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Comment by gdebel | Hacker News Reader

Refractive surgeon here. I work in a well-known eye hospital in Paris. I operated my sister (PRK) and my best friend (LASIK). My mother underwent PRK when I was a child and I think the amount of admiration/gratefulness that she had for her surgeon afterward actually gave me interest for this surgery. We regularly operate ophthalmology residents as well, and one of the surgeons of the center underwent LASIK. However, if you consider surgery, please turn to a well-known and experienced surgeon. It is a very secure surgery that can turn really bad if errors are made during patient selection, surgery planning, surgery itself, and management of the unfrequent complications that can occur. Patient selection is especially important. So you have to choose a surgeon that really cares about his reputation, and that will not operate you whatever your examination.

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Thanks for weighing in.

A decade back, my SO worked on clinical trials at a research hospital in the eye clinic. I understand nothing about this stuff.

However, I gleened one important bit of advice:

Avoid any surgery, procedure that surgeons themselves avoid. My SO claims that eye doctors avoid LASIK.

Maybe 10 years ago, a visiting eye doctor was lecturing about LASEK (not LASIK), an operation he had done on himself, and other doctors took note. That was evidence to my SO that LASEK was worth considering.

https://en.wikipedia.org/wiki/Photorefractive_keratectomy#LA...

Again, I know exactly nothing about this stuff. I am not saying to have LASIK or not. Progress marches on and I'm certain techniques have improved.

But I do think this is a good universal heuristic. So am encouraging patients to ask their care provider if they'd get it done themselves.

Actually, we looked yesterday how many eye surgeons underwent LASIK/PRK in the previous 5 years to write a study about this specific topic (this . We found 16 people. LASEK had a surge of interest 5-10 years ago because it was tought that it could have the pros of both PRK and LASIK. Nowadays it is more or less forgotten (no real benefit in comparison with PRK).

Eye surgeons not getting surgery was totally true 15 years ago but it is not anymore (at least in France)

Do you have thoughts on LASIK/PRK vs. refractive lens exchange? I’ve been holding out for something “better than LASIK.” Would love your perspective on whether that’s sensible or misinformed.

It depends a lot on your age, and also on your refraction. Refractive lens exchange can be a good option for high myopia/hyperopia after 60, and can be considered after 45. This is hard to give an advice with no context, the topic is quite complex ;-)

Thanks, I appreciate it. From my layman’s reading, it seems like RLE is very safe and doesn’t have the same side effects as LASIK. I guess my real question is why shouldn’t it be more widely used for younger or less extreme corrections. It’s likely that I am misunderstanding something and I am wondering if it’s obvious to you as an expert what it is.

Ok I get it! It is very simple : RLE implies the removal of the cristalline lens and insertion of an artificial lens that corrects the initial ametropia. The procedure is exactly the same as cataract surgery. The problem is that the lens is the organ that allows accomodation. So while it is usually simple to give you a glass free vision for a given distance, you will need glasses for other distance (usually, you will have a good far vision and glasses to read) which is not something that you want when you are young. The reasoning is that when a cataract surgery will be done anyway a few years after, it is more simple to do one surgery earlier than doing two. Patients with extreme ametropia are more likely to accept glasses. Finally, multifocal lenses exists, but they induce aberrations that are well tolerated when they follow the blurry vision and impairment of cataract, but not so well in previously well-seeing patients.

Got it, thanks. I think it is your last sentence that is most clarifying for me. I thought the multifocal lenses were a good solution but it sounds like they aren’t as great as I had hoped. Thanks for taking the time to reply.

Great perspective. Genuinely curious: how often does a refractive surgeon such as yourself visit this website? Do you feel the need to activate the noprocrast feature?

I'm interested in data sciences and coding (Python) for research, and I am/was involved in two startups. I visit HN at least 4-5 times a day ;-)

Have you noticed any pattern of adverse post-op symptoms in your Lasik patients that corroborate the ones experienced by patients in the article?

Halos are frequent especially in the months after surgery. They tend to reduce with time. They are usually not noticed in everyday life but rather by night, while driving for example (dilated pupils). They also depend on the type of treatment (optical zone, amount of correction) that you perform, and for the quality/generation of the laser platform... Information is essential.

Chronic pain is usually related to dry eyes. Those patients should not be operated at all. Bad patient selection can result in terrible results.

Loss of visual acuity after refractive surgery is more than exceptionnal. It is usually manageable with hard contact lenses.

The special thing about refractive surgery is the contrast between its apparent easiness (non specialist eye surgeon will often refer to it as an "easy surgery, no technical difficulties") and the rapidity with which hard to treat complications can occur if everything does not go as planned. Little things (water drop on the cornea during the treatment, centration error, mismanagement of flap cut incidents...) can lead to disasters that you sometimes cannot repair.

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