Talk to me about really bad vision and lasik?

[Ann.without.an.e]

Younger DD has really bad vision. She is 20/1200 with an astigmatism in one eye. She used to be fine with contacts but this is the second year where she cannot get a prescription that works. Her vision is always a little blurry. Last year she thought the new eye doctor was the problem but this year she went back to her old one and none of the samples they gave her to try truly work. The doctor said she cannot take her up or she risks double vision and other problems. 

She is a paralegal so she does a lot of computer work and this has been hard with headaches and blurry vision. 

Is lasik ever covered by insurance in these cases?

Who here has had it done and do you think it may be the answer for DD?

[prairiewindmomma]

Look at PRK surgery instead. But, even still, eyes that need significant corrective measures aren’t a great choice for eye surgery.

ETA: do a consult with a specialist. We did, and got turned away. Her eyes may be different. Her Rx has to be stable for five years to even consider it.

Edited May 3, 2023 by prairiewindmomma

[Mrs Tiggywinkle Again]

It is going to depend on the type of astigmatism and what the place treats.  It would probably definitely be worth a consult, at least.

[Indigo Blue]

Ann, I have really bad vision like your daughter. The only thought I have is that (and this is just MY own thought) I have always been too afraid to do it. Being very nearsightedness  poses its own risks, but those risks have gone a bit down over the years because of improvements in correcting people with strong prescriptions. I have read it might not be a good idea for people who have dry eyes, which I do, potentially as a result of wearing contacts for so many years. 
 

If I were your daughter, I would just be fanatical about doing research. If I decided to do it, I would again be fanatical about researching the best doctor for me. There have been people with long term problems due to not being good candidates. You must be sure you are, and I would get second and third opinions with a prescription that strong, or if there is an inkling or a hint of some “thing” that could even remotely lower my chances of being a perfect candidate. 
 

Being 58, I will probably never have that procedure. 
 

Good questions to ask are how does having that procedure affect near vision as you age? Cataracts and cataract surgery?

[itsheresomewhere]

I have bad vision (no astigmatism) and really need to start thinking of doing this.  If I can ever get myself to do it, I am doing one eye at a time due to some fears/anxiety/etc.  my eye doctor did recommend two really nice specialists who both had no issues with my issues or my eyes.  I just haven’t found the inner courage to do it as something  other than a contact coming near my eye freaks me out ( Yes I know they will give medication for this). Lol. 
 

If she does it and would feel comfortable letting you share her experience with us, please do. 

Edited May 3, 2023 by itsheresomewhere

[almondbutterandjelly]

Do they still do gas permeable contacts? Those worked great for me in my younger days. My vision was similar to your daughter’s and I have an astigmatism.

or embrace glasses, ha ha, until you’re old enough for cataract surgery.

[SKL]

I was legally blind with astigmatism, and I got the zap zap in my late 30s.  It was perfect for me.

However, everyone's eyes are different.

She could probably get a free consult from a lasik provider to find out if she is a good candidate and if this would solve her main problems.

I would assume that at least some of the procedure would be covered by good insurance.  But even without coverage, a successful laser eye surgery is worth it many times over IMO.

I plan to offer to pay for my kids' lasik when they are old enough, if they want it.  It is life-changing.

[catz]

My husband had horrible vision and had it done 23+ years ago.  He did have a slight complication while healing which was a little stressful at the time.  But it's been great, it was life altering for him, he's been thrilled with the results.

If you are considering, go to a surgeon that does this all day every day.

[City Mouse]

I don’t know about LASIK, but if the regular drs can’t get good correction for her, she might want to try a low vision specialist. They can do all kinds of things with eyeglass prescriptions that other optometrists/ophthalmologists don’t do.

[Bambam]

2 hours ago, perky said:

Do they still do gas permeable contacts? Those worked great for me in my younger days. My vision was similar to your daughter’s and I have an astigmatism.

or embrace glasses, ha ha, until you’re old enough for cataract surgery.

