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FlyGirlla

Lasik or PRK?

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After you initially asked the question, I was intrigued with what advances may have occurred, and if the relative merits between LASIK and PRK had changed much since I had PRK in the late 90s...especially since there were some comments in this thread claiming that new evidence supposedly refuted the long proclaimed warning that the LASIK flap never fully heals.

Whilst I did not do an exhaustive search, it didn't take long to find medical experts in the field who continue to stress that the LASIK flap does NOT completely heal, and in general is a poor choice for those involved in contact sports, or any other activity which could cause physical impingement on the flap. These are the experts who have studied this issue and have published papers on the results and made presentations at medical conferences. Many of these studies have been released in the last year or two, so are very current. I found NO REPORT that supports even adequate healing for the LASIK flap... ALL indicate that the only healing that can show any strength at all (28% of original corneal strength) occurs only at the edge of the flap, and therefore only creates a fairly weak seal around the edges.

Though you may be interested to hear our experiences, your decision should not be made based on those of us giving you our anecdotal satisfaction report on the surgery we as individuals chose.

I also think it would be very foolish to make a decision based on whether or not you endure a few days of post procedure discomfort (which can be mitigated by following instructions given). In spite of some claims of extreme suffering, I didn't find it that bad.

I see there has been NO CHANGE in the relative merits, and should I have vision correction again, there is no question which procedure I will go with. LASIK has no benefit to warrant the additional risks, and every metric proclaims PRK with the possible exceptions of cost and the preference of the clinics pushing LASIK.

They are your eyes...CHOOSE WISELY.

Russ

Generally, it is your choice; will your life serve as an example... or a warning?

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I called two of my ophthalmology colleagues to clarify

1: LASIK and PRK have similar costs and LASIK is still currently more expensive by about $500 at most places
2: The "sports risk" is actually not true. BOTH surgeons said that once they have healed the amount of impact necessary to break open the flap would (in a healthy eye) have displaced the lens and also required emergency surgery.

I asked about skydiving and they said that they did not have direct experience but said they would simply require a slightly longer recovery time since the high wind forces could be harsh on the flap for the first 2 months. Otherwise, the only concern with either would be dry eyes in that environment.

The military uses PRK because it is simpler, easier, and cheaper.

Complication rates are comparable. With LASIK you have the flap issue, with PRK you have a scored cornea which is much more easily infected. Plus the pain.
You are not the contents of your wallet.

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I had Lasik done back in 2001. I went to a new doctor a month or so ago and mentioned that I had had Lasik. He was surprised and could only just barely tell when he went looking for it that anything had ever been done because it had healed so well. So it can heal completely.

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Hi,
I recommend to not do lasik unless contacts and glasses don't work. Contacts and glasses give perfect vision without surgery and doesn't leave scars. If you change prescription you jyst buy a new lenses and have perfect vision again.

The flap never heals, unfortunately lasik doctors don't inform patients about that.

Google Glass lasik warning
https://support.google.com/glass/answer/3064131?hl=en
"If you’ve had Lasik surgery, ask your doctor about risks of eye impact damage before using Glass."
http://androidheadlines.com/2013/05...r-glass-says-it-may-be-bad-for-your-eyes.html
"The company goes on to advise people who have had Lasik eye surgery to avoid wearing the device. If you’re really eager to try, then Google recommends that you go to your doctor for final approval"

Dr. Oz lasik flap warning
https://www.youtube.com/watch?v=buf5ReMswTk


http://lasikcomplications.com/flapdislocation.htm

Dr. John Kanellopoulos: “There was evidence presented by Emory University’s Henry Edelhauser at this year’s Refractive Surgery Subspecialty Day at the Academy of Ophthalmology meeting that the LASIK flap never actually heals onto the underlying stroma, especially centrally... This was a real eye-opener for me..." (Review of Ophthalmology 2/1/2009)

"To put it more simply, the corneal flap after LASIK provides no more corneal strength than the wearing of a contact lens." William Jory, MD. J Refract Surg. 2004 May-Jun;20(3):286.

"Laser in situ keratomileusis is another surgery in which the flap is prone to traumatic dislocation because the interface does not seem to heal except at the edges." Source: Protective effect of LASIK flap in penetrating keratoplasty following blunt trauma. Canto AP, Vaddavalli PK, Yoo SH, Culbertson WW, Belmont SC. J Cataract Refract Surg. 2011 Dec;37(12):2211-3.

