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    RBW Member Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol's Avatar
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    Laser eye surgery and deep diving

    Has anyone out there had laser eye surgery and dived deep.

    I was due to have LASIK surgery yesterday, however have now postponed this after meeting the surgeon and he didn't have the answers to the safety of it with regard to diving over 50 metres. (this conflicted with what his optometrist advised at a previous consultation) The surgeon then seemed to be recommending LASEK which I had not planned for in terms of recovery time off work - so I ended up postponing.

    Any experiences that anyone has had with either and any advice/ medical studies regarding the relative vulnerability of the eye and diving Post LASIK treatment would be gratefully received.

    The LASEK concerns me regarding recovery period and the outcome - again stories/advice/ good or bad would be very welcome.

  2. #2
    RBW Member Rangaman70 will become famous soon enough Rangaman70 will become famous soon enough Rangaman70 will become famous soon enough Rangaman70's Avatar
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    rEvo Mini III eCCR

    Re: Laser eye surgery and deep diving

    I am an optometrist who worked in a laser vision centre for 18 months in Australia and have a fair idea of what you are going through. My role was to do the initial consultation including pretesting, council the patient, answer most of the questions and then put the person through to see the surgeon who went through the surgery with the patient and answered any final questions.

    To help you understand the second part of your post you need to look at it from the surgeon point of view. They assess your "risk profile" for the surgery to determine what is the best for you. Someone who is totally risk adverse you might consider telling them that glasses and contact lenses may be better suited to their personality.

    The next level down is someone who understands the risks but still has doubts. They want the surgery but doubts linger so the surgeon tells them LASEK/PRK is the best option for them. The heal time is longer by a fair time but there is no flap created so the total risk is less.

    The third person understands the risks and trusts the surgeon to do everything to minimise the risks. These people would be the LASIK group.

    I have had many a person who I talked to during the consultation who were suitable for LASIK but who after speaking to the surgeon were told LASEK/PRK was what they were "suitable" for. Corneal thickness, prescription and corneal curvature are only a part of the entire picture of who is suitable for what surgery.

    The other part of the post is in regard to diving after surgery. In the days after surgery for LASIK the big issue is infection. This is why there is a no swimming and be careful in the shower period. I assume you are worying about the flap lifting while diving ?

    If so then consider the US Navy have cleared pilots for LASIK fully aware that ejection is a real possibility for them. I have also assisted on "retreatments" where peoples eyes had changed years after the surgery and I can tell you the effort required to lift a fully head LASIK flap is considerable.

    Finally I know an insturctor who is advanced trimix, mixed gas CCR and full cave certified who has had LASIK many years ago and has had no problems. I amsure there are many divers on this forum who have had LASIK and are now diving without any issue.

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    RBW Member thetrickster is on a distinguished road thetrickster is on a distinguished road thetrickster's Avatar
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    Re: Laser eye surgery and deep diving

    Whatever you do, don't go cheap.
    I for one, wouldn't opt for one of these, 'treat now, pay next year' opticians in the UK....

    I work in the medical malpractice field (insurance), so know there are 100's if not 1000's of claims from patients relating to laser eye surgery that has not fully corrected the underlying 'fault' or actually caused more issues than before.

    I've stuck with glasses and contact lenses, until I find a proven surgeon.

    Good luck

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    HammerMeg

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    Re: Laser eye surgery and deep diving

    I guess I fall in the "Don't Do it" side of the opinion.

    I think I have posted my experience before so a search would pull up the details but in summary.

    1) I had it done by an expensive well trained medical facility/eye doctor.
    2) Before I needed glasses to see distance but not for reading.
    3) I had it done about 8 years ago at around 46 year old.
    4) Immediately following the procedure I could see distance without correction.
    5) Had dry eyes following the procedure which is normal during recover but mine continued.
    6) Within 3 month post procedure I had regressed back to needing correction for distance and now needing correction to read.
    7) In mornings my vision is better and I need less correction then at the end of the day and it seems to relate to how dry my eyes are.
    8) Not scientific but I believe my vision is worst on deep dives versus shallow dives.