They still have gas permeable, but you have to ask for them. I wear them. My vision is bad, and I get clearer vision with gas perms. Eye doctor said everyone would (over soft contacts), but some folks have some trouble adjusting to gas perms (I never did, but I started years ago with the old hard contacts, so when I switched, there was no adjustment).  I don't get samples, but when I first started with this eye doctor, he would change out the contacts if they were not quite the right prescription. I now order them online (Boston EO lenses) ($40/eye). I usually wear the same pair for a year or two. I was told gas perms have better oxygen transference than soft contacts, but I have not verified that with research, so they are not bad for your eyes. 

[Lori D.]

Blurry vision (i.e., unable to get focused vision) can also be a symptom of being pre-diabetic, so if she can't get a prescription to work for her eyesight, it might be good to rule out elevated blood sugar levels.

Also note: NOT everyone is a good candidate for it due to any number of reasons (enlarged pupil, thin cornea, previous eye surgery or eye injury, glaucoma, etc.), so be prepared for the possibility that it may be a no-go.

I had lasik surgery in my mid-40s, and it worked well. I had reached a point where contacts (which I had worn for over 20 years) were irritating, and glasses were getting very heavy and I could never get them adjusted so that they focused right. So -- lasik.

However, 2 minor downsides: I did "lose" my in-focus close vision (I still see close up, just blurry now). I was near-sighted (could see close things, but not farther away). I can no longer focus sharply on anything closer than about 18" and if I were did close/fine work that required it being close to my face, I would need reading glasses or use one of those magnifier lamps. The other minor downside: I am also more prone to "dry eye" now -- although I may have had that happen anyways with age. I just use "liquid tears" eye drops occasionally (like, maybe once a week).

re: insurance
Lasik was not covered by insurance, but at the time, we had an option of a pre-pay plan that allowed us a major discount on medical procedures that we pre-paid for. So, DSs' wisdom teeth removal, and a minor surgery for DH, and lasik for me -- all things we knew in advance that we were going to have done.
 

4 hours ago, Ann.without.an.e said:

... She is a paralegal so she does a lot of computer work and this has been hard with headaches and blurry vision...

Does she do re-focusing exercises once every 20 minutes?
(The quickest suggested "exercise" is "the 20-20-20 rule" -- after 20 minutes of screen time, look at an object 20 feet away for 20 seconds.) 

Also -- blink frequently. Starring at screens, we tend to blink less frequently, allowing the eye to dry out and vision becomes more blurry/less able to be focused.

Is her computer screen positioned correctly?
(20-28" inches away from her face, and slightly below eye level -- 15-20˚ below eye level, or about 4-5", as measured from the center of the screen)

Also -- lighting (position computer screen to avoid glare from overhead light/windows), and anti-glare screen filter.

 

Edited May 4, 2023 by Lori D.

[Ellie]

Although my vision wasn't as bad as your dd's, I did have astigmatism as well as being nearsighted and farsighted. I think I was -700 in one eye and -500 in the other. I opted for the best distance vision the doctor could give me, meaning I have to be corrected for close-up things, but apparently the astigmatism is gone. It was almost 18 years ago, and my vision has stayed the same, about 20/40, which isn't perfect, but it's so much better than what I had before. I've been very satisfied, although if I had thought about it more, I might have done mono vision (one eye for close up, one for distance). As it is, now I have a contact to wear on just one eye, which works most of the time, unless I'm doing lots of heavy reading or computer, and then I wear glasses.

However, now that I"m old, I'm facing the possibility of cataracts, and I can't have that done at this point, because of the lasik. My ophthalmologist, who didn't do the surgery but with whom I have a close relationship [said tongue in cheek] because I now have glaucoma, says my cataracts are very small and very slow growing, and she thinks that by the time I might need surgery, it will be possible. No one mentioned that to me 18 years ago; I might or might not have done lasik had I known this.

[prairiewindmomma]

One more thought and a question:

1. How does she see with glasses? Does she have the same issue? Half of us can't wear contacts. They just don't work well for us.

