[David Ellis]

Folks,

I'll be in Dayton Ohio for 2 weeks for PRK eye surgery.  I am really looking forward to this, but my web conection is hoaky.  I can receive email messages, but probably won't be able to send email messages.  I tried this morning with no success - argh!

Anyhow, if you are trying to get in touch with me via email, my response will be VERY slow.  Please post any & all queries in this thread.  I'll check it daily and respond as necessary.

Dave

[bryanb]

Hey Dave,

I got the eye laser surgery about 4 1/2 years ago now. It has been like a gift from above. I don't think I ever spent better money. Went from 20/{crappy} to 20/15 in 4 hours; which is amazing.

I just introduced myself here last night, but I also wanted to say good luck and wish you well. Just saw the pictures of you and your son in the shop, and it reminded me of my little girl, Sophia, who is 2 1/2, and loves our shop. ::end misty mode>::}

I can sure wait a week or two for you to answer my dumb questions, but I'm thinking about beginning a 1801b diy in a while, with spousal approval, of course.

In the mean time, enjoy your new eyes!  

Regards,
Bryan

[David Ellis]

Bryan,

Spouse approval is indeed highly important.  My wife thought I was surely nuts when I built my first speaker.  She still thinks I am nuts, but for different reasons.

Did you get PRK or Lasik?  I learned yesterday that I actually have a choice.  PRK was what everybody got until recently.  I was prepped yesterday and have a consult appointment with the doc on Monday.  I guess the doc might make some recommendation at this point.

You really are welcome to post your questions here.

Dave

[jackman]

Dave,
I'll try to call you but DON'T get PRK.  I spoke with my doctor (who performed Lasic on my wife and I) and he said he couldn't believe people were still doing PRK.   My wife and I had lasic and both had excellent results.  It wasn't cheap but my vision is 20/10, twice as good as "perfect" and there were no complications.  I was back to work the next day and could see perfectly immediately.  It was amazing.  Almost NO recovery time and no complications.  I'll call you to discuss.

Best of luck!

Jack

[JoshK]

Indeed from what I have learned from knowing many doctors is Lasik is the way to go for sure.

[bryanb]

Dave,

Yes, what I got is Lasik. I'm an engineer, and I've been watching the tech for eye correction for 15+ years, and I will echo, DO NOT GET Radial Keratectomy or PRK unless your really understand the implications! When last I looked, this involved (for RK) radial incisions directly through the surface of the cornea, like spokes of a wheel, or laser ablation of the surface of the cornea (PRK). It is done with either a scalpel, or a laser, respectively.

PRK (Photorefractive Keratectomy) is different in that rather than incisions, the surface of the cornea is sculpted by the laser. The outer layer of the cornea must then re-grow, sometime unpredictably, and usually slowly.

The RK technique was used extensively in Russia for a while, and done in an assembly line fashion. It depends on the cut causing the cornea to collapse and flatten, thereby reducing myopia. At the time, it relied primarily on the skill of the scalpel wielder. I suppose lasers can do the job more accurately, but...

This method has some major problems:
1) It is very difficult to predict how much a particular cornea will collapse and flatten in response to the incisions, and
2) The incisions through the cornea leave very subtle scar tissue, which causes a star shaped refraction around lights at night. If you have astigmatism, something similar may already be familiar to you. When you remove your glasses at night and look at a light, astigmatism will cause the out of focus light blob to look egg shaped. The RK will make a light look like a sharp multi pointed star.
3) Progressive changes to the eye are often noted, leading to irreversible over-correction, as well as (with RK) weakening of the cornea.
4) The re-growth of the corneal surface can be unpredictable and take a while.

Caveats:
I gave up on RK and PRK as too crude a choice for me, so I may be uninformed about recent advances, but I imagine the problems I mentioned are still significant.

