Eye surgery - laser and other

Lounge
1

This thread is about surgery to correct defective vision, primarily thinking of elective surgery rather than when conducted for a medical reason such as to cure cataracts, though the experience from that is very much valid. Whilst I have a specific question, the subject seems to be one that might be of wider interest so I invite all contributions.

Laser eye surgery has become pretty commonplace these days and with a very high success rate (though in many cases natural changes in vision means that spectacles may eventually be needed, or repeat surgery). In my own case I am shortsighted and have worn contact lenses (hard lenses) since 1975. I have sometimes thought of laser surgery, but been put off by tales of people still needing spectacles afterwards which is one thing I definitely donā€™t want.

Then recently both my sons decided to have laser eye surgery. They reasoned that if they get maybe 10 years glasses/contact lens free it would still be a good thing, indeed for the one who can only wear the most expensive contact lenses it is actually a significant cost saving! I was very impressed with the reports they received on the health and state of their eyes. So much so that when the second one went for his surgery and needed someone to accompany him I went, and booked an eye test as if I was interested in similar treatment. In doing that I had no intention of going through with surgery, just wanting that comprehensive report on my eyes. In fact when they tested me they said they felt that because of my age a better approach would replacement lenses. That would have the great advantage that my eyes would never change (ignoring other eye issues such as retinal damage), and I would not then develop cataracts in respect of which I apparently have the first signs visible, and I know is that both my parents havenā€™t had it that it is a likelihood. So it is actually tempting to do that.

Although on the one hand I could wait until I get cataracts, when maybe I will get replacement lenses on the National Health - but doing it now would mean I wouldnā€™t have to go through sight deteriorating and then waiting lists etc etc first.

Now comes the question. There are two types of lenses: I could have one eye longsighted and one shortsighted, apparently giving full vision, with no need for reading glasses while still seeing well in the distance. They say the brain adapts fairly readily to that. The alternative is something they call multifocal lenses: apparently somehow they manage to focus both long distance and near. That to me seems like disregarding the laws of physics! The surgeon explained it has something to do with concentric rings on the lens or something like that, which I didnā€™t really understand. She claimed that you do genuinely end up being able to see distance well enough, and be able to read without reading glasses, though witha ā€œslightā€ propensity to problems such as glare at night, which she seemed to think I would get used to. So I want to understand more about this: aside from the significant cost, the last thing I want to do is end up with vision worse than now, or worse than that easily corrected. Has anyone out there had replacement lenses, of either type or know anyone who has? What is vision really like: can you see distance, sharply, and read small print, all without using spectacles? Is it really good, or just tolerable?

Any/all experiences or observations welcome!

2

To be candid I would never have (or advise) any eye surgery that was non-essential, ie not to correct a health problem rather than for convenience. There is always a risk of side effects with any procedure however routine it may have become and serious eye complications are often irreversible You get one pair for life; there are no spares. Spectacles rarely have serious side effects.

Lens replacements can become dislodged, and you can develop posterior capsule thickening over time needing an additional procedure. Cataract extractions also carry a very small risk of retinal detachment and other complications. I also have personally seen a number of patients with poor outcomes after laser correction surgery (ie still needing spectacles) as well as one who has suffered permanent visual damage.

I know this is not quite the feedback you want, but remember that fundamentally the clinics are trying to sell you a product and are not independent. Good results after these things are usually good, but a bad one is usually permanent.

Bruce

3

Thanks Bruce, professional view greatly appreciated.

For myself I have resisted temptation to do laser for just the reasons you give, thou usefully you have identified more about the potential issues with replacement lenses than I was aware. The same would be the case with replacement lenses, the one thing that makes a difference is that I believe that I will require them to cure cateracts some time anyway - just a matter of when, 20 or more years time, 10, or less, as no-one seems to know how fast they develop (Iā€™m 64, my father had it causing significant loss of vision by 78, my mother by 86. Routine eye test a year ago noted some change, consistent with early stages of cataract development.)

The question regarding type of lens and the pros, cons and experiences of both applies whether I elect to do earlier, or wait until I have to - and of course will be of interest to anyone facing the question, for whatever reason.

On the general position with laser surgery, typically they quote figures like 99% of people will have at least 20/20 vision. That has always have focused my attention on the 1% who will require glasses for if they want to see well (and in fact with my contact lenses my vision presently better than 20/20, and that is not the only factor in good sight). To me it is totally ridiculous to spend a lot of money and some risk to health having laser surgery, only to find you still needs glasses or contact lenses! (Except perhaps where your glasses at present have extreme descriptions with very thick lenses.) But of course many people think it is worth the risk and do it, successfully, my two sons being cases in point despite my advice against - hopefully they will get a good many years before they need to wear correction, and more significantly I hope no complications will develop, it still being early days.