2. If she is still dealing with blurriness and headaches, really consider being seen by someone who does vision therapy for a screening.  One of mine has functional vision problems. IOW, in addition to the physical structures of his eyes giving him vision difficulties, how his brain uses what eye captures was a bit wonky. We've done two rounds of vision therapy (it's common to need another round of it at puberty), and it makes his headaches and blurriness go away. The best people to do the screening are generally COVD fellows.

https://www.covd.org

List of practitioners by area: https://locate.covd.org

We've had two top notch ophthalmologists who did some degree of vision therapy work also, but they are rare as hens teeth.

[Emba]

I was fairly near sighted (but I think not as  bad as your DD; I can’t remember the numbers now) and had an astigmatism in one eye, and LASIK worked well for me. I did have about an year of terrible dry eye, and used a lot of eye drops for awhile.  And I never really felt that the surgery corrected my vision quite as well as glasses did, but it was in the acceptable range, and I didn’t need glasses anymore. Now, 7 years later and in my early 40s, I’m beginning to use a little prescription for reading (which the eye dr warned me would happen; the surgery does not prevent future presbyopia due to aging) and my distance vision has slipped a bit and glasses for driving at night, while not absolutely necessary, are helpful.  But compared to the time when breaking a pair of glasses rendered me essentially helpless because I was completely unable to drive to work or to the eye doctor(yes, I should have had a spare pair  but money was tight), this is nothing. It really was life changing for me.

i would get an appointment to see if she is a good candidate for surgery, at least, then go from there. 

[KungFuPanda]

I wear glasses. It’s just easier. 

[Mom_to3]

I would be cautious, as being extremely nearsighted puts your daughter at higher risk of other eye problems like glaucoma that could potentially be complicated by Lasik type surgery (even simply having glaucoma diagnosed becomes more difficult, as a thin cornea after surgery leads to lower readings of eye pressure). So be sure to go to a specialist who deals with these issues for extreme myopes and ask specifically about any potential complications in the future. 

[Lori D.]

2 hours ago, Ellie said:

...However, now that I"m old, I'm facing the possibility of cataracts, and I can't have that done at this point, because of the lasik. My ophthalmologist, who didn't do the surgery but with whom I have a close relationship [said tongue in cheek] because I now have glaucoma, says my cataracts are very small and very slow growing, and she thinks that by the time I might need surgery, it will be possible. No one mentioned that to me 18 years ago; I might or might not have done lasik had I known this...

I heard of that, too -- and also AFTER having had the lasik surgery -- and it worried me a great deal, too, as cataracts run on my mom's side of the family.

However -- GOOD NEWS! It looks like that is actually not the case. I am finding this positive news in multiple places, here's a quick confirmation from a Mayo Clinic article:

"Successful cataract surgery is possible for most people who have had ...LASIK ... or other types of refractive surgery that reshape the cornea to correct vision. There is one important caveat, though. To ensure the most predictable vision outcome following cataract surgery, you need to provide your cataract surgeon with specific information about your eyes and eyesight from before and after your LASIK surgery...

... For people... who have had LASIK surgery, providing the appropriate lens implant for cataract surgery takes additional calculations to determine the correct lens power. In addition to taking measurements of the eye, the surgeon also needs an accurate record of your prescription before and after LASIK surgery, as well as an accurate measurement of the curvature of your cornea before LASIK. The records from your LASIK surgery should contain this information..."

So now I need to figure out how I can track down that info from years ago, in case I need future cataract surgery...

[prairiewindmomma]

43 minutes ago, Lori D. said:

I heard of that, too -- and also AFTER having had the lasik surgery -- and it worried me a great deal, too, as cataracts run on my mom's side of the family.

However -- GOOD NEWS! It looks like that is actually not the case. I am finding this positive news in multiple places, here's a quick confirmation from a Mayo Clinic article:

"Successful cataract surgery is possible for most people who have had ...LASIK ... or other types of refractive surgery that reshape the cornea to correct vision. There is one important caveat, though. To ensure the most predictable vision outcome following cataract surgery, you need to provide your cataract surgeon with specific information about your eyes and eyesight from before and after your LASIK surgery...

