Flaps aren't inherently dangerous either (flap detachments are very rare, even more so with modern systems that create essentially a cavity where the flap can rest in), but the difference in healing post OP is a lead cause of heightened dry eye after LASIK. Both PRK and SMILE, due to the way they work, are less likely to suffer from this, but every procedure has trade-offs naturally.
With PRK, the epithelium in the area is removed and has to regrow, a process that takes a few days (to get the initial part done, full regrowth takes far longer but isn't noticeable in general). This regrowth can be both rather painful and also rob you of the "instantly perfect sight"-effect many people desire from their laser eye surgery. As the epithelium does regrow naturally however, it is less likely (both in theory and in medical literature) to lead to dry eye and other side effects in the short and long term, making it the preferred choice by many ophthalmologists when choosing such surgery for themselves.
SMILE, on paper, might be able to offer the best of both worlds, but is severely more expensive than either and there is not a sufficient degree of long term research to make a definitive statement that the side effect amount and severity is comparable to PRK, simply because it is rather new. What research is out there is promising though.
Overall, each option is very well tolerated, leads to major QOL improvements and we need to keep in mind that even the more common side effects one may face with LASIK may not affect everyone and still are comparably small considering other medical fields and their elective procedures.
In this context, I'm very excited to see whether this method might have even fewer short and long term side effects than PRK, but like with SMILE, it may take decades to have a conclusive answer.
Edit: Another thing I missed and which was not covered in the article, is the potential that this new method could be applicable to people who, because of a variety of factors, are not eligible for any ablative eye surgery. I myself was at the upper limit for Trans-PRK in regard to the severity of my Myopia and the thickness (or lack there off) of my Epithelium. In that regard, I see far more potential than just reducing already low side-effect risks further.
This is exactly opposite to how I understood and experienced healing after Trans-PRK. My eyes are still very dry 6 months post surgery. Being at the upper limit of Trans-PRK yourself, did you actually go through with the surgery? If yes, how was your healing process? I would be very interested in chatting about it, since I am not particularly happy with mine, and wondering what can be done (and whom to blame).
From there on, the pain and foreign object feeling quickly subsided alongside the remaining "haze" and by day five, I neither had any subjective pain, nor any major issues reading text (both typed and digital). Had multiple check-ins of course, both at the clinic which performed the surgery and with my decades long ophthalmologist, no issues were found there either. Subjectively, I do not experience a heightened severity in dry eye symptoms for what that is worth.
Also had a clinical rotation in Ophthalmology just this month (small world, though was why I felt the urge to comment) and the attendings did assess my epithelium as having regrown evenly too.
What could have gone wrong for you and how to go about this, I really can't say and I am sure you have already considered /pursued it, but I can only suggest getting a second opinion from another established ophthalmologist, including looking at the eye drop regiment prior to the surgery and during, as well as post recovery.
In any case, I agree that a second opinion would be most helpful.
[0] https://crstodayeurope.com/wp-content/uploads/sites/5/2019/0... referenced from https://pubmed.ncbi.nlm.nih.gov/26871764/
[1] If you look at the source they are referencing, it compares TransPRK to aaPRK after three months and they were using Schwind machines, though did not clarify whether this was using Smartsurface. Very cursory search engine use tells me that this is toggleable, so an option on these machines. Even if this study did use Smartsurface though, that doesn't answer whether outcomes are different in TransPRK with Smartsurface vs TransPRK without Smartsurface. Additionally, I do not know whether this option was used in my case.
Some unsolicited advice: wait for widespread adoption, and review data on long term side effects from sources without a conflict of interest before you have a procedure like this. I went from 20/150 to 20/15 for a few years (which was pretty cool) but they're 20/40 now so I wear glasses/contacts when I leave the house anyway. Glasses and/or contacts aren't that bad.
This is the first I've heard of this. In my area it seems comparable in price, within 1.5x the cost of LASIK. Considering how relatively cheap it is (a couple months' rent, or a fraction of the price of a car, to correct your vision for decades) I've never seen cost mentioned as reason to choose one over the other.
Maybe “severely more expensive” wasn’t the best wait to phrase it, but the difference is still quite steep and this can be a decision maker for many people. Especially as currently it appears that medium term/6-month outcome between PRK and SMILE are very comparable, or even slightly better in PRK [0].
It is an unpleasant procedure and the recovery is quite painful. There is a reason why it is almost never done today.
I had it done about fifteen years ago. My vision was perfect for a decade, but now I'm back in glasses.
PRK recovery was certainly uncomfortable, but I'd gladly do it again for another decade without glasses.
Yes, if the ophthalmologist messes up. Sadly!
https://moskowitz-eye.com/blog/most-popular-laser-eye-surger...
It seems that ASA is a wide term for methods of moving the epithelium and replacing it after the procedure. I had this with one of my treatments. It is far more pleasant. It makes sense that it is growing in popularity.
My bet is on SMILE evolving but we'll see where it goes
https://www.youtube.com/live/Dw9D7C8CpM0?si=e-KJ8J2u_oVy4RvM
Originally there was a mention of developing a less invasive method of correcting a deviated septum, but I guess they went with the harder problem first.
In any case I'm up for both, because while my vision is not terrible, it's slowly, but consistently getting worse, so max-twice-a-lifetime interventions like laser eye surgery won't cut it for me.