"Although LASIK remains the most popular refractive surgical procedure, it is becoming apparent that corneal surfaces, cut to create the midstromal flap during surgery, fail to fully reunite postoperatively; surgeons can simply peel back an anterior corneal flap several years later. Such patients... are at risk for progressive visual disability due to general corneal weakness that may progress to ectasia or even traumatic displacement of the insecure flap." Source: Mi S, Dooley EP, Albon J, Boulton ME, Meek KM, Kamma-Lorger CS. Adhesion of laser in situ keratomileusis-like flaps in the cornea: Effects of crosslinking, stromal fibroblasts, and cytokine treatment. J Cataract Refract Surg. 2011 Jan;37(1):166-72.

"Delayed trauma has been shown to cause flap defects,demonstrating that LASIK flaps remain vulnerable to traumatic dehiscence and dislocation even 6 or 7 years after surgery." Source: Roxana Ursea, MD and Matthew T. Feng, MD. Traumatic Flap Striae 6 Years After LASIK: Case Report and Literature Review. J Refract Surg. Vol. 26 No. 11 November 2010

Dr. George O. Waring III: "This means you can lift the LASIK flap indefinitely after LASIK. My longest personal LASIK flap lift is 12 years, and it was done very easily. We have performed biomechanical studies now at Emory up to eight years post-operatively and find that the strength of the lamellar wound is about 2 percent of the normal cornea."
Source: Am J Ophthalmol. 2006 May;141(5):799-809. Peer Discussion: Corneal keratocyte deficits after photorefractive keratectomy and laser in situ keratomileusis.

"The LASIK flap once cut may contribute little to the mechanical stability of the cornea and probably never completely adheres to the underlying stromal bed..." (O'Brart et al, 2007)

""I was in the middle of trephining a donor cornea, when it fell apart," he said. "Fortunately, we were able to send a new cornea right away, and the surgeon finished the operation," said Ronald E. Smith, MD, medical director of the Doheny Eye Bank in Los Angeles. Later, back at the eye bank, researchers examined the ruined cornea and determined that it had had LASIK." Source: Laura J. Ronge. LASIK Shatters Assumptions. EyeNet, August 2001. Read article

"Another aspect of LASIK surgery is that during this procedure, a corneal flap is made, which will create lifelong lamellar corneal potential space." J Refract Surg. 2006 May;22(5):441-7. Galal et al.

"However, this case illustrates that even 4 years following the procedure, the lamellar flap remains an inherently weakened area of the eye, susceptible to traumatic disruption." Source: Nilforoushan MR, Speaker MG, Latkany R. Traumatic flap dislocation 4 years after laser in situ keratomileusis. J Cataract Refract Surg. 2005 Aug;31(8):1664-5.

"Your corneal flap will never adhere to the surface of the eye with quite the same strength it did prior to the surgery, so there is a rare but possible risk of the flap becoming displaced with sufficient force." Source (pg 4)

Dr. Gary Conrad, Kansas State University Biology Professor: "It was once believed that the flap would re-adhere permanently. However, the unique connective tissue of the cornea and a lack of blood vessels limit its ability to fully heal even years after the procedure." Source

"The corneal flap of approximately 160 μm, of one third thickness of the average cornea, has been shown to never heal fully by Seiler and Marshall (personal communication, June 26, 2000). Approximately 22 million corneal fibers are intersected, their severed ends never rejoining, meaning that the flap is held in place only by glycosaminoglycans and peripheral scar tissue. To put it more simply, the corneal flap after LASIK provides no more corneal strength than the wearing of a contact lens." Jory W. Corneal ectasia after LASIK. J Refract Surg. 2004 May-Jun;20(3):286.

"Furthermore, if [LASIK] interface transparency is indicative of absent wound healing, one might expect that the interface remains a potential space and flap adhesion is impaired for the lifetime of the flap." (Ursea and Feng, 2009)

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DrDom

I called two of my ophthalmology colleagues to clarify


2: The "sports risk" is actually not true. BOTH surgeons said that once they have healed the amount of impact necessary to break open the flap would (in a healthy eye) have displaced the lens and also required emergency surgery.



