Lasik v. replacement lens?

[atyclb]

7 hours ago, Arkady said:

The Russians pioneered the technique before LASIK by opening up the eye to reshape the cornea with a scalpel or other cutting instrument. 

 

 

fyodorov did not open up the eye. he made direct incisions into the cornea in an attempt the refraction would change based upon where he made the cuts. a rather imprecise surgery.

Edited August 12, 2018 by atyclb

[Sheryl]

8 hours ago, jerry921 said:

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....

 

 

Used to be the case but no longer so. I was  -12 so had to wait a number of years before surgery was possible. Lasik in 2000 at TRSC and still perfcct vision in one eye, a little undercorrected in the other which is great as I have thus far been able to avoid reading glasses.

[atyclb]

2 hours ago, Sheryl said:

Used to be the case but no longer so. I was  -12 so had to wait a number of years before surgery was possible. Lasik in 2000 at TRSC and still perfcct vision in one eye, a little undercorrected in the other which is great as I have thus far been able to avoid reading glasses.

apparently you had adequate corneal thickness. a myopic eye is still a myopic eye physiologically despite the lasik refractive correction and subjetc to all the usual precautions and evaluations.

[jerry921]

On 8/12/2018 at 12:52 PM, atyclb said:

apparently you had adequate corneal thickness. a myopic eye is still a myopic eye physiologically despite the lasik refractive correction and subjetc to all the usual precautions and evaluations.

Related to the OP, but my case also - can you still have lasik after you've had lens replacement to "fine tune" your vision if the lens replacement leaves you a little too near-sighted?

 

 

[NYGuy816]

My mom had Lasik and it was quite life-changing for her. Made things more convenient for her plus the migraines are all gone. I guess the dry eye thing happens from time to time though not a major nuisance for her. 

[James2020]

6 hours ago, jerry921 said:

Related to the OP, but my case also - can you still have lasik after you've had lens replacement to "fine tune" your vision if the lens replacement leaves you a little too near-sighted?

 

 

Yes, but it depends on what you mean by "fine tune".   Many patients are left with a small refractive error that they live with quite well, whether they've had lasik or lens replacement.  A little myopic is a good place to be for most patients.  Remember, it's still surgery, and the risk of complications is not zero, no matter who performs the operation.  If you're the compulsive type, looking for a 'perfect' result, you might be disappointed.  In the business of refractive surgery, we have the concept of '20-happy'.  It means that while one person is very happy with 20/30 vision without glasses, another might be unhappy with 20/20 -1 vision.  We try to not operate on the latter group - who wants a patient speaking ill of a surgeon when the result is perfectly acceptable for most patients?  Results are a Bell curve, and while most patients are happy, there are always a few outliers.  The best surgeons keep their personal Bell curve within a narrow range and choose their patients carefully.

[cheeryble]

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.   

Very interesting thank u staiht from the horse's mouth.



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[cheeryble]

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!!!

As I said my pal had lens replacement onsimple and one multi foca, and is much happier with the simple lens......which happened to be a lot cheaper haha


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[cheeryble]

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.

 

 

You might try cleaning the meibonian glands on the lower eyelid for dryness. Google.


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[cheeryble]

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.
 
 

If 350k was for lens replacement only it sounds like a zero too many.
You could have had a heart bypass.


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[cheeryble]

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.
 

Wife nearly 40


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[Tocher]

47 minutes ago, cheeryble said:

If 350k was for lens replacement only it sounds like a zero too many.
You could have had a heart bypass.


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Both procedures were for repair of detached retina and lens replacement.

 

One was done at Rutnin (under local anesthetic) the other  a year later at Bangkok Hospital, Pattaya (under general anesthetic) BUPA paid the bill both times and they are not in the business of allowing overcharge.

 

Correct number of zeros.

 

[atyclb]

12 minutes ago, Tocher said:

1 hour ago, cheeryble said:

If 350k was for lens replacement only it sounds like a zero too many.
You could have had a heart bypass.


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Both procedures were for repair of detached retina and lens replacement.

 

One was done at Rutnin (under local anesthetic) the other  a year later at Bangkok Hospital, Pattaya (under general anesthetic) BUPA paid the bill both times and they are not in the business of allowing overcharge.

 

Correct number of zeros.

