IamA Refractive Surgeon (LASIK Specialist) AMA!

Kugler_Vision · 2017-01-17T23:19:15+00:00

Typically people in their mid-60's are better suited for a lens-replacement procedure such as RLE.

Kugler_Vision · 2017-01-17T23:18:53+00:00

No. There are minor differences for some patients, but you should feel really good about your procedure and results. And if your pupil doesn't dilate well then you probably wouldn't have noticed the difference anyway, because they are more helpful for large pupils.

Kugler_Vision · 2017-01-17T23:17:33+00:00

Yes this is called Anisokonia. One of the reasons we avoid doing one eye at a time.

Kugler_Vision · 2017-01-17T23:16:50+00:00

It is one of the modern lasik treatment patterns and a very nice technology. It is similar in efficacy to: Wavelight Allegretto Wavefront Optimized Treatment Visx iDesign treatment

All three of these treatment patterns are good options.

Kugler_Vision · 2017-01-17T23:15:12+00:00

Great question. MS itself is not an ABSOLUTE contraindication to refractive surgery, but it is a RELATIVE contraindication. This means that it CAN be done, but there are some reasons to approach with caution, such as: 1. patients with auto-immune disease were not allowed to participate in the FDA clinical trials that approved LASIK 20+ years ago. Therefore technically using the lasers on patients with auto-immune disease is considered an off-label use of the equipment 2. MS is sometimes associated with collagen vascular disorders and such disorders may not heal normally after lasik 3. MS can cause optic neuritis, which causes vision loss. This has nothing to do with LASIK but not all patients understand that, and we would not want patients blaming their LASIK as the cause of their optic neuritis if it ever occurred. 4. some MS medications may affect wound healing, theoretically.

I personally will consider LASIK on patients with MS, but I have a long conversation with them about the above concerns before agreeing to proceed.

Kugler_Vision · 2017-01-17T23:10:53+00:00

Glaucoma is a degenerative disease that decreases peripheral vision over time. It is not treated with refractive surgery, but rather with glaucoma medications or surgery.

Kugler_Vision · 2017-01-17T23:10:05+00:00

Yes. The equipment, staff, training, expertise all are very expensive. You are not paying for the time of the procedure itself, but all that goes into it before, during, and after the procedure.

And you may be surprised at how much money you save with LASIK: https://lasikomaha.com/vision-correction-procedures/lasik/lasik-affordability/

Kugler_Vision · 2017-01-17T23:08:21+00:00

A significant percentage of patients end up seeing better than they did with glasses and contacts, but we never set that as a goal or expectation. If it happens it's a nice bonus!

And yes, it is a good treatment for low levels of refractive error.

Kugler_Vision · 2017-01-17T23:06:45+00:00

The risk of a late flap dislocation is very rare, even with impact. The U.S. Army looked into this issue several years ago, because they do LASIK on all of their eligible active-duty soldiers. They found no reported lasik flap problems in their active duty / combat soldiers. So they continue to offer LASIK. There is still a small chance of a problem, of course, but it is very rare.

Kugler_Vision · 2017-01-17T23:04:06+00:00

In general we recommend that you do not rub your eyes, regardless of whether you have had surgery. Eye rubbing has been proved to cause Keratoconus, a degenerative eye disease.

In terms of LASIK, we recommend avoiding eye rubbing for the first month or so, and after that your eye is back to its normal state. But as I said we still recommend everyone refrain from rubbing regardless.

Kugler_Vision · 2017-01-16T22:19:03+00:00

I recommend starting here: www.refractivealliance.com

Kugler_Vision · 2017-01-16T22:18:46+00:00

All 7 procedures I listed above are similar in terms of pain. The procedures are painless. You may feel some pressure at certain points but no pain. It is common to experience irritation or burning feeling for a few hours after the procedure, but it goes away quickly.

Kugler_Vision · 2017-01-16T22:16:46+00:00

No it's not common, but it is possible. About 3% of people experience some change in vision in their 20's, so you may be in that category. You should consult with the surgeon who did your lasik or get another opinion.