One other reason RK / PRK may be one's only choice (I think, check this out yourself): Blue eyed people may have eyes with two significant features that may counter-indicate Lasik, which are thin corneas, and pupils that dilate widely at night. My wife couldn't get Lasik for both reasons. I believe PRK doesn't require the cornea to be as thick as Lasik (I may be wrong about this) I'll explain further.

Lasik:

The method used a microkeratome to (sorry if this sounds rough, but the valium provided made the whole procedure rather curious, a-la alien close encounter examination) cut back a flap of the cornea. The laser then ablates very small plugs of interior corneal tissue, in a pattern determined by the pre exam. The flap is then gently smoothed back over the formerly flat, now precisely ablated concave corneal section. The advantage of the flap is that it gets the scar tissue out of the optical path. Corneal surface layers aren't as likely to heal well as the interior layer.

The corneal thickness and pupil dilation come into play thus:

The depth of ablation depends on the level of correction required. 20/500 requires a deep ablation, 20/100 a relatively shallow ablation. I believe a typical cornea is about 500 um thick (1/2 mm), and there must be ~200um for the flap, and ~150um for under the ablation, leaving about 150 um for correction.

The diameter of the ablation is driven by nighttime pupil dilation. Small dilation, small ablation diameter. Since the cornea is nominally spherical, the demand for a larger diameter ablation also drives a DEEPER ablation. This should be clear with a little thought.

So, my procedure was sort of ideal, even though I had astigmatism and about 20/550. I have brown eyes, which typically mean thick corneas and small nighttime dilation. Thick cornea means about 625 um. So if need be, I can return for further correction, since I still have 500um+ to work with. My wife was the opposite, blue-gray eyes, thin corneas, large nighttime dilation, which makes her very cute, but not when she found out she couldn't get the surgery too.

If the Lasik is your choice, just remember to hold absolutely still. I practiced not breathing for the 45 seconds it takes per eye, and I'm convinced it made a difference. The laser can stop itself if it detects you've moved, but why test that feature? Also, I used to wear contacts, which I suspect contributed to some major discomfort (felt like a lot of sand in my eyes) for about 4 hours afterward. I laid down, let my eyes tear, but NO RUBBING, no matter what! After that 4 hours, I COULD SEE! AMAZING!

If any of this is unclear, please let me know right here. I will certainly try to respond if I can, but your Dr. should be much more informative. I will check this thread again today.

One word on Lasik / PRK providers. Some will do the surgery in spite of counter-indications. My Dr. was in Montreal, and flatly refused to do my wife's eyes; this is a man with integrity, which in my opinion, is sorely lacking these days. I recommend these guys to everyone who asks. I heard a story of a man who should have been denied the surgery (done elsewhere), but wasn't, leaving him essentially night blind. He expressed, as I recall, huge regret.

Demand objectivity and integrity, its your money, but more importantly, your sight! No compromise here! Apologies in advance if any of this misses the mark, but I wanted to get it out.

Best Regards,
Bryan

[David Ellis]

Honestly, I did very little/no research on this matter since I thought PRK was my only choice.  Since I am a G.I. asset there was only 1 method approved (PRK) - until about 6 months ago.  Now it's possible to get Lasik.  I apprecaite your remarks, and will take them into consideration when I speak with the Doc on Monday.  My eyes are already mapped and such, so he will have the pertinent information to make the correct decision.

BEFORE your remarks, I probably would have gotten PRK.  This is because it's the oldest approved method.  I am a traditional sort of guy.  Following your remarks, I'll ask for Lasik - providing all other variables are equal.

I do understand this is a judgement deal, and really apprecaite your input.

Dave

[TheeeChosenOne]

FYI:
http://www.allaboutvision.com/visionsurgery/intralasik.htm (a good all-in-one site)
http://www.2020eyesite.com  (a good all-in-one site)
http://www.google.com/search?sourceid=navclient&ie=UTF-8&oe=UTF-8&q=intralase  (Intralase)
http://www.google.com/search?sourceid=navclient&ie=UTF-8&oe=UTF-8&q=wavefront+lasik  (Wavefront)


Lasik seems to be the way to go these days.