Not trying to be offensive or mean spirited, but according to the published studies of experts in the field, your colleagues are wrong...and I think I'd be inclined to put more confidence in those opinions which have been vetted for publication in the medical journals than your associates. The experts are on record as saying flap dislocation happens far easier, and more often than is commonly thought. They have repeatedly shown that the healing is almost completely confined to the very edges of the incision, and that there is only about 28% strength where it DOES heal.

The above post by Sky323 references a few of the many Journal Papers documenting the problems NOT BEING made public.

You are free to make all kinds of statements of opinion, as am I, but there are potential patients seeking input here (perhaps foolishly) that may be drawn into a false sense of security regarding the integrity of incision healing. I hope they don't get their information from me, and I certainly hope they don't listen to you.

Quote

I asked about skydiving and they said that they did not have direct experience but said they would simply require a slightly longer recovery time since the high wind forces could be harsh on the flap for the first 2 months. Otherwise, the only concern with either would be dry eyes in that environment.



See above

Quote

The military uses PRK because it is simpler, easier, and cheaper.



You obviously have no idea what the DoD spends on their Spec Ops and Aircrew warfighters. You obviously have no idea who pays for most eye surgeries. You appear to be prone to making statements which are not evidenced in fact...and no, I'm not immune to that either. The DoD are not about to let cheap charlie the eye surgeries be performed on the aforementioned personnel in whom they have so heavily invested. What the commanders and medical staff involved in these commands will do is ignore the pabulum being spoon fed to all who will listen by the LASIK mills cranking out patients by the thousands.

Quote

Complication rates are comparable. With LASIK you have the flap issue, with PRK you have a scored cornea which is much more easily infected. Plus the pain.



Possible complications DO EXIST for both procedures, and every person should be aware of them all...that is the point of these posts. The danger of infection exists for both, but with LASIK, it exists for a much longer time frame, and current treatment regimes with PRK have reduced the incidence of both infection, and scarring or hazing to levels significantly lower. In addition, the rapid healing of the surface in PRK (a few days) means any infection which develops will be found rapidly in the first few follow-ups.

Yes, by all accounts, PRK is a less comfortable option pain wise for a couple days...but MOST people describe it as mild discomfort...YMMV.

LASIK can be a very effective solution for many people...but I still maintain the evidence overwhelmingly militates against it for those involved in skydiving or similar activities.

Caveat emptor...

Russ

Generally, it is your choice; will your life serve as an example... or a warning?

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How coincidental! I have an appointment on the 1st, and I'm told that my surgeon specializes in Epi-Lasik, which as I'm reading, is supposed to be similar to PRK and LASEK, with the only difference being the method employed to remove the epithelial cells.

That being said, I'd really like to hear from the community, if anyone here has undergone any eye procedures which adversely affected their skydiving?

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I do not have time to address all your statements but I'll highlight a few. Medicine is as much experience as it is research. I gave you an opinion from two clinicians that practice in the field in question, its the best I can provide. The opinions are theirs and not my own (the entire post was from what they informed me since I know only a surface of the LASIK/PRK/Glasses debate).

At the end of the day I got the info free, and distributed it free, and you get what you pay for.

I could never go through either procedure because anything with the eye freaks me out. Therefore looking too deep doesn't interest me, I tried to do a favour by asking. I clearly will not do that again.

What is the reality? Both work, both have problems. Just like everything else in medicine.

I did not take you as mean spirited, you used evidence and that is what my field is founded on. Your tone is admittedly a bit condescending and unappreciated but it is your own and the internet is rife with misinterpreted tone so I don't take it to heart.

I don't have the time or inclination to sort through the data since its outside of my field of Emergency Medicine; so I asked an expert(s). I can only assume they know the literature, and I fed that forward. If you want to yell at them I'll give them the info. As for my knowledge of DoD, that, again, was from one of my ophthalmology colleague who works part time for the VA system.

Again, their professional opinion was that the kind of injury that would result in flap dislodgement would already have caused a fairly tragic eye injury. Their opinion, not mine.
You are not the contents of your wallet.

