Lasik v. replacement lens?

[cheeryble]

My wife has poor vision -5 and -4.

She would really like to have lasik.

 

I had lasik and have suffered with dry eye ever since and though it has also helped my eyes after 14 years have somewhat reverted so I'm wearing glasses a fair bit.

I'm aware there are more modern laser methods now.

 

It just strikes me that simply changing the lens such as is done for cataract is such a simple procedure with no dry eye likelihood it may be a better option.

I had a friend who had lens replacement ....one multifocal, one regular......he cant remember the prices except that the multifocal was much more expensive than the simple lens and he found the former less satisfactory for some reason 

 

Be interested in comments and also about prices for procedures. 

Thanks

[Sheryl]

Simply changing the lens is not that simple and definitely not recommended for correction of myopia.

She should have a consultation at the Thai Refractive Surgery Center (TRSC) which specializes exclusively in refractive surgery and discuss options with them.

Not everyone gets dry eye after Lasik, in fact most people do not. You were unlucky.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[c18gmr]

I would not recommend replacing the lens current IOLs have no accommodation. Meaning you lose your ability to focus on either close or distance objects 

[yankee99]

As you said lasik where's off. Bkk Pattaya has super sight which might be worth checking into 

[James2020]

I had lasik in 2001.  Dry eye that lasts is an uncommon complication of lasik.  I am a retired ophthalmologist from the US, and although I never performed lasik, I did many cataract procedures, which is identical to RLE (refractive lens exchange).    It used to be that RLE was not a popular procedure, but now that lens procedures are more common and the risks of the procedure are very low, it's popularity among eye surgeons and the general public has increased.  It is an intraocular procedure, so more complicated than lasik, but most surgeons are very familiar with it, because it's identical to cataract surgery, which is the most common procedure performed in the US.  Everyone starts to lose accommodative (focusing) ability about age 45, and most people will need reading glasses.  The RLE procedure usually doesn't change a need for reading glasses for patients over 45.  And there are ways around this by using accommodative lens implants or monovision.  Each person is different, so, of course, your wife needs to be evaluated by an ophthalmologist, and a second opinion is usually worthwhile.  My bias is towards a surgeon who is very familiar with the procedure, and volume matters.  If I had to make a decision today, I would seriously consider RLE.   

[Tocher]

I had both lenses replaced after separate incidents of detached retina about six years ago and for a couple of years I enjoyed perfect vision with no side effects apart from an initial period of adjustment as my brain got to grips with my being able to see again (I was -11 and -9). The total cost was about 350,000 Bt. and each procedure entailed just one night in hospital and was actually quite a pleasant experience. No post op pain at all.

 

But as the years have gone by my eyesight has deteriorated again and I am back to wearing glasses  (I'm now -1.5 and -2 so not drastic). Lens replacement does not guarantee 20/20 vision for ever. On the plus side I don't think I'll ever get cataracts.

 

I can recommend Rutnin Eye Hospital on Asoke Road, excellent staff and facilities.

 

 

[GreasyFingers]

6 minutes ago, James2020 said:

My bias is towards a surgeon who is very familiar with the procedure, and volume matters.

Excellent advice. I have recently had a cataract operation go wrong at a regional private hospital. It may seem rude to ask direct questions but you need to do it.

[Arkady]

Some spivvy get rich quick eye surgeons in places like Pattaya will do cataract surgery on patients who don't yet have cataracts, just to correct their refraction with IOLs.  But reputable surgeons in hospitals like Rutinin Eye Hospital refuse to perform unnecessary surgery, since there are risks involved in any surgery. The wide boy surgeons who will do this type of procedure are probably not the most skillful.  Therefore the risk of going with them is probably greater than with more ethical surgeons.  Although it is a relatively safe and simple procedure, you have a greater risk of detached retina after cataract surgery and during the procedure things can go wrong, such as dropping the IOL through the capsule onto the retina which can result in impaired vision. There is also a risk of infection following invasive eye surgery.  