The FDA recently approved new (10/02) machines (Wavefront) that are more accurate.  In addition, they now have a laser (Intralase) to cut your eye instead of metal object...........As a result of these two new tandem technologies, 20/20 vision has gone up from 75% with the "old" Lasik procedure to 95%.  In addition, complications resulting in dry eyes or halo night vision (most of it apparently coming from the cutting machine) has gone down to a less significant percentage, making the risk of doing this procedure much more compelling (IMHO).

[brj]

I spent some time researching this before the holidays, so I'll make a few comments...

First, bryanb's comments generally agree with what I have read, but by mixing the RK comments with the PRK comments, you might get a biased view of PRK unless you are really paying attention.  RK is definitely a superseded technology.  PRK, however, can still be applicable in the right situations.  (Consider all of this background research, by the way, since I'm certainly not a doctor!)

BTW, my personal research was aimed at near-sighted corrections, so things will be somewhat different if you are far-sighted.

Basically, PRK is done using the same lasers as LASIK, and in both cases you are ablating the cornea into a new shape.  The difference is that in PRK you ablate the epithelial and base layers (they grow back) and in LASIK you make an incision that allows you to peel the layers back, replacing the flap once the cornea shaping is done.  PRK takes longer to heal, has a longer period of initial discomfort, and has a greater (but still small) chance of hazing.  I haven't found documentation yet, but I've been told that you have a lesser chance of halos with PRK than LASIK.  Remember that, while very popular, these procedures ARE surgeries and have the attendant risks.  (The Internet is full of worst-case stories.)  That said, however, most laser corrections produce results ranging from very good to  outstanding.

Things to remember:

1) The lower the required amount of correction, the less corneal thickness you need.  In addition, the lower the required correction, the better the chances of success.  (Again, this is relative... large corrections have been done many times with great success.)

2) Pay attention to the pupil diameter, as measured via infrared.  I backed out of a CustomVue LASIK procedure because I wasn't completely comfortable with this.  CustomVue is the wavefront guided LASIK procedure done using the STAR S4 laser from VISX.  Bausch & Lomb just had their Zyoptics wavefront guided approach approved by the FDA last month.  The STAR S4 laser system has a 6 mm correction field with a "blend" out to 8 mm.  The B&L Technolas 217z laser has a 7 mm correction field with a blend I can't remember offhand.  If your nighttime pupil size is larger than the correction field of the laser, there is a greater risk of seeing halos around light sources (since some light will be passing through the under-corrected or uncorrected portion of your cornea).  That said, however, there is a theory stating that any light entering outside of the 6 mm diameter doesn't matter, because it hits the retina at too steep an angle.  I meant to look this up in greater detail, but never got around to it.   The theory is named after the two principle doctors, however.

3) A primary selling point of wavefront guided systems is that they can correct higher order abberrations in the eye.  (The first and second orders being the cylindrical and spherical values you see on eyeglass or contact prescriptions.)  Results have been outstanding to date, but this is still a point of study, primarily because your vision system includes your brain, and not just your eyes.  A few people have had a hard time getting their brains to process the "signal" their newly corrected eyes.  Some doctors speculate that this is due mostly to the corrected "higher order abberrations."

4) Cutting the flap in a LASIK procedures can be done via microkerotome (a very special blade) or a laser.  Many people like the laser option, but many surgeons find the microkerotome works every bit as well.  Of course, those that use the laser charge more for the option.

There is always more to consider (and more that I could write), but your best bet is to find a good surgeon and ask every question that comes to mind.  I would make a point of talking directly to the surgeon, not just a technical assistant.  Good luck!

