Lasik’s Risks Are Coming into Sharper Focus • Hacker News Board

Re: Lasik’s Risks Are Coming into Sharper Focus

#91

Post by rm999 » Tue, Jun 12, 2018, 4:56 AM UTC

forapurpose wrote: post #79

rm999 wrote: post #47

As a subscriber I love the New York Times, but like many articles in the Wellness section this is low quality. The article starts off with: >A recent clinical trial by the F.D.A. suggests that the complications experienced by Mr. Ramirez are not uncommon. Nearly half of all people who had healthy eyes before Lasik developed visual aberrations for the first time after the procedure, the trial found. And then five minu…

For anyone who hasn't read the article, the parent is very misleading. The article presents at least half a dozen studies, interviews at least 20 people, and their list of credentials is exceptional.[0] In this case at least, it's not the Times' research that is 'low quality'. [0] I copied and pasted the credentialed people quoted in the article below; I only made it 80% of the way through and then realized it had be…

I'd say we're both right: the article is based around a flawed study that hilariously contradicts the title and is full of circumstantial evidence. You are right that they cite plenty of other studies and quote qualified people. But I'd claim that the faults I cite instantly disqualify it from being a quality objective piece, and that there are likely better places to get a well argued viewpoint.

Re: Lasik’s Risks Are Coming into Sharper Focus

#92

Post by serpix » Tue, Jun 12, 2018, 5:01 AM UTC

simonebrunozzi wrote: post #83

So, this poorly written article at least sparkled a good discussion here on HN. I have an "Ask HN" for you here: it's the year 2018, I am 41, live in Bay Area, have myopia (~2 sx and ~3 dx), and have pondered doing surgery. What's the absolute best option I have? Is it LASIK? Are there different types of LASIK? I spoke with two eye doctors in the past 5 years, and none of them managed to either convince me, or to cla…

There is an alternative to Lasik. It is a new generation of PRK. the difference is you dont get a flap in the surgery and instead they burn and take away a layer from the eye.

The type of surgery I had done was TransPRK.

The benefits are less halos, extreme acuity and perfect dark sight.

I have no halos, no dryness and see better in the dark than before.

The healing process takes a bit longer than Lasik. You need to wear a contact lens for two weeks to protect the new layer growing over your eye. During this time your eyesight fluctuates and there is some nausea associated. This was thoroughly explained to me and I had no problems since every day it got better.

On some days I can count leaves on far away trees. Read license plates on cars way ahead of me. I would do it again even if it cost triple.

Re: Lasik’s Risks Are Coming into Sharper Focus

#93

Post by peatmoss » Tue, Jun 12, 2018, 5:10 AM UTC

toomuchtodo wrote: post #38

vowelless wrote: post #31

Has anyone tried refractive lensectomy for astigmatism and/or myopia? Think cataract surgery, but for improving near/far sightedness, etc. So you end up with artificial intraocular lenses. It costs about double what LASIK does, but doesn't seem to have the side effects.

My father had it done due to cataracts, and was satisfied with the artificial lenses and resulting vision. I had PRK done instead of LASIK (the top layer of the cornea is discarded [it regenerates] instead of being cut and lifted prior to abalation; recovery time is longer, but corneal integrity is preserved) 8 years ago. The recovery time was a few weeks, but I had no LASIK side effects. I highly recommend it versus…

Did the same. I really think it’s a pay now or pay later affair. PRK was a more painful recovery for sure, but I’ve had no issues and no restrictions.

I healed very quickly. I did a review of medical research and did a few things to make PRK better for me:

1. Vitamin C supplements leading up to and after treatment. Reduces risk of corneal haze (though risk is very low with modern PRK which uses Mitomycin off-label for prevention)

2. Extra omega 3 supplements before and during recovery. Keeps the tear coatingon your eye from evaporating / breaking up as quickly which supposedly shortens re-epithelialization time (the epithelium is what is removed on the surface of your cornea).

3. Wetting drops way more frequently than the minimum that the doctor prescribes. You basically can’t use these fast enough for the first few days. The wetter the surface of your eye, the faster the regrowth of your epithelium (fun fact: this is the fastest growing tissue in the body—at least according to the surgeon who did my eyes).

Also, pick a surgeon with the latest and greatest laser. I believe the latest ablation tech had some benefits from an optics / recovery perspective.

Re: Lasik’s Risks Are Coming into Sharper Focus

#94

Post by dbtqgoat » Tue, Jun 12, 2018, 5:21 AM UTC

gameshot911 wrote: post #40

I think this is a unique view, but I've come to appreciate nearsightedness. Partially because I like having the ability to soften the external world by removing my glasses (like wrapping myself in a warm fuzzy blanket), but even more so because it grants me the ability to see things near me in sharper focus than someone with 20/20 vision. I can put on contacts or glasses to see something at a distance just as clearly…

I do the same when I feel disillusioned with superficial beauty. Really pretentious, I know. Either way, it feels good to reduce people to blobs every once and a while. I sometimes get too distracted by looks, so being able to turn that off is nice.

Re: Lasik’s Risks Are Coming into Sharper Focus

#95

Post by TeMPOraL » Tue, Jun 12, 2018, 5:25 AM UTC

NetOpWibby wrote: post #74

cm2012 wrote: post #49

Earlier quoted context omitted.

That's a wrap, folks. This comment is more valuable by far than the article.

I've learned to read the comments to any posted NYT article, than visiting said article itself.

I've learned to read the HN comments to any posted article first - and then decide whether or not I want to catch up with the article itself.

