How should I go about selecting a Lasik doctor/equipment type?

In My Humble Opinion
1

I’ve been thinking about Lasik for a long time but I’ve always worried about gambling with my vision - I know the complication rate is low, but if something happened to my eyes that would be catastrophic. Has this improved over time? I know a common complaint about Lasik years ago was having halos at night, which I think was based on how they cut the corneal flap. Have they ironed out some of those problems on the newer techniques and equipment?

I read recently that once you’re 40 or so, you become a worse Lasik candidate over time because of the changes of your eyes and I’m just about there, so it pushed me into deciding to get it done before I become a worse candidate.

I have what I assume to be a fairly uncomplicated need - I’m nearsighted around -3, and have a slight astigmatism around -0.5 that’s something like +/- 8 degrees.

But I don’t know how to go about actually picking where to go get it done. There are chains/franchises and independent shops. Lots of highly rated independent opthamalogists here in Las Vegas, at least by google reviews and yelp, and I have no idea if those are really trustworthy for medical procedures. There are different levels of high-tech equipment, like wavefront Lasik.

I’m not looking to go cheap on this, as your eyes are pretty much the most important thing you have, but based on what I’ve read it seems reasonable to think I can get pretty good surgery for $4000-5000 so that’s my target budget. I would prefer to get the newest/best tech if possible, although I don’t know what that actually is.

Does anyone have advice about shopping for doctors? What to look for? What is the best type of surgery/equipment? Any advice in general? I know that you can get “touch up” procedures when your vision changes. I probably won’t live in Vegas in 3 years. Would going to a chain/franchise Lasik place mean that I could get the touch up at any location, or do you have to go back to the original place you got it?

2

I have no advice to offer but I am following this thread keenly as well. I’m considering doing either LASIK or PRK in the next few months. My concern is that LASIK has been known to make the eyes more vulnerable to injury.

3

PRK is an option too, so if anyone has Lasik vs other types of surgery option advice that’s good too. There are other surgeries now available too that involve stuff like implanting micro-lenses in your eye, but I think they’re not recommended unless you have special needs or aren’t a good lasik/prk candidate.

4

I went to the place that the CEO of my company (and a smart guy) went to. I figured if it was good enough for him, it was good enough for me.

It might be hard to use this advice, but I’d lean toward places where you’ve heard of people being turned away. Not everyone is a great candidate for Lasik. A place that doesn’t turn people away (due to thin corneas, etc.) is doing a disservice to their customers.

My lasik surgery (~15 years ago) used wavefront tech; I have a hard time believing anyone wouldn’t be using that at this point, but maybe some are and just have ancient equipment. I’d avoid them. They used a mechanical cut for the corneal flap, as the laser cut version was only just coming into practice. I don’t have significant haloing, but maybe I got lucky (it depends on various factors, like how much your pupils dilate and the corneal thickness). Anyway, I think everyone now should be using the laser cut flap. If not… again, it seems like they must be using ancient equipment if they aren’t offering that.

Sorry I don’t have anything more specific. My knowledge is 15 years out of date. I’m still very happy with the results, though. I can certainly answer questions about the basic process.

Incidentally, I did need a touchup in one eye a couple of months after. I know there is a time period where it is easier, because the cornea isn’t fully healed and they can just peel back the existing flap. After that, it is just like getting the full process over again.

5

My wife had eye surgery this summer, and she went from something like a -9 and blind without glasses to being able to see and function without glasses. She still uses glasses to read, and to help with an astigmatism, but her vision was so bad we expected that going in.

Initial consultation should be free, so you can check out a few places; that’s what we did. She ended up picking the university hospital, which is where we go for everything else covered by insurance, even though the eye stuff was all out of pocket.

The doctors should tell you what kind of surgery you’re the best candidate for. Depending on the correction, the thickness of your cornea, etc, different ones will be better.

My wife got implanted lenses, because of the large correction. They could have done lasik or PRK, but independent doctors both told us the same thing, that lenses were her best option.

What we paid was inclusive. She just went for 6 month check today, and it didn’t cost anything. We even had an aborted surgery (before any cutting), and that didn’t cost us anything.

6

So far I’m leaning towards this provider. Sounds like he was doing Lasik from the very start, in 1995, and has done tens of thousands of surgeries and basically only does lasik and PRK. It claims the “allegreto laser” is the only one in the state and cutting edge tech that reduces the chance of night vision halos. It’s called “allegreto wave” so I assume that’s a wavefront technology. They also claim to use nidek laser technology.

Can anyone who knows a lot about LASIK tell me if that sounds good? Anything bad?

7

When my wife got Lasik, I suggested she have one eye done by the cheapest provider we could find. If it worked, that provider could do the 2d eye. If they botched the first one, well, we could splurge on the remaining eye.

For some reason she no longer asks my opinion on such matters.

8

I would imagine that the age-related changes (loss of flexibility, leading to presbyopia) would occur regardless of the age you are when you have it done, though I could imagine the surgery being slightly trickier in general.

