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Medical Forum / General / Vision / August 2006P-IOL vs PRK, age 49 with dry eyes
Went for an eval with a well-respected local surgeon, and as expected, he said no Lasik for me with my dry eyes. A friend just had PRK, and I have to say that the long recovery time would probably make me very anxious. I'm a 49 yr old female, used to wearing contacts with -6.00 and -.75 astigmatism, dry eyes and 4 punctal plugs for years. For the last several years I had been using OTC reading glasses with my contacts. Just recently my new opthalmalogist didn't like my recovery from an allergic reaction and said no contacts for 2 months. I've been trying Restasis since then but don't think it's going to work. The surgeon said I would probably ultimately be happy with the PRK results, but to also consider a Visian ICL, which I had never thought of. What are the downsides of this? What is the post-surgical period like? Doesn't seem like there could be much long term data, either. My biggest question is that all of the Visian material seems to say 45 and under. Would my subjective experience be much different than what I had with contacts, or would have with PRK? I know I would need reading glasses, but again subjectively where would the "reading zone" tend to begin -- cell phone, normal phone keypad, computer screen, or ??? Thanks for all help -- can't seem to find much info out there. Deborah Deborah, you should read this: http://www.allaboutvision.com/visionsurgery/refractive-lens-exchange.htm Thanks, Sandy. I had actually seen this site, which is excellent. There's something about extracting my so far healthy lens that is just too much for me. Actually, any of this may be too much for me, but I really don't like wearing my glasses much at all. > Deborah, you should read this: > http://www.allaboutvision.com/visionsurgery/refractive-lens-exchange.htm > Went for an eval with a well-respected local surgeon, and as expected, > he said no Lasik for me with my dry eyes. A friend just had PRK, and I [quoted text clipped - 21 lines] > > Deborah Why not consider progressive glasses? They will be much more comfortable than contacts because of your dry eyes and if you already wear glasses much of the time for reading, might as well get progressives which will give you clear vision at all distances. This will probably sound vain and trivial, but I really liked wearing my contacts, both for appearance and for the feeling of "just being able to see". I am trying to get used to just wearing the glasses, and may have to, but I really just wish I could see. Not to mention all the other things, like trying to find the swimming pool, the time during the big earthquake that I had to run back and find my glasses so that I wouldn't be a liability to my family, and all that other stuff. I'm very grateful not to be living 200 years ago, but ..... you know? >>Went for an eval with a well-respected local surgeon, and as expected, >>he said no Lasik for me with my dry eyes. A friend just had PRK, and I [quoted text clipped - 26 lines] > wear glasses much of the time for reading, might as well get > progressives which will give you clear vision at all distances. > This will probably sound vain and trivial, but I really liked wearing my > contacts, both for appearance and for the feeling of "just being able to [quoted text clipped - 5 lines] > > I'm very grateful not to be living 200 years ago, but ..... you know? Then stick with contacts as much as you want. My mom also is vain like you and only wears glasses around the house. Try different brands of contacts, they may be more tolerable and dry your eyes less. Lasik is the worst thing you can do. PRK is almost as bad. Clear lens extraction(aphakic IOLs) is the best option but not everyone believes in it unless they have cateracts. My mom isnt getting IOLs till she develops cateracts. Your too old for lasik/prk anyway and with your dry eyes you arent a candidate. Not only that, lasik/prk will be "wasted" when you develop a cateract because IOLs can take care of that and your myopia. Some people get clear lens extraction instead of lasik/prk because it saves them from cateract surgury in the future and they will never need to worry about cateracts. If you decide to do anything, aphakic IOLs are the only thing that makes sense other than sticking to glasses/contacts. > Lasik is > the worst thing you can do. PRK is almost as bad. Clear lens > extraction(aphakic IOLs) is the best option but not everyone believes > in it unless they have cateracts. these are the stupidest comments you've written yet. > My mom isnt getting IOLs till she > develops cateracts. thats nice. we wondered what your Mom thought > Your too old for lasik/prk anyway how ridiculous. > Some people get clear lens extraction instead of lasik/prk > because it saves them from cateract surgury in the future and they will > never need to worry about cateracts. If you decide to do anything, > aphakic IOLs are the only thing that makes sense other than sticking to > glasses/contacts. really? but you just recommended clear lens extraction. Ace, could it be that you really don't know very much about what your talking about? I think the original poster here is kind of asking a serious question and she doesn't realize that she has some drug-tripping unemployed idiot like you giving her advise. you should learn to keep your mouth shut unless you have something really valuable, gained from personal experience or expertise (not what you read on some website) to contribute. retinula barked: > these are the stupidest comments you've written yet. Says