Borderline candidate - going for second opinion
 

Hi everyone,

I recently had my pre-op testing done by my optometrist to see if I'm a candidate for Lasik. My optometrist said that it looks like I'm a good candidate except that my pupils are slightly large (which may cause glare/haloes after surgery), but that I was just barely over the cutoff so it may not be a huge issue. The main concern was my dry eyes. He ran 2 tests to test my tear film stability (one where he put a strip of paper under my lower eyelid, and another where he put yellow dye in my eyes). He said that my tear film replenish rate was borderline (13 seconds is considered good; mine were inconsistently around 5-6 seconds....if they were consistently 3 seconds, he would have said that I was definitely not a good candidate).

He suggested that I have a 2nd opinion with the ophthalmologist who will actually be performing my surgery. But the fact that my dry eyes are borderline still makes me nervous, even if the surgeon says he feels ok doing it. Has anyone had experience with being "borderline" dry eyes, and going through the surgery anyway?

I have my consultation with the surgeon next Tuesday, but I just wanted to get everyone else's opinion.

Surgeons deal with this exact issue on a daily basis, so your surgeon will likely be able to let you know exactly how borderline your dryness is and give you some answers on how it affects your candidacy for surgery.

If your eyes turn out to be too dry for surgery, your surgeon may recommend a number of treatments to boost them up to a more moist level that would allow you to proceed. Potential treatments include aggressive lubrication with drops and ointment, plugs in your tear ducts to keep your natural moisture on your eyes longer or perhaps the prescription dryness medication Restasis. It is also possible that your surgeon may recommend that you undergo a flapless procedures such as PRK, since this technique is friendlier on dry eyes.

Please let us know how things turn out.

Oh good, that makes me feel a lot better that there are other options for people like me with dry eyes! I will see what the surgeon says on Tuesday and let you know! Thanks!!

Well, I went to the opthalmologist, and she didn't seem too concerned about my dry eyes, she said they weren't as bad as they could be. So she put me on lubricating drops (Systane is what they're called) and told me to come again in 2 weeks to see how they're working.

I asked about PRK, and she said that they really don't prefer to use it because it has longer recovery time, your eyes are more sensitive and prone to infection because the flap is completely removed, rather than replaced with the regular lasik.

She also said that with my large pupils, she would recommend the custom Lasik with wavefront technology because it allows them to get a more precise, tailored surgery that is specific to my eyes. Since my pupils contract a lot in the light (down to 3-4 mm), she said that glare or haloes shouldn't be a problem if I get the custom Lasik.

I have one other question though. The opthalmologist who saw me for this consultation was very nice and willing to answer my questions, however she is not the opthalmologist who will be doing my surgery. Is that kind of weird? Or is that typical? I have been assured that the surgeon is very nice and has good credentials, but I just find it weird that I didn't consult with the person who would be doing the surgery first.

It is possible that the doctor who saw you was not an ophthalmologist. She may be an optometrist. It is up to you to decide if meeting your actual surgeon before surgery is important. Most "traditional minded" surgeons meet with their patients beforehand and these surgeons do think that it is a bit weird that some patients would have surgery without meeting their surgeon. However, the approach at your center is also fairly common. At the end of the day, you must decide if you are comfortable with it or not.