 

I had cataract surgery in both eyes at the same time as bilateral macula hole surgery at Rutnin Eye Hospital which I highly recommend for anyone who needs surgery.  My left eye was previously long sighted but now I can drive without glasses for the first time in 30 years.  Soft focus IOLs, which allow older people to read and see distance without glasses, are not yet perfect and are still quite expensive.  In future they will undoubtedly improve and become cheaper.  It makes sense for a younger person to wait until they actually need cataract surgery and the level of correction they need for reading and distance has more or less stabilised. Otherwise you may need more surgeries in future to get the best IOLs for your vision. Also you need to go for regular follow up after cataract surgery to ensure the IOLs are still properly seated and there are no other problems. Since my cataract surgeries I have had to have laser surgery twice in my right eye and once in left eye to clear posterior capsule opacification, i.e. secondary cataract or cloudy vision. This is a complication associated with cataract surgery that is supposed to be quite rare but has already happened to me three times.

 

I would advise the OP's wife to stick with glasses, contact lenses or try lasik until she really needs cataract surgery. 

[Dionigi]

I had my lenses replaced at Bangkok Pattaya hospital seven years ago. The procedure was painless, one night in hospital and antibiotic eye drops for a couple of weeks to ensure no infections. You are shown exactly what your sight will be after the operation. This does not give overall vision at any distance but for me the problems are small. It does not last forever as if the original problem was weak muscles around the eye then they will continue to weaken. This is why the operation should only be carried out if you have been a number of years and the prescription for lenses has not altered.

I found that I have a halo around lights at night time and was told that it would go away although it has decreased it is still noticeable. Overall I am well pleased with the operation and would recommend anyone to talk to the doc at Bangkok Pattaya hospital to find out if they are suitable and how much as the cost differs.

[atyclb]

I had lasik in 1995 at a university teaching hospital located in the country considered to be one of the most experienced in cornea/refractive surgery and in fact home of the father of modern refractive surgery, Dr. Jose I barraquer.  Dr barraquers disciples carry on. Won't hurt to get their opinion via email. They are absolutely not a " get rich quick" outfit but a world renowned facility. Many Canadian and USA eye surgeons went there to learn lasik and have lasik and other procedures. They will provide a non money biased opinion.

 

http://www.en.barraquer.com.co

 

[Monkey Boy]

Looked into this for the wife. Super sight in Pattaya is basically cataract/lens replacement surgery. In the end went with Rutnin Eye Hospital in Bangkok who recommended Lasik. Initially she had some haloing and dry eyes but this is reducing. Just had her 3 month post op checkup and everything looks good and she is very pleased with the results (no more glasses required).

[Arkady]

30 minutes ago, Dionigi said:

I had my lenses replaced at Bangkok Pattaya hospital seven years ago. The procedure was painless, one night in hospital and antibiotic eye drops for a couple of weeks to ensure no infections. You are shown exactly what your sight will be after the operation. This does not give overall vision at any distance but for me the problems are small. It does not last forever as if the original problem was weak muscles around the eye then they will continue to weaken. This is why the operation should only be carried out if you have been a number of years and the prescription for lenses has not altered.

I found that I have a halo around lights at night time and was told that it would go away although it has decreased it is still noticeable. Overall I am well pleased with the operation and would recommend anyone to talk to the doc at Bangkok Pattaya hospital to find out if they are suitable and how much as the cost differs.

You point out another significant issue to do with cataract surgery.  Because the the IOLs need some space for seating in the capsule, their diameter is always going to be fractionally shorter than the natural crystalline lenses they replace.  That means you get some light scattering around the peripheries of the IOL that results in the halo effect at night, particularly noticeable from car headlights when driving at night.  The perception of this is normally a bit less pronounced when the procedure is indicated by the presence of actual cataracts.  This is because cataracts tend to cloud the crystalline lenses from the outside in, rather than clouding the whole lens equally.  Thus cataract patients have often already been experiencing the halo effect caused by light scattering around the the clouded peripheries of their crystalline lenses before surgery.  So the halos caused by the IOLs may not be much worse than the effect caused by the cataracts.  Patients having cataract surgery performed before they have cataracts should expect to notice a more pronounced halo effect.  The effect doesn't go away or improve but your brain can adjust so that you don't notice it so much.  