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I really advice all to not do lasik, prk, ..... unless your glasses and contacts don't work. Majority of eye doctors still wear glasses and contacts and don't have surgery. They will just tell the points that sells more surgeries as you can see in all lasik center webpages. With surface ablation surgery (prk, lasek, epi lasik,...) the Bowman's Membrane is removed forever and never grow back. This is also something doctors don't tell to patients

Some website about lasik.
www.lasikscandal.com
www.lasikcomplications.com

I don't want to look to negative, but patients are buying dreams with this surgeries. Everybody will need glasses again(farsighted, nearsighted or both), and because you had surgery you will not be able to wear contact lenses comfortable and safe as before. There are many other problems that this doctors dont tell. Beware!

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Sky323

I really advice all to not do lasik, prk, ..... unless your glasses and contacts don't work. Majority of eye doctors still wear glasses and contacts and don't have surgery. They will just tell the points that sells more surgeries as you can see in all lasik center webpages. With surface ablation surgery (prk, lasek, epi lasik,...) the Bowman's Membrane is removed forever and never grow back. This is also something doctors don't tell to patients

Some website about lasik.
www.lasikscandal.com
www.lasikcomplications.com

I don't want to look to negative, but patients are buying dreams with this surgeries. Everybody will need glasses again(farsighted, nearsighted or both), and because you had surgery you will not be able to wear contact lenses comfortable and safe as before. There are many other problems that this doctors dont tell. Beware!



It is not quite that black and white of a decision though. Many people get LASIK who will never be in a sport event or anything high risk. My wife is one of those people. She is a nurse. She was getting eye irritation from contacts and her glasses were perpetually uncomfortable and made it hard for her to enjoy being outdoors (uncomfortable glasses or possibly lost/dirty contacts). She got LASIK and is happy as she could ever be.

Now, for high risk sports its a risk/benefit issue. Risk of complication (early or late) vs a potential lifetime of being free of required lenses.

for the record, a lot of docs have LASIK, both eye specialists and non.

Everyone needs to weigh their options and risks. If it were me I'd wear glasses but admittedly this is because I usually wear safety glasses at work to prevent the blood/vomit/spit in the eyes. I don't know how I'd feel having to wear glasses all the time skydiving or paramotoring. Contacts arent an option... I could never touch my eye.
You are not the contents of your wallet.

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DrDom


...

She was getting eye irritation from contacts and her glasses were perpetually uncomfortable and made it hard for her to enjoy being outdoors (uncomfortable glasses or possibly lost/dirty contacts). She got LASIK and is happy as she could ever be.

...



For two more anecdotal data points - I have a faint scar on one eye from a contact. Bacteria got between the eye and contact. This also happened to a former coworker. We both got LASIK, so no worries about that now.

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My eyes were so bad that before Lasik I couldn't read the "big E" on the eye chart. Couldn't read an alarm clock at night without bringing it to 3 inches from my face. I lost a contact a few times back then and it made landing rather interesting.. 15 years later I wear mild distance vision goggles when skydiving and prescription sunglasses when driving. But my vision is still good enough that I could do either without the glasses. Before - no way..

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faulknerwn

My eyes were so bad that before Lasik I couldn't read the "big E" on the eye chart. Couldn't read an alarm clock at night without bringing it to 3 inches from my face. I lost a contact a few times back then and it made landing rather interesting.. 15 years later I wear mild distance vision goggles when skydiving and prescription sunglasses when driving. But my vision is still good enough that I could do either without the glasses. Before - no way..



I COULD read the big E, but not really anymore. So, 20/400. Now 20/13. :)

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Hey everyone! I got to meet my eye surgeon on Thursday and got my eyes all mapped out and ready to go ;) I asked my doctor a ton of questions about Lasik and PRK, and I decided that Lasik would be better for me and I'm all scheduled to get it done very soon. It was reassuring to see that not only did my eye doctor have Lasik done, but a few other office people did as well and one had PRK. I did mention to him that it was difficult to get a straight answer from a credited source about the procedure for skydivers. He is thinking of possibly writing an article for us jumpers. I thank you all again for your input and opinions and feel that it has helped me pick which procedure was right for me, but it is everyones personal choice at the end of it.

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FlyGirlla

Hey everyone! I got to meet my eye surgeon on Thursday and got my eyes all mapped out and ready to go ;) I asked my doctor a ton of questions about Lasik and PRK, and I decided that Lasik would be better for me and I'm all scheduled to get it done very soon. It was reassuring to see that not only did my eye doctor have Lasik done, but a few other office people did as well and one had PRK. I did mention to him that it was difficult to get a straight answer from a credited source about the procedure for skydivers. He is thinking of possibly writing an article for us jumpers. I thank you all again for your input and opinions and feel that it has helped me pick which procedure was right for me, but it is everyones personal choice at the end of it.