    I guess the bottomline is if you do it and it works it is fantastic but if you happen to be one of the few in which it does not then you will regret ever doing it. The problem is you do not know which one of these two categories you fit into until after it is too late.

    I would have been better to have never done it and would have several $1000's of dollars more in my bank account.

    John

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    Megladon

    Re: Laser eye surgery and deep diving

    I am a ful Trimix instructor, and had Lasik in 2002. I made my first 200' dive 10 days after surgery (that was my decision, I wouldn't recommend that you do that), and since then I have made several hundred dives in excess of 200'- no problems whatsoever. My husband is also a very active CCR diver and has had Lasik- he hasn't had any issues either.

    I recognize that some people have had bad experiences with Lasik, but mine (and my husband's) have been stellar. As someone else said above, do your research on the surgeon and don't go cheap. I chose a surgeon who specializes in corneal transplants. She does Lasik one day a month. She was about $2000 more expensive than the average in my area, but entirely worth it in my opinion.

  6. #6
    RBW Member Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol's Avatar
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    Re: Laser eye surgery and deep diving

    Quote Originally Posted by thetrickster  View Original Post
    Whatever you do, don't go cheap.
    I for one, wouldn't opt for one of these, 'treat now, pay next year' opticians in the UK....

    I work in the medical malpractice field (insurance), so know there are 100's if not 1000's of claims from patients relating to laser eye surgery that has not fully corrected the underlying 'fault' or actually caused more issues than before.

    I've stuck with glasses and contact lenses, until I find a proven surgeon.

    Good luck
    This is a great point - do you know if there are any statistics that are accessible regarding the most or least reliable sergeons and who has outstanding cases against them?

    I would be interested in any on or off forum advice if you have any relating to this.

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    rEvo

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    Re: Laser eye surgery and deep diving

    I had the kind of lasar surgery on both of my eyes that was done by creating a flap, I don't remeber if it was lasek or lasik.

    It was done several years ago and I have had no issues with it. My doctor told me that the flap would begin to heal immediately and that I could safely dive in 2-4 weeks depending on my recovery.

    After 4 weeks I was back in the water and doing 250' dives. I have since been to 484' and below 400' a couple of other times.

    I am still glad that I had the surgery.
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  8. #8
    RBW Member Rangaman70 will become famous soon enough Rangaman70 will become famous soon enough Rangaman70 will become famous soon enough Rangaman70's Avatar
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    Re: Laser eye surgery and deep diving

    Hi Wol,

    I have only seen 2 cases of a flap either lifting or shifting after the surgery. Firstly your Surgeon should tell you to take things easy for a couple of weeks to a month after the surgery. This will depend on what you would normally do in life. If you are active and into physical sporting or work related pursuits it is likely to be 4-6 weeks of taking it careful.

    If you are like me and the heaviest thing you lift is a pen and adventure is defined as watching Bear Grylls on TV then it will be much less.

    Back to the 2 examples. First one was a lady in her 60's who had the surgery 15 years prior. She bent over to prune her roses and one of the branches hit her in the eye at the point where the flap scar was. She was in a little discomfort (the same as you or I would be if we had been poked in the eye by a rose bush). The amount of lifting of the flap was about 1 mm x 2 mm (very small). Treatment was antibiotic eye drops for 1 week, a contact lens was placed on the eye for 3 days to give her comfort and speed up the healing process. I saw her daily for 4 days and the eye had completly healed. At her 1 month follow up it was like the injury had not occurred. No dry eye or deterioration in her vision.

    The second one was a young lady (in her early 20's). She had her surgery one day and we always seen the person the next day to confirm the flap is flat and central, as well as checking for signs of infection and inflamation. Drops are prescribed by the surgeon. All was good at this appointment. Well 2 days later she contacted the emergency number that we give to each patient saying she could not see out of 1 eye. She was seen within 3 hours and it was found that the flap had shifted. This young lady was immediately taken back into surgery where we realigned the flap.