 

One of the problems associated with soft contact lenses, which many people having IOLs implanted before they have cataracts opt for, is a worse halo effect.  You can read reviews of the different brands online and always get the surgeon to explain which brand he is planning to implant and why.  I complained about the halo effect after my first macular hole and cataract surgery and the surgeon decided to use a different brand in the second eye which produced a lesser halo effect.  The halo effect was quite noticeable in my case because I had cataract surgery prematurely due to the fact that the gas injected into the eye during macular hole surgery invariably accelerates cataract formation. Therefore many surgeons will suggest cataract surgery at the same time, rather than have the patient come back for it within two years.    

[jippytum]

I had replacement lenses fitted ten years ago at the Ram Chaing Mai to correct cataracts .The operation changed my life .No more reading glasses or magnifying glass to read ingredients at the supermarket .  

[pmarlowe]

Had lasik 22 years ago after a lifetime of severe nearsightedness. Corrected with lasik monovision technique -- one eye for reading the other for distance. Worked beautifully and changed my life. Back to reading glasses now however -- but distance vision still good enough to get a drivers license in Thailand and the USA without corrective lenses. Dry eye began a couple of years ago however -- about the time i started needing reading glasses. Chalking that all up to old age.

Quote

 

 

[wanderluster]

25 minutes ago, Monkey Boy said:

Looked into this for the wife. Super sight in Pattaya is basically cataract/lens replacement surgery. In the end went with Rutnin Eye Hospital in Bangkok who recommended Lasik. Initially she had some haloing and dry eyes but this is reducing. Just had her 3 month post op checkup and everything looks good and she is very pleased with the results (no more glasses required).

what was the cost?

[jerry921]

I had -9 or worse in both eyes, and they told me (a US ophthalmologist) that lasik wasn't recommended for such a large correction, the more you shave off the more dangerous it is, or something like that. I don't know where they draw the line on that, so maybe -5 is ok.

 

As people have indirectly pointed out, your wife's age matters, as everyone gets cataracts eventually (and high nearsightedness is a risk factor for early-onset cataracts, as I found out). If she's 60 I'd say just continue living with vision as-is until cataracts force the lens replacement - and hope by that time the lenses are better than they are now w.r.t. presbyopia.

 

If your wife is 20, then it's a different set of trade-offs.

 

Lens replacement is no small risk, a lot of things can go wrong, even with a "successful" operation. My operations went well, but I was left with a lot of floaters that haven't gone away after 2 years and leave me not much better off than I was with the cataracts. I also had some retina detachment in one eye after a few months, and I had the "secondary cataracts" (cloudiness that isn't cataracts that comes on after a few months) in both eyes. So altogether after the surgery I had 3 different laser treatments, and I still have the floaters.

 

Oh, and the surgeon was "aiming" to leave me a little nearsighted (about -1.5) in both eyes because of the presbyopia, and my constant computer use. He missed, and I am -2.5 and -2.

 

So the technology is getting better all the time, and time will eventually force your hand on the lens replacement, but anything you do sooner than necessary is an unnecessary risk that may constrain your future choices. With vision, be conservative.

 

edit: all my work was done in the US under insurance, but it still cost me a couple thousand.

 

Edited August 12, 2018 by jerry921

[Expatthailover]

16 hours ago, Sheryl said:

Simply changing the lens is not that simple and definitely not recommended for correction of myopia.

She should have a consultation at the Thai Refractive Surgery Center (TRSC) which specializes exclusively in refractive surgery and discuss options with them.

Not everyone gets dry eye after Lasik, in fact most people do not. You were unlucky.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Well it happened to me as well.

