Eyes laser surgery

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Hi all, I'm sorry that this is a bit off topic but concerning photography anyway... I'm wearing corrective glasses and considering having laser surgery for my eyes... My questions is: anybody (as photographer) having this kind of surgery... is there any improvement in focusing... any downside... does it worth the money... thanks in advance...

-- dan n. (dan@egmail.com), September 26, 2001


Dan: I looked into this and decided it wasn't for me. Everybody I know who has had the procedure (20 or more people I've talked to) is thrilled with the results. And I mean thrilled. The worst side effect (one person) is a slight halo around bright lights. And that person is still thrilled with the results. Minimal pain, fast recovery. But it all depends on what kind of correction you need. (Most of these places are so eager for business they're giving free consultations, so why not find out what they can do for you?) If you're like me, with basically pretty good eyes (I'm still 20/20, 20/15) but losing or without any close up ability due to being 40+, my understanding is that this procedure will not fix the problem. People in my situation keep (subconsciously) moving their work further and further away until their arms aren't long enough, then go get reading glasses. Even with my "great" eyesight, I cannot focus a view camera without reading glasses any more because I can't get far enough back. The cheap drug store glasses do the trick on the ground glass for me, I keep a pair in each camera bag. They weight essentially nothing (half frames) and don't take up space. If this is your problem, measure how far away you'd like to be with your head under the darkcloth, go to the drugstore, check out the choices at the same distance, and you're in business. Something mild in the 1.00 to 1.25 range might do the trick. All of the above was true as of last year. I have since heard recent ads claiming the surgery is now available for people who only need reading glasses. Not worth the bother for something so minor as far as I am concerned. If you have other problems which are correctable, I can only say I've heard person after person tell me how much they wish they'd done this years ago, etc. If you wear glasses all the time, there could be a lot of benefit to it.

-- Kevin Crisp (KRCrisp@aol.com), September 26, 2001.

LASIK won't do anything for presbyopia, the condition where you lose the ability to focus close when you get older, although a new surgery is being tested for that.

My friend had the surgery done and is thrilled. Another friend who is a photographer had it done and is thrilled, especially when she shoots 35mm. Some people do have problems. Halos are a problem for some. Some folks end up seeing double. Check out www.surgicaleyes.com. It shows some of the potential complications.

I've also heard it's quite common to experience a decrease in the ability to distinguish shades of grey as well--this isn't a total loss, but a decrease in ability. You should follow up to make sure that I heard correctly.

Here's how I see it. I'm finishing my PhD in 6 months, and medical school 12 months after that. I'm planning a career in radiology. I'll be making a living with my eyes. No one wants a radiologist or a surgeon who sees double. If you're a photographer, you also make your living with your eyes. I'm not going to take a risk with something that critical to my life. I'd love to get rid of my glasses and see the alarm clock when I wake up in the morning. But I'm not willing to take the chance on a complication. That being said, there are more than a few professional athletes who have had it done, and eyesight is very important to them.

As is always the case, you have to make the call. If you decide to do it, shop around very carefully for the surgeon. Find out the number of procedures they have done, their complication rate, how they measure the pupil size, etc.


-- Dave Willis (willisd@medicine.wustl.edu), September 27, 2001.

Dan, I also looked into this and didn't do it because I shoot professionally and don't want anything to go wrong. My brother-in-law and his fiance had it done and hers came out fine but my b-i-l's didn't take. Look into contacts and think about a bright screen for your camera. Beatties are nice and I have them on all my cameras. Maxwell's are supposed to be very good also but the was a thread recently that he wasn't responding to customers emails/phone calls even though he cashed the clients check...

-- Scott Walton (scotlynn@shore.net), September 27, 2001.

I had the LASIK procedure done about 4 weeks ago and I'm very happy with the results. I wouldn't say there is any improvement in my focusing, or my photography, :-) but it is easier to use a loupe, under a darkcloth, without having to wear glasses. I don't think it provides any advantage, photography-wise, other than convenience. Feel free to email me if you have questions about my experience with the procedure.

-- Scott Bacon (sbacon@naturalorderphoto.com), September 27, 2001.

For the record, I am an eye surgeon who performs refractive surgery, and I'm a large format photographer (when work and the kids allow). Here are a few personal opinions regarding laser and other refractive eye surgeries and their relation to large format photography.

Because the machine costs a half-million dollars and one needs to do a lot of cases to pay for it, the most heavily advertised refractive surgery currently is Lasik. Other refractive procedures are available and are perhaps better suited for certain individuals, depending on their eye condition.

