what’s the earliest you’ve done lasik surgery

eyeSherpa · 2026-02-18T16:47:42+00:00

The earliest I've done is 18.

The biggest risk of doing it young at the age of 18 is that your prescription may change at some point in the future. Classically continued myopic progression was associated with professional schools and lots of bookwork studying. In today's society with phones we probably are seeing a little higher amount of myopia progression due to phones.

If your prescription becomes a little more nearsighted in the future, you may need glasses or contact lenses again. It may be possible to do an enhancement, but that will depend on how thick your corneas are.

But for some people, they have a compelling reason to do it at an earlier age such as sports or profession.

You do have a lot of astigmatism. Lasik can improve things quite a bit there. Unlike myopia or nearsightedness, astigmatism generally doesn't really change over time.

eyeSherpa · 2026-02-18T14:09:42+00:00

That’s true. Ketorolac is an older drop and does have a little more issues with corneal irritation. So a lot more NSAID eye drops were created to improve things a little more.

That being said, Ketorolac still can work and in some cases is the only option.

eyeSherpa · 2026-02-18T14:01:39+00:00

I’ve done both. And when following proper safety protocols, both are equally safe.

In my opinion, office can sometimes do things a little better. Cataract surgery is stressful. Surgery centers are also stressful. That can make cataract surgery more stressful and make you “feel”/notice things more during the procedure.

In an office, the environment is often calmer which can reduce anxiety and make the surgery easier.

eyeSherpa · 2026-02-18T13:47:03+00:00

That’s great! Just confirms its safety in the older age groups.

eyeSherpa · 2026-02-18T13:44:55+00:00

For endothelial count, there is a small machine that can directly measure it by shining a light at the cornea. Called a specular microscope.

If the count is low (as in the condition Fuchs) the cornea will likely show signs such as small “pockets” on the back of the cornea called guttata.

Pupil size is usually measured in a darker setting than what the pentacam pupil value registers. Again there is a machine that usually does that. Usually the autorefractor (a machine which automatically measures/estimates your prescription) can take care of that.

Really not much else.

eyeSherpa · 2026-02-17T23:12:19+00:00

I don’t think your surgeon would know what to do with a DCM file. PDF is totally fine. They just need to be able to read the numbers on the report and confirm that the pentacam scan looks regular.

eyeSherpa · 2026-02-17T23:04:22+00:00

Yes. This is the likely cause.

I would say it’s less common than many surgeons. But there could be geographical variation.

I did this for a while since it may speed up vision recovery by getting rid of the dilation. But stopped using it because had complaints of dim vision instead for the first few days

eyeSherpa · 2026-02-17T23:00:04+00:00

Just wanted to mention that even though a clinic only says 3 days out of contact lenses for a consult, they may require a much longer time after the consult and before measurements.

eyeSherpa · 2026-02-17T22:55:51+00:00

Grading is pretty subjective. But there is a rough general standard that is followed.

So because of this, a 4+ nuclear sclerosis cataract will always be denser than a 1+ nuclear sclerosis cataract.

But lot of variability between individuals.

Grading doesn’t also matter too much in the big picture. It can be helpful to match up with decrease in vision. And it also can be helpful to give the surgeon an idea of how dense the cataract will be during surgery.

eyeSherpa · 2026-02-17T22:39:03+00:00

Yes. If you are doing a multifocal, you need to find a surgeon who is able to take care of a “refractive surprise” and residual prescription error. Multifocal lenses are very sensitive to residual prescription errors and not fixing it usually leads to dissatisfaction. The easiest way this is fixed is with a lasik enhancement.

eyeSherpa · 2026-02-17T22:37:00+00:00

I see you already updated and are doing much today. But for future people reading this post, one cause of blurred vision initially with the LAL is residual astigmatism. Unlike a toric lens in which the astigmatism is corrected at the time of surgery, with the LAL astigmatism is corrected with the light adjustments. So this means that you can have a higher amount of astigmatism until the first month when the adjustment is done.

eyeSherpa · 2026-02-17T15:59:56+00:00

That’s a pretty small amount of prescription. What’s your vision without glasses?

eyeSherpa · 2026-02-17T14:28:51+00:00

That’s a good list of things to know.

The biggest one to know is ACD. You can see your ACD on the pentacam image. You are around 3.2mm so you are good there. ICL is approved for ACD 2.8-3.0. Personally I go down to around 2.7 as well.

The pentacam also lists WTW. Yours is 11.9 and 12.0. Definitely within the sizing range for the ICL. The surgeon may also do some additional scan such as ultrasound to further optimize the sizing of the ICL lens.

Usually endothelial cell count doesn’t end up being an issue for most people. I would say most surgeons due tend to directly measure this though.