 

 

that seems to be what it would cost if done in one of the priciest countries for medical care, us & a

 

According to AllAboutVision.com's 2012 report, the average, basic cataract surgery in the US would cost roughly $3,429 per eye if you paid everything yourself. If you wanted an advanced technology lens which corrects astigmatism or presbyopia, expect to pay an additional $449 or $895 per eye.Jul 6, 2014

Edited August 17, 2018 by atyclb

[mogandave]

 
 
that seems to be what it would cost if done in one of the priciest countries for medical care, us & a
 
According to AllAboutVision.com's 2012 report, the average, basic cataract surgery in the US would cost roughly $3,429 per eye if you paid everything yourself. If you wanted an advanced technology lens which corrects astigmatism or presbyopia, expect to pay an additional $449 or $895 per eye.Jul 6, 2014

Actually, the cost of elective procedures in the US are generally pretty cost effective.

[Arkady]

On 8/12/2018 at 11:16 AM, Tocher said:

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.

 

I paid a total of B340,000 for cataract surgery along with vitrectomy and macular hole repair in both eyes at Rutnin.  I thought the cost was reasonable as macular hole repair is a delicate procedure that can easily be messed up, involving peeling 2-6 microns of membrane from the central part of the retina. AXA PPP covered all costs.  Results from all parts of the procedures have been good, I am glad to say.  I don't know what it would have cost in the West but an OCT retina scan and a consultation with a top retina specialist at Moorfields Eye Hospital in London cost me GBP 250, whereas the same thing at Rutnin was B5,300.  Both my British and Thai retina specialists are world class in my opinion.  I don't know if the same differential exists with surgery fees.

[atyclb]

4 hours ago, mogandave said:

10 hours ago, atyclb said:

 
 
that seems to be what it would cost if done in one of the priciest countries for medical care, us & a
 
According to AllAboutVision.com's 2012 report, the average, basic cataract surgery in the US would cost roughly $3,429 per eye if you paid everything yourself. If you wanted an advanced technology lens which corrects astigmatism or presbyopia, expect to pay an additional $449 or $895 per eye.Jul 6, 2014

 

Actually, the cost of elective procedures in the US are generally pretty cost effective.

 

 

 

news to me

[yankee99]

18 minutes ago, atyclb said:

 

 

news to me

lasik is much cheaper in the USA.. 

[atyclb]

13 hours ago, yankee99 said:

13 hours ago, atyclb said:

 

 

news to me

lasik is much cheaper in the USA.. 

 

"

The average cost of LASIK surgery performed the United States in 2017 was $2,088 per eye, according to a report prepared for All About Vision by a leading vision care industry analytics company. This is slightly higher than the average price for LASIK performed in the U.S. in 2016, which was $2,059 per eye.Jun 13, 2018"

 

https://www.allaboutvision.com/visionsurgery/cost.htm

[yankee99]

7 hours ago, atyclb said:

 

"

The average cost of LASIK surgery performed the United States in 2017 was $2,088 per eye, according to a report prepared for All About Vision by a leading vision care industry analytics company. This is slightly higher than the average price for LASIK performed in the U.S. in 2016, which was $2,059 per eye.Jun 13, 2018"

 

https://www.allaboutvision.com/visionsurgery/cost.htm

these guys start at $250 per eye

 

https://www.lasikplus.com/procedures/lasik

 

I paid 300 per eye but that was 20 years ago

[atyclb]

3 hours ago, yankee99 said:

these guys start at $250 per eye

 

https://www.lasikplus.com/procedures/lasik

 

I paid 300 per eye but that was 20 years ago

 

 

interesting site.  seeing the following is most definitely a RED FLAG for medical care;  hurry,  limited time offer .  in addition just out of curiosity i looked at one of their surgeons,  Jessica Fleishman, MD . and googled a bit. lasik plus claims more than 46000 procedures . seems to have been doing lasik there since 1993.  46000 divided by 15 years = more than 3000 per year. thats a very high number. its not uncommon to exaggerate in lasik marketing as its perceived as a goldmine.  also they are in 28 states, sort of like a mcdonalds of lasik.  maybe they have good results but the "hurry limited time offer wording to mean means NO. 

 

Special Offer

LASIK starting as low as $250!♥

Hurry! Limited Time Offer!

Schedule Today!

 

LASIK Starts at $695/eye for Members of Most Major Insurance Plans.

[Sheryl]

I paid about 1000, 18 years ago. (In Thailand). That was going to the very best; it was done by the US trained doctor who was first to do it in Thailand and had more experience han anyone else.

 

I DO NOT recommend doing this on the cheap. Nor having it done by anyone who pushes you to have it, makes excessive claims or guarantees, or does not clearly explain all possible complications and risks.