-Brian

[droliver]

David,

for what it's worth..... I'm a surgeon & I had Lasik done 5 years ago & had wonderful results. Since that time the imaging software they've refined has led to even more predictable results. I would not reccomend the older type surgey with the RK/PRK unless you're not a candidate for the new operations. While they RK surgery has a longer track record, there is a signifigant difference in successful outcomes associated with the surgeon skill. The lasik procedures are essentially operator independent..... you map the eye with computer & IT does the operation with near 100% precision. The opthamologist is essentially a bystander except for the keratome part, which is essentially an unskilled step that is done with an instrument & could be performed by anyone.

[David Ellis]

Thanks a bunch for your response gentlemen.  I do know the machine being used is some super high speed LASER setup.  I am not sure what the exact terminology decsribes it best.  I am very comfortable going in to this, but most of the details are very foreign.  As mentioned above, I never really looked into this because I thought PRK was my only choice.

The program I fall under is setup for warfighter G.I.'s.  Some of the desk-jockey's mange to get into this, but it's primarily for operators.  Pilots and those only flying duty are high priority, but missileers ain't too far behind.  My wait was longer, but I finally got accepted.

Anyhow, following your encouraging remarks (and research) I will certainly ask more intelligent questions.  I will also lean heavily towards Lasik.  I am very certain the doc, and support staff, are very good, and have no concerns abuot their competency.  There is no profit motive for the medical staff in this.  It is simply a service provided to G.I. operators like myself.  The lack of profit motive is somewhat encouraging because I know the recommendations provided will be VERY unbiased.

Thanks again for all of your input on this matter.  It is quite overwhelming.   I will surely let you guys know what happens on Tuesday.

Dave

[Al Garay]

We'll keep you in our prayers.

Now, if this is a 1-day procedure, why the 2 weeks? I can understand ... it's classified.

Al

[David Ellis]

Actually, it's 10 days + my travel time.

There are about 5 days before and 5 days after the surgery.  All of this is simply because the military is very "anal" about this.  The 5 days before are to again ensure that the preparation work is totally perfect.  The 5 days after the surgery are to ensure that I am totally fine when returning home.  I'll have follow up visits with my local Doc in Omaha, but the specialist folks are in Dayton Ohio.  These folks are really smart about eye surgery.

Staying here is somewhat expensive for me, but my degree of confidence in the G.I. program is very high.  It is well worth my time - IMO.

[Rob Babcock]

I had a friend who had RK done about 4-5 years ago, and he's been delighted every day.  I'd like to do it too, but I'm a wussy when it comes to going "under the knife."   Still, Lasik is looking very appealing; it'd be nice to ditch glasses & contacts forever.  Life would be a lot simpler and lower maintainance, for sure.

Good luck, although the Lasik is pretty routine nowadays.  I'm sure you'll be really happy with the results.

[totti1965]

Oh Dave,

shit happens, I just read now about your operation,
I think it is a little to late now......

I did some reserch about the lasik operation because I was interestet in it.
But, after I have got all the Information I decidet to don´t do it!

Because ther are definitely some risks in it.

Bill Gates, who have enough money for the operation is also wearing glasses until now.........

But if you want to make the operation it is important to now,
that there are definitely   D I F F E R E N C E S   between lasik and lasik
and PRK and PRK

In 2003 there were only 3  (in words: three!!!!) places in Europe, where they did a special form of lasik.

But there where lasiks and PRK in the normal form also in Germany quite in every supermarket.

The new form is only aviable in Wiesbaden, in Hamburg and in Vienna (Austria) in the University Kliniks.

In 25 % of the cases of the new modified form of the Lasik / PRK
they reach a view sharpness of 200%!!!!! It means eagle eyes!!!!

I don´t really now, how it is called I think, there is another word than Customized Ablation: here is an link in german:


http://www.gutes-sehen.ch/index.php?cat=1&subcat=3&subsubcat=4





Topolink (Customized Ablation) zur Optimierung der Abbildungsqualität der Hornhaut
 
Topolink ermöglicht individuelle Behandlungen am Patientenauge. Das Verfahren nutzt präzise topographische Daten der Hornhaut welche zur Korrektur der durch diese Hornhautunregelmässigkeit verursachen Brechungsfehler benötigt werden. Die ermittelten Daten bilden die Grundlage einer "customized" Laser-Ablation.

