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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Had Lasik (PRK) a couple years ago. Ive needed an enhancement

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Had Lasik (PRK) a couple years ago. I've needed an "enhancement" for over a year but am nervous about the people that did it last time. I was very near sighted 20/550 and 20/575 and had thinner corneas besides so I was told PRk was my only option. Had it done and got to about 20/30 and no halos or brightness issues but I've had a couple issues:
1- The darker it gets the more fuzzy things get. I was told that this was likely because the laser they used only did the center of the cornea and as it gets darker and my pupils dialate it gets into the area that was not lasered, hence the increasing blurred vision at night. Is this true and do they have lasers that can actually do the whole cornea now?
2- After the surgery I was told that I'd likely have some "slight discomfort" for a couple days and they gave me a prescription for some type of pain pills. "Slight discomfort" felt more like a blow torch being held on each of my eyes. Pills didn't really help so I just sat in bed miserable. I was told that a certain amount of this is normal but the amount of discomfort is also a result of the type of laser used. I also can't help but wonder if, being it was one of the cheap places, that if they would have just slowed down a bit it may have helped. Don't know if there's a "coarse" vs. a "fine" setting but since I'm sure some of these places crank through so many people that time is of the essence. Is this true also and what would you recommend?
3- I'm 48 years old and in the last year or so I've noticed that I'm on the verge of needing reading glasses. I was told that if I get this done again I can have one eye done for reading and one for farther away, if I so choose. I guess this would be my decision but in your experience do people tend to be happy with this type of set up? I'm thinking I'd rather just have them done right and if I need to wear reading glasses I'll just wear reading glasses. I guess I'd just like your opinion on that.
4- I can't give you hard numbers but when I had this done they said there'd probably be just enough "material" left for maybe this one last enhancement. I paid for the "unlimited enhancements" so if I get it done by the same people it's paid for. My concern is that I don't like the way that they didn't bother to tell me of the problems I'd likely have with my night vision, I still get furious about the "slight discomfort" nonsense and last year at my annual eye exam when I complained about wanting them to redo it they said that my vision was still 20/30 so they considered it a success. He also said that my eyes were too dry and put me on restasis. When I had gone in I intentionally hadn't used drops for a couple days because I felt that it would give them a more accurate exam. I also explained that 20/30 was only in full sunlight or in their chair looking at their brightly lite up chart. I let them talk me out of it but I'm going back in this saturday for another exam. I'm not made of money but this is my eyes I'm talking about and I'll likely only have this one more crack at getting them done right. If I let them do it I want to know what to ask them to insure it will be done right this time. If I decide to bite the bullet and go somewhere else it seems like there's the $500 per eye places like this one or the $3,500 per eye places. In your opinion is this another one of those "you get what you pay for" things or do the pricier places tend to use the same equipment and take just as many shortcuts? What would you recommend to insure that I get the results I want regardless of who does it?
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Are you available to chat?

Dr. Rick :

Let's address your issues one at a time: 1. They are correct. If your pupil is dilating beyond the treatment zone your vision can become "fuzzy" I am sure that the laser they used treated the largest circle of cornea possible. It is not possible to treat your cornea from edge to edge with the laser.

Dr. Rick :

2. That "discomfort" you experienced after PRK was one of the major motivating factors driving the invention of lasik -- much, much less pain with a quicker recovery time. As you mentioned, due to your high myopia and thin corneas you were not a candidate for lasik, which requires a thicker cornea for the same amount of refractive error correction then does PRK.

Dr. Rick :

PRK is painful. There is no getting around that fact. It really has nothing to do with the settings on the laser, how fast they crank through the patients or what they charge for their services. If you are able to have an enhancement using PRK it is going to hurt just as much and, most likely, for just as long as it did during your primary treatment. Once again, however, your residual refractive error and remaining corneal stromal thickness will determine if you can safely have more PRK.

Dr. Rick :

3. There is the possibility that you have already had too much of your natural near sightedness corrected to be a candidate for monovision (one eye for near, one eye for far). However, before you have this prescription "cut" into your cornea forever you should try walking around in contact lenses that mimic what you would expect after the PRK to do this. Some people love it, some people hate it and the only way to tell which group you are in is to give it a try. Personally, as a surgeon, I'd just wear the reading glasses.

Dr. Rick :

4. It sounds like you are not happy with the doctor who did your first surgery and, no matter what happens if you go back to them, you won't be happy. So. My advice? Go somewhere else for another opinion on your current vision and options. What should you pay for this service -- the $500 or he $3,500? Well. How much is your vision worth to you? Is this REALLY the place you want to try and save a few bucks? When you do go for this second opinion, it is important to bring with you your pre-PRK data, your PRK treatment data, and your post PRK data from the first doctor so you can get an informed opinion from the new guy.

Dr. Rick :

There is no way to insure that you will get the results you want. Eye surgery is not like fixing the transmission on your car; doing the exact same surgery on two patients may very well give two different results. Humans are not like machines when it comes to therapy. The only thing you can do is to make sure you first, go to a doctor you trust, second, ask around to see what others say about this doctor and , most importantly, be very realistic about what can be done with the treatment you are going to have and what type of things can go wrong.

Dr. Rick :

I know we have covered a lot of material here. I hope you find this information helpful.

Dr. Rick :

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Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Expert:  Dr. Rick replied 3 years ago.
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Expert:  Dr. Rick replied 3 years ago.
Let me know if there is anything else I can do to help.

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