... For people... who have had LASIK surgery, providing the appropriate lens implant for cataract surgery takes additional calculations to determine the correct lens power. In addition to taking measurements of the eye, the surgeon also needs an accurate record of your prescription before and after LASIK surgery, as well as an accurate measurement of the curvature of your cornea before LASIK. The records from your LASIK surgery should contain this information..."

So now I need to figure out how I can track down that info from years ago, in case I need future cataract surgery...

This is true for most people. However, if you've had a high degree of correction, there is often not enough remaining corneal tissue to do cataract surgery well. It's kind of like a windshield that you've carved. If you dig any deeper, the thing will break. In technical terms-they do intraocular lens power (IOL) predictions.  What Lori D. explains is a modified formula for doing so, but now they are also using OCT scans (optical coherence tomography) in pre-op planning and intraoperative aberratometry as well.  They can estimate pretty well beforehand if the surgery is feasible and kind of make corrections on the fly if they have enough tissue to work with.

All of that is to say: 1. It might not be possible if you had high correction (more than 6D), and 2. even if they think it's possible, there's a higher likelihood things are not going to be 100% perfect afterwards because they are having to do some artistry in getting you there. 

It is true, however, that for most people, you need your records of your cornea before surgery, what corrections were done during LASIK or PRK (same laser, different procedure on the surgeries), so that they can adjust the math in figuring out what they need to do to the lens post cataract surgery....and you can just get 'er done.

-----

FWIW, if she gets deep into planning and they want to do an OCT---as someone who has OCT scans on the regular, it's been hard getting insurance coverage on them. They are about $200-250 out of pocket, and provide good info, but I have to do two layers of appeal every time I get one and they only cover it about half of the time. I do generally get good coverage for my visual field exams.

Another serious consideration, as someone else mentioned, once you get past -6.00, you hit "pathological myopia" where your future risk of glaucoma and cataracts goes up pretty significantly. 

----

At 20/1200 (you didn't mention diopters, and it's not necessarily a straight line conversion), she may not be fully correctable. Dh isn't.  Has she asked what she is corrected to? I mean, theoretically, you can get glasses that are out as many diopters as you want (I think -108 is the record, with a cylinder of like 6---we're just talking lenses here and you can wear a telescope....)....but what your eyes actually do with the lenses is another thing altogether. This idea loops back to my earlier note about looking into vision therapy as a possibility as well if she's not fully correctable to try to deal with what she can see.

[skimomma]

I had it done 15+ years ago and I have not looked back. I was told it would "last 10 years or so," but it seems tone holding just fine.  I did start needed reading glasses around age 45 or so.  I did not know of the cataracts thing!  That is troubling.  But I have to say that 15 years of being able to see free of glasses or contacts has been wonderful.  It would for sure be worth a consult.

[Lecka]

One of my eyes is 20/50 after having Lasik.  It’s a huge improvement for me and I consider it very worth it.  
 

I believe this eye was 20/800 before.  No astigmatism or anything.

 

I have a hard time with contacts, to the point I consider myself unable to wear them.  
 

I feel like my vision is either better or basically the same as it was with my last pair of glasses.  I was frustrated with my choices of frames (even with paying $$$ for lenses so they wouldn’t be SO thick).  I was frustrated with keeping my glasses the exact spot on my face where I had the best vision.  Not that they were not adjusted well — just the tiniest movement could throw them off.  
 

Anyway — I think this is an individual choice.  I have something with my teeth where I don’t have the “big procedure” and I just don’t have the problems that a lot of people have.  
 

But I had a lot of frustrations and irritations and I consider it a major quality of life improvement to have my eyes be 20/20 and 20/50 now.  
 

But I think if I could wear contacts that would be different.

 

I also think there are many people who would be very bothered by having a 20/50 eye.  
 

Edit:  I got it 20 years ago at this point and I definitely agree with looking into different options!  
 

