600/eye and it's the best money I"ve ever spent ever. I was in the 4-5 diopter range w/o astigmatism.

But I wanted to share the advice I got from my eye doctor: pay whatever it takes to get the most experienced eye surgeons you can, and then research them. My eye doc gave me the option of referral to two clinics-- a local chain of clinics with a very experienced doctor, or a national chain which gets mentioned a lot at the above "negative outcomes" sites. Part of that, I'm sure, is the downfall of having lots and lots of patients, but my suspicion is that the chain doesn't refuse the borderline patients, and so I went the other way and asked my would-be surgeon (before they measured my cornea) what it would take for them to refuse to give me the surgery. Mainly the issue was corneal thickness but he gave a few specifics, and that's what I wanted, was specific criteria for saying "no, that surgery's not for you," rather than "yes, fine, billing department is down the hall."
posted by Sunburnt at 11:24 AM on June 19, 2012 [1 favorite]

Another thought to consider: switching to eyeglasses, should you ever need to, probably won't be nearly as bad as you imagine. After decades of loving my contacts (-12), I dreaded the thought of ever needing to go back to the glasses. When I would use them for a short bit now and then, the "funhouse effects" made me nauseous and dizzy. Then one day I felt too flu-ey to deal with the contacts, so I wore the glasses all day. By the end of the day, I wasn't noticing the weirdness anymore. I went back to glasses full-time, cause it's just easier to deal with, and a bit safer. The eyes and brain are very adept at making these adjustments.
posted by Corvid at 2:07 PM on June 19, 2012

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