4

The RNIB produce some good information on cataract surgery (ie lens replacement) here, including a 40 page leaflet.. they are a good independent source of information (and a very good charity too).

5

The figures for complication rates after cataract surgery are generally quoted as 3-5%. Some of these will be temporary and reversible. Donā€™t forget this is a heterogenous group that may include eyes with other pathologies and it may be an older group than those having elective lens replacement without having developed cataracts.

Iā€™m suspicious of the 99% 20/20 figure for refractive surgery. Does that mean unaided or with spectacles where needed? Does that mean for distance, near or both? The data I have quickly looked at suggests up to 5% require spectacles at 12 months and that rises slowly over time. As ever there is a lot of subtlety here; the results depend a great deal on the case mix pre-operatively. If it is done on those with high refractive problems the success rates will drop.

Nothing is ever totally safe or totally effective; it comes down to your own balance of risk and benefit.

Bruce

PS Highly technical review of long term laser correction outcomes below. 90.6% at 5years achieved binocular 20/20

6

This is exactly the same as using multifocal contact lenses. Iā€™ve been using these special contact lenses for about 3 months and, overall, Iā€™d say a good thing. Itā€™s all to do with the eye using the central part of the lens for long distance and the peripheral part for close up. So the eye tends to look through the part of the lens with the appropriate focal length. However NOT perfect. Basically what you get is okay long distance and okay reading distance. I use the work ā€˜okayā€™ intentionally. They arenā€™t brilliant at all. In my case the rewards out weight the failings. Sitting at a desk all day long means I can read the screen and keyboard fine and distance is perfectly okay for office etcā€¦ Driving is also okay (advantage can read the MM screen now) but NOT at night. The glare, particularly from rear/red lights is horrible. First time I drove at night with them it was a nightmare. Now I have some lens wash and container if the glove box so if I end up having to drive in the dark I can whip them out. tbh unless Iā€™m going out (day time) at the weekend Iā€™ve stopped wearing themā€¦ they compromise distance too much, I mean anything beyond about 3m has got a hint of blur to it, though being able to read labels on products and menus is a good thing :slight_smile:

Anyway, what Iā€™m saying is I guess this is exactly the effect when you have multi-focal replacement lenses. After living with the effects of multi-focal contacts my STRONG advice is donā€™t do it.

Perhaps try multifocal contacts first of all? I used the well known shoe makers who were excellent. Trying several different brands and strengths over the course of 3 months. Cost, btw, is Ā£26pmā€¦ this is for the top of the range vari-focals. You can get the concentric rings type for cheaper. Also, tbh, you can get the same lenses online working out cheaper BUT ā€˜shoesā€™ throw in some other incentives to make it worth while.

7

Previous forum had a similar thread along these lines and Iā€™m pleased to see Bruce posting in calm, sensible terms. Iā€™m what somewhat entertainingly is called an expert patient. Iā€™ve mixed feelings about that but Iā€™ve had (non-laser) eye surgery; take part in lots of eye research; work with 2nd and 5th year medical students and have also been a patient of (and do publicity for) 100,000 genome.

In that context I come across an awful lot of eye researchers. Southampton, Nottingham, Plymouth, Liverpool, Manchester, Bolton and Leicester off the top of my head. The range of views is eclectic as one would expect but there are five areas of absolute consensus as follows

  • The regulation of laser eye surgery is poor at best.

  • The claimed ā€œsuccessā€ rate is at best debatable and at worst wholly lacking an evidence base.

  • The relatively recent nature of such surgery means there is naturally little quantative evidence re: long term effects.

  • The qualatative evidence is amassing and is being largely swept under the carpet with a dismissive ā€œAh but thatā€™s most likely because it was a long time ago and techniques have improvedā€. Thereā€™s no evidence base I know of for the specifics of that improvement. There are a small number of fairly scary negative stories. Itā€™s hard to judge those in context as NDAs tend to be involved.

Most people you will talk to will talk positively but most will have had it in the last 10 years. Where they will be in 15 to 20 years is very much up for debate.

What also doesnā€™t get mentioned is the tendency of the eye to dry out and become more rigid as vision deteriorates as we get older. Contact lenses and spectacles can take account of both issues. Laser surgery cannot.

I find that I can spot people who have had such surgery quite easily. They have a slightly startled look and appear to have their eyes popped open with matchsticks a bit like A Clockwork Orange. Itā€™s up there with Botox for me in terms of 21st century quackery.

The other area in which thereā€™s a growing consensus, but which is wholly unrelated to this, is simply that Snellen tests should not be used for anything beyond refraction. They have erroneously become a measure of visual impairment and yet the outcomes are largely meaningless.

8

Been there, done it, bought the Tee shirt

I started wearing glasses in 1952 for short sighted. The short sightedness got progrressively worse until I had clear vision up to 5 or 6 inches.