 

 

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[James2020]

19 hours ago, atyclb said:

 

"

The average cost of LASIK surgery performed the United States in 2017 was $2,088 per eye, according to a report prepared for All About Vision by a leading vision care industry analytics company. This is slightly higher than the average price for LASIK performed in the U.S. in 2016, which was $2,059 per eye.Jun 13, 2018"

 

https://www.allaboutvision.com/visionsurgery/cost.htm

About $2000 per eye is average in the US.  If you want to do it as cheaply as possible, you can get the cost down to about $1000 per eye, but I also know where there's a great deal on parachutes...  I really doubt that anyone gets lasik for $250 per eye.  It costs that much to turn on the laser (the company that manufactures it gets a cut).  Maybe this company buys its equipment in bulk, has a special deal with the manufacturer, buys all of its lasers in another country, etc?  Also they typically offer the cheapest price to less than -2.00 diopter myopes (who you could argue don't need lasik anyway), and charge extra for higher myopes, astigmatism correction, re-do's, pre-op work-ups, etc.  They hire young doctors just out of training, who have little experience.  The large numbers that they have done are cumulative numbers, not for individual doctors.  It can work though for some who would not have it done otherwise due to cost, but I would stay away if you can afford to pay the average.

[atyclb]

13 hours ago, Sheryl said:

I paid about 1000, 18 years ago. (In Thailand). That was going to the very best; it was done by the US trained doctor who was first to do it in Thailand and had more experience han anyone else.

 

I DO NOT recommend doing this on the cheap. Nor having it done by anyone who pushes you to have it, makes excessive claims or guarantees, or does not clearly explain all possible complications and risks.

 

 

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 18 years ago US trained in LASIK was not an advantage. Additionally as the thai fda follows us fda approvals likely the excimer laser technology used at that time was probably legacy, eg; no eye tracker, etc etc

Edited August 19, 2018 by atyclb

[clokwise]

Had LASIK done in Vancouver Canada in 2000. I'm not Canadian but at that time (and maybe still today) there were newer procedures available in Canada which were not available in the USA due to FDA regulations. Doctor had already done over 14,000 eyes at that time! Came out with perfect vision, but some dry eye from time to time. Unfortunately old age has set in, and I now need reading glasses and I have early cataracts. I'm anticipating getting my lenses replaced in 5 to 10 years. There is a new "bionic" lens which has nearly completed clinical trials which will apparently give better than 20/20 vision. I'm waiting for that!

[wpcoe]

On 8/16/2018 at 10:04 PM, Tocher said:

Both procedures were for repair of detached retina and lens replacement.

 

One was done at Rutnin (under local anesthetic) the other  a year later at Bangkok Hospital, Pattaya (under general anesthetic) BUPA paid the bill both times and they are not in the business of allowing overcharge.

 

Correct number of zeros.

 

 

That caught my eye.  Does BUPA cover traditional cataract surgery as well?  (I'm overseas now on an extended visit, and my BUPA policy is back in a drawer in Thailand, so thought I'd ask now while I remembered.)

[Sheryl]

All insurers (assuming regular health insurance not an accident only policy) that I know of cover cataract surgery. This includes cataract surgery done as a n outpatient and policies that are inpatient only -- it is considered a day patient case.

The big exception would be if the cataract pre-existed getting the pilicy. Cataracts take years to progress to the point of requiring surgery so if for example you got the policy just a year ago they might question it.

Policy might limit the type of lens implant it will cover though, either specifically (i.e. traditional lens only) or by the maximum amount they will reimburse for that procedure. Depending on your polucy there may be a schedule limiting reimbursement according to type of surgery.

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[wpcoe]

Thanks, Sheryl.  That's good to know.

 

I'm going to stretch the bounds a bit a see if they cover corrective surgery to remove an epiretinal membrane.  The doctor said we should discuss doing a cataract (lens replacement) surgery at the same time, since my cornea might be weakened from RK surgery and we could avoid disturbing (stressing?) the cornea twice, (or something like that.)  Since these are both outpatient procedures it never occurred to me that BUPA would cover either/both of them.

[Sheryl]

Check your policy. If it includes day surgery, they should.

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[GinBoy2]

Since I've worn daily contacts for 20 years, I've thought many times that the $2K an eye in hindsight sounds like a bargain

[simon43]

I had Lasik surgery about 15 years ago at a top hospital in the UK. I was extremely short-sighted (-12 in each eye), totally unable to function without 'goldfish bowl' glasses or contact lenses.  I had been short-sighted since 5 years old.

 

I opted for the very best treatment, since these were my eyes!  The doctor said that since so much correction would be necessary, he could not guarantee a 100% positive result.  He would treat one eye and then wait a few weeks to see the result.  The cost was about 2,000 GBP per eye.

 

The 2 operations were a total success!

 

For me, close to being registered-blind, this was a LIFE-CHANGING operation ?

 

Since then, I have had no problems at all with my eyes, no dryness etc.

 

But remember that this is an operation on your eyes - don't cut corners on the doctor's skill and experience!