The combination cutting and laser technique known as Lasik works best at reducing mild to moderate nearsightedness. In other words, it helps moderately nearsighted people see better at a distance with less need for glasses or contacts. Within these parameters it is over 90 percent successful. Remember, however, it is an actual surgery involving cutting and removal of tissue and like any surgery there are small but very real risks. For extreme nearsightedness, astigmatism, farsightedness and presbyopia (difficulty seeing up close after age 40), I believe there are better options.

Lasik is generally not designed to improve near vision such as required to see a view camera ground glass.

For us optically minded folks, it is noteworthy that the optics of current Lasik techniques create a small amount of increased spherical aberration in the eye, giving rise to some of the postop descriptions of glare around lights at night and decreased contrast sensitivity. There is fascinating research along the lines of equipping the lasers with active-deformable optics (like some advanced telescopes), allowing more individually customized treatment, which may result in providing the eye with better internal optics than ever occurs naturally, so-called "super-vision". This research may prove unsuccessful or may have something available to the market within the next five years.

To see your ground glass better there are a variety of options. The best one is to be under age 40. If that's not available, another option I provide for my patients is "monovision" where one eye is set for distance vision and the other for close-up vision. It's called monovision because you're using only one eye at a time. This can be done with laser, surgery or contact lenses.

I'm over 40, I have trouble switching from looking at the ground glass, then at the subject and back again, so what do I do? In the business they're called "occupational bifocals". Since my head position under the hood looking at the GG required looking through the top of my glasses, that's where I put the close-up lens. Kind of like upside-down bifocals. Electricians, plumbers and other trades that require working with your hands above your head have used these types of lenses for years. I take them off when I'm done shooting and keep them with the camera gear.

-- Dr. Dan (soareyes@hotmail.com), September 27, 2001.

1. The laser surger "burns" to remove tissue. Burns heal differently than cuts.

2. The surgery hasn't been done long enough to know if there are any long term side effects.

3. I don't know of any opthamologists who have had it done. All the ones I know wear glasses.

You've only got one pair of eyes. So far, I know of no significant risks to wearing glasses, even if the prescription is a little off.

When the surgury has been done for 2x my remaining life expectancy with no long term problems, I might consider it.

I'm strongly nearsighted with a strong astigmatism correction. I don't think it's for me.

What's your correction for & how strong is it? That alone can tell you if you are a candidate.

-- Charlie Strack (charlie_strack@sti.com), September 27, 2001.

To answer you question in a single sentence ...... Do not take the chance. I did, and I am one of the people that suffer from the advertised side effects.

I had the Lasik surgery performed 3-1/2 years ago. I was near sighted with astigmatism. My right eye is 20/20 and the result is wonderful. No glasses for golf or daily activities. I have developed a slight amount of astigmatism again, but is is less than .75 as compared to before the surgery it was 4.25.

My left eye is another story. I have been left with irregular astigmatism which gives me double vision, a pretty good loss of contrast and a measured vision of 20/150. I can not be corrected with glasses. I have been fitted with a contact lens that increases my vision to 20/40 with no double vision. The contact only works for short periods of time and then it dries out and my vision is not quite as good.

I am told that in time, custon ablation programs will be developed that may fix my problem. I must tell you that in general seeing with two eyes open and with the contact in I have 20/25 or 20/30 vision. The inconvenience of one contact lens for me is much better than the thick glasses I used to wear.

Night vision is not a problem. I did experience glare and halo problems but they disappeared after a year or so.


-- Mike Kravit (mkravit@kravit.net), September 27, 2001.

Thank you all for posting your advices, experiences and thoughs... after much thinking... my eyesight is not that bad after all ;-) ..... I will save the $$$ for lenses... Thanks again....

-- dan n. (dan@egmail.com), September 27, 2001.

I am planning on having LASIK done in January. My opthalmologist, who has done over 1000 patients, is the most experience refractive surgeon in the area, has been doing some form of refractive surgeries for 20-30 years, and is chief of opthalmologic surgery at the local hospital HAS had it done to himself, and all of his family members. From what he has told me, there has been a couple of generations of machines in the last 3-1/2 years. In fact, when I asked him about it 3 years ago, he suggested I wait. When I saw him a year ago, he highly recommended it. I asked him why his opinion changed, and he told me because the technology had matured so much in the previous two years.

Be careful of where you have it done, research the methods and the surgeons. Don't shop for this based on price. I'm not going to the place in the mall - I'm going to the established, large, opthalmologic organization in the area. I may pay more, but I know they know what they're doing. ALso look out for the teaser rates that are advertised. They are often for a very small diopter corrections (-1/+1 - if I had that, I probably wouldn't bother.), charge for required follow-ups and corrections, and add charges for other things like the medications and corrections for astigmatism.

