LASIK surgery

[Brad Pitt]

21 hours ago, DaffyDuck said:

 

As far as I know, there are two types:

- one where your natural lens is removed, and replaced with a special one.

- one where an additional lens is inserted under your cornea.
 

The 2nd one: "lens inserted under your Cornea" Can you expand on that? 

[DaffyDuck]

2 hours ago, Brad Pitt said:

The 2nd one: "lens inserted under your Cornea" Can you expand on that? 

What did Just Standing have done, which he so raved about?

The procedure I'm referring to is ICL - Implantable Contact Lenses.

https://www.centreforsight.com/treatments/implantable-contact-lenses

 

[DaffyDuck]

I like ICL, because it's reversible, and because it does not alter any structures.

https://www.docshop.com/education/vision/refractive/icl

[Brad Pitt]

12 hours ago, DaffyDuck said:

I like ICL, because it's reversible, and because it does not alter any structures.

https://www.docshop.com/education/vision/refractive/icl

Hey Daff, I've got a tech here that used to work at a local Refractive eye care center: http://www.maloneyvision.com/

& she says that they did a few of the implantable lenses, none of the patients were happy w/ them and some developed Cataracts after the lens implant procedure!?! You might want to do a little more checking in to that?

[Brad Pitt]

It's interesting how much the eye and the camera are alike. I found some interesting info in how "Focus" works (on this camera site): Before there was autofocus, there was focus. The camera is a light-tight box that is used to expose a photosensitive surface (film or digital sensor) to light. In order to focus the light onto the surface, most cameras (and your own eyes) use a lens to direct the light. Why did I say, “Most?” Well, there are many types of cameras around that do not rely on lenses to focus light. The “pinhole camera” is a box with a tiny hole on one end and a photosensitive surface on the other. Light comes through the tiny opening and is projected onto the rear wall of the box. A search of the Internet or your local library will reveal that scientists and engineers are currently working on developing lens-less cameras that are never out of focus and avoid the unfortunate characteristics imparted to light when it passes through glass or plastic lenses. For the time being, however, nearly all of us are using cameras that focus light through a lens.

 

Focus

A lens is an optical device that consists of a curved material that allows light to pass through it. Depending on the design, a camera lens, either built into the camera or attached and interchangeable, consists of one or more elements that both diverge and converge light to focus it onto the photosensitive surface and re-assemble the light reflecting from the scene that has passed through the optics, resulting in an image. You might see lens specifications on the B&H Photo website that mention “elements” and “groups.” Each individual piece of glass is an element and one or more elements are designated into groups inside the camera.

Why do we need to bend the light to create an image? Well, we do not truly need to bend the light at all. The issue is that the film, sensor, or back wall of your eyeball is usually much smaller than the view we are trying to capture. Therefore, we need to bend the light to reduce the size of the image. How else would you get an entire mountain or building to fit onto a camera sensor without bending the light?

Source: https://www.bhphotovideo.com/explora/photography/tips-and-solutions/how-focus-works 

[DaffyDuck]

Hey Daff, I've got a tech here that used to work at a local Refractive eye care center: http://www.maloneyvision.com/
& she says that they did a few of the implantable lenses, none of the patients were happy w/ them and some developed Cataracts after the lens implant procedure!?! You might want to do a little more checking in to that?

This is the beginning of what will most likely be a 2 year process of researching these various solutions.

I’ve laid out what I’m looking for, and I really like something that it reversible, or doesn’t permanently alter structures.

The questions is which of the two brands of lenses did her office implant?

It also sounds like doing these is an outlier situation for them, ie not much experience?

[Brad Pitt]

Hey Daff, my tech here says they were using the "Visian" lens. I called over there and they are still using the same lens. Here's a vid: 

 

 

[DaffyDuck]

The Visian is the one that sits behind the iris. Interesting about the whole cataracts connection. I wonder how that compares to the Verisyse one?

[Kandinski]

Didn't read all thread and may be off but had the IOL aka ICL procedure on both eyes some 8-10 year ago by Dr Nattawat at Pattaya Eye Center http://www.pattayaeyecenter.com/

Procedure took a couple of hours all included (was able to hit the bars later same night however couldn't read the bills)

Total cost for 2 eyes was, from memory,  THB 120-130K THB ( clinic had an opening promotion)

Result was as expected, good/perfect sight but focus takes slight longer and night vision is diminished which makes driving on dark, wet road a challange. All in one;  recommendable procedure is glasses is a pain and to, permanently, prevent  cataracts

 

[Harry Brown]

2 hours ago, Kandinski said:

Didn't read all thread and may be off but had the IOL aka ICL procedure on both eyes some 8-10 year ago by Dr Nattawat at Pattaya Eye Center http://www.pattayaeyecenter.com/

Procedure took a couple of hours all included (was able to hit the bars later same night however couldn't read the bills)

Total cost for 2 eyes was, from memory,  THB 120-130K THB ( clinic had an opening promotion)

Result was as expected, good/perfect sight but focus takes slight longer and night vision is diminished which makes driving on dark, wet road a challange. All in one;  recommendable procedure is glasses is a pain and to, permanently, prevent  cataracts

 

Is the situation with night vision and driving still a problem now or was it only for a short period of time while the eyes were healing?

