Thursday, July 26, 2007

Custom LASIK Answers

I did a little more homework and I think that I sufficently answered my questions. Unfortunately, because of the competition, there is so much misinformation out there. Everyone wants to do your LASIK so they are going to convince you that their machine, or method is the best and anyone else is going to make you blind. Overall, I think I could get a good result at any of the clinics but I think EyeCareOne/MCG is the best. Trouble is that the technology is new and there isn't a lot of data yet.

LASIK factory vs. General practice
It seems the optho guys who just do LASIK want to convince you that they're the one who should do your procedure because they do so many every day. They caution you about those other guys who just do a couple on the side to pad their income. I think it is important that a practice do a critical number of them and has the best resources. But, apart from having the best machince, since the flap is the most technical step, if the optho guy is a good surgeon he is gonna make a good flap. I don't see how an optho guy who couldn't hack it in the OR can say he has anything over another optho surgeon who does complex lense, cornea, and retinal surgeries. Besides, the new microkeratomes are now automated anyways.

Intralase vs. microkeratome
The intralase people make it sound like the microkeratome is a butter knife. Actually, I don't see how a laser is better than a knife. We don't use lasers in the OR or ED because they actually can cause more tissue damage by heating up surrounding tissues and cause more inflammation, which could impede healing. I'm not sure If the data shows any difference, but I don't buy it that a laser is better just because its a laser. The new microkeratomes are just as precise and just as automated. The new ones are actually machine driven. Although they do look a lot like a meat slicers. Give me the meat slicer!

The 15th street people were telling me that the microkeratome was going to forsure result in corneal wrinkling or other abborations and subject me to a higher risk of needing a redo. After considering the issues, I don't see how this could be true. I think flap problems have less to do with what makes the flap and more to do with flap thickness, how the flap is replaced, and healing than anything else. And interlase still requires the surgeon to choose the flap size and thickness, the flap to be manually retracted and the flap to be manually replaced after the procedure.

Wavefront guided vs. Wavefront optomized
Allegretto Wave Excimer Laser at 15th steet is infact only wavefront optomized. It says it in their broshure. And when I asked their people about it they first told me I didn't know what I was talking about and then that its all the same and then it could do both guided and optomized. Haha, nice try.

It is my understanding that the difference between wavefront guided and optomized is that wavefront guided is a truly custom LASIK. The wavefront guided machine will do sophisticated mathematics to measure not only spherical and cylindrical corrections but also "higher-order abberations" (which cause night halos and stars) and correct for those exact abberations. Wavefront optomized measures for higher-order abberations but only uses a pre-set "one-size-fits-all" correction. That't akin to knowing you are far-sighted and just going to the local CVS and picking up reading glasses from the cheap-o reading glasses display. Consequently, only a wavefront guided correction is a true custom LASIK correction.

LASIK on dilated or nondilated eye.
Eye Care One/MCG performs the procedure on a dilated eye. Although having a dilated eye is rather annoying for 3 days, I don't think it matters. MCG says they do it dilated so that they don't overcorrect. 15th strest says they measure the cornea and perform LASIK on an undilated eye so they can treat the eye in its relaxed state. MCG says that paralyzing the ciliary body may help lessen inflammation and mostly because I believe their particular corneal mapping machine requires it. I'm not sure that it matters. The important thing is the if you take the measurements with a dilated eye that you do the LASIK with a dilated eye and visa versa.

Allegretto vs. VISX
EyeCareOne/MCG uses the VISX’s CustomVue WaveFront System, with the newly added Fournier transform wavefront algorithm upgrade to calculate ablation shapes with more precision and individualize treatment to each patient. Additionally the VISX Customvue system offers Iris Registration and Activetrak™ to compensate for intra-operative cyclotorsional movement, and to ensure treatment is delivered to each eye accurately. Allegretto uses an activetrak-like system too but you can't beat a machine that can do fournier transforms.

1 comment:

Danielle said...

Your research is very helpful, even a year later!! Thanks so much. So ... what did you decide on and how did it turn out? Pros and cons?