Did your doctor told you the flap never heals? Ask him what laser he use, then i will send you the fda patient information booklet with the results from that particular laser. If you want reliable information about lasik, this is the best you can get. Don't be naive and do lasik just because lots of people in the lasik center did lasik. They also do millions of dollars with lasik. Only a small minority of eye doctors have done lasik, most still wear glasses and contacts. You should think why this is a reality.

Also ask the doctor why he didn't give you the patient information booklets.
You can see here why.
lasikdangers.blogspot.com

Contact lenses and glasses are much better because it give perfect vision without surgery, scars or recovery time. When you change prescription you just buy new lenses and have perfect vision again. After lasik you will not be able to wear safe and comfortable contact lenses. Also 100% of patients will need glasses again for farsighted, nearsighted or both .Lasik is only the equivalent of ONE LENS.

2 more lasik websites.
lasikscandal.com
lasikcomplications.com
lasikadvisiory.com

LASIK IS A VERY BAD DECISION FOR SKYDIVERS, BECAUSE IF YOU LOOSE THE SAFETY GLASSES IN THE AIR, THE FLAP CAN BE LIFT! FLYING AT 200KM/H WITHOUT SAFETY GLASSES AND A FLAP THAT NEVER HEALS IS A HUGE PROBLEM! SHAME ON YOUR LASIK DOCTOR!

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I know you do not agree with Lasik, but at the end of it it is ultimately the individuals decision. And I believe I chose what was the correct one for me. I understand your concern with the flap and with skydiving. I wear a full face (G2) and wrap around sunglasses when I jump. So I should be ok as far as the wind issue. No matter what procedure there will be risks and benefits.

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Ya except the risk in this case is potental complete vision loss.

Ten days after I got PRK I got slapped in the face and the persons finger caught my eye. My vision went completely black, followed by bright white followed by a very short period of very of distorted vision before it came back in focus (as much as it was going to go in focus at that time). I 100% believe that if I would of just had LASIK I would of had a serious problem at that point.

You're right, it's your decision, and you'll probably be ok like the millions of other people, but all it takes is a stray hand (maybe a child) or an airbag or a stray branch you didn't see while hiking and you have the potential for complete vision loss in an eye. Shit happens, is it worth the risk? I personally don't think so and went with PRK.

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Hi FlyGirlla,
The problem with 'individual decisions' is that usually lasik doctors don't give all the information necessary for the patient to give a true informed consent. If lasik doctors talk about the problems patients will not want to do lasik.

I really advice you to at least call your doctor and ask what laser he use. I will give you the link for the fda patient information booklet. It contain lots of good information. Many lasik doctors have 10 years old laser and charge $5000.

Also your doctor should use last generation equipment, including flap creation with laser (last generation not first laser generation). There are 2 equipment's laser and microkeratome).

One of the most important aspects about lasik is that long term complications are unknown.

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FlyGirlla

Hey everyone! I got to meet my eye surgeon on Thursday and got my eyes all mapped out and ready to go ;) I asked my doctor a ton of questions about Lasik and PRK, and I decided that Lasik would be better for me and I'm all scheduled to get it done very soon. It was reassuring to see that not only did my eye doctor have Lasik done, but a few other office people did as well and one had PRK. I did mention to him that it was difficult to get a straight answer from a credited source about the procedure for skydivers. He is thinking of possibly writing an article for us jumpers. I thank you all again for your input and opinions and feel that it has helped me pick which procedure was right for me, but it is everyones personal choice at the end of it.



Beware that you are a guinea pig for your lasik doctor! When he told you the possibility about writing an article about jumpers, it prove the information available about lasik and jumpers is very little. Lasik flap never fully heals and that is an huge contra-indication for skydivers.

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Sky323

***Hey everyone! I got to meet my eye surgeon on Thursday and got my eyes all mapped out and ready to go ;) I asked my doctor a ton of questions about Lasik and PRK, and I decided that Lasik would be better for me and I'm all scheduled to get it done very soon. It was reassuring to see that not only did my eye doctor have Lasik done, but a few other office people did as well and one had PRK. I did mention to him that it was difficult to get a straight answer from a credited source about the procedure for skydivers. He is thinking of possibly writing an article for us jumpers. I thank you all again for your input and opinions and feel that it has helped me pick which procedure was right for me, but it is everyones personal choice at the end of it.