[Kandinski]

11 hours ago, Harry Brown said:

Is the situation with night vision and driving still a problem now or was it only for a short period of time while the eyes were healing?

Only a slight improvement over the years.

Won't exactly call it a problem but under certain condition (dark, wet, narrow roads) will headlights from passing SUV with Xenon/LED lights have a fairly wide bright corona that makes it difficult to focus on roads dark edge for a split second after car has passed ,otherwise no problem driving when you first get adjusted to it take slightly longer to focus (I blink fast a couple of times to "reset" focus).

Personally I'm very happy with the procedure... assume half the cost is already paid from all the glasses I didn't loose

[Brad Pitt]

On ‎2‎/‎2‎/‎2016 at 08:15, Encora said:

One thing about surgery that requires inserting a new lens in your eyeball not sure if the OP was offered that option)

I had that done as part of my cataract surgery. I was offered choices ,

Fixed focus, e.g the lens would make either your eye great for close up, or far sight

The same, but one eye made to do far sight , the other close up

3 variable focus.

I chose the latter . A mention was made that it may reduce total brightness of your vision a bit, but I didn't really take that on board.

Wrong! In practice, now it means that at low light levels (e.g. restaurant menu reading) I cannot read anything.

Any low light close up stuff, I am hopeless.

It was mentioned in my briefing, but not really explained in detail what the effect may be....

If I'd have the choice again, I'd choose fixed focus, distant, both eyes. Close up, use reading glasses....

Can I offer up two of my own case studies. Patient "A" Had a "Multifocal IOL" (like @just hanging) lens when it came time for her to have Cataract surgery. She's been unhappy ever since (Sep '17). She was referred to me sometime around Nov '17. I ordered an Angiographic study of the Retina. The results were negative for any Retinal issues but, as she states that she can't see out well, everything seems just slightly out of focus & her Ophthalmologist can't correct her w/ glasses. I can't see in her eye very well either. Every time I've had one of these patients that have had the "Multi-focal" IOL referred to me it's the same result. I try to look at their Retina and the view is just "blunted" and not "Crisp".  I'll post up a photo for you're collective review (review the overall clarity & sharpness): 

[Brad Pitt]

Patient "B" was sent to me recently for Retinal evaluation. She'd previously had Cataract surgery (standard single vision IOL) some years ago (2012ish) and has been happy w/ her vision since. Recently she had some blurring but, it is indeed secondary to a Sub-Retinal issue and nothing to do w/ the IOL. Take a look at the clarity, sharpness and detail compared to patient "A". The difference to me is obvious. Both of the posted photos was resized w/ PhotoImpact but, no manipulation (other than resize) was done. Both photos were taken w/ my personal cell phone. I do notice some blurring in the photo of patient "B" but, if you look at the boarders the blurring is present there as well; suggestive of an issue w/ my Cell and not the patients Retina. Photo attached for you're collective reviews:  

[Brad Pitt]

It was just brought to my attention that the photos have patient names attached. I took this in to consideration before I posted the photos and I decided that it would be better to just leave them, I as stated: didn't want to "photoshop" the photos in any way. As far as I can tell w/o any additional ID ie: Date of Birth, Address, Social Security etc. They are just random names. 

Thanks to Harry Brown for bringing this up (and having my back); I think we're good here !?! 

[DaffyDuck]

Does this apply to all implanted contacts, or just the multi focal ones?

How do the multifocal ones perform their magic?

Is it possible to override a doctor’s “prescription” when it comes to Lasik/Lasek or ICLs - thus, instead of choosing close or far, opting for a value somewhere in-between?

[Brad Pitt]

21 hours ago, DaffyDuck said:

1. Does this apply to all implanted contacts, or just the multi focal ones?

2. How do the multifocal ones perform their magic?

3. Is it possible to override a doctor’s “prescription” when it comes to Lasik/Lasek or ICLs - thus, instead of choosing close or far, opting for a value somewhere in-between?

1. Just the "Multi-focal ones. 

3. Yes but, one must consider the majority of their visual importance. For most 80% or more is using your eyes for distance and a considerable less % at other focal points. 

2. They preform their magic by having multiple focal points: Usually the central 2mm is set for distance w/ alternating (Distance - near - intermediate) rings of correction. Photo attached: 

[Brad Pitt]

The problem w/ the "out of focus" issues occur in the "transitional rings". Where each different "distance" change in the lens is a "dead" zone: where each ring has a "transition" zone that is providing no visual correction but rather, an opaque circular space = glare. 

[DaffyDuck]

Thanks, that's enough for me to decide against any multi-focal options.

You may be right that 80% (or thereabouts) we use our eyes for distance, but I value my near-sifted abilities, AND want the ability to see sharp in the distance -- without having to resort to glasses for close-up sight.

That's why I'd be okay with an intermediate correction -- my correction need is not that significant (1.25 diopter), as I can see fine without glasses -- but corrective lenses just make it 'nicer'.

