What kind of God would make me thick everywhere but the corneas?
March 5, 2013 3:20 PM   Subscribe

I want Lasik. I went to two leading practitioners in my town and got conflicting answers about whether I'm a candidate for the surgery. Any opthalmologists in the house want to weigh in?

Doctor 1 told me I could not have Lasik because my cornea was 500 microns, too thin. (In reliance on the orb scan and pentacam measurements taken by his tech.) He said the surgery could put me at risk of a nasty complication (I forget the term but basically herniation from the cornea getting cut too thin.)

Doctor 2 said I was a great candidate for Lasik because my cornea is actually 540. He measured me himself with an ultrasonic pachymeter that touched the surface of my eye. I asked about the complication and he said it wouldn't happen because my cornea is fine; that the practice turns people away whose corneas are thin; and that he's never had that herniation thing happen since establishing his practice in 1995, in thousands of surgeries. I asked why Doctor 1's equipment would have given the other result, and Dr 2 said that the tech could have made a mistake, and that if they used an orb scan (they did, but also a pentacam) that it's not as reliable a measurement.

Now I really don't know what to do. I want the surgery and Doctor 2 was recommended to me as a thorough, thoughtful, soup-to-nuts opthalmologist; he is also a corneal specialist and he should know how to measure a cornea. Doctor 1 is a famous Lasik specialist and that's all he does (plus the other corrective surgeries).

I guess I could get a third opinion but before I do, I wonder is there anyone who can speak to how reliable the various measuring machines are? Because if I go for a third opinion, I'll want it based on the most reliable corneal measurement and I'll be asking what they use when I call around. Thanks MeFi...
posted by fingersandtoes to Health & Fitness (8 answers total) 3 users marked this as a favorite
I think I would call the first doctor and ask them if it's possible they made a mistake in the measurement. Perhaps they will allow you to come back in for a repeat test? I feel your unease here!
posted by two lights above the sea at 3:48 PM on March 5, 2013

Keep in mind that you also have the option for PRK surgery instead of LASIK, which might be the right call with borderline thin corneas. PRK has a longer and more painfall recovery but there is a marginally lower risk of complications later in life (no flap!). I did PRK surgery about 6 months ago and the results turned out quite well for me.
posted by zxcv at 4:39 PM on March 5, 2013

When I went in for my LASIK consultation, my doctor told me that my eyes were very, very dry and accordingly my cornea was very thin (I don't recall the exact numbers). He put in punctal plugs and had me buy a box of the natural eye drops for frequent use before the surgery. On the day of my procedure (9 days later) he said my corneas were fine and he wouldn't have known them to be thin or dry if he hadn't seen them himself a week earlier. I'd imagine that either doctor would have said something to you, but I figured it was worth mentioning.
posted by _DB_ at 4:49 PM on March 5, 2013

I can't answer your question re: the accuracy of measuring tools, but I can tell you one thing: corneal thickness is a Very Important Thing when considering LASIK (memail me if you want to know how I know). Personally, I think a lot of people take the decision to have LASIK way too lightly. (My opthalmologist, who specializes in post-LASIK complications, agrees.)

Is it possible to get a third opinion re: corneal thickness?
posted by Salamander at 9:08 PM on March 5, 2013

I’d get yet another opinion. I think some people are more willing to do the surgery on borderline cases than others.

There’s also lens implants, but it’s pretty expensive (I think).
posted by bongo_x at 11:10 PM on March 5, 2013

I asked about the complication and he said it wouldn't happen

This part would make me suspicious. Complications can always happen, even if they're rare. It's irresponsible/possibly illegal for any doctor to lead you to believe that complications "won't happen". Thin corneas are directly responsible for a lot of the complications seen with LASIK. If in doubt, I'd believe the worse measurement - your eyes are important! Especially since it's coming from the LASIK expert rather than the general eye doctor (who probably does far fewer LASIK surgeries).

And yes, if you haven't yet, look into methods that work a little better for people with thin corneas. LASEK is another option, sort of halfway between PRK and LASIK.
posted by randomnity at 7:51 AM on March 6, 2013

Seconding PRK. I had it done about 5 years ago and am very happy with the results. That said, the first three days after the procedure were hell. All you can do is stay in a dark room with your eyes closed. If you decide to go the PRK route, I can't recommend audio books enough. Also, while it's no guarantee, don't go cheap. Good luck.
posted by hangingbyathread at 8:21 AM on March 6, 2013

I had LASIK, and the thing that was emphasized to me was getting a super-experienced eye-surgeon; 10,000 eyeballs at a minumum. (LASIK is also the best money I ever spent on anything, and for both eyes it was around $4600.)

IIRC, the mechanically-cut flap needed some 150μm, and the laser removes around 10-12μm per diopter (rounded up) of correction required, and beneath that they want at least 275 or 300 remaining. They have lasers that can cut the flap to a more shallow depth, leaving more room in the "bed" beneath the volume removed by the surgery.

If corneal surgery turns out to be a complete no-go, you may want to find out about "OK" Contacts, aka overnight orthokeratology which uses hard contact lenses to flatten your corneas as you wear them overnight. It can treat some degree of myopia.

Finally, you're gonna need eyedrops for your dry eyes after any surgery. Protip: keep them in your pocket. Cold eyedrops suck. (Your eyes will be dry for a few months, but keep the drops around; after 3 months, you'll be a pro at dropping them into your eyes, but also a pro at recognizing the symptoms of dry eyes.)
posted by Sunburnt at 9:00 AM on March 6, 2013

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