My brother had Lasik 15 years or so back - he was about 50 at the time, I think - and his biggest disappointment was that he couldn’t read without glasses. I was shocked when he confessed this to me, as I assumed he’d have been reminded about the fact that they were setting the eyes up for distance vision. Even I knew that the surgery would require a choice between distance and close up, but he’d never figured that out. Anyway, the tl/dr lesson is make sure you’ve got your expectations set correctly.

Definitely discuss options with whatever surgeon you go with. “Monovision” is an option: one eye is set for distance and the other for close-up; you wind up relying on the one for things like driving and the other for close-up. I always assumed that would be insta-headache fodder, but I knew someone who did this and loved it, and when I began stumbling down the Cataract Trail, I was essentially doing that. Surprising how well the brain adapts.

Interesting. Back when I was preparing for my cataract surgery, about 4 years back, I read about people opting for replacement lenses when cataracts were not even an issue. That kinda horrified me, especially given the issue with implants and the inability to adjust to different distances as natural lenses do. Irrelevant in my case, as the surgery / implant was not anything optional due to the cataracts.

In your wife’s case, did they remove the factory-original lenses? Or are those still in place?

I had actually gone through pre-op testing for Lasik, 10 or so years ago, with a specialist recommended by my optometrist (and this fellow had done the optometrist’s eyes). I was sort of pushed / talked into going for the evaluation because I was having a lot of trouble getting the right
“fit” for glasses (couldn’t tolerate full multifocals; it took some experimenting to get a combination that worked for me without having to carry THREE pairs of glasses around). I’d had zero interest in optional eye surgery, but it was somewhat interesting doing the testing. I’ve got wonderful corneas for the process, apparently (nice and thick).

Not having 5K to drop on it, and not being terribly interested anyway, I did not pursue it any further.

9

Her surgery kept the original lenses, and added new ones to change the shape. I think there is a tiny air gap in there, or something. The implanted lenses can be replaced, but they really don’t want to do that soon, as a buildup of scar tissue can be a problem. The doctor did say when she’s ready for cataract surgery in 20-30 years, they’ll put in new ones.

10

That sounds like a good choice–you want someone who could almost literally do this in his sleep. I had Lasik in my early thirties, and it is now wearing off in my fifties–I need one contact lens for far vision and my near vision is crap. Be prepared. Best money I ever spent, though!

11

I don’t know that it’s accurate to say that Lasik “wears off”, I think your eyes just change as you age and lasik can only correct up to the point where you had it. You’re still better off than you would’ve been otherwise, but it may have changed enough that you may need glasses (or additional lasik surgery) again.

12

True–that was aging humour. I really enjoyed being 20/15 for 15 years and it bums me out I no longer am.

13

BTW, my wife was like -22 with severe astigmatism (need glasses to find the glasses) and had new lenses put in 2 years ago–a real miracle. I think she sees better than me at this point.

14

I was almost decided and ready to move ahead with the surgery, but then I was reading a little bit about the allegretto laser system and I asked the doctor’s office and they said they were using the original 200 hz system (approved in 2002) and not the newer 400 or 500hz systems (approved in like 2012 and 2016). I want to try to have the best, so having an old machine scares me - after all, it does most of the work. I’m not sure how much difference the version actually makes, though. So I kind of got sidetracked and I guess I should be calling around to every office and figuring out what equipment they use.

15

Sorry I missed this before. I had LASIK done in January of 2007.

So I researched the Doctors in the area. I found the top 3 for NJ and found 1 of them was pretty local. So he is the one I chose.

I paid for the Lasik using a Medical Savings account so to get the pre-tax advantage.

My eyes are still doing great 15 years later. No halos.

Lasik from a good doctor is very safe.

16

So, did you end up doing it?

17

Yes, I got it done 6 months ago. I decided on the laser first (alcon wavelight ex500) and then found the best doctor with it here. The surgery went perfectly according to the doctor but I’ve had healing complications, I think at least partly because I live in a desert and eye dryness is one of main post-lasik problems.

I struggled to keep my eyes lubricated even using lots and lots of drops, and in particular, they’d dry out as I slept and how much they dried out would determine how good my vision was the next day. I’d get some double vision and/or fogginess in either eye - some days would be a good left eye day, sometimes would be a good right eye day, rarely… neither were very good. Some days both were good.

The doctor assured me that the actual change to my lens was correct and good (and the fact that on a good day I could see 20/16 seemed to confirm that) but that I was having these other problems because of the healing complications of having dry eyes in a desert. That’s probably true, as the problem has become slowly better as my normal tear function starts to return. I still have better days than others, but they never get as bad as they could get in those first 2 or 3 months.

For the first 2-3 months after the procedure I was really unsure whether I was even happy about it, but around things got better by enough that I was happy that I did it at that point. I still don’t consistently get my best vision every day but my hope is the consistency continues to improve.

18

Sounds good. Hope it all works out optimally.

I have SMILE scheduled for next week. I’m still yawing back and forth like a metronome in indecision. The main reason is that every opinion about laser eye surgery is highly polarized. On Reddit, half the crowd is crowing “It’s the best thing I ever did, so glad, zero regrets” and the other half is “It’s the worst decision I ever made, my eyes are wrecked.”