Leistungsfähige Computer berechnen aus den topographisch ermittelten Daten der Hornhautoberfläche ein Abtrageprofil, welches aus einer irregulär geformten Hornhautoberfläche im Bereich der optischen Zone (Durchblicksbereich) eine möglichst regelmässige Hornhautoberfläche entstehen lässt. Mit dieser Methode können Hornhautunregelmässigkeiten weitgehend ausgeglichen werden. Sie stellt jedoch höhere Anforderungen an Chirurgen und Technik. Die Topolink- bzw. Customized Ablation-Technik erfordert neben der entsprechenden Messtechnik ein aktives Blickverfolgungssystem (Eye-Tracking) und einen "Spot Scanning"-Laser.


Einsatzgebiet

Das Verfahren wird in Fällen einer lamellären Keratoplastik (Ausgleich der unter Umständen bei der perforierenden Keratoplastik entstandenen narbenbedingten Hornhautverkrümmung), bei dezentrierter Optik (z.B. als Folge früherer Laserbehandlung ohne Eye-Tracking-System oder ungenügender Zentrierung der Laser-Abtragungszone zur Fixationsachse) angewandt.

[David Ellis]

Thanks for your thoughts and concern.

My eyes are doing fine, and I received your email too.  I got PRK, and realize the recovery process is slow due to the healing process of the outer layer of my eye.  I had the Surgery 2 1/2 weeks ago, but will still be healing for th next 2-3 months.  Because of this my current vision is fuzzy.  This is fine though.  While some things are very bothersome, I have learned not to expect much from my eyes lately.  I blink often when looking at the computer and have not attempted to rub more cabinets.  

PRK was really my only option.  As a Govt asset I really didn't have much choice about what variety of eye surgery to get.  Lasik seemed like an initial option, but the Doc said "no" after looking at the odd slope (astigmatism?) in my left eye.  Further, being on flying status requires me to have PRK in the current Air Force.  While I am NOT currently on flying status, there is potential for this in the future.

I am very optimistic this procedue will come out nicely.  The other guy's in my shop who received PRK are now seeing 20/20 or better.  They all reported cruddy vision while healing.

I noticed some query for pictures from Emilio.  Here is a current picture of 1 of the Cherry cabinets.  It's a little dusty in spots, but I am very pleased with the quality of my finish work.

[totti1965]

thank you for your quick answer Dave,

beautyfull work !!!!!!

I wish you and your eyes a very good recovery, but I think too, it needs time (3 months) to become perfect.

Do you have problems with your computer at this moment?
My computer was completely demolished by worms and virusses.

I made a complete new setup at saturday and I am very glad that a good friend of mine helped me.

Now it works fast and perfect as never before!!

I use now:   zone alarm as a firewall against the pop ups and mc affe against worms and virusses. I think it is the best kombination and it really works.
It is transparent and I now have the control about what the computer wants to do.

[David Ellis]

I am frustrated by this too, but I have not lost hope yet.  I have implemented the following on my win XP system.

- disabled the "messenger" service in the registry.

- deleted MSN messenger

- deleted (unfortunatly not completely) IE

- running Norton Anti Virus

- running AdAware

- running pop-up stopper

- running spybot

I am still getting a few annoying pop-ups, but I remain virus free.  This is continually frustrating on a daily basis!  

You are not alone in your computer endeavors.

[bryanb]

Hey Dave,
Glad to hear your vision procedure went well. Wonder if you could respond to my post of Feb 18 when you have a chance.
Regards,
Bryan

[rosconey]

i have netzero and never ever get a pop up-
i wonder if you have a worm thing