I know, I'm being difficult :-)

[Brad Pitt]

22 hours ago, DaffyDuck said:

Thanks, that's enough for me to decide against any multi-focal options.

You may be right that 80% (or thereabouts) we use our eyes for distance, but I value my near-sifted abilities, AND want the ability to see sharp in the distance -- without having to resort to glasses for close-up sight.

That's why I'd be okay with an intermediate correction -- my correction need is not that significant (1.25 diopter), as I can see fine without glasses -- but corrective lenses just make it 'nicer'.

I know, I'm being difficult :-)

Presbyopia a must read:

Happy for now but, as you age your internal corrective lens looses it's ability to "accommodate" as much as when you were younger. At some point we all will need correction for "Presbyopia" (age related loss of ability to see at near)!

When we're young our internal lens is able to change shape to accommodate for distance or near. It literally changes it's shape to either "constrict" (get thinner) to see in distance or "relax" (get fatter - like a magnifier) to see at near.

For near: the lens relaxes making it "fatter" for more magnification. As we age, the lens (such as many other parts of the body) become less flexible. Your lens no longer has the ability to relax enough (creating enough Magnification) as it once did.

When you see older people wearing "Bi-focals" they are using two different lenses one higher in the glasses than the other. The upper portion of the lens is to correct for their distance vision and the lower "bifocal" (higher magnification) is to correct for their "age related" inability to (relax) the natural lens to see at near (we typically look downward to read) thus, the placement of the lower bifocal "higher Magnification" lens.

The need for a replacement lens for people that have had the natural lens removed: be it from Cataract or people just wanting to not have LASIK. A new lens is required for focus; be it for distance or near. "Multifocal" IOL's try to make up for the natural lens ability to change from distance to near however, we've discussed the downsides of having "Multifocal" lenses. So, you're left w/ the decision: "Distance" or "Near".

If you choose "Distance" you'll still need something to compensate for near ie; reading glasses, Multifocal lens or Mono-vision!

There's no escape from this equation (unless you can stop ageing). 

I see where you say that w/ your -1.25 glasses work for you but, they are for distance, yes? When you remove your -1.25 lenses your effectively adding +1.25. Your still at the point where your Natural lens will allow you to focus at near @ the "Zero point". As you and your lens ages the "Magnification" number will change and become grater than the +1.25 you achieve by just removing you're -1.25 lens. You will need more Magnification as you age ! 

Imagine the "Zero" point: you're wearing a "minus" 1.25 lens - by removing that -1.25 lens you're effective adding +1.25 to get you back to the "Zero" point. As you age and your natural lens looses it's ability to "zero" you out: requiring you to add more + points (Magnification) to get you back to the point where you can see at near! As we age we all need more + or "Magnification" to see at near. This factor will change year for year as your natural lens looses it's flexibility. 

Post up a picture (observe the relaxation - magnification of the Natural lens > in a younger eye vs an ageing eye): Top picture showing a "fat - young - magnification lens". Middle showing an "aging" limp unable to focus lens. Bottom an aging lens assisted by a "bifocal" glasses lens to correct focus. 

[DaffyDuck]

Right, but also this is caused because my eyeball is “longer” than a normal one, so would that help or work against me?

So far, at 54, I’ve only noticed that my distance vision has gotten worse, and my close up vision went through a change in my 40s, when suddenly I could no longer see up close WITH my contacts. That’s when I made a change in my prescription, that lowered my distance vision, but allowed me to see in focus close up.

If I had to pick between one of the other, that’d really suck.

[piehead]

my wife had super sight at bph 10 years ago. she still says its the best thing she ever did (apart from marrying me). she now has 20/20 vision and was reading the bangkok post 30 minutes after the op.i need it too but i am a wimp. i will give it a go when i get back in a weeks time (maybe) .

[Brad Pitt]

20 hours ago, DaffyDuck said:

Right, but also this is caused because my eyeball is “longer” than a normal one, so would that help or work against me?

So far, at 54, I’ve only noticed that my distance vision has gotten worse, and my close up vision went through a change in my 40s, when suddenly I could no longer see up close WITH my contacts. That’s when I made a change in my prescription, that lowered my distance vision, but allowed me to see in focus close up.

If I had to pick between one of the other, that’d really suck.

In my best "Yoda": "eventually pick one you must" ! 

[Brad Pitt]

19 hours ago, piehead said:

my wife had super sight at bph 10 years ago. she still says its the best thing she ever did (apart from marrying me). she now has 20/20 vision and was reading the bangkok post 30 minutes after the op.i need it too but i am a wimp. i will give it a go when i get back in a weeks time (maybe) .

If you do: please post up your opinion. If you decide to let it go for a bit: "Hang w/ us" !  

[Brad Pitt]

19 hours ago, piehead said:

my wife had super sight at bph 10 years ago. 

Can you expand on what is "Super sight" ? 

[forcebwithu]

2 hours ago, Brad Pitt said:

Can you expand on what is "Super sight" ? 

IOL procedure. Bangkok-Pattaya Hospital offers Super Sight.
https://www.bangkokpattayahospital.com/en/healthcare-services-en/lasik-and-supersight-surgery-center-en.html