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Laser Eye Surgery

For $1500 they were probably getting standard LASIK as opposed to wavefront-guided LASIK. This is ok for people with comparatively thick corneas and weak prescriptions... but wouldn't have been the best choice for me for example.

However $5400 is a bit on the pricey side. I paid $3980 for the same procedure as TheProfessor, however I had my flap made using a microkeratome instead of the IntraLASE laser. (It actually makes no difference whatsoever... it's just a matter of preference). I also get a lifetime guarantee and all follow-up appointments are included.

As for one clinic being better than another, most of the "opinions" you hear are based on nothing. I went to YELC, bochner, herzig, lasikmd, etc etc. They all recommended wavefront-lasik. In many cases they are using the exact same laser to perform the surgery. So how is one place "better" than another? Really in that case it comes down to the doctor performing the surgery. However bear in mind all the doctors at all the clinics had performed over 10,000 surgeries. So ultimately, it probably would have made no difference whatsoever which clinic I chose. So I just chose based on price and convenience.
 
One place can be better than another based on a variety of factors, not the least of which is customer service, price, technology, experience etc. At the end of the day go to a place that makes you comfortable. Just make sure to do some homework on the differences between types of surgery (PRK, LASIK, and custom LASIK), etc.
 
TheProfessor said:
One place can be better than another based on a variety of factors, not the least of which is customer service, price, technology, experience etc. At the end of the day go to a place that makes you comfortable. Just make sure to do some homework on the differences between types of surgery (PRK, LASIK, and custom LASIK), etc.
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Yes and I already discussed those relevant factors - tehcnology and experience. Nearly every reputable clinic these days is using a wavefront-guided laser... and many in Ontario are using identical ones. And again, all the doctors at all the clinics I went to had performed over 10,000 surgeries each. If you feel like paying an extra couple of thousand for 'experience' then I suppose that is your choice.

This is a guess, but I'd say for $1500 your friends are likely having the flaps cut using a blade....considered to be inferior technology now (and actually for quite some time).
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I'm afraid you've been grossly misinformed. Seems to me that your 'research' is based entirely on what one clinic was trying to sell you. When IntraLASE was first introduced several years ago, it was able to create a slightly smaller flap than microkeratome's at the time (what you're refering to as a 'blade'). The difference was about 10-20 microns.

Now-a-days, with modern microkeratome technology, the flap created using this 'blade' is about the exact same size as a flap created with an intralase laser. In fact there are many doctors who recommend the microkeratome over intralase because they are more reliable. Ultimately, there is virtually no difference. The only reason these days people choose intralase over the microkeratome is because they're not comfortable with a blade touching their eye. The doctor who performed my surgery for example was certified to use the intralase laser, and there was one at the clinic, but most clients decided to go without... because there's really no advantage to it.

In a report published as a supplement to the November/December 2004 issue of Cataract and Refractive Surgery Today, studies showed that there were no significant differences in visual acuity and instances of higher order aberrations between eyes with IntraLase created flaps and eyes with flaps created by the Hansatome microkeratome manufactured by Bausch & Lomb. In addition to not offering any statistically better outcomes, the report showed that IntraLase introduced its own possible complications including photophobia, inflammation, and a less-than-smooth stromal bed (the part of the cornea exposed after flap creation).
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Anyway to those reading this thread, this is a good example of why it's good to do your own research. Advice based solely on "my friend said" or is generally useless.
 
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Gei,

You are correct that I was informed that intralase was superior to the microkeratome, but not by just one doctor/centre but all doctors/centres I visited (four in Toronto plus one in Ottawa). The ones considered to have the 'best' reputations in Toronto only offered intralase whilst the others generally offered both, though typically charged a premium for intralase as they felt it to be superior.

You suggest a person should do their own research (which I fully support as I mentioned once already above), however should that research not include the information presented by highly respected/experienced doctors in this field? Are you suggesting that if a doctor who has performed over 10,000 surgeries (or over 80,000 in my doctor's case) suggests intralase is superior they are incorrect and should instead trust research comprised heavily of information gathered from online forums?
 
TheProfessor said:
Gei,

You are correct that I was informed that intralase was superior to the microkeratome, but not by just one doctor/centre but all doctors/centres I visited (four in Toronto plus one in Ottawa). The ones considered to have the 'best' reputations in Toronto only offered intralase whilst the others generally offered both, though typically charged a premium for intralase as they felt it to be superior.

You suggest a person should do their own research (which I fully support as I mentioned once already above), however should that research not include the information presented by highly respected/experienced doctors in this field? Are you suggesting that if a doctor who has performed over 10,000 surgeries (or over 80,000 in my doctor's case) suggests intralase is superior they are incorrect and should instead trust research comprised heavily of information gathered from online forums?
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I'm not suggesting these "highly respected" doctors are incorrect. However the problem is that laser eye surgery is a business... and ultimately they are just trying to sell you something.

I agree that clinics that ONLY offer intralase do seem to suggest it is superior... is that surprising? Microkeratome technology improves every year... and I doubt the doctors that don't use them are at all familiar with the latest ones. I only went to one clinic that offered both microkeratome and intralase, and all the doctors there suggested that there was virtually no difference in the outcome. The particular doctor I spoke to had also performed over 50,000 surgeries.

And the information I quoted above comes from a published study... so I would hardly call it information gathered from online forums. And unlike the doctors who gave you your information, the ones who conducted the study were not trying to sell anyone anything.
 
Well the problem with information presented such as the journal article you referenced is that there is a plethora of them endorsing both sides of the argument. For instance, the following is a study that was conducted in the same year as the one you referenced (2004) and presented in the "Review of Ophthalmology" publication:

Kansas City, Mo., surgeon Dan Durrie, MD, says Intralase has proven its worth both in terms of flap quality and outcomes.

