Arthur Benjamin, MD

For reasons unknown to me the promises  of toric ICL approval by the FDA have gone unfilled  for the past 10 years at least. A BIOPTIC procedure is an excellent strategy for correcting both astigmatism and nearsightedness. The procedure consists of a two step process where in the first stage the spherical  ICL is implanted to correct most of the nearsightedness and  the second stage a couple of weeks later to address residual myopic astigmatism with LASIK. The procedure is safe, precise and extremely effective.  It is called BIOPTIC  because it affects the visual system from both the corneal and the len sides. You really  get the best of both worlds, because when you develop a cataract in the future and your ICL is removed with the cataract the corneal astigmatism will have already been corrected. 

Hello, 

From the parameters you describe the best solution for you in the US would be a BIOPTIC procedure. In short, this is a procedure where most of the nearsightedness, up to -15.0 diopters in your case, would be corrected with the ICL. The residual myopic astigmatism would be safely and precisely corrected with a corneal based procedure such as LASIK or PRK. Of course for this to be successful, you must be a good candidate for both procedures and your surgeon must be experienced in both as well. If you reside outside of the USA your surgeon may have access to a toric ICLs. Use of such an icl would obviate the need for the cornea based procedure to correct astigmatism. Good luck!

Hello. You have a somewhat an uncommonly encountered situation where
you have a tremendous difference between the two eyes. One eye is
minus 3.5 while the other is minus 11. Because the brain cannot tolerate
a difference of more than 2 diopters of correction in spectacles, your
difference of almost 9 diopters makes it impossible for you to wear
spectacles. The only options that would allow for binocular vision are
contact lenses or vision correction surgery. In fact, vision
correction surgery was made for folks like you.
The eye that is minus 3 should do great with lasik, The eye that is
minus 11 should be corrected using an ICL. Provided you are a good
candidate for each procedure medically, you will be pretty amazed with
the quality of your vision. I have been fortunate to be able to help
several patients in a similar circumstance and all of them were
literally amazed by the quality of resultant vision.
When choosing a surgeon make sure you find someone who has a skill set
to be able to offer both LASIK and ICL vision correction.
Good luck in your journey!

For years many vision correction surgeons, myself included, had this psychological threshold of 500 microns for performing LASIK.  501 or more LASIK is ok, 499  or less consider PRK.  A recent study of 50,000 LASIK patients has revealed this 500 micron threshold to be completely arbitrary and irrelevant.  What is more important to consider than the thicknes is the shape of the cornea, especially the shape of the back or inside surface of the cornea.  Such evaluation  cannot be performed by a typical corneal topographer capable of imaging and analyzing the front surface only.  Specialized equipment such as Oculus Pentacam, Zeimer Gallilei, or Bausch and Lomb Orbscan  are preferred.  These can image and analyze both the front and the back surfaces of the cornea.  If the shape and architecture of the cornea is shown to be normal and healthy as imaged  with these devices, it would be safe to proceed with lasik.  Good luck with your pocedure!

PRK is a surface treatment procedure during which corneal epithelium, the clear top layer of the cornea, is removed to access the underlying stromal layers so they can be reshaped with the EXCIMER laser.  It takes 3-4 days for the epithelium to regenerate and to cover the treated area completely.  These initial 3-4 days are the most uncomfortable.  Thereafter the vision improves a lot (usually enough to drive a car or better) but may fluctuate  slightly for 4-6 weeks after the procedure while the healing continues.  A lot depends on what kind of correction was performed.  If the treated astigmatism was myopic (minus Rx in glasses or contacts) the recovery should be much faster and vision more stable.  Hyperopic astigmatism (plus glasses or contacts Rx) the treatment algorithm usually results in an overcorrection which  pull back to the target correction over a period of a few weeks.  With any PRK treatment careful postoperative care is very important to prevent haze formation or delayed healing.  Lubrication with artificial tears, good UV protection and adherence to your doctor's advice are key to attaining excellent results.