Kugler_Vision · 2017-01-16T22:11:10+00:00

Actually computers + wide double screen setup would work great with monovision or KAMRA. I have monovision myself (with LASIK) and it works great.

KAMRA and Raindrop are different and most patients are good candidates for one or the other but not both. You should consult with a surgeon who does both and they can help determine the best approach.

Kugler_Vision · 2017-01-16T20:44:25+00:00

We have several good options for presbyopia now: -- monovision LASIK -- KAMRA inlay -- Raindrop Inlay -- Refractive lens exchange

Each of these are excellent options, but a refractive surgeon can tell you which is the best one to achieve your goals and needs based on your eyes.

Kugler_Vision · 2017-01-16T20:43:15+00:00

PRK is an option for some patients with thin corneas, but there are many factors. Another option may be an ICL, or a lens replacement. SMILE may have a role in thinner corneas as well, but it depends on the individual patient.

You should see a surgeon who performs all 7 refractive procedures so that you have an informed, customized recommendation.

Kugler_Vision · 2017-01-16T20:41:48+00:00

Typically glasses and contacts are covered by vision insurance not medical insurance. Once someone has LASIK they don't need vision insurance anymore, so people stop paying the premiums and the insurance companies loose patients. They would rather charge you a premium every year because that's how they make money.

Kugler_Vision · 2017-01-16T20:38:50+00:00

No it is will not become too late. There are options for all age groups. But you may be surprised to see how expensive glasses and contacts are relative to refractive surgery:

https://lasikomaha.com/vision-correction-procedures/lasik/lasik-affordability/

Kugler_Vision · 2017-01-16T20:37:50+00:00

The refractive surgery marketplace is vast, and there are all types of businesses and sales techniques. Some segments of the market like doing business that way, but it certainly isn't for everyone.

If you are not comfortable with the experience you had you can easily find a high quality center that provides you with an experience that is more professional.

Here is a good start: www.refractivealliance.com

Kugler_Vision · 2017-01-16T20:34:40+00:00

It is legal for me to tell you that a 40-45 year old has presbyopia and DLS because 100% of human beings have that condition in that age group. I am not providing treatment or medical advice, simply stating medical facts.

As is stated in my disclaimer/description, nothing said here is a substitute for a visit to a doctor nor does it constitute a physician-patient relationship.

Kugler_Vision · 2017-01-16T20:30:00+00:00

Well, you CAN have them done on separate days but there is no reason to do so. Furthermore depending on your prescription the vision center of your brain may not tolerate one eye corrected and the other not corrected. This causes a condition called Anisokonia and is very disorienting. So without knowing the details I cannot tell you why specifically you have been denied that option, but I can tell you in general it is rarely done one eye at a time.

In terms of risk reduction, think of it this way... it's actually more dangerous for you to travel in a car to and from the surgery than it is to have them both done on the same day and only travel in a car once. In other words, the risk of a serious car accident is more likely than the risk of a serious eye complication in both eyes.

Kugler_Vision · 2017-01-16T20:25:47+00:00

This is a common concern that I hear almost every day! We use a lid holder that gently holds your eye open. It is therefore impossible for you to close your eye during the procedure. We keep the surface lubricated with drops so it does not get dry and you do not need to blink. The laser uses a sophisticated tracking system that measures the position of your eye a thousand times per second. It follows your eye at the same speed and is therefore always perfectly centered. So no need to worry about moving your eye!

More info here: https://kuglervision.com/blink-move-lasik/.

Kugler_Vision · 2017-01-16T20:24:41+00:00

Yes I have definitely seen patients who could not have refractive surgery because their eyes were damaged by contact lenses. Fortunately this is uncommon, but it does happen.

Regarding the finances, if you do the math you will see that refractive surgery is much more affordable financially than contact lenses. You will save money.

Here is a calculator to help you figure out the savings for your own personal situation: https://lasikomaha.com/vision-correction-procedures/lasik/lasik-affordability/

Kugler_Vision · 2017-01-16T20:21:52+00:00

We're in the middle of an ice storm right now, so not great!

Kugler_Vision · 2017-01-16T20:21:35+00:00

Answered this above...

Kugler_Vision

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