    The reason for this mishap still makes me shake my head as I type. She was told to rest, keep her eyes closed as much as possible, not to lift heavy objects that can cause you to screw up your eyes (this can move a flap). Being the weekend and being young she went out clubbing with friends, got blind rotten drunk, was dancing on the dance floor and was elbowed in the eye by someone. As she was so drunk she did not realise till the next day what had happened.

    Lucky for her there was no long term effects of the incident. She moved interstate and our only measure of the surgery were the followup reports from her local optometrist/optician. Vision was reported at 20/20 6 months after the incident.

    So my advice is to follow the Surgeons post operative care to the letter and the risks are not zero but as low as you can realistically get.

    Drye Eyes

    Is a problem that can be associated with all forms of laser eye surgery. The risk factors for having dry eyes after the surgery are smoking, dry eyes before the surgery, age, sex (male or female not if you are doing it), medications, general health, air conditioning/gas heating, hydration and work environment.

    smoking = the smoke irritates the eyes and interferes with proper tear formation.

    age = the older we get the less tears we produce (i.e more dry eyes)

    Sex = females due to taking the contraceptive pill and also menopause contribute to dry eyes

    medications = some medications interfere with proper tear formation ( heart medications, steriods

    general health = people with autoimune problems or strong family histories of autoimune issues I would not recommend have the surgery. Diabetes can also prove to increase risk

    environment = heating and cooling reduces the humidity in the air and thus increases the rate of evaporation of our tears

    hydration = if we are dehydrated the body will not produce as much tears. RB diving being moist rather than dry on OC will help with this.

    work = when you talk to someone you blink about 10 times per minute. When you stare at a computer screen you can blink as little as 2-3 times per minute. Think of this as the reverse of a cars windscreen wipers in the rain.

    Think about all these factors and how they may be appropriate to you. Discuss these with the surgeon.

    LASEK heal time.

    A brief anatomy lesson to begin with. On the surface or your eye is a thin layer of clear skin cells called epithelium. Epithelium like normal skin can heal in a matter of days. This makes it unsuitable to be treated with the laser as you want the shape change to be permenant. This surface layer is relatively smooth and is organised in a particular way to optomise vision. Under this is the stromal layer that contains nerve endings, provides rigidity to the eye ball and is the area that the laser will remove to reshape your cornea (front of the eye) so you can see without glasses or contact lenses.

    LASEK moves the epithelium (several different ways) to expose the stroma. The laser will remove a very tiny amount of stroma, changing the shape of the eye according to your prescription. The surgery is now over and the eye needs to heal.

    1 day post op your vision is going to be not perfect but not too bad. You are going to reasonably happy.

    2 days post op is when the discomfort starts. If patients are not ready for this they think that there is something wrong. You will be very light sensitive and your eyes feel like they constantly have sand in them. Vision is less that day 1 post op. THIS IS NORMAL.

    3 days post op the discomfort is there still and people may also now be sleep deprived due to this interrupting sleep. Vision is much worse. The reason for the drop in vision is the epithelim is now growing back over the visual axis (fine vision) and the edges of the epthelium are very rough.

    4 days post op the epithelium has completely covered the stroma (where the nerves are) and discomfort is much less.

    7 days post op the discomfort has gone but the new epithelium is still rough and the cells are not "lined up" like they were before the surgery to give you the best vision. Most people can easily see to get around and drive but still find it difficult to watch TV, read a book and look at a comuter screen.

    90 % of your final vision comes within 3 weeks of the surgery. That final 10 % is the epitheilium cells correctly "lining up" again can take a while. If you sit infront of a computer 8 hours a day you will notice this slight drop in vision versus someone who say is a trades person. At the 2 month post op appointment pretty much everyone has the clear vision they were hpoing for.

    Remember everyone heals at different rates and everyone has different tollerance to pain.

    I hope this long winded post will help. If you have any other questions feel free to either post or PM me.