Scroll forward to 2011 ish - I was getting very frustrated in having to have new prescription lenses every year and also loss of clear vision. I had cataracts.

I went to a presentation at the local Eye hospital, and booked in for a free apppointment to assess my eyes.

Offered a dual focus lens replacement using Oculentis dual focus inserts. Ā£6.5k aprox for both eyes. Done - where do I sign.

I had the left eye done, then 2 weeks later I was to have the right eye done.
However the left lens slipped so I had to have it reinserted/relocated. Three days later the right lens was replaced.

Wow what an impact, a greeny browny filter was removed from my sight, colours were bright and easy to see the difference between the different shades of white eg light switch plastic that is 40 years old vs new light switches. Before they were all the same colour.

I was able to drive after a few weeks (canā€™t remember how long). I only have to use glasses for the computer screen. My lenses are designed for reading and driving, so I need glasses for the 20 to 30 inches.

After 4 years I had some problems with one eye, there were some scars on the capsule that hold the lens in one eye. A YAG laser treatment solved that problem.

The use of new lenses removes any vision defects due to astigmatism as the insert is custom made to correct the defect.

The brain ignores the image from the out of focus lens except at night when bright lights can give a blurred fuzz that blocks out the shadow information.

My face misses the comforting feel of glasses on it, and my eyes miss the protection from wind and rain.

Apart from that I am very pleased with the result.

9

Both my wife and myself have replacement lenses. Usual caveats apply to anything I say, YMMV, I am not a medical practitioner etc, and obviously I can only document our experiences.

Mine were done due to early onset cataracts around 2001 and 2003/4, at age 47. I had been wearing glasses for about 10 years. Because they were done separately, mine are the ā€œone long, one shortā€ variety. Both were done by the same surgeon, although the first was funded by my company health policy and the second on the NHS,
In the intervening period I still wore glasses to correct the other eye.
A most uncomforatable non-sedated 20 minutes on the operating table - I remember thinking Iā€™d rather be at St. Maryā€™s watching Saints being thrashed than be here! Surgery was carried out with a scalpel, and the eyes took over a week to heal (more of this later). During that time I had to wear an eye patch, and would get artefacts (like from a starburst camera lens filter). Each eye took a couple of months for the brain to readjust.

The result: over the last 15-16 years my vision has been good enough to not need glasses. Issues are that the cross-over point between the long and short lenses is around 18 inchesā€¦just where my computer screens sit - mostly OK. I cannot read very small print on jars, especially 6 point yellow typeface on a green background (more again later)

My wifeā€™s were elective, about 4-5 years ago. She had been extremely short sighted from her teens, and had spent her life with many combinations of different glasses, hard and soft contacts. They were done at a private eye clinic near Southampton, the surgeon being a Consultant at Soton General. The cost was around Ā£8000. She has the varifocal type. They were done in successive weeks, and following my experiences, she was sedated.
Because the cutting was done by laser, they healed very quickly (the doc commented that the cuts would be almost healed by the time she got home); I donā€™t recall her wearing an eye patch. Her brain took longer (several months) to come to terms with the change and she did have to go back for an adjustment (but that took only 10 minutes with. Laser gun).

The result: I think her eyes are ā€œbetterā€ than mine; she CAN read very small yellow print on a green background, and can thread needles! She does have a pair of nighttime driving glasses to cut down glare from streetlights but thatā€™s it. and best of all from her point of view, no more trailing back and forth the the opticians, contact cleaning potions etc.

So there you have it. In our case, both must count as successful.

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Anecdotal evidence with no context. I doubt the unsuccessful stories will be posting any time soon.

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I had problems, but they were overcome apart from the night vision.

More people are cured from blindness through catact surgery than any other way.

12

Anecdotally then, I was ā€œgoing blindā€ā€¦

Now Iā€™m not.

Next question?

13

Without knowing the eye condition; the type of surgery; the other options available and the comparative success rate such comments are utterly meaningless. No more relevant than ā€œI have recovered from a coldā€.

Oh, guess what. Thereā€™s no way of knowing the comparitive success rate. The best you can actually say is that you had eye surgery and thus far it has been successful.

14

Would you care to clarify? More people than what? Where? What other way?

This kind of nonsense does my head in.

15

Anecdotal reports are always interesting. If it works for you then, well it works for you. That is what the Op was asking for in part too. Almost all of the HiFi advice on this Forum falls into that category after all, and a whole lot of the other stuff too!

Iā€™d rather hear genuine experiences than be fed data supplied by commercial organisations that are not independent.

The plural of anecdote is, of course, not evidence. Iā€™m sure the OP can search for and assimilate that sort of data as well as anecdotal experiences too.