you. > thats nice. we wondered what your Mom thought It was something the OP could relate to. > how ridiculous. Old people really dont make good candidates for laser surgury due to dry eyes and developing cateracts. Anyway to the woman considering IOLs, which would you prefer? P-iols or clear lens extraction? The big advantage with clear lens extraction is youll never have to face a second surgury for cateracts in the future. > Old people really dont make good candidates for laser surgury due to > dry eyes and developing cateracts. Deborah said she's 49. and you told her that shes not a good candidate because she's old. boy are you dumb. not only do you not understand that there is no upper age requirement/recommendation for lasik (i know a man who was about 70 and had lasik successfully-- where did you read that stupid peace of information?) but you insult the woman by suggesting that 49 qualifies her as an "old person". as to what my preference would be for lens implants vs. clear lens extraction thats a more complicated question than you are equipped to discuss. you think you're smarter than you really are. get an education, get some real-life experience, and then you are in a place where you can offer people advise. just repeating something you read on the internet doesn't make you an expert. it sure makes you look like a fool though! > > Old people really dont make good candidates for laser surgury due to > > dry eyes and developing cateracts. [quoted text clipped - 15 lines] > something you read on the internet doesn't make you an expert. it sure > makes you look like a fool though! I mean no offense to her, I was being factual, not condescending. Age is a reason for poor candidacy. Older people have drier eyes and lasik will make it much worse. Secondly they will still need glasses after lasik, readers or bifocals. Thirdly, IOLs are a better choice because they offer better vision, they dont touch the cornea and best of all, they are a pre-emptive measure against cateracts and save you from cateract surgury. I know lots of people who got lasik only to end up needing cateract surgury a few years later and they are upset they got lasik for nothing and not IOLs in the first place! Her surgeon would probably reccomend clear lens extraction over p-iols because it has the advantage of saving her the trouble of cateract surgury down the road. i believe you are talking about the Staar Visian intraocular lens. I have seen a handful of patients who had this lens implanted into their eyes. they were deemed non-LASIK candidates due to various reasons. they all seemed happy and healthy and when i examined their eyes they all had excellent vision. this all happened during a class that was set-up by a ophthalmic surgical practice so i would expect that they would show us their best. the most critical measurement is your anterior chamber depth. the lens must be very carefully implanted in the sulcus behind the iris without touching the corneal endothelium. likewise the lens cannot rub on the lens or a cataract will develop. this is a delicate procedure. the lens has only recently been approved and there is little experience with it. also consider the Verisyse Phakic Intraocular Lens. this is a claw lens that attaches to the iris in the anterior chamber and has less likelihood of causing a cataract. i have watched several surgeries using these lenses and followed-up a few of the patients. they too all turned out pretty well and were quite happy. if i were considering these procedures, and i would consider it if i were you, i would go to the MOST EXPERIENCED surgeon using those lenses I could find. probably NOT your well respected local surgeon. these are new procedures, and only a handful of doctors have had much experience with these surgeries. and there isn't much longitudinal data on the long-term effects of these lenses either so realize you are going into uncharted waters. good luck, retinula PhD OD ========== > Went for an eval with a well-respected local surgeon, and as expected, > he said no Lasik for me with my dry eyes. A friend just had PRK, and I [quoted text clipped - 21 lines] > > Deborah Thanks for your comments, here and elsewhere. I am talking about the Staar Visian, and fortunately for me, if I did decide to go with it, the person I'm consulting with has been involved in the clinical trials and has been doing both types of lenses for several years. Paul Dougherty in Los Angeles and Camarillo. It's a mighty big step and a mighty expensive one too. For right now, I'll be checking with my regular opthalmalogist and OD to see how much further I might be able to go in contacts. But in all likelihood, I'm going to be told that I have to have a shorter and shorter wear time. But I see perfectly with my glasses, just not happily, so we'll also have to see how attitude adjustment works. Thanks everyone for your input. I'm an intermittent lurker on this group, and I really learn lots from it, about all types of issues! Deborah > i believe you are talking about the Staar Visian intraocular lens. I > have seen a handful of patients who had this lens implanted into their [quoted text clipped - 56 lines] >> >>Deborah Keep in mind that the STAAR Visian ICL is a temporary correction. At some point that lens will need to be removed. For most people, that point is when cataracts form. RLE is exactly the same thing as cataract surgery. This is another reason why RLE is commonly recommended rather than a P-IOL if the patient is over about age 45. Glenn Hagele Executive Director USAEyes.org Patient Advocacy Surgeon Certification "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. > Keep