And it does affect my quality of life: forget glasses? Good there goes your day until you've found a replacement. The best improvement so far has not been the glasses but a simple string to make sure I don't put them down but they stay around my neck. That has made a massive difference and it also helps when looking down (so the glasses won't fall off) and it has cut the rate at which I was losing them to zero from about one pair per month (which really was not sustainable).
If you don’t mind the aesthetics (though I personally can’t get past them), they solve the same problem as your string in an integrated way. Plus they rest more like a necklace, since it doesn’t require as long of a loop.
https://www.elektor.nl/cdn/shop/files/andonstar-ad409-101-hd...
It is also one of those things that you find more and more uses for over time.
https://modernod.com/articles/2020-sept/coming-soon-presbyop...
(This is assuming your farsightedness is due to age-related presbyopia, hardening of the lens, and not true farsightedness from a change in eyeball shape)
"However, the difference in the eye exam scores after 3 months of taking UNR844-Cl was not large enough to be considered better than placebo, and may have been due to chance."
Which is a shame, because it seemed like a great alternative to pilocarpine, which in turn kinda sucks because the only thing it does is create a temporary pinhole effect.
In my case it's not even the defect itself, but the associated astigmatism. For a long time I was unaware of the issue because it started in one eye, so the other compensated until it couldn't.
Now I get around two weeks of perfect vision upon getting a new glasses prescription and it's back to "normal".
I tried them and they were awful for me. Didn't last the full day, caused terrible halos while driving (and that was BEFORE 90% of cars drove with LED high beams), were generally too uncomfortable.
I gave up after extended tries with three different lenses (I think it was six to nine months total), with my highly experienced doctor consulting with different manufacturers and researchers from around the country. Turns out my pupils naturally open up too wide, made worse by corneas that apparently are not thick enough to retain the reshaping all day. These issues, incidentally, make me ineligible for the popular cut-n-burn style of eye surgery.
On the bright side, it was indeed completely reversible and I've suffered no effects of any kind after about two days of non-use. That was a bit over a decade ago.
take my money!
I only have wore glasses, i dont care about trying contacts. Its the glare with or without thats pretty bad driving at night in US
Contacts (especially the rigid or scleral kind) can sometimes smooth out those imperfections, but if you’re not interested in them, the next step is usually an eye exam to look for things like lens changes or surface dryness. Cataracts, even very early ones, are a common culprit for glare driving at night in the U.S.
Laser surgery can sometimes make halos worse, especially if someone already has them, so you’re right to be cautious. But it’s not the only option. Treating dry eye, using anti-reflective coatings on your glasses, or addressing cataracts (if present) can all help a lot.
In short: it’s not hopeless, but the “fix” depends on what’s causing the scatter in the first place. A detailed eye exam is the best way to pin that down.
Source: Had LASIK in 1999. Severe myopia and astigmatism, corrected to 20/10 and 20/15 (right and left eye).
My night vision was definitely worse after the surgery, but improved over a year or two. I still get blurry when my eyes are dry and tired, but otherwise remain glasses-free at 50+.
I'm surprised LASIK still can't correct for astigmatism though, I know that was the case when it first came out but in principle I can't see why it wouldn't work.
the flap size itself keeps the lens in place; the elasticity of the underlying tissue itself, until it heals into an encapsulation.
the surgery videos of that procedure make me squeamish unlike other surgery videos. Watching an eyeball get deflated/inflated with liquid pressure from the surgeon is just un-nerving to me; not as bad as watching a glaucoma surgery -- but up there.
That brings me to one of my personal pet peeves which is selling pensioners that qualify for cataract surgery on an expensive, but in fact identical but privately paid for IOL.
Same with selling some Myopic+Presbyopic person on laser eye surgery of any kind. At best you get a few short years out of the expense before it catches up with you or you tolerate mono, at worst you spend thousands to suddenly need reading glasses you didn't require before.
Course, if you are financially solid and Presbyopia is starting, getting a high quality lens exchange can be a very neat luxury, with the added benefit of not needing Cataract surgery later in life. Do note though that artificial lenses, while incredibly advanced, still cannot accommodate as well as the real deal as of now.
I had a conversation with my ophthalmologist about this. She said the same thing. Then I said, I don't understand, right now I have to wear glasses for far vision and glasses for near and mid vision. If I got the surgery, I would still be presbyopic, but I wouldn't need glasses for far vision, only for near vision? and she said yes. So I said, that sounds like in improvement. What's the catch? She said it's mostly a matter of expectation. People think that LASIK means they don't have to wear glasses again, period.
But I keep hearing this, so I'm wondering if there's something more to it that she didn't explain? Is there some other disadvantage?
When I heard that LASIK is not a solution to farsightedness, I specifically asked my eye doctor if there are other solutions for this. The only one mentioned was monovision (getting two different prescriptions for different eyes).
> Do note though that artificial lenses, while incredibly advanced, still cannot accommodate as well as the real deal as of now.
Cannot accommodate what as well?
LASIK is almost the same as grind down and fille, isn't it? In the sense that the lens is a new shape when it's over. We replace lenses too.
Braces are essentially forcing teeth into new positions mechanically. Once they're in those new positions, we glue on wires and wear retainers to keep them in place, often for the rest of our lives. This doesn't sound like a comfortable eye procedure.
Let's hope it pans out for eyesight, and I'm sure there must be a whole lot of other things this could apply to.
I'm reading that flap detachment is very rare. It very well might be. Maybe the eye is vastly over-engineered and 8% is sufficient for most modern humans. But I'm sceptical.
