Laser Eye Surgery, Revisited 10 Years Later

gunner_von_diamond (3461783) happened upon Ask Slashdot: Experiences with Laser Eye Surgery from ten years ago, and asks: I was just reading a story on /. from 10 years ago about Lasik Eye Surgery. Personally, I've had Lasik done and loved every single part of the surgery. I went from wearing contacts/glasses every day to having 20/15 vision! In the older post, everyone seemed to be cautious about it, waiting for technical advances before having the surgery. Today, the surgery is fairly inexpensive [even for a programmer :) ], takes about 10-15 minutes, and I recovered from the surgery that same day. So my question is: what is holding everyone else back from freeing themselves from contacts and glasses?

Comments

Astronomy, and general poor night-time results.

[popoutman]

Given that I have a few telescopes and I have been stargazing for ~30 years, I really value my night sight. Knowing that the majority of the laser surgeries have a significant proportion of post-operation aberrations that would directly affect my stargazing abilities is a real hindrance to my taking up the eye surgery.
Halos and diffraction spikes around bright objects, increased glare at night, are all relatively common issues to be dealt with afterwards. Most people aren't bothered by this as they rarely come across the situations where these aberrations would show up (exception being night-time driving).
If the surgeries were able to correct higher-order aberrations and a proper wavefront restoration across a portion of the eye that would be larger than the relaxed iris, then it might be a possibility for me. However, the tech is not yet mature for this, for my use cases.

Re:Astronomy, and general poor night-time results.

[BStroms]

Also the fact that it won't prevent future changes to vision. I'm thirty now, and my vision still continues to slowly get worse. I fear I'd be paying for a 5 year reprieve from glasses and then be back to wearing them with side effects I also have to live with for the rest of my life.

Re:Astronomy, and general poor night-time results.

[swillden]

One common technique for people who are close to or have age-induced presbyopia is to perform the surgery on only one eye, or, depending on the prescription, to apply it in different amounts. The idea is to get one eye which is good for near vision and one that is good for far vision. Sort of the same notion as bifocals, but applied directly to the eyes. Apparently the brain adjusts quickly and effectively to this and you end up feeling as though you have good vision at all ranges as long as both eyes are open.

I'm considering doing that. I'm 45 and my eyes have just begun to change. I'm still generally myopic, but so far the change just requires me to take my glasses off when doing close work. I'm going to give it a couple more years to be sure my eyes have more or less settled, then get surgery on one or both, in whatever degrees will give me the best overall visual acuity and flexibility.

If your eyes haven't actually changed yet, then it's something of a crapshoot. The idea is to adjust your vision based on guesses as to how they're going to change. That said, my optometrist says that they can make very good guesses. The only reason he's recommended that I wait is because I'm not far from the point where guessing won't be required, based on my history of general visual stability and current rate of change.

Re:Astronomy, and general poor night-time results.

[David_Hart]

I'm considering doing that. I'm 45 and my eyes have just begun to change. I'm still generally myopic, but so far the change just requires me to take my glasses off when doing close work.

I'm also 45 and I'm experiencing the same thing. I am overdue for a new set of glasses anyway, but I've noticed my new farsightedness the most when doing work on the test bench. I've had to start using a set of head-mounted magnifying lenses regularly for close-up work. If I was to consider some sort of corrective procedure, I'd need something that's compatible with close-up hands-on work, staring at a computer screen most of the time, and shooting which requires both close-up vision (to see the signs) and long range vision (to see the target). I haven't researched yet whether any of the existing procedures would be a good option for a person of my age with my vision and range of activities.

I'm 45 too, am near-sighted, and have the same concerns (reminds me that I also need to get my annual checkup). I make my living off of my eye sight (network engineer), drive a lot for both work and play in all kinds of conditions, am a bit of a armature photographer, like downhill skiing, and one of my passions is movies. All of which could be screwed up if things went badly. When I am at work I wear glasses and when I play I wear contacts. Both of these are easy and cheap to fix and replace, unlike my eyes.

Re:Astronomy, and general poor night-time results.

[Anonymous Coward]

"am a bit of a armature photographer"

What's the biggest motor you've taken a picture of?

Uncertainty/fear?

[robinsonne]

Maybe it's just silly, but I'm really scared of someone shooting a laser into my eye. I don't want to be that 0.01% of cases that has something horrible happen.

Re:Uncertainty/fear?

[jammer170]

That's not entirely accurate, and to me is high on the scare-factor. As someone who has had LASIK, here is the full procudure:

They have you come in and lie down on a table. They then use a very small device, really nothing more than just a couple of wires, to prop your eyelid open. Next, they do use a very tiny bit of suction to pull on the eyeball (I couldn't really feel it, but your mileage may vary), to ensure you can't move it very much during the operation (the eye does still move slightly, but the laser can track the movement and compensates or cuts off - it does the same if you twitch your head). They then use a laser to cut a very tiny flap in the front part of the eye, and the device causes it to flip open. This is the moment you go "blind". The reason is because once that flap has been moved, the normal refraction of light onto your retina no longer occurs. They used to use a very small blade, but from my understanding the laser is cleaner, has basically zero risk for contamination/infection, and creates a more precise cut. At this point, they shoot the laser onto your eye. This is probably the most frightening moment, because while you don't see or feel anything (even with the eye not currently being operated on), you can smell what is happening. However, it really does not last very long, 60 seconds in my case, and the doctor counted down the time for me (your mileage may vary on this). Once he was done, he put the flap back, removed everything, put on a contact lens used as a "band-aid" on the eye and told me to go home and take a nap. I had a follow-up in the afternoon, and I had something like 20/40 or 20/50 vision. The contact lens came off, and I could do things that day. By the next morning, I was back to normal. I ended up with 20/30 vision at the end.

