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Old 19-08-2007, 15:27   #1
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LASIK outside of US

I'm one of those with eyes over 45 (Yeah, I'm sure some of you are squinting at this, too) and have been weighing the pros and cons of LASIK. It sure seems like a great thing, and I'd love to not have to worry about losing the specs in the drink, but it is so darn expensive in the US.

So, since we're looking at being elsewhere in about 12 months time, I'm wondering how much the procedure costs in other countries, especially in the Caribbean and Central America. Anyone had it done? How was it? Were you satisfied? What did it cost?

Thanks.

ID
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Old 19-08-2007, 18:30   #2
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Quote:
Originally Posted by Intentional Drifter
I'm wondering how much the procedure costs in other countries, especially in the Caribbean and Central America. Anyone had it done? How was it? Were you satisfied? What did it cost?

Thanks.

ID
Here's looking at you, ID.

I can't speak specifically to the cost of LASIK anywhere south of the border, but given the relative bargains in other medical and dental care in the Latin countries, I'm sure it will be less expensive to have it done there. As to how safe it is, who knows, but I'm sure there are a few very experienced surgeons, and some less so (like anywhere else, I suppose), and going with a referral from someone whose opinion you trust seems logical.

I had LASIK on both eyes in 1998 in LA. I was concerned about the downside, of course, but as my uncorrected vision was more than 20/400 in each eye, I was eager to have it done. The initial operation brought my left eye to 20/25 and my right eye to about 20/40. A second prodecure to fine tune things didn't change my left eye, but brought my right eye to 20/15, and I couldn't be happier.

The downside, as it turned out, is that a very near-sighted person with almost microscopic vision out to about 8-10", can now see the tiniest things way off in the distance, but can no longer focus up close at all. This is partially age-related, and reading glasses were probably in my future in any event, but I liked being able to see small details clearly on the tiniest things held right in front of my eyes.

Still, it was a small price to pay for having good, uncorrected vision. The larