Lasik v. replacement lens?

[cheeryble]

On August 19, 2018 at 11:39 AM, clokwise said:

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!

As Ive mentioned my pal who had a simple lens and a multifocal wishes he'd had simple lens both sides .....very much cheaper too tho yes that's secondary.

[Arkady]

I read somewhere that having lasik places limitations on the types of multifocal IOLs that can be implanted when you later need cataract surgery, or makes them less effective.  Has anyone heard anything about this?

[atyclb]

20 hours ago, Arkady said:

I read somewhere that having lasik places limitations on the types of multifocal IOLs that can be implanted when you later need cataract surgery, or makes them less effective.  Has anyone heard anything about this?

https://crstodayeurope.com/articles/2017-jun/multifocal-and-trifocal-lenses-in-post-lasik-eyes/

 

https://crstoday.com/articles/2011-aug/my-most-difficult-case-incorrect-iol-power/

[luk AJ]

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.  

It is possible to get rid of these floaters using laser or as in my case they suck out the fluid from the eye ball, filter it and inject again. No fun but very effective.


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[Sheryl]

I read somewhere that having lasik places limitations on the types of multifocal IOLs that can be implanted when you later need cataract surgery, or makes them less effective.  Has anyone heard anything about this?

I recently looked into this as I had Lasik 18 years ago and have cataracts now though not yet needing surgery.

 

The main issue is that the surgeon needs to have the exact measurements of your eyes prior to Lasik, especially the corneal power. So get that data now from your Lasik provider - even if you don't have cataracts now, you likely will sooner or later and you don't want it to be when your Lasik provider has gone out of business or otherwise no longer able to locate your records.  If newly getting Lasik, get that information and store it for future use.

 

It is also advisable to have the cataract procedure done by an opthalmoligist experienced in doing so on Lasik patients. Dr. Roy at Rutnin is one such.

 

 

[Arkady]

5 hours ago, Sheryl said:

I recently looked into this as I had Lasik 18 years ago and have cataracts now though not yet needing surgery.

 

The main issue is that the surgeon needs to have the exact measurements of your eyes prior to Lasik, especially the corneal power. So get that data now from your Lasik provider - even if you don't have cataracts now, you likely will sooner or later and you don't want it to be when your Lasik provider has gone out of business or otherwise no longer able to locate your records.  If newly getting Lasik, get that information and store it for future use.

 

It is also advisable to have the cataract procedure done by an opthalmoligist experienced in doing so on Lasik patients. Dr. Roy at Rutnin is one such.

 

 

 

Thanks a lot for that.  That was exactly the information I wanted for my own wife who is also contemplating Lasik for her near sightedness.

 

I fully endorse Dr Roy.  He did my macular hole and cataract surgery in  both eyes which were an hour and a half procedures.  A very knowledgeable and competent surgeon.  He told me about the Jetrea injections for macular hole which were not yet approved by the Thai FDA at the time and which he personally thought would not be a reliable option, just so I could know there was another option to surgery I could have overseas, if I wanted to look into it.  I did look into it and found a top surgeon at Moorfields Eye Hospital who concurred 100% with Dr Roy's approach to my case and and also declined to use Jetrea, which was already in use in the UK. He said his only experience with Jetrea was operating on patients who had been unsuccessfully treated with it by other surgeons (who often exaggerated the benefits).  Probably treatment with Jetrea or other injectable drugs will be refined enough in future that certain types of retina surgery will no longer be needed but it seems that more work is needed.   Perhaps Dr Roy wouldn't have mentioned Jetrea to patients who would have been confused by additional options but he knew I had an interest in researching my eye condition and had already seen specialists overseas about it.

[wpcoe]

On 8/20/2018 at 9:55 PM, luk AJ said:

It is possible to get rid of these floaters using laser or as in my case they suck out the fluid from the eye ball, filter it and inject again. No fun but very effective.

Oh, that's interesting.  I need to check into that since as I've aged, the floaters seem to be more plentiful.  The surgery I'm eventually going to have does require the temporary removal of the vitreous fluid in the eye.  I need to see if they can "filter it" before they put it back in.

 

I hear you about the "no fun" part.  I'm squeamish about my eyes.  I hope to be heavily sedated when they do this!

[atyclb]

1 hour ago, wpcoe said:

Oh, that's interesting.  I need to check into that since as I've aged, the floaters seem to be more plentiful.  The surgery I'm eventually going to have does require the temporary removal of the vitreous fluid in the eye.  I need to see if they can "filter it" before they put it back in.