in mind that the STAAR Visian ICL is a temporary correction. At > some point that lens will need to be removed. For most people, that [quoted text clipped - 15 lines] > > I am not a doctor. Welcome back Glenn and this is why I suggested clear lens extraction in her case because of her age and lack of accomodation. Her surgeon would also suggest clear lens extraction. PRK would be counterproductive for the reasons I stated. why don't you do like Glenn does and add a disclaimer at the end of your posts. it should say "I am not a doctor. I get all my information from the internet." ========================== > > Keep in mind that the STAAR Visian ICL is a temporary correction. At > > some point that lens will need to be removed. For most people, that [quoted text clipped - 20 lines] > also suggest clear lens extraction. PRK would be counterproductive for > the reasons I stated. > why don't you do like Glenn does and add a disclaimer at the end of > your posts. it should say: > "I am not a doctor. I get all my > information from the internet. except that which I simply make up." > Went for an eval with a well-respected local surgeon, and as expected, > he said no Lasik for me with my dry eyes. A friend just had PRK, and I [quoted text clipped - 22 lines] > > Deborah This isn't really answering your question, but what kind of allergic reaction did you have that caused your surgeon to advise against contact lens wear for two months? Was it CLPC (=GPC)? Two months seems a long time to be without contacts. Were you happy with the contacts apart from this? Dom Hi Dom Sorry for the delay -- went on vacation and then it was hectic. Your question is really pertinent at least to me. I've worn contacts of various sorts since age 13, and about every other year I'd get a regular seasonal allergic reaction, use drops like Patanol, occasionally need 2 weeks of steroid drops, and be good to go. This time my cat's fur flew a bit much, AND I couldn't get into my old MD, so I went to a new guy. Did a course of Elastat, during which he tested my chronic dry eyes and got a Schirmer's of 2, which he didn't like. Didn't think steroid drops would help, and told me that if I didn't watch out, I was at risk for developoing a GPC reaction, or maybe a corneal ulcer if the eyes are just too dry. Also said, hey, you're 49, maybe you'll just to have to give up contacts. Bottom line is, I've been trying to be a good patient, was exploring options in the meantime, and have finally gotten an appt with my old MD who I'm hoping will say let's put the contacts back in and see how you do. Because, yes, I was fine with the contacts, and if I could wear them 10 - 12 hours daily I'd be perfectly satisfied. For all I know, my old Schirmers tests were that low too, but they were so long ago and my MD visits so intermittent that those records are gone. Anyway, long answer to a short question. Liked the contacts, miss them mightily, hope I can have them again, don't know that I have the nerve for surgery or the tolerance for a less than perfect result. Deborah > This isn't really answering your question, but what kind of allergic > reaction did you have that caused your surgeon to advise against contact [quoted text clipped - 3 lines] > > Dom > Hi Dom > [quoted text clipped - 11 lines] > a corneal ulcer if the eyes are just too dry. Also said, hey, you're > 49, maybe you'll just to have to give up contacts. I think the guy needs a visit to the eye care library for a little continuing education. I'm surprised he didn't blame your hormones ;-) There are medical treatments for dry eye. There are nutritional therapies for dry eye. There are contact lens materials better suited for dry eye. Cornea ulcers result from foreign bacteria (or very rarely fungus or parasite) invading the cornea, not dry eye, although chronic dry eye with a dry contact lens rubbed with dirty fingers might well bring on an ulcer. --LB, O.D. Deborah, While PRK and its cousins LASEK and Epi-Lasik traditionally do not induce dry eyes as much as Lasik or IntraLasik, it is still possible that PRK will exacerbate your existing dry eye problem. Evaluation may be wise, but do tread carefully. As you have noted, the recovery with PRK is much longer than with Lasik. You may want to read http://www.usaeyes.org/lasik/faq/lasik-dry-eyes.htm The Visian is a phakic intraocular lens (P-IOL) that is placed in front of the natural lens of the eye. The reason a P-IOL is often suggested for people under age 45 is because under age 45 you will still have some ability to change focus from distant objects to near objects. P-IOLs retain the ability to make this change. You may find http://www.usaeyes.org/lasik/faq/lasik-visian-verisyse-icl-p-iol.htm interesting. Refractive Lens Exchange (RLE) is commonly suggested for people over about age 45. RLE replaces the natural lens with an artificial lens. RLE makes more sense after 45 because the natural lens is no longer changing focus and the patient will not lose this important ability with RLE...it is already gone. You may want to read http://www.usaeyes.org/lasik/faq/lasik-cle-iol-rle.htm There are a couple of multifocal lenses for RLE that may be appropriate and with RLE you can use the monovision technique to see both near and far. Visit http://www.usaeyes.org/lasik/faq/lasik-monovision.htm RLE would probably not affect your dry eye situation, but this is invasive surgery and should be considered carefully. Glenn Hagele Executive Director USAEyes.org Patient Advocacy Surgeon Certification "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. |
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