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I am 41 and have -5.0 approximately. My cornea thickness is around 550. My corneas are flat at 42. I think my pupils are 4.7mm. Would you recommend PRK for me versus thin flap LASIK due to my flat corneas or something else? I am worried about poor night vision, halos and dry eye from LASIK but the long process of sub-Bowman’s keratomileusis (SBK) scares me. I have been told my eyes are otherwise healthy. I don't think I would be a candidate for traditional LASIK due to my flat corneas.
To determine the best option for laser vision correction, many factors come into play, which makes this a difficult question to answer unless I am examining your eyes myself. While corneal thickness and corneal curvature are important variables in the preoperative testing, corneal topography (mapping of the corneal surface) is perhaps the most important variable to predict whether laser in situ keratomileusis (LASIK) or a surface ablation technique is the best option for you. This also depends on what technique your eye surgeon implements. For example, femtosecond-assisted LASIK affords slightly better flap thickness predictability than microkeratome-assisted LASIK and may allow some borderline candidates to become suitable for LASIK. This is also the case for surface ablation techniques, which have slight variations in surgical technique but all avoid a flap in the cornea. These techniques include photorefractive keratectomy (PRK), subepithelial keratomileusis (LASEK),
advanced surface ablation (much like PRK), or SBK that you mention. Second opinions can also be useful if you have concerns after the evaluation and discussion with your eye surgeon.
In regards to complications of LASIK, anything you do involving surgery has potential risks and the risk-to-benefit ratio must be considered by patient and surgeon for any procedure. Having said that, with an appropriate evaluation to rule out eye diseases such as severe dry eye, keratoconus, cataract, and other ocular diseases, laser vision correction has perhaps some of the best outcomes of any surgical procedure performed in modern medicine. Glare and halos can always be a risk after laser vision correction, but if pupil size is what you describe and the technology used by your surgeon is state-of-the-art, these problems are much less likely than in the early days of laser vision correction with older laser devices and smaller treatment zones in the cornea. Dry eye disease risks should be discussed after your examination to gauge your risk as it varies from patient to patient.
Answered by: W. Barry Lee, MD
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Answered: Apr 25, 2013
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