these tired ol' eyes o' mine....
July 31, 2007 7:01 PM   Subscribe

best surgical procedure for extreme near-sightedness (-12 diopters) + mild astigmatism? best doctors in sf bay/napa area? your own "blind but now i see (or dont, as the case may be)" cautionary tale? thank you as always excellent mefite mind.

ps: anybody had the lens implant? and what about presbiopia (?) aka age-related farsightedness? bi-focular lasik? lens implants?
posted by oigocosas to Health & Fitness (18 answers total) 9 users marked this as a favorite
Ooh, I totally have the same problem, except not as severe nearsightedness and worse astigmatism. Lasik sounds much better than PRK. I have two friends who've gone through LASIK successfully, but they had mild myopia cases. Warning: I've heard of rainbow haloes and problems with night vision. Totally looking forward to hearing other opinions.

It's funny, I know a few eye surgeons and optometrists. I polled them, and half of them have done it, while half of them still wear glasses. When questioned more closely, one of the surgeons said. "If there are complications, then it's game over, and a total waste of my medical school investment- not worth the risk." Someone who's been teaching a dispensing optician program for 30 years told me he was concerned about a possibility of detached retinas in the future (although I couldn't blame him for being biased!).

That said, I walked into an Indian restaurant and the owner came right up to me and told me to eat almonds to improve my vision! YMMV. (The reasoning is that they are alkaline, and are good in terms of ayurvedic principles). Hasn't helped me yet.

Good luck. Thanks for posting this. It would be nice to know how things turn out for you- should you go ahead with it.
posted by solongxenon at 7:48 PM on July 31, 2007

From what I understand, you may not be able to get it. You are on the cusp (I am, too). Some docs say up to -14.0 diopters, some only up to -10.0, because of the amount of thinning of the cornea that is required for correction. Personally, I don't want to take the risk of getting popped in the eye by a ball or any other odd thing and having my cornea split, I would rather live with contacts & glasses.
posted by kellyblah at 8:02 PM on July 31, 2007 [1 favorite]

My mother had the lens implants done 20 years ago when she was diagnosed with cataracts at age 45. Now she has glaucoma and says that her current doctor tells her that it was probably a consequence of the lens implants. I don't know if they've done studies that prove that or if it's just his theory, but it really made me rethink my desire to go the implant route.
posted by MsMolly at 8:41 PM on July 31, 2007

A photographer in the small town where I grew up went to the city to have LASIK performed. Unfortunately, mid-way through the procedure, the machine or laser or something malfunctioned. He lost much of his sight. As a result, he had to shut down his photography studio, which had been in business for 30 years. I believe he sued the LASIK providers, but no amount of money can really make up for permanently damaged sight. I recognize this is probably an extremely rare case, but it's been enough to scare me away from any sort of elective eye surgery.
posted by acoutu at 9:10 PM on July 31, 2007

How long has your prescription been stable?

If your prescription has been changing your whole life, then this procedure is a waste of time and money, because in a couple of years you'll need corrective lenses again.
posted by Steven C. Den Beste at 9:21 PM on July 31, 2007

Response by poster: thanks, all.

my prescription has (oddly) fluctuated up and back between about -11 and almost -13. kaiser didnt refract me and their fancy computer, operated by a terse optician, lowered my prescription for the first time ever. and i immediately felt that the prescription was too weak.

unfortunately, with kaiser (which otherwise has been good to my family) i dont warrant being seen by an ophthalmologist....
posted by oigocosas at 9:45 PM on July 31, 2007

To Acoutu: yeah, that is really horrible, but these days most Lasik is done one eye at a time, so you are unlikely become blind.
posted by melissam at 10:02 PM on July 31, 2007

My father, who was legally blind, had Lasik and it worked wonders. He still has glasses, but they are thin.
posted by melissam at 10:03 PM on July 31, 2007

The thing is that this kind of surgery, whether done with knives or with lasers, is once-per-lifetime. And if your eyes are constantly physically changing, then there's little point in having it done. (Except in really extreme cases such as MelissaM's father.)

It happens that it isn't possible for this kind of surgery to correct my vision, but even if it could I wouldn't be a candidate, because my correction has changed every time I've gotten new glasses my entire life, and there's every reason to believe it's going to keep happening.
posted by Steven C. Den Beste at 12:00 AM on August 1, 2007

I'm very interested in this askmefi, because I'm looking at getting something (probably lasik) done in about 5-10 years - I'm a -8/-8.5 with mild astigmatism, and the rate of degradation has slowed a lot over the last 5 years. I've heard about the rainbows and halos, but I currently get those *anyway*, so I'm not overly worried.
posted by ysabet at 2:18 AM on August 1, 2007

My optician has a similar prescription to me (about -8.50) and he said that I'd be a good candidate for lasik. I asked if he would get it done and he laughed sheepishly and said no. That said it all for me.
posted by essexjan at 2:51 AM on August 1, 2007

Tried Ortho K?
posted by A189Nut at 2:55 AM on August 1, 2007

Tried Ortho K?