“You can control things with the femtosecond laser that you can’t with a microkeratome,†he says. “You can control the depth, the diameter and the position of the flap relative to the treatment zone, and you really can’t control these as precisely with a microkeratome. So, the original things that people were pushing the Intralase for, such as preventing buttonholes, incomplete flaps and epithelial defects, and enabling surgeons to control the depth better, those have proven to be true. But a lot of people, myself included, said, ‘So what? Does that translate into better quality vision?’ Now, the data is starting to be pretty convincing that it’s at least as good, if not better, than a keratome in terms of quality of vision postop.â€

As evidence, Dr. Durrie offers a prospective, randomized comparative study he performed, in which 51 patients (102 eyes) received Alcon CustomCornea LASIK in both eyes. The flap of one eye of each patient was created with the Intralase and the other flap was made with a mechanical microkeratome (Hansatome, Bausch & Lomb). The patients’ average error was -4.11 D (range: -0.75 D to -7.38 D), and average cylinder was 0.46 D. (The six-month uncorrected vision results appear in Figure 1.)

“The longer we followed the eyes,†says Dr. Durrie, “it became obvious at one day, one week, and now at three and six months, that the Intralase eyes had a better quality of vision in terms of contrast sensitivity, uncorrected visual acuity and improvement of lines of best-corrected visual acuity. The Intralase was also better in terms of patients whose uncorrected vision postop was better than their best-corrected vision preop.†There were no complications in either group. Dr. Durrie says he now only uses a keratome for patients who might not be good candidates for Intralase flaps due to corneal opacities.
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Anyways, I'm sure we could go at this for quite some time, but if I'm correct we both agree that the surgery was worth it, and anyone considering it should do their homework. If you want, I can chime in on the thread over at RFD :)
 
gei said:
However $5400 is a bit on the pricey side. I paid $3980 for the same procedure as TheProfessor, however I had my flap made using a microkeratome instead of the IntraLASE laser. (It actually makes no difference whatsoever... it's just a matter of preference). I also get a lifetime guarantee and all follow-up appointments are included.
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What do you get with a 'lifetime guarantee'? If your eyes worsen after the surgery, will they fix them again?
 
Yes, essentially they offer what is called 'touch ups'. If your eyes worsen, they can perform another surgery to correct them. Dr. Stein told me however, that regardless of which method of surgery a person gets initially (PRK vs. LASIK), the touch up is always PRK.
 
As mentioned earlier, people with stronger prescriptions tend to have a higher chance of regression. For example, in my case with a -6.5 prescription in both eyes, I have a 15-20% chance of regression. So if my eyes happened to regress I would get another LASIK procedure for free to correct it (if I wanted).

However TheProfessor (don't mean to argue again), but my touch-up would certainly NOT be done with PRK. In fact since there would be so little corneal tissue to remove with a touch-up surgery (most it would regress to is -1 or so).. you would be an even better candidate for LASIK. I've never heard of a person getting their touch-up done with PRK when their original surgery was LASIK.. unless there was some sort of complication that prevented a flap from being created again.

Your case may be unique in that you may have had thin corneas to begin with, and your doctor may not recommend removing any more after your first LASIK surgery, however in the vase majority of cases, touch-ups are NOT PRK.
 
Wow, again both my surgeon and eye doctor both told me that follow up procedures are always PRK since they never want to risk cutting a flap twice. As you said though, this could be for my eyes only.
 
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Having a touch-up surgery is a pretty common thing... and I know many people who have had it done (at many different clinics). None of them had PRK the second time around. PRK is an entirely different procedure... and the recovery is long and painful (for example you wouldn't be able to drive for at least a week). If I had to have PRK the second time around I would probably think long and hard about doing it.

That being said, if two different doctors told you that... it probably had to do with your corneal thickness. If your corneas were significantly thinner than average then they probably just didn't want to create the flap twice and risk removing too much corneal tissue. To be honest if that was the case I'm curious why they wouldn't have explained it to you in greater detail in the first place...
 
I'm aware of the differences between LASIK and PRK, and both Dr. Herzig and Dr. Stein informed me that all touch-ups would be done via PRK, regardless of the fact that my initial surgery was done via LASIK. Herzig did mention that my cornea's were slightly asymmetrical, but nothing that would impact the surgery in any way. Both doctors confirmed that I was well within the allowable limits to have a flap cut. Coincidentally, my brother was also told that PRK was the only option for touch ups by Focus Eye Centre in Ottawa.

Just goes to show you, there's a lot of conflicting information out there.


Edit: Just did a bit of online research (taken with a grain of salt) and it definitely appears to be possible to have LASIK done twice, but as Gei mentioned it is based upon the thickness of the corneas and the overall health of the eye. If a cornera is not thick, most surgeons will prefer the patient have a touch up via PRK.
 
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TheProfessor said:
This is a guess, but I'd say for $1500 your friends are likely having the flaps cut using a blade....considered to be inferior technology now (and actually for quite some time). They are also not likely getting custom lasik, but rather a one size fits all correction. Call me crazy, but I wasn't going to skimp when it came time to have my only eyes worked on :) As has also been stated above, all of my follow up appointments, medications, etc. are included at that price whereas with the cheaper places those are all out of pocket expenses.
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I agree with TheProfessor. Having permanent surgery performed on your eyes is one thing you don't want to cheap out on. Unless there's a premium for the doctor's reputation but an identical procedure can be done elsewhere for less by a less known but competent surgeon, I would go with the more expensive option.
 
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