[wwest5829]

It has been 1.5 years since I went to Rutnin Eye Hospital in Bangkok (Asoke/Montri). I had worn glasses for 59 1/2 years, nearsighted, my focus was at about 6 inches. Had both eyes natural lens removed and multifocus lens put in. . First eye on a Friday, 2nd eye the following Tuesday. No afteraffects. Now I can see pretty Thai girls at distance altho, if they get within an arms length, I put on the reading glasses to check the Adam's Apple... $1800.00 USD each eye. Stayed at a university hotel within walking distance. Currently have just developed a floated in the vitreous. Bugger...look it up, cause is "aging". well, of all the nerve! I am only 71!!!

[atyclb]

1 hour ago, atyclb said:

I had lasik in 1995 at a university teaching hospital located in the country considered to be one of the most experienced in cornea/refractive surgery and in fact home of the father of modern refractive surgery, Dr. Jose I barraquer.  Dr barraquers disciples carry on. Won't hurt to get their opinion via email. They are absolutely not a " get rich quick" outfit but a world renowned facility. Many Canadian and USA eye surgeons went there to learn lasik and have lasik and other procedures. They will provide a non money biased opinion.

 

http://www.en.barraquer.com.co

 

 

i have zero commercial interest in any medical facility.  some interesting and fascinating historical perspective. 

 

 

LASIK surgery is already a big hit in USA, but the story behind this radical technique takes us to Bogota, capital of Colombia.

 

 

 

 

Edited August 12, 2018 by atyclb

[Arkady]

As mentioned by Jerry, floaters, which are very common after cataract surgery, are another consideration following cataract surgery.  Most of them dissolve and go away but you can be left with some permanent floaters which your brain will try to adapt to. I have a floater which I originally mistook for a mosquito and tried to swat it.  It is still there two years later but I am still much better off after surgery, as I would have lost my entire central vision without the macular hole surgery.  Cataract was just an add on.  

[Arkady]

43 minutes ago, atyclb said:

 

i have zero commercial interest in any medical facility.  some interesting and fascinating historical perspective. 

 

 

LASIK surgery is already a big hit in USA, but the story behind this radical technique takes us to Bogota, capital of Colombia.

 

 

The Russians pioneered the technique before LASIK by opening up the eye to reshape the cornea with a scalpel or other cutting instrument.  They discovered the process by accident while treating car accident victims who had glass in their eyes. In the late 70s they moared a hospital ship in offshore waters opposite Larnaca in Cyprus, promoting it to tourists on shore.  I know two people who had the surgery there while on holiday, having not known about it before they went.  Both were quite pleased with it, although the full benefits were not permanent.  My former boss was one of them, formerly a life-time wearer of coke bottle glasses and contacts with -6 shortsightedness.  He eventually had to go back to wearing low powered contacts as the effects wore off but was happy that he could see enough to go the bathroom etc without glasses in the middle of the night and that, if he wore glasses they were no longer the coke bottle type.

[MyFriend You]

18 hours ago, Sheryl said:

Simply changing the lens is not that simple and definitely not recommended for correction of myopia.

She should have a consultation at the Thai Refractive Surgery Center (TRSC) which specializes exclusively in refractive surgery and discuss options with them.

Not everyone gets dry eye after Lasik, in fact most people do not. You were unlucky.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

18 years on after my Lazik in Rutin Eye Hospital, I still have good eyesight, but with age, cataracts are forming, very slowly, get a eye exam every year, always told "Surgery - not yet, you have time"   but am starting to experience double vision when focusing on small print, so I think I will insist on somthing next year.  I haven't had 'dry eyes' any more than normal folks do........'cept during Haboobs in Sudan  ?

[Wake Up]

3 hours ago, Arkady said:

Some spivvy get rich quick eye surgeons in places like Pattaya will do cataract surgery on patients who don't yet have cataracts, just to correct their refraction with IOLs.  But reputable surgeons in hospitals like Rutinin Eye Hospital refuse to perform unnecessary surgery, since there are risks involved in any surgery. The wide boy surgeons who will do this type of procedure are probably not the most skillful.  Therefore the risk of going with them is probably greater than with more ethical surgeons.  Although it is a relatively safe and simple procedure, you have a greater risk of detached retina after cataract surgery and during the procedure things can go wrong, such as dropping the IOL through the capsule onto the retina which can result in impaired vision. There is also a risk of infection following invasive eye surgery.  