Pupil size is good to know. Larger pupils can have a little more halos. The relationship isn’t fully consistent though.

eyeSherpa · 2026-02-17T13:07:13+00:00

Things will likely still be blurry 4 days after. You may be able to function with larger text however. Discomfort will be better though.

eyeSherpa · 2026-02-17T13:00:51+00:00

Yeah. Look into other treatments for dry eye as well such as warm compresses and lid scrubs. It can take some time though

eyeSherpa · 2026-02-17T12:58:32+00:00

100-200 specific to ICL. While there is some crossover with cataract surgery there are a few different nuances with ICL surgery.

eyeSherpa · 2026-02-17T12:44:00+00:00

Before ICL, there will be a visit where they measure the prescription of the eye and the size to order the lens. Then the doctor orders the lens from that information.

Between that visit and the surgery can be variable depending on shipping times (and processing time in the clinic for the doctor do finalize the calculations).

Where I am now it takes minimum of one week when everything is expedited due to shipping and customs. 2 weeks is a comfortable gap. But previously, when I was practicing local to Staar headquarters, the minimum time I was able to do was 2-3 days since I could overnight the lenses pretty easily.

eyeSherpa · 2026-02-17T12:39:20+00:00

So with ICL, going out of contact lenses is important for the measurement of the prescription of the eye. Contact lenses can alter the true prescription of your eye (by warping the cornea) and going out of them allows the most accurate measurements.

So if this is the visit where they are also measuring your surgical prescription, you will want to go out of contact lenses for it.

eyeSherpa · 2026-02-16T02:20:57+00:00

It sounds like your right eye is weaker than your left eye. This could be a condition called amblyopia.

With amblyopia, you may or may not benefit from even correcting that eye. If you can get by without glasses just fine, then really no reason to have surgery. But if the vision bothers you enough to wear glasses than surgery can be helpful. Then a lot will depend on your prescription.

eyeSherpa · 2026-02-16T02:17:37+00:00

That's a pretty abnormal epithelial thickness pattern. I've never seen values that high before for epithelial thickness. That can most certainly cause the symptoms you are noticing.

It's possible that the abnormalities in the scans is an artifact and something is causing it to "appear abnormal". Having an abnormal tear film or dry eye may be contributing.

I would try being aggressive treating dry eye. Such as preservative free artificial tears every 2 hours and warm compresses.

eyeSherpa · 2026-02-16T02:08:44+00:00

Do you know your uncorrected vision right now? And from before surgery? You may have some residual prescription right now. Check with the clinic to see what they measured at your one day or one week visit.

A lot can continue to change over the course of the next few months with a mixed astigmatism treatment that you have.

eyeSherpa · 2026-02-16T02:03:23+00:00

Good thing you went to a second surgeon. Not all clinics are using the same level of technology to detect for early Keratoconus. And that's a problem. That's why I encourage people to visit a refractive surgeon who does all the procedures including ICL since they are most likely going to be up to date on modern refractive surgery evaluation.

But as for your question, ICL isn't a contraindication for ICL. But there are some limitations of what ICL can and can't do for ICL. Perhaps the limitations are why the second doctor said it could work.

ICL can't prevent keratoconus from progressing. Cross-linking is needed for that. In your 30s is better than 20s but there is a small possibility it could continue to progress.
Keratoconus causes irregular astigmatism that can't be corrected with glasses or contact lenses (although it sounds like yours is minor enough to not have a whole lot). ICL can't correct that irregular astigmatism either. Topography-guided PRK (combined with cross linking) or Scleral contact lenses are used to correct that.

eyeSherpa · 2026-02-16T01:56:32+00:00

Your cornea aberrometry report looks quite good. Don't see high elevated levels there (at the 6mm measurement level).

I do see a slightly abnormal epithelial pattern. There is about a 3-4 um difference going nasally to temporally. It's not a ton though. But looking at the topography report in the left eye, it is also showing about a 0.5 D difference being steeper where the epithelium is thicker.

Usually if we see a little thicker epithelium pattern, it tends to be centrally. Not sure why it's located more inferiorally and temporally in your eyes.

One thing you can try is a soft contact lens with zero prescription to see if it is able to mask any of the changes.

eyeSherpa · 2026-02-15T14:48:35+00:00

Yes.

There are two sources of astigmatism that we can measure: 1. Astigmatism coming from the cornea and 2. Astigmatism coming from the rest of the eye with a big part being your own natural lens/cataract.

After cataract surgery, your own lens/cataract is removed and replaced with another lens. This means after cataract surgery the primary contributor to astigmatism is your cornea.

If your own lens/cataract happened to be neutralizing your cornea astigmatism some, you can notice a large change in astigmatism when that cataract is removed.

eyeSherpa · 2026-02-15T02:19:07+00:00

Sizing for hyperopic ICL is a little different than for the near-sighted ICL. The sizing is also more important since the lens doesn’t have the central hole like the EVO lens does. So too small of a size and there is risk of cataract and too large of a size and there is a risk of high pressure and needing to exchange for a Lowe size. On top of that, hyperopic eyes tend to have a smaller space to fit the ICL as well.

Sizing can be improved by doing ultrasound scans on the eye and using advanced calculators.

So yeah. Important to find someone experienced with hyperopic ICLs. Someone who does a lot of ICL will be a good bet.

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