Personally, I never was given anything to help me relax. The closest thing was a small animal-shaped pillow to keep my hands busy and out of the doctor's way. If a person is really nervous, they may give them a Valium, but that is a case-by-case/doctor-by-doctor thing, not standard procedure. Frankly, it was one of the easiest doctor visits I have ever had. At most, it is about fifteen minutes of being slightly uncomfortable, pretty much all of it a mental thing, and then your done.

Re:Uncertainty/fear?

[Ark42]

Where I went, everybody got 1 Valium and they gave you a stress ball to squeeze while everything was going on. Everything else sounds the same, except I didn't get a band-aid of any sort, they just put the flap back and I went home. Drove myself to the follow up the next morning at 8am.
Agree that you can smell the laser burning your eye away. That's one thing they never said up front. You can't feel or see anything other than a blurry blinking red spot, and you hear some clicking as the laser pulses, but that was all expected.

not a good candidate

[forgottenusername]

I don't have enough material in my cornea. If they mess it up, there's not much they can do for adjustments.

As long as your eyeball remains parabolic, they can correct your vision more or less indefinetly assuming there's no other issues going on. Once you get lasik, your cornea becomes flattened so they can't really correct stuff with optics so well anymore.

I'd rather be safe and be able to have my vision correctable by contacts and glasses than take a chance at having really terrible vision that is then uncorrectable.

I feel like that's something people need to be made more aware of - lasik flattens your cornea so corrective lenses won't really work as well.

Re:Cost

[Austerity Empowers]

Also, having worn glasses for so long I've gotten used to the built in "objects flying at my eye" protection they offer. My glasses have caught more than a few flying objects and/or children's fingers.

Then there's reality:
1) Something might go wrong
2) My eyes are unbelievably important to what i do for a living and how I entertain myself, I'm not sure I'd want to live without them
3) I don't like the idea of being concious while someone/thing is cutting on me, especially my eyes

Re:NASA

[Anonymous Coward]

Yeah, that probably explains the vast majority of the cases.

However minute, risks remain.

[MouseR]

I'm missing part of a finger, but I can manage.
I could live with a limp.
But eyesight is a pretty big gamble. Yeah its small. But still higher than lottery.

That's why I opted for orthokeratology. I put my lens for one night, once every 7-ish days, and have 30/20 vision for the first 24h and then 20/20 for the rest of the week.

Elective surgery on a critical organ

[SuperBanana]

That's how a friend's father, an eye surgeon, put it.

It doesn't always go right, and (yes, rarely) it goes very wrong. There are no take-backs with the laser surgeries.

If you must, do the surgery that is reversible - they insert a small piece of plastic that corrects the lens shape.

Re:Cost

[danbert8]

It was weird for me after the surgery when in the winter I was all like, "what the hell is this shit pelting me in the eyeballs?"

Re: Astronomy, and general poor night-time results

[Anonymous Coward]

Yes, the older cheaper version of lasik did result in halos and star bursts at night, however for many years now the newer version of lasik does correct for higher order aberrations. I believe it is called 3d wavefront technology. They perform a 3d scan of the eye prior to the surgery and thus can correct for higher order aberrations. The older and significantly cheaper lasik was only a 2d scan. I had lasik done with the newer technology 8 years ago and still have 20/10 vision with no degradation thus far and no post operation issues. I'm fairly certain the percentage of people who have post operation problems is at most a few percent.

Re:My reason

[pthisis]

Yep. My dad's an ophthalmologist, and he doesn't recommend LASIK for anyone over 30 because of this (except in a handful of unusual circumstances). You're trading off future reading vision for distance vision now, and the older you get the closer "now" becomes.

I'll gladly keep my ability to read without holding things at arm's length or putting on reading glasses for as long as possible, though admittedly my distance vision isn't that bad (I wear my contacts if I'm going to a movie or something, but I don't need to wear them for normal daily life) and I was already pushing 30 by the time LASIK really matured (about 10 years ago)

If you're, say, 26 now (so you'll get a good 14-20 years of fully corrected vision) and have terrible distance vision, LASIK may make a lot more sense.

Astronomy, and general poor night-time results.

[cheddarlump]

As many who have replied to you have already noted, they do full remapping and correct for 2nd and 3rd order abberations. It's amazing tech now. If you can, go in for the free scan where they do a 3d surface map of your eyes, the detail and resolution of the mapping machine is just pure nerd-porn, especially if you're an optics guy. I've done both eyes, and would like to share my story: I've been extremely near-sighted with astigmatism my whole life. I'm now in my late 30s, and my eyes stopped changing in any real fashion about 5 years ago -- they stabilized around -8.75 diopters of correction needed. I'd always worn disposable contacts, but hated being blind at night when they were out. When I was 5 or so, I walked into a branch that left a scar on my left cornea that previously excluded me from lasik -- UNTIL the new 3d wave mapping came out. They did have to use the blade to cut the flap on my left eye (as opposed to the ilasik cutter on the right eye), but I can now see at 20/25 out of my left eye for the first time since I was 5. Previously it was correctable to a best of 20/40. They actually almost totally removed the scar tissue automagically while at the same time corrected for the extreme nearsightedness. I'm a believer. If you are worried about the night vision effects, those are truly present in the first couple of months. Those that say they're not are the same people that don't notice the low bitrate on satellite radio.. ;) After about a year, however, I personally have zero effects, starbursts, rings, hazing, or lack of contrast anymore. It takes a while for the lens to heal up, but it did for me. Negatives: I now need UV protection in the sun. I didn't realize that my contacts previously provided UV blocking, and the sun is annoying now without sunglasses.. :)

Re: Astronomy, and general poor night-time result

[Anonymous Coward]

I'm waiting for the 4D revision so I'll be able to see through time.