 

I hear you about the "no fun" part.  I'm squeamish about my eyes.  I hope to be heavily sedated when they do this!

 

normally the vitreous fluid is removed and replaced with a saline solution resembling vitreous so in essence the eye assumedly will modify over time to make it vitreous (my educated guess as a non ophthalmologist) 

[GarryP]

How about in a case like mine? I am now long sighted and started wearing glasses about 7 or 8 years ago  when I turned 46 or 47 for reading, using my computer and other close up stuff.  I am forever putting on and taking off my glasses and wonder whether Lasik would allow me to do away with glasses. Since I started using glasses my eyesight hasn't got much worse so has probably stabilized. 

 

One of the staff in my office has worn glasses since she was small, not being able to see far or close up clearly, but now everything is very clear for her. She wishes she hadn't waited so long. She had it done at Bangkok Metropolitan Administration Hospital a.k.a Klang Hospital.  On the other hand one of the bosses had it done about 10 years ago and suffers from dry eyes.

[Sheryl]

22 hours ago, GarryP said:

How about in a case like mine? I am now long sighted and started wearing glasses about 7 or 8 years ago  when I turned 46 or 47 for reading, using my computer and other close up stuff.  I am forever putting on and taking off my glasses and wonder whether Lasik would allow me to do away with glasses. Since I started using glasses my eyesight hasn't got much worse so has probably stabilized. 

 

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

 

describes the options

[GarryP]

Just now, Sheryl said:

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

 

describes the options

Thanks for the link. Much appreciated. I did not realize there were so many options.

 

I have already done a bit of reading on the topic but was hoping a poster or posters who have had it done for the same reasons could chip in.

 

In any case,  I obviously need to do a lot more research and your link is a great starting point.   

[Sheryl]

While not done for far-sightedness (I was myopic), I had monovision Lasik and love it. 20 years on, still don't need reading glasses. Monovision Lasik (or NearVision Lasik if the far-sightedness is only for reading) is probably the most readily available procedure in Thailand.

 

But not everyone adjusts to it. A good idea for anyone considering monovision is to test it by wearing a contact lens in the eye planned for under correction (eye doc can provide) and give it a week or so. that way you can experience what it will be like first before deciding to go ahead with surgery.

[mogandave]

While not done for far-sightedness (I was myopic), I had monovision Lasik and love it. 20 years on, still don't need reading glasses. Monovision Lasik (or NearVision Lasik if the far-sightedness is only for reading) is probably the most readily available procedure in Thailand.
 
But not everyone adjusts to it. A good idea for anyone considering monovision is to test it by wearing a contact lens in the eye planned for under correction (eye doc can provide) and give it a week or so. that way you can experience what it will be like first before deciding to go ahead with surgery.

So they do Lasik on one eye for reading and do nothing to the other?

[Sheryl]

1 hour ago, mogandave said:

 

So they do Lasik on one eye for reading and do nothing to the other?

 

Depends on whether there is presbyopia (far sightedness) or only trouble with accommodation (the seeming far sightedness that comes with age - in which case the problem is only for reading).

 

In the first instance they will do Lasik on both eyes but intentionally  leave one myopic while aiming for 20/20 in the other. In the second case they will do just 1 eye to render it myopic.

[mogandave]

I’d like to get rid of my readers...

Just old eyes...

[James2020]

37 minutes ago, Sheryl said:

Depends on whether there is presbyopia (far sightedness) or only trouble with accommodation (the seeming far sightedness that comes with age - in which case the problem is only for reading).

 

In the first instance they will do Lasik on both eyes but intentionally  leave one myopic while aiming for 20/20 in the other. In the second case they will do just 1 eye to render it myopic.

Sheryl is correct, although presbyopia is the problem with accommodation that happens to everyone at about age 45, whereas farsightedness (hyperopia) can occur at any age. Myopia and astigmatism are the other conditions people can have.  The link has very good information.  I had monovision lasik also, in 2001, and only recently started to wear reading glasses for some things.  I wore contact lenses before that, so I had first hand experience about monovision.  Any type of surgery is not to be taken lightly though, and there are reasons why some countries have not approved some types of presbyopia surgery yet.  

[Arkady]

2 hours ago, James2020 said:

Sheryl is correct, although presbyopia is the problem with accommodation that happens to everyone at about age 45, whereas farsightedness (hyperopia) can occur at any age. Myopia and astigmatism are the other conditions people can have.  The link has very good information.  I had monovision lasik also, in 2001, and only recently started to wear reading glasses for some things.  I wore contact lenses before that, so I had first hand experience about monovision.  Any type of surgery is not to be taken lightly though, and there are reasons why some countries have not approved some types of presbyopia surgery yet.  

