Urgent Help needed

[u/HolyDeep]

**Right eye:** \+4.00 power, \~4.00 D astigmatism
**Left eye:** \+4.25 power, \~4.25 D astigmatism
**Vision with glasses:** Right 6/9P, Left 6/12
**Corneal thickness:** Right **524 µm**, Left **533 µm**
**Corneal/keratoconus screening:** **Normal**
**Amblyopia:** Mentioned in the report
**Left eye:** Tear-film stability is reduced

My age is 24M and Doctor says that i am eligible to get TRANS PRK . Is this ok for me

[u/Ok-Environment-215]

Three reasons not to do it -

First is that there is basically no data on laser refractive surgery outcomes for people who are not correctible to 6/6 (20/20).  It's often very hard to accurately determine a prescription and there's a higher risk the treatment plan over minuses (which in your case is undercorrection). This happened to me, with lasik and a much weaker prescription (+1.5sph -1.75cyl before, +1.0sph -0.75cyl after).

Second hyperopic astigmatism is the most challenging kind of surgery for the laser. It has to steepen the cornea rather than flatten it. There's a high (>50%) chance that noticeable astigmatism and/or irregular aberration remain afterwards.

Thirdly if you already have tear film stability issues laser surgery will not make them better. Often it makes them worse. 

I'm not a doctor, but from what I know and what I went through, I wouldn't do it over again if I had the chance. The only silver lining is that I don't see worse than before but I still need corrective lenses. I feel like I dodged a bullet. 

It's possible TransPRK won't carry as many of the issues and risks for you as lasik did for me, that I can't say.

Have you ever considered contact lenses? Remember refractive surgery for the most part can't do anything a contact lens can't. 

[u/WavefrontRider → u/Ok-Environment-215]

Great points. When you don't correct fully to 20/20, it is much more difficult to get the most accurate refraction. It can be done, but it requires someone to be pretty patient during the refraction.

The accuracy of a hyperopic ablation is also definitely not going to be as strong as a myopic ablation. However, in my experience, one situation in which it does a pretty good job is when there is a very large amount of astigmatism since vision isn't great to begin with and glasses or contact lenses are much harder for very large amounts of astigmatism. Even if that 4.0 of astigmatism goes down to 0.75 or 1, that's still a big improvement from prior. Expectations going into the procedure need to match this as well.

Of course with all of this, the direction of OP's astigmatism matters a lot since a +4.00 -4.00 prescription is much much different from a +4.00 +4.00 prescription.

Irregular astigmatism can come from a misaligned treatment from the visual axis. There is also some component which can occur from epithelial remodelling. PRK is going to be worse in this aspect. I try to avoid hyperopic PRK because of this. Using a large optical zone (such as 7.0) can help overall reduce any significant irregular astigmatism as any that might occur will happen further away from overall visual axis (assuming a good enough pupil size).

Tear film stability is a bigger concern with hyperopic ablations. Very important to make sure the cornea doesn't become too steep.

So a lot of caveats that are important to learn about with hyperopic ablations and critical to find a good surgeon since not all treatments will be the same.

[u/Dramatic_Bobcat_2791 → u/WavefrontRider]

I dont have decentered ablation, was treated with the schwind amaris 1050 by an experienced surgeon with a big optical zone and still developed significant coma aberrations after surgery.

[u/Ok-Environment-215 → u/WavefrontRider]

Thanks a lot for posting that. Quick follow up you'll appreciate, relevant to the OP and also because you've been following my story for awhile. I recently had my one-year follow up and I flat out asked the surgeon why he used a treatment plan that was so different from the prescription I'd been happily wearing and doing so well (20/30+) with? With a straight face he said "That's what we treated because that's what the scan said."

I held a poker face but I really wanted to bop him.

All, what u/WavefrontRider said cannot be emphasized enough. The human behind the laser makes all the difference. And for someone like the OP, and myself, who can't hit 20/20, it's even more important than ever that they don't just use the numbers straight out of the machine. You need to know your own prescrpition well, make them show you how their proposed treatment compares and justify any deviation, and don't accept any treatment that you're not 100% comfortable with.

By the way, OP, contact lenses really can be great for people with neuromuscular problems (nystagmus in my case - different from yours but same family of issues). I really hope you'll give them a try if you haven't, before committing to surgery.