    Andrew

  9. #9
    RBW Member Rangaman70 will become famous soon enough Rangaman70 will become famous soon enough Rangaman70 will become famous soon enough Rangaman70's Avatar
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    Re: Laser eye surgery and deep diving

    Quote Originally Posted by Wol  View Original Post
    This is a great point - do you know if there are any statistics that are accessible regarding the most or least reliable sergeons and who has outstanding cases against them?

    I would be interested in any on or off forum advice if you have any relating to this.
    I would look for the following information.

    1. Does the Surgeon exclusively do laser surgery/cataract surgery ?
    2. How many people would they treat in a year ?
    3. How old is the laser ?
    4. what is the support post operatively ?

    I would go elsewhere if

    1. They only did a few procedures each week. (The surgeon I worked for treated 30 + people per week)

    2. They do not explain the risks fully or try to gloss over them. (All surgery has risks and can happen even if you have the best surgeon in the world and follow the post op care to the letter)

    3. Post Op care (we had 2 contact numbers and these people were not allowed to turn their mobiles off or ignore a call. Both of these people were optometrists working for the surgeon so knew what they were talking about.)

    4. Gut Feel. If you do not totally feel comfortable with the surgeon or the clinic then go where you feel comfortable. (you are trusting your vision to another person).

    5. Ask your regular optometrist/optician who they would recommend. They generally have no monetary gain to sway their view. You might also be surprised to find they may have had the surgery themselves.


    REPEAT AFTER ME - The internet has a lot of infomation buy most of it in this area is not based on facts or produced by people who know are trained to know.

  10. #10
    RBW Member Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol is just really nice Wol's Avatar
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    Re: Laser eye surgery and deep diving

    Quote Originally Posted by Rangaman70  View Original Post
    I am an optometrist who worked in a laser vision centre for 18 months in Australia and have a fair idea of what you are going through. My role was to do the initial consultation including pretesting, council the patient, answer most of the questions and then put the person through to see the surgeon who went through the surgery with the patient and answered any final questions.

    To help you understand the second part of your post you need to look at it from the surgeon point of view. They assess your "risk profile" for the surgery to determine what is the best for you. Someone who is totally risk adverse you might consider telling them that glasses and contact lenses may be better suited to their personality.

    The next level down is someone who understands the risks but still has doubts. They want the surgery but doubts linger so the surgeon tells them LASEK/PRK is the best option for them. The heal time is longer by a fair time but there is no flap created so the total risk is less.

    The third person understands the risks and trusts the surgeon to do everything to minimise the risks. These people would be the LASIK group.

    I have had many a person who I talked to during the consultation who were suitable for LASIK but who after speaking to the surgeon were told LASEK/PRK was what they were "suitable" for. Corneal thickness, prescription and corneal curvature are only a part of the entire picture of who is suitable for what surgery.

    The other part of the post is in regard to diving after surgery. In the days after surgery for LASIK the big issue is infection. This is why there is a no swimming and be careful in the shower period. I assume you are worying about the flap lifting while diving ?

    If so then consider the US Navy have cleared pilots for LASIK fully aware that ejection is a real possibility for them. I have also assisted on "retreatments" where peoples eyes had changed years after the surgery and I can tell you the effort required to lift a fully head LASIK flap is considerable.

    Finally I know an insturctor who is advanced trimix, mixed gas CCR and full cave certified who has had LASIK many years ago and has had no problems. I amsure there are many divers on this forum who have had LASIK and are now diving without any issue.
    Many thanks for the reply on this. My main concern really is the increased risk of dry eyes and the real vulnerability of the flap lifting. Do you know of anyone who flap did end up lifting. I have been told I already have slightly dry eyes - is this likely to predispose me to worse dry eyes if I opt for LASIK in your view.

    Additionally - in your experience how long is the real average that people tended to need off work with LASEK - is 4 days of pain and a total of 7 days off work a realistic time frame?


    Your input is very valued on this many thanks

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