Baltimore Ophthalmologists

42 and +5 Hyperopia - What Are my Options?

I've been farsighted since my teens. I started in the 2-3 Diopter range as a teen, and now I am +3.75 in my dominant eye and +5.00 in my non-dominant eye. My ADD for reading is +1.50 (both eyes). A few years ago I looked into LASIK, but was told that my eye was already too round, so making the lens steeper would result in extreme eye dryness toward the center of my eye. That was 10 years ago. I'm wondering what my options are today.

Your surgical options range from PRK to Lasik to RLE(Refractive Lens Exchange). Considering your age and the severity of hyperopia in your nondominant eye, I would most likely encourage lens based rather than corneal based surgery. A Refractive Lens Exchange is, essentially, a lens removal procedure identical to a cataract surgery(except you don't have a cataract). Once your natural lens is removed, a replacement lens can be put in place that takes away your farsightedness(hyperopia) and also corrects your need for reading glasses. There are several different lens implants available that will correct both of these issues for you, so I think this is the way to go. There is no question that RLE is a bit more invasive than Lasik, thus exposing you to a slightly increased risk, as well as increased cost, but, in my opinion, these negatives will be more than exceeded by your satisfaction. Also, when you consider that you likely have 40+ years to enjoy this new vision, it will be more than worth it!

Anthony J. Kameen, MD

Baltimore Ophthalmologist

Does Using Latisse Promote Growth of Missing Lashes?

I had a bad habit of playing with my lashes whenever nervous/worried, to the point where I'd pull them out. I now currently have noticeable gaps where lashes once were and I use liquid eyeliner daily to hide the gaps. Would using Latisse promote growth of the missing lashes in the 'bald' areas????

Latisse works by stimulating the eyelash hair follicle to grow fuller, thicker and longer eyelahes. This all sounds great, however, you have to have a working hair follicle in order for the treatment to have an effect. If you have permanently damaged or destroyed the follicle by repeated injury to that area, then you will not see a direct effect on that dead follicle. You will, however, receive an effect on the collateral living follicles, thus, likely will notice a filling out of your eyelash line. The gap created by the nonworking follicles would then be filled in somewhat by the Latisse effect on the working follicles.

Anthony J. Kameen, MD

Baltimore Ophthalmologist

Do You Recommend ICL or PRK For Thin Corneas?

I am 28, have a prescription of -3.0 (right) and -2.0 (left) and a central corneal thickness of 470 in both eyes which I understand too thin for Lasik. I have been to two separate eye clinics and one advises PRK and one ICL. The surgeon recommending ICL says they believe my corneas are too thin even for PRK and that ICL would be much safer. ICL does sound like the more pleasant option but is twice the price! Any advice?

You describe your corneas as 470 microns thick, which is on the thinner side of the average range of corneal thickness. You do not mention any other corneal abnormalities from the computer testing, so, for the purposes of this discussion, I will assume your corneas are otherwise normal.

PRK(Photorefractive Keratectomy), also known as Advanced Surface Ablation and, with a few minor variations in technique, LASEK, is a surface corneal procedure that does not require a corneal flap(that is LASIK). I have performed about 25,000 PRK procedures and also had it performed on my eyes in 1994(before other procedures existed). This is an extraordinarily safe and effective way to correct the refractive error you describe and is a relatively easy procedure to perform as the surgeon, and to experience from the patients perspective. Where the "work" of PRK comes in is in the aftercare and visual recovery. Since this procedure is performed on the very outer layer of the cornea, the patient is left with a surgeon induced corneal abrasion that takes about 4 days to heal. During this period, the patient wears a bandage contact lens to remain comfortable. In my experience, on average, the visual improvement with PRK is about 50% right away, then it stays that way for about 4 days until the bandage lenses are removed. Upon removal, and the normal friction occurs as one blinks thousands of times per day, visual improvement improves quite readily in most cases. I performed 15 cataract procedures 5 days after my PRK, if that helps. So, other than the up front inconveneince of PRK(vs LASIK) it is marvelous and the long term visual results and stability are at least equal to LASIK, if not just a tiny bit better. It is true that most surgeons perform many fewer PRK procedures now compared to LASIK, but that is strictly because of the faster recovery.

The ICL or Intraocular Contact Lens procedure(seen on my website under "Phakic Implants") is a more involved procedure that involves making a surgical incision and entering the eye, then gently gliding a permanent plastic contact lens type lens into position in front of the human lens. Just as I describe it, it sounds more complex, doesn't it? It is also performed in an out patient surgical center, not in the office as PRK and LASIK are. Any time you enter a surgical center you can count on the cost of a procedure rising about two fold. In the case of the ICL procedure, my patients pay me a global fee, then from that I buy the ICL, pay the surgery center for the cost of using it and all of its supplies, pay the anesthesiologist for his or her services, then pay myself. In addition, at least in my office, we follow you for no charge for one year. From a financial perspective, I make more money seeing three patients for an annual eye exam than I do performing bilateral ICL procedures! On the other hand, and this is huge, my ICL patients are also the happiest patients I have ever seen! Seeing better than they have ever seen!

All in all, my thought process goes like this. If a patient has a nice thick and normal cornea I perform LASIK. If a patients corneas are on the thinner side, yet normal, and their prescription is not huge(this is you), I perform PRK. If a patients corneas are thin and their prescription is huge I perform the ICL procedure. So, if I were you, I would have PRK. Good Luck! 

Anthony J. Kameen, MD

Baltimore Ophthalmologist