Did you read the link you posted, and the original question? Olgocosas is about 6 diopters too nearsighted to be a candidate for Ortho K, and is 8 diopters past what they suggest is an ideal candidate.
posted by Forktine at 5:55 AM on August 1, 2007

I had the oldfashioned eye surgery done (knives and lasers) about 10 years ago. I was a -4/-4.5 and have had better than 20/20 vision ever since. No halos or rainbows. Recommend it 100% - just make sure you find a stellar doctor.
posted by widdershins at 6:33 AM on August 1, 2007

I'm -8/-8.5 with mild astigmatism too, and I had a consult for LASIK, but was denied because of my high prescription and my (apparently) overly large pupils. They said they'd have to take off so much that it would compromise the internal structure of my eyes, so no LASIK for me. At the time, the implanted lens were just getting going, but I still feel that not enough time has past for them to be sure of the long term problems for me to go that route yet. Vision is too important to be on the bleeding edge of technology for me.

That being said, my mom had LASIK done awhile ago (she has a much lower prescription than I do) and loved it. My brother also had it done (also lower prescription) and I haven't heard complaints yet.
posted by JonahBlack at 8:32 AM on August 1, 2007

Best answer: I had LASIK about 4 years ago at age 39 and have been extremely pleased and now wish I had had it done sooner; however, I did a lot of research before taking the plunge. First of all, you mentioned that your prescription fluctuates. This can be normal. As you go through the day and your hydration changes your eyeball swells and contracts slightly, enough to cause noticeable changes in your optics. This is even more pronounced in poorly controlled diabetics where fluctuations in blood glucose alter the osmotic pressure of various body fluids and cause the same effect. Whether or not this normal fluctuation accounts for a change from -11 to -13 diopters is a question for your ophthalmologist. Which brings me to the most important thing: choosing the right doctor. It should go without saying, but I didn't even consider the budget LASIK places; my vision is too valuable to trust to the lowest bidder. I was fortunate in that an anesthesiologist I worked with at the time was married to an ophthalmologist who had done a fellowship in corneal surgery. You should insist on someone with this level of training; my operation was routine but it sounds like yours might not be. Someone with fellowship-level training in corneal surgery (or refractive surgery) will also be able to discuss all the options and alternatives with you in detail. At the (free) initial visit he spent about two hours with me personally doing a battery of tests and explaining what he was looking for. I got the impression he was actively looking for a reason to say I was not a good candidate and so I was reassured when he said I was. I was also impressed that he did not rely on someone else to examine me. Among other things he looked at were ensuring that my pupil was not too big (this is what causes halos at night), ensuring that my cornea was thick enough for the degree of reshaping that would be needed, and checked to see how much accommodation I had left. This last one was important because it relates directly to your question about presbyopia. Nearsightedness helps compensate for presbyopia and so if you fix the nearsightedness you will need reading glasses sooner; there is no way around that. I did not consider monovision (making one eye nearsighted and one farsighted) because that can affect depth perception, which I felt I needed in my work. At 43 I still do not need reading glasses but do notice my very close vision is not as good as it once was. You do not mention your age, but the vast majority of people need reading glasses between the ages of 40 and 50. The Mayo Clinic page on presbyopia is good and discusses the pros and cons of various treatments. I looked at all the options (and they haven't really changed much in 4 years) and ended up going with straightforward LASIK for pretty much the reasons described in the Mayo Clinic article; what is best for you may be different. I paid out of pocket for my surgery; I am not surprised you insurance won't pay for yours either. It was worth it in the end and it has probably paid for itself in glasses, as I have always been pretty hard on glasses and replacing them gets expensive pretty fast. I don't have any specific recommendations for physicians in your area, but to recap-make sure they are fellowship trained, ideally they do their preop and postop care themselves, and they should take the time to discuss all the issues I have mentioned (and any others you come up with) in as much depth as you need to decide. Sorry this got so long, but this is a big decision and it takes a lot of information to make it.
posted by TedW at 8:47 AM on August 1, 2007 [1 favorite]

Response by poster: yall never let me down. ive already learned a few valuable things--fellowship in refractive surgery a definite yes--thanks tedw!

im not quite 40...seems like maybe i'll find an appropriately trained doc to evaluate me and take it from there.

ted, et al: any follow-ups on those who've had the the lens-implant? the glaucoma sequela bears looking into--can one "self-medicate" sufficiently to keep the pressure within safe levels (new thread, huh?).
posted by oigocosas at 9:14 AM on August 1, 2007

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