 

I had cataract surgery in both eyes at the same time as bilateral macula hole surgery at Rutnin Eye Hospital which I highly recommend for anyone who needs surgery.  My left eye was previously long sighted but now I can drive without glasses for the first time in 30 years.  Soft focus IOLs, which allow older people to read and see distance without glasses, are not yet perfect and are still quite expensive.  In future they will undoubtedly improve and become cheaper.  It makes sense for a younger person to wait until they actually need cataract surgery and the level of correction they need for reading and distance has more or less stabilised. Otherwise you may need more surgeries in future to get the best IOLs for your vision. Also you need to go for regular follow up after cataract surgery to ensure the IOLs are still properly seated and there are no other problems. Since my cataract surgeries I have had to have laser surgery twice in my right eye and once in left eye to clear posterior capsule opacification, i.e. secondary cataract or cloudy vision. This is a complication associated with cataract surgery that is supposed to be quite rare but has already happened to me three times.

 

I would advise the OP's wife to stick with glasses, contact lenses or try lasik until she really needs cataract surgery. 

I am 58 and have cataracts and appreciate your post. The Rutnin doctor diagnosed my cataracts and told me I could have surgery now but probably should wait and get yearly check ups and do the surgery later. 

[Monkey Boy]

2 hours ago, wanderluster said:

what was the cost?

1,500 THB for initial consultation and eye check then 96,000 THB to do both eyes. Femto Lasik procedure 

[Arkady]

17 minutes ago, Wake Up said:

I am 58 and have cataracts and appreciate your post. The Rutnin doctor diagnosed my cataracts and told me I could have surgery now but probably should wait and get yearly check ups and do the surgery later. 

I think there's optimum time for both the patient and the surgeon.  Easier to remove (obliterate with ultrasound) the old lens when it's ripe but not overdone. The patient notices more benefit from the surgery when it's progress to a certain stage and it is more worthwhile taking the risk.  Cataracts usually develop quite slowly and the patient will not notice any visual impairment in the early stages. However, they progress at different rates in different people, so the surgeon might think you could last many years without needing the surgery.  The problem I had with cloudy vision needing laser surgery after the cataract procedures is much rarer when you just have cataract surgery alone and don't have a vitrectomy and gas injected into your eye.  So probably no need to worry much about that and it is easily fixed anyway.

 

Rutinin is definitely the place to go, if it is convenient for you.  It is the only specialised eye hospital in Thailand and I don't think charges any more than any other private hospital. Other hospitals might employ an ophthamologist who is only so so just to fill a slot but Rutinin only does eyes, so it is likely to be extremely picky about who it takes on.

[jackdd]

You are looking at the wrong alternative

The alternative to Lasik is not replacing the existing lense but implementing an additional lense in the eye: https://en.wikipedia.org/wiki/Phakic_intraocular_lens

So your natural lense stays where it is and it is basically like a contact lense which gets implemented in your eye

I had this surgery done about 2 years ago in Germany, don't have anything to complain about.

The main advantage is that if in the future there are other procedures, or my eye sight changes, this lense can be taken out again and replaced. What you once cut off using Lasik can not be added back again.

Other than that i now have UV protection integrated in my eyes ?

A disadvantage are the higher costs (In Germany i paid about 220k THB, but who cares about a few baht if it's something as important as your eyes...) and the surgery is a bit more risky (infection or similar) than Lasik

 

 

Edited August 12, 2018 by jackdd

[newnative]

   My partner and I both had lasik done about 5 years ago at Bangkok Hospital Pattaya.  The doctor was excellent, truly great.  After the procedure, my vision wasn't that good and I had trouble reading a newspaper without reading glasses.  He told me, try not to use reading glasses, just wait and your vision will improve.  I thought, yeah, right.  Well, he was absolutely right--it did get better and at 66 years old it is still 20/20.  Before the lasik I was struggling with bifocals, now I don't need any glasses at all.  In America I was told if I had lasik I would still need glasses--either for distance or reading, so I didn't have it done there.  My Pattaya doctor was able to give me good vision without having to use glasses.  Partner is doing good, too, with no problems.

