Will the outcomes of LASIK be worse if I have high myopia?
I am 24 years old, and have myopia of 1000 - 1100 degrees. Am I still a possible candidate for lasik/epilasik etc? I understand that it also depends on the thickness of my cornea. However, with such high degrees, will the outcomes of lasik be worse for me? Or will I experience worse after effects of lasik? Asking this as I understand that the evaluation of lasik in Singapore costs >$100, thus I just want to confirm if there is a possibility that I am still a candidate for LASIK for my high degrees. I wouldn't want to waste money and time going for a evaluation if it is unheard of or rare that someone of my degrees can undergo lasik. I am also open to additional B12 cross linking treatment as long as it is beneficial for me.
The main added concern with LASIK for patients with high myopia is the risk of cornea thinning. This is because with the LASIK procedure, a cornea flap is cut first with the femtosecond laser before the doctor can proceed to correct your high myopia with the excimer laser. Due to the cut flap in LASIK, there is an added risk of corneal thinning.
You may want to consider the alternative no cut flap, surface-based “Trans-PRK” procedure. In TransPRK, there is no need to cut a cornea flap as the excimer laser vision correction is done on the surface. Instead of a cut corneal flap, a protective bandage lens is places on the surface to promote surface healing and removed after five days.
Thus, there is no concern about cornea flap complications and also less risk of cornea thinning.
Your range of myopia still permits your case to be considered for LASIK surgery.
However, several other factors will have to be taken into consideration before a surgeon can pronounce you suitable for LASIK. These include the thickness of your cornea, the shape of your cornea and your overall eye health. At these levels of myopia, other techniques should be considered as well, which include implantable collamer lens (ICL). Each technique has their own unique set of pros and cons and would be best explored after a thorough eye evaluation and through discussions with your refractive eye surgeon.
You would like to know that not all eye specialist centres charge over $100 for a LASIK evaluation. It would be worth your while to make some enquiries as some centres charge $19 for an evaluation.
My attitude towards collagen cross-linking is that it’s a good option to try to reduce risks of post-LASIK ectasia but it should not be used by an eye surgeon to justify modifying the regular exclusion criteria used to advise patients against have LASIK.
I wish you every success in your search for spectacle independence.
Dr David Chan
For high myopia close to 1000 degrees, the option of which refrative surgery technique to choose depends on a few factors:
1) How thick is the cornea
Thick corneas with regular features may be worth a shot with LASIK (or LASIK EXTRA or SMILE for more stability of power in the long run).
However, as the cornea will be made thinner with all of these laser-based procedures, you may not have adequate tissue thickness left for future enhancement should there be regression of myopia, which can still happen even if LASIK EXTRA or SMILE was chosen.
Surface ablation techniques such as epiLASIK or LASEK or PRK or transPRK are generally not advisable as there is a higher risk of corneal haze with high degree treatment using these so-called first-generation techniques.
2) Is there any astigmatism?
Astigmatism treatment will take up cornea thickness too. So that needs to be factored in.
SMILE is currently CE approved for treatment up to 1000 degree of myopia and astigmatism up to 500 degree. Again the extent that SMILE can safely treat depends on the individual corneal measurements.
3) What sort of occupation and lifestyle?
4) Are you prone to having dry eyes?
5) Pupil size?
6) Would you like to consider ICL which gives better quality of vision for high myopia but is more costly?
I hope you find a good and lasting solution for your high myopia! Best wishes!
Yes you are still a possible candidate for LASIK! While it is true that you will need evaluation of your cornea thickness to be absolutely sure whether you qualify for LASIK, you can be assured that your high myopia does NOT make the outcome or experience worse for you. LASIK has been done successfully for people with high myopia up to 1800 degrees. And yes, adjunctive cross-linking treating is also an option which is beneficial for even those without high myopia.
I would recommend that if you are seriously considering refractive vision correction, you should see an eye doctor for full eye evaluation and LASIK screening. Even if your corneas are too thin or you should be deemed an unsuitable candidate for LASIK, there are multiple other options including ICL which may also be considered.
It is not true that all LASIK screenings are expensive. In fact, I believe Atlas Eye offers LASIK screening at $9 only. And I’m sure many other centres provide rather affordable LASIK screening as well. You may wish to explore those options if you want greater spectacle independence. It is prudent to realise that cost is not the most important consideration. You must be absolutely comfortable with your LASIK surgeon and confident of his/her clinical advice.
I wish you all the best in your LASIK journey and I hope this was helpful to you!
Dr Claudine Pang