Re: Lasik’s Risks Are Coming into Sharper Focus

#96

Post by forapurpose » Tue, Jun 12, 2018, 5:32 AM UTC

rm999 wrote: post #91

forapurpose wrote: post #79

Earlier quoted context omitted.

For anyone who hasn't read the article, the parent is very misleading. The article presents at least half a dozen studies, interviews at least 20 people, and their list of credentials is exceptional.[0] In this case at least, it's not the Times' research that is 'low quality'. [0] I copied and pasted the credentialed people quoted in the article below; I only made it 80% of the way through and then realized it had be…

I'd say we're both right: the article is based around a flawed study that hilariously contradicts the title and is full of circumstantial evidence. You are right that they cite plenty of other studies and quote qualified people. But I'd claim that the faults I cite instantly disqualify it from being a quality objective piece, and that there are likely better places to get a well argued viewpoint.

> I'd say we're both right

I'd say the parent comment is factually wrong:

> the article is based around a flawed study

The article is based around at least 6 studies and a long list of interviews with experts. And the article's subtitle says, studies show (note the plural). So it's false to say the article is based on one study.

> a flawed study that hilariously contradicts the title

The title is, Lasik's Risks Are Coming Into Sharper Focus. Which study contradicts those words? Certainly not the one discussed in the GGP, which supports the claim that there is growing information about the amount of risk from Lasik. Again, the line quoted above is false.

> circumstantial evidence

I'm not sure what the parent refers to with that term, but as I pointed out, there is a large amount of evidence and experts analysis in the article. Circumstantial evidence is not a bad thing; it's evidence and is admissible in court, for example (AFAIK). It's just generally not considered sufficient by itself; in this article, it certainly has plenty of company.

> disqualify it from being a quality objective piece

They quote people and research on all sides of the issue, extensively.

> hilariously ... instantly

For me, hyperbole disqualifies comments from being taken seriously. It conveys a desire to rant and be dramatic, not a desire to reason about the facts. In fact, the former is often used as a substitute when the latter is lacking.

Re: Lasik’s Risks Are Coming into Sharper Focus

#97

Post by jonknee » Tue, Jun 12, 2018, 5:39 AM UTC

No mention here of SMILE which seems to be gaining ground in much of the world, but pretty rare in the US.

https://www.allaboutvision.com/visionsurgery/smile.htm

Seems interesting, no flap like with LASIK and it may result in fewer cases of dry eyes. Has anyone here had it?

Re: Lasik’s Risks Are Coming into Sharper Focus

#98

Post by lern_too_spel » Tue, Jun 12, 2018, 5:46 AM UTC

bradleyjg wrote: post #41

Anyone here wear the contact lenses that reshape your eyes at night and then during the day you have corrected vision and no lenses? Mostly I don't mind glasses and contacts, but there are some activities I'd rather not have to rely on them.

Yes. It works great. It doesn't have all those complications, it's much cheaper, and it's trivially reversible — just stop wearing the contacts.

Most people here would probably be better off with ortho-k than with LASIK, so long as their myopia isn't severe.

Re: Lasik’s Risks Are Coming into Sharper Focus

#99

Post by Rebelgecko » Tue, Jun 12, 2018, 6:06 AM UTC

3pt14159 wrote: post #20

I had completely shit vision. I couldn't swim safely for long distances because of how bad it was. Got Lasik in Lithuania (same complication rate; 1/6th the price of Toronto) and it was completely, totally worth it. That beings said, my eyes are itchy sometimes. Just because there is a complication doesn't mean that the tradeoff wasn't worth it. I was under no illusions that I wasn't risking permanent damage, but the…

Wow, looks like I could fly to Lithuania and have Lasik done, while spending less money than getting Lasik done at home. How does that work with follow up appointments? Did you just stick around for a few weeks?

Re: Lasik’s Risks Are Coming into Sharper Focus

#100

Post by OrwellianChild » Tue, Jun 12, 2018, 6:10 AM UTC

toast0 wrote: post #45

Groxx wrote: post #5

This, and other summaries of trials / research in here, do indeed imply dramatically more complications than I've ever heard. Gonna have to dive in deeper, I suppose, but the fuzziness around this kind of stuff has been part of the reason I haven't done it already :| > A recent clinical trial by the F.D.A.[1] suggests that the complications experienced by Mr. Ramirez are not uncommon. > Nearly half of all people who…

I suspect a lot of people who have these procedures and don't like the results don't make a big fuss about it, because it's not like they can undo it. And they usually spent a bunch of money on it. You might as well try to be happy with the results. For me, it never seemed worth it to deal with the permanent change leading to potential side effects for a temporary benefit. If my corrective lenses were big and heavy,…

It helps to understand the benefits of the procedure to understand why folks would undertake the risk... I had correction at -6 diopters, which is equivalent to about 20/500 vision. My near vision uncorrected was bad enough that the focal distance was closer than the distance needed to resolve 3D vision. This means that to read my phone without correction, I had to close one eye and hold it in front of my face. Further, I was developing an astigmatism, which results in double vision, even when optically corrected (glasses can fix this, contacts do so poorly).

I got PRK in Vancouver, BC for less than $2K USD. Recovery took about 5 days to functional vision, and maybe 1-2 months for complete recovery. It is a world of difference. I wake up and can see the world immediately. I can go hiking/camping without gear that requires a sanitary environment just to wake up and go to sleep. Cheap sunglasses work. I can participate in sport with no notice or prep. I can swim without eye protection. My day-to-day experience is dramatically improved.

If you don't perceive the benefits, LASIK/PRK may not be for you. For some people, though, life with glasses or contacts is a noticeable burden, and correction can provide measurable upside. In these cases, it can be well worth the perceived risk.