    Recently a friend had lens replacement and he has had a lot of problems--blurry vision being the biggest one.  It's been 3 or 4 months since he had it done and I still don't think his vision is that good.  If lasik is an option, I would go with that choice first before lens replacement.

[ricklev]

6 hours ago, Expatthailover said:

22 hours ago, Sheryl said:

Simply changing the lens is not that simple and definitely not recommended for correction of myopia.

She should have a consultation at the Thai Refractive Surgery Center (TRSC) which specializes exclusively in refractive surgery and discuss options with them.

Not everyone gets dry eye after Lasik, in fact most people do not. You were unlucky.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Well it happened to me as well.

Dry eye for me as well, and just calling it dry doesn't come close to describing how uncomfortable it is. Lasted for years for me and was a serious problem but I've gotten better at living with it.  Google  lasik dry eye forum to understand the risk better.  But yeah, it doesn't happen to most people.

[atyclb]

6 hours ago, Arkady said:

7 hours ago, atyclb said:

i have zero commercial interest in any medical facility.  some interesting and fascinating historical perspective. 

 

 

LASIK surgery is already a big hit in USA, but the story behind this radical technique takes us to Bogota, capital of Colombia.

 

 

The Russians pioneered the technique before LASIK by opening up the eye to reshape the cornea with a scalpel or other cutting instrument.  They discovered the process by accident while treating car accident victims who had glass in their eyes. In the late 70s they moared a hospital ship in offshore waters opposite Larnaca in Cyprus, promoting it to tourists on shore.  I know two people who had the surgery there while on holiday, having not known about it before they went.  Both were quite pleased with it, although the full benefits were not permanent.  My former boss was one of them, formerly a life-time wearer of coke bottle glasses and contacts with -6 shortsightedness.  He eventually had to go back to wearing low powered contacts as the effects wore off but was happy that he could see enough to go the bathroom etc without glasses in the middle of the night and that, if he wore glasses they were no longer the coke bottle type.

 

 

dr fyodorov did that and is known as radial keratotomy but is was an imprecise attempt to change the refraction by creating a series of incisions.

 

irregardless fyodorov's procedure came about circa 1974.

 

barraquer's pionerring mathematical equations and initial cornea lathe reshaping procedure first researched 1948 and performed in mid 1960's

 

 

references;  https://www.ncbi.nlm.nih.gov/pubmed/22496438      https://en.wikipedia.org/wiki/Radial_keratotomy   http://sclerallens.com/rk/599-keratomileusis-by-barraquer-followed-by-rk

Edited August 12, 2018 by atyclb

[atyclb]

1 hour ago, jackdd said:

You are looking at the wrong alternative

The alternative to Lasik is not replacing the existing lense but implementing an additional lense in the eye: https://en.wikipedia.org/wiki/Phakic_intraocular_lens

So your natural lense stays where it is and it is basically like a contact lense which gets implemented in your eye

I had this surgery done about 2 years ago in Germany, don't have anything to complain about.

The main advantage is that if in the future there are other procedures, or my eye sight changes, this lense can be taken out again and replaced. What you once cut off using Lasik can not be added back again.

Other than that i now have UV protection integrated in my eyes ?

A disadvantage are the higher costs (In Germany i paid about 220k THB, but who cares about a few baht if it's something as important as your eyes...) and the surgery is a bit more risky (infection or similar) than Lasik

 

 

 

 

it would seem that procedure is also a good option for those with corneal thickness not sufficient for lasik.  really need info as refraction, best corrected and uncorrected vision, corneal thickness,retinal condition, etc prior to knowing what are viable options.