I also understand that some of the halo effects are due to the surgery being done to people whose pupils open too wide and go beyond the surgerical area - just like opening a lens too wide degrades the performance because of spherical abberation. Your opthalmologist should measure your pupil dilation and refuse to perform the surgery if it is too much.

I have some friends who don't to have it done because they're heard that you lose ability to focus near. Well, yeah, but that's not a normal focussing range. I can focus at 4 inches without my glasses, and I'll lose that if I have LASIK, but that's not a normal focussing range. LASIK will restore a normal focussing range for you. So if you like to focus very close up without glasses, then you might not like it if LASIK restores a normal 10" close viewing distance.

-- John H. Henderson (jhende03@harris.com), September 28, 2001.


It sounds like you have done a lot of good research and probably will be quite happy with your upcoming procedure. For the sake of accuracy I would like to refine a few of your comments.

You are correct in noting that pupil size is important, but not quite for the reason you stated. A slight increase in spherical aberration occurs after almost every Lasik procedure regardless of pupil size. Glare, halos and decreased contrast sensitivity are noted by a few patients, even those with small pupils. The problem with large pupils is that the optically-poor transition zone at the edge of the treated area is included within the pupillary aperture, analogous to non-aligned optics in a camera or enlarger (Trying to keep this thread somewhat photographic). Small pupils are better for many of the same reasons that smaller apertures make better photographic images.

The ability to focus at near after the procedure is very age- dependent. If you are older than say, 45 years, and if you have a perfect distance postop result, say 20/20 or better in both eyes, you will not, repeat not, be able to focus at 10 inches, or even 20 inches. If you are younger - yes, near vision can also be good, but even then you will lose it after a certain age.

-- Dr. Dan (soareyes@hotmail.com), September 28, 2001.

I hear that many people are developing a severe dry eye problem due to this procedure. I would look into this before I did anything....

-- mark lindsey (lindseygraves@msn.com), September 28, 2001.

Dan Depending on your view camera, maybe you could try a binocular viewer. I have an Arca-Swiss 6x9 and due to my aging eyes (47) I could not see to focus on the small ground glass without being almost outside of the dark cloth. When I got Arca's bino viewer, however, thanks to the magnification I can see great!

-- Sandy Sorlien (sand44@mindspring.com), September 28, 2001.

Dan, I must admit that I have only scanned the answers because everytime I mention having had Lasik work done I hear the same general negative comments. Speaking only for myself, I am very happy with the results. I chose mono-vision and again I am very happy with the results. Now, after 50 years, I don't have to wear glasses anymore. No more trouble with fogged and dirty glasses. I don't have to hunt for my glasses any more. I can't think of any downside in my photography or day to day living. I had the work done last year at age 64. Because of my age it took about six months to heal completly. Although, I never had to wear glasses since the surgery. My vision improved as each month passed. Good Luck if your decide on Lasik, Harry

-- Harry L Martin (hmartin@tns.net), September 30, 2001.

I have an number of photographer friends who have had this done with excellent results. Then one who had it done & the surgeon screwed up & put three holes in his eye. A year & a half of major pain reduced him to almost useless and finally he lost the eye. The surgeon did not screw up on purpose, but the eye is still gone. His is only one story among many with most being positive. Like anything else it can be a great thing when it works, which is most of the time. But don't do anything if you are not able to accept the consequences if all does not go right.

-- Dan Smith (shooter@brigham.net), October 01, 2001.

Dan or Anybody Else Considering this: Don't be too shy to ask about risk. There will come a point in time when the MD delivers to you a talk about the risks. This could happen, that could happen, another complication is X, etc. This is basically a description of everything that could go wrong and when you have that list explained to you, only then do you give what lawyers call "informed consent." But "risk" as it relates to informed consent is not (or should not be) merely a recitation of possibilities. A listing of possible bad outcomes means nothing without the additional information (which MD's often overlook or avoid talking about) concerning the frequency at which those untoward events (called in medical-legal circles "a bad result") occur. And the only number that matters to you is how many times YOUR DOCTOR has had that "bad result" with one of his/her patients. (Isn't that better to know than the rate of X complication in the general population of people who've had the procedure you are going to have?) So when a certain unfortunate complication is described to you, before the MD gets to the next one, you should ask how often he/she has had that occur to a patient. This should not offend the doctor and you have a right to know. You can then intelligently size up the risk you are taking and make a decision. Also, it should not go without saying that you should be assured that the doctor who tells you his/her track record is the one that will be doing the procedure. If you show up for the appointment and somebody else is going to do it (yes, this does happen) the information you were told (or requested and received) about the doctor who isn't working on you doesn't mean much.

-- Kevin Crisp (KRCrisp@aol.com), October 01, 2001.

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