Bruce

1 Like
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The OP did ask for personal experiences. As I stated right In my first post, I can only document my own (and somewhat periphally my wifeā€™s) experience. Derek was similarly offering his personal experience.

So that would appear to be three good ones. But for some reason Mike seems reluctant to acknowledge this.

Hey ho, I suppose thatā€™s forum life for you. After all there are folks that believe in mega expensive mains cablesā€¦whereas the electrical engineers are more sceptical.

Anyway, by the time I had my first op (the right one I think), the cataract in that lens had limited my depth of vision to about 30 feet. Not blurred vision, just a thick fog. The optician, GP and consultant came to the conclusion that there were no other options available.

The other eye done sooner rather than later; the same medical team as before reckoned it was going in the same direction.

And as for longevity, I would suggest that for me, compared to the prospects at the time, another 15-17 years of pretty good sight was worth it.

Happy days,

Suzywong
C.Eng. M.I.E.E.

1 Like
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Thanks to everyone who has responded so far. It is these real experiences that are of particular value for me personally in thinking through this, and also no doubt for anyone else in a similar position. Just going back to Bruceā€™s query about the 99% claim: the laser eye surgeon to whom I spoke apparently has a 99+% success rate at achieving at least 20/20 vision unaided - but no statistics for possible other adverse effects, and as I said previously I am well aware that 20/20 vision is not on its own an indication of good eyesight (my own eyes with contact lenses achieve better than 20/20, and for many purposes my eyes are pretty good as corrected, yet my distance night vision is not great).

Some of the other aspects mentioned here are things of which I had some awareness, some not- and all real experience and knowledge is very useful in helping build an understanding. My natural inclination is wariness and caution, because sight is so important and I wouldnā€™t want to risk it being harmed. Whilst there is an attractiveness to being able to stop wearing contact lenses after 44 years of wearing them (and I want never to have to wear glasses, though just tolerable for part time specific tasks), I am inclined to wait until I need surgery rather than do it when not essential. But if the surgery would make my eyes better than they are with contact lenses - e.g. not needing reading glasses as I increasingly do now - then it is temptingā€¦ And helping me think through it was my purpose in starting the thread.

So again thanks for all contributions, and please keep them coming! And hopefully this will be of use to others as well.

18

Could I say that I have found the personal, and professional, posts here very interesting. I also feel somewhat guilty as a catalyst for the thread having, jokingly of course, suggesting laser treatment as an alternative to wearing 3D spectacles on the other thread.

Personslly, even though I have worn spectacles (and occassionally contacts) since my uni daysā€¦thats about 40 yearsā€¦I have never contemplated eye surgery. This was simply fear of complications. Anecdotally, I had a work colleague who had surgery, albeit many years ago, and things went very wrong.

Finally to suzywong, I agree with you itā€™s my opinion we all benefit from the experience and professionalism of others. I can remember frequently having to advise electrical engineers not to horizontally chase cable runs in to Loadbearing walls :wink:

Annalogg
C Eng. M.IStructE

1 Like
19

You add your qualifications to posts!!!

Far from being ad hominem my comments were very clear. @Innocent_Bystander was not talking about cataract surgery and as @BruceW says ā€œthe plural of anecdote is not evidenceā€.

My issue is simply that elective laser surgery is largely unregulated - https://www.londonvisionclinic.com/is-the-laser-eye-surgery-industry-regulated/ for one example - and the claims for success rate unverifiable. I am aware of one piece of work being done by an eye hospital at present looking at the percentage of work derived from private laser surgery which may not have gone to plan. Itā€™s a long term study and obviously Iā€™m not at liberty to disclose detail but the suggestion thus far is that anyone claiming more than a 70% success rate is likely to be flattering themselves.

A forum is not really the place for such questions. Anecdotal evidence will always be skewed towards perceived success stories and it must always be borne in mind that no-one can estimate the rate of deterioration had surgery not taken place.

Now see if you can find a link for independent verification of success rates in the UK.

20

I respectfully suggest that you re-read the OPā€™s post again. Although he started with laser treatment (which I emphasise is not applicable in mine and SWMBOā€™s operations), he then went on to discuss lens replacement procedures, to which I can claim to be ā€œa patientā€, although very ā€œnon-expertā€.

One of his discussion points was about varifocal vs short-long. And again I could claim a modicum of experience, albeit remaining very much ā€œnot-an-expertā€.

I also though it might be useful, as IB is contemplating the op, to mention what he might in the course of the procedure as seen from the patientsā€™ point of view.

Again, this is based upon mine and,peripherally, my wifeā€™s experience as patients.

As for posting my post-nomsā€¦ well it appears that I may just have a small modicum of expertise in certain areasā€¦

Anyway itā€™s good to see other C.Engs ā€œcoming out of the closetā€

Cheers