Beware that you are a guinea pig for your lasik doctor! When he told you the possibility about writing an article about jumpers, it prove the information available about lasik and jumpers is very little. Lasik flap never fully heals and that is an huge contra-indication for skydivers.

Do you have a science based resource for LASIK being a contraindication in skydiving? I can not find one and as a doctor I do not see it as a true contraindication, only a consideration.

As for those websites, they are biased garbage but we see this a lot in healthcare. You know once we did not use an electrical union in our hospital and they made up websites about every doctor and administrator on staff talking about how "evil" they are. I was noted as having a malpractice claim against me. In reality I was a witness in a med-mal case but they didnt care. You can post anything you want on the internet.

Yes there is a flap that never completely heals. THere are bones that never completely heal after surgery. My valve will never "completely" heal. Are these all contraindicated? No. I've talked to two professionals who have no financial interest in this particular case (and don't know any skydivers) and said it should not be an issue, and you should still wear eye protection.

So, lay off the OP, he made his decision and just because you did not convince him to go "your way" doesn't mean you need to harass him. His decision is not yours. I believe he is making the right decision. My wife got LASIK, the doc who did her LASIK had it, and much like that other office discussed, most of the staff (nobody there wearing glasses... not a coincidence). 1/2 of the nursing staff in my ER have had it, and 3 of the 8 docs (the rest of us just did not need it).

Lay off, he made his decision. Any discussion after that is just obnoxiousness.
You are not the contents of your wallet.

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FlyGirlla

Hey everyone! I got to meet my eye surgeon on Thursday and got my eyes all mapped out and ready to go ;) I asked my doctor a ton of questions about Lasik and PRK, and I decided that Lasik would be better for me and I'm all scheduled to get it done very soon. It was reassuring to see that not only did my eye doctor have Lasik done, but a few other office people did as well and one had PRK. I did mention to him that it was difficult to get a straight answer from a credited source about the procedure for skydivers. He is thinking of possibly writing an article for us jumpers. I thank you all again for your input and opinions and feel that it has helped me pick which procedure was right for me, but it is everyones personal choice at the end of it.



I'm willing to put beer on the line you are very happy with it.
Trust your surgeon, not some lay person with a vendetta against LASIK.

If you needed more encouragement, procedures like this carry a lot of liability from lawsuit. If he tells you its "OK" to skydive and you have a problem and sue he knows he opens himself to HUGE liability. So he is even going as far to betting a few million dollars that you'll be fine.

Let me tell you something about doctors (if any of you other doctors out there want to chime in I'd love to hear it). Doctors are not these malicious money grabbers you think they are. They do procedures they believe in and care about their patients. I've see it from the other side and also as a patient. They will not bullshit you, and they have to contend with people bored enough to search the internet for conspiracy theories and angry patients who simply had a bad outcome.

LASIK has come a long way, and there is a reason it is still widely done without issues. Sure, there are a few bad cases and they are VERY vocal. But this is about risk management and mitigation... kind of like skydiving. All procedures carry risk.

Since you guys insist on bogus websites, here is one for you about the "evils of PRK".
chew on that: http://www.lasikcomplications.com/PRK-complications.htm

I can post as much internet drabble that says PRK is worse. Your argument is not based on science, training, or experience... unless you're an ophthalmologist and I missed that somewhere.
You are not the contents of your wallet.

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You are a very good salesman for LASIK, congratulations!

I would have done it already if there wouldn't be the risks!
Just be fully aware that if it goes wrong, you won't jump anymore and that might be your smallest problem then.

I know a couple of guys who did it. None of them is completely happy...

As a sidenote: "Conspiracy theory" is invented by the CIA!

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If patients have perfect vision with glasses and contacts i advice to not have surgery. Majority of population haven't done surgery yet, including eye doctors and many important persons as Bill Gates or the deceased Steve Jobs...

You shouldn't trust lasik center webpages, they are made to sell lasik, and show nice pictures, good colors, beautiful words... they don't talk about lasik problems.

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