The WaveLight Allegretto laser is a flying spot laser that has had the
ablation profile optimized with wavefront data. In the laboratory as
the laser was being developed the technicians and doctors used
wavefront diagnostics to determine the best static map for the removal
of corneal tissue.

The Visx S4 CustomVue, the Alcon LADARVision 4000 Custom Cornea, and
the Bausch & Lomb Technolas 217z Zyoptix lasers are custom wavefront.
Each patient's individual wavefront diagnostic is used to create a
customized ablation map.

Outside the United States, the Allegretto is available in a fully
custom mode.

Although the Allegretto is not custom wavefront, the wavefront
optimized ablation did very well in the FDA clinical trials. Some
compare the outcomes favorably to the fully custom CustomVue, Custom
Cornea, and Zyoptix.

Whether or not you require full custom wavefront or if the wavefront
optimized laser is adequate depends upon your unique circumstances. If
the surgeon who intends to use the Allegretto also commonly uses other
lasers, then it may be that based upon your unique situation the
surgeon has determined that the Allegretto is best for you. If the
Allegretto is the only laser the doctor owns, there would be the
appearance of a bias.

At age 58 it may be that LASIK or any other cornea-based refractive
surgery is not the most appropriate method to resolve your myopia
(nearsighted, shortsighted) vision. It may be that Refractive Lens
Exchange (RLE) is more appropriate.

RLE is the process of removing the natural lens of the eye and
replacing it with an artificial intraocular lens (IOL). The IOL would
be of a power to resolve your myopia. RLE is exactly the same as
cataract surgery.

A potential advantage of RLE is that there are three IOLs that also
attempt to resolve presbyopia while resolving your myopia. Presbyopia
is when your natural lens is no longer able to change focus on objects
near and you need to use bifocals or reading glasses.

There is no "cure" for presbyopia, but there are was to work around
it. Monovision is the process of correcting the dominant eye for
distance vision and the non-dominant eye for near vision. After a few
weeks the brain figures out what is going on and will "look" through
the dominant eye when you want to see something distant and will look
through he non-dominant eye when you are looking at something near.
Monovision can be accomplished with cornea-based refractive surgery
like LASIK, IntraLASIK, PRK, LASEK, and Epi-LASIK, with contact
lenses, and with RLE.

If you elect to have RLE, there are three IOLs attempt to work around
presbyopia in different ways. The Crystalens moves back and forth
inside the eye and mimics the focus changes of the natural lens. The
ReZoom IOL is multifocal to provide vision both near and distant. The
ReSTOR IOL is multifocal, but has a larger area of correction for
distance vision and may be best if your normal activities primarily
require distance vision.

RLE is more invasive and has risks that some would say are greater
than LASIK or a cornea-based surgery, and all IOLs have limitations.
Sometimes the Crystalens simply does not change focus, the ReZoom can
cause significant halos around light sources, and the ReSTOR can cause
halos (albeit less than ReZoom) but at the cost of near distance
vision. And a standard single focus IOL will provide only vision at
distance or vision at near. A standard IOL may be appropriate for
monovision, but not every patient tolerates monovision well.

I've given you some additional options to consider, but I recommend
that you read more detail at our website. Start with
http://www.usaeyes.org/faq/subjects/monovision.htm
http://www.usaeyes.org/faq/subjects/wavefront_custom_lasik.htm
http://www.usaeyes.org/faq/subjects/rle.htm

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

I'd be suspicious of WAVE stuff.  My wife wants a WAVE radio, but
as far as I can figure out, it is only more expensive.  "Excimer" is probably
hot sh.t, though.  ALLEGRETTO sounds really fancy.  Should be good
for an expensive Italian sports car.

Just a thought:  If you wait a few more years, you may get, or be able to
feign, cataracts.  Then Medicare will buy you IOLs.  My understanding
is that IOL implantation is less likely to go wrong than Lasik, certainly
hot-sh.t Lasik.  Well, you don't always get 20/20 exactly, but frequently
close enough.  At your age, you will need eyeglasses for something
(reading|distance|cocktail parties) even if your operation (Lasik or implants)
is a total success.  That's because >58-yr. old eyes have lost almost all of
their ability to accommodate.

Well, if you wait long enough, accommodative IOLs may be developed to
the point of practicality.

But, consider this, if you get your corneas messed up by sloppy Lasik
surgery, your eventual IOLs will not do you as much good as they
otherwise might.

Maybe the real doctors will tell you something different.

--
Dicky

Don't do it.  It will only complicate your eye situation and can be
catastrophic.  Instead have refractive lens exchanges, but stay away
from multifocal and focusing IOLs, unless the most important thing in
the world for you is to not need glasses, ever, and you are willing to
give up some clarity of vision and some night vision permanently for the
freedom from reading glasses. Consult a cataract specialist for your
surgery (not that you have cataracts, but it is essentially the same
procedure at your age).  Do not go to a LASIK surgeon, whatever you do.

w.stacy, o.d.