 

My brother had his eyes set up like that with lasik (one for reading and the other for distance) 20 years ago and he is still happy with it.  If your eyes are both exactly the same and equally good, it is an option worth exploring.  If your eyes are not exactly the same, it is not likely to be a good solution. I had one eye far sighted about +175 with astigmatism and the other needed no correction for distance or astigmatism.  After cataract surgery they are both now similar but the one that had good distance vision is a strongly dominant eye.  Despite the cataract surgery I know I could not rely on my non-dominant eye either for distance or reading.  I need to have my dominant eye available for both with the other one helping. 

[James2020]

6 hours ago, Arkady said:

 

My brother had his eyes set up like that with lasik (one for reading and the other for distance) 20 years ago and he is still happy with it.  If your eyes are both exactly the same and equally good, it is an option worth exploring.  If your eyes are not exactly the same, it is not likely to be a good solution. I had one eye far sighted about +175 with astigmatism and the other needed no correction for distance or astigmatism.  After cataract surgery they are both now similar but the one that had good distance vision is a strongly dominant eye.  Despite the cataract surgery I know I could not rely on my non-dominant eye either for distance or reading.  I need to have my dominant eye available for both with the other one helping. 

Not quite true - best to see an ophthalmologist about it... it can get complicated...

[Thomas J]

I had lasik done in Canada over 20 years ago.  I can tell you I would never do it had I known all of the ramifications.  First, yes my distance vision and astigmatism was immediately cured.  However, though I had to use single vision glasses occasionally for activities like driving, my close up vision was compromised so I needed reading glasses and that means I had them hanging from my shirt all of the time.  Now I am 70 and guess what, your vision changes.  Mine has actually "improved".  It has now been found out that your vision often changes back regressing to what it once was.  It is often referred to as "second sight"  That means I am now over corrected and I am back to blurry.  Since I have had Lasik the new multi-focal contacts won't work since my cornea has been altered.  The Lasik also makes fitting for cataract replacement lenses more challenging.  If I had it to do over again, I would have stuck with mono-vision wearing one contact for distance and the other for close up. 

[Sheryl]

It is also possible to do mono vision with Lasik, intentionally under correcting one eye. That' what I did and 20 years later still managing without reading glasses.

But of course no guarantee.

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[atyclb]

1 hour ago, Thomas J said:

I had lasik done in Canada over 20 years ago.  I can tell you I would never do it had I known all of the ramifications.  First, yes my distance vision and astigmatism was immediately cured.  However, though I had to use single vision glasses occasionally for activities like driving, my close up vision was compromised so I needed reading glasses and that means I had them hanging from my shirt all of the time.  Now I am 70 and guess what, your vision changes.  Mine has actually "improved".  It has now been found out that your vision often changes back regressing to what it once was.  It is often referred to as "second sight"  That means I am now over corrected and I am back to blurry.  Since I have had Lasik the new multi-focal contacts won't work since my cornea has been altered.  The Lasik also makes fitting for cataract replacement lenses more challenging.  If I had it to do over again, I would have stuck with mono-vision wearing one contact for distance and the other for close up. 

 

the informed consent should/would have listed regression among the other issues you cite as it was well known even 20 years ago. were you not offered monovision lasik option? which should be simulated with a lens before committing surgically 

[Arkady]

3 hours ago, Thomas J said:

I had lasik done in Canada over 20 years ago.  I can tell you I would never do it had I known all of the ramifications.  First, yes my distance vision and astigmatism was immediately cured.  However, though I had to use single vision glasses occasionally for activities like driving, my close up vision was compromised so I needed reading glasses and that means I had them hanging from my shirt all of the time.  Now I am 70 and guess what, your vision changes.  Mine has actually "improved".  It has now been found out that your vision often changes back regressing to what it once was.  It is often referred to as "second sight"  That means I am now over corrected and I am back to blurry.  Since I have had Lasik the new multi-focal contacts won't work since my cornea has been altered.  The Lasik also makes fitting for cataract replacement lenses more challenging.  If I had it to do over again, I would have stuck with mono-vision wearing one contact for distance and the other for close up. 

It is apparently quite common for short sighted eyes to improve with age due to presbyopia. I had an eye that became slightly short sighted (-25 to -50). As time went on it went back to 20/20 for distance vision but reading vision deteriorated.