Edit:  it was also recommended for me in a way because I don’t think I was actually corrected to 20/20 with glasses, in practice.  The optometrist I went to (not the person who does LASIK) told my mom he usually didn’t think it was needed but he thought it would be good for me.  Nothing where he go a referral fee or something.  But who knows, it’s too long ago and I was on the younger side.  
 

Edit:  I’m just remembering I think my other eye might have corrected to 20/30.  I know one is 20/50.  

Edited May 4, 2023 by Lecka

[Brittany1116]

I had it nearly 20 years ago. Instant results, no side effects. I am not yet 40 so I don't know how I will fare later when many have significant vision changes. 

[kbutton]

A couple of others talked about seeing a low vision specialist, and I recommend that as well. I have heard of people having a combination of contacts and glasses, usually from a low vision specialist.

My mom looked into Lasik and was not a good candidate (severe myopia and astigmatism). Since then, she's had cataract surgery (preceeded by surgery for floaters), and she's very pleased with her vision now. 

I would want to know what potential complications would apply to her down the road before getting the surgery, but I am very, very cautious about these things. I know a couple of people with severe myopia/astigmatism that are really happy they had the surgery, but at least one of them still requires glasses or contacts (and is exceedingly happy for them to be a light Rx).

[MercyA]

DH had vision correction surgery and cataract surgery in his mid-40's. His vision was quite bad. The surgery was about two years ago.

He has to use eye drops about every two hours every day. He lost his ability to read easily and has had to switch mainly to audio books. This was a huge blow, as reading was the joy of his life. With reading glasses and bright light, he *can* still read, but he has to consciously focus and it is tiring. He has a different pair of glasses he uses for the computer screen and does better with that. He has been back to see his doctor and optometrist many times and his vision is not expected to get better at this point.

On the plus side, he can easily see things that are not up close, without any glasses. This is great for driving, swimming, etc. 

Don't quote please.

 

[Lecka]

It would have been worth it to me to not have 100% improvement and just have a milder prescription.  
 

I think I was told that might happen.  
 

I just had a lot of problems and even still wearing glasses I do think it would have been an improvement.

 

I think I could have gotten glasses and some people would!  But I don’t feel like I need them.  
 

I think it depends on a lot.  
 

I also broke my glasses during the summer before my Senior year in high school and it was a big problem. I didn’t have a back-up because my glasses cost $$$.  It took time to get new glasses from “the specialty lab” or whatever.  Would it even be that way now?  I don’t know.  It was so frustrating to me, though.  I could not see well during the beginning of my Senior year in high school.  I wore my glasses with tape on them but they weren’t “adjusted just right” and I couldn’t see as well as I should have.  I had to sit in the front row to see the board, and I had trouble seeing my stand in orchestra.  I had to talk to my orchestra teacher and ended up crying in the office in front of the orchestra teacher and the band teacher.  
 

I got LASIK between my junior and senior year in college.  It is something that made me feel like I could study abroad.  I don’t know if it was that definitive but I just felt like — it wouldn’t be a huge disaster if my glasses broke while I was an exchange student.  I went the year after my Senior year in college.  

[Lecka]

I’m going to add I did have a halo effect around lights for a while and it would have been an issue for me if I had needed to drive at night in the 2-3 years after I had Lasik.

 

I knew someone who seemed like she had a very similar halo effect and it was a major issue for her because she did need to drive when it was dark!  
 

It’s also the kind of thing where — I had a halo effect and still thought “worth it,” and she thought if she’d known it would happen she wouldn’t have done it, it wasn’t worth it at all.  
 

I was just way on the side where it would be worth it even with a fairly high number of potential problems that I was more at-risk for from having a worse prescription.  
 

But so much of that is individual preferences.  

[ktgrok]

16 hours ago, City Mouse said:

I don’t know about LASIK, but if the regular drs can’t get good correction for her, she might want to try a low vision specialist. They can do all kinds of things with eyeglass prescriptions that other optometrists/ophthalmologists don’t do.

This. She needs a low vision specialist. They can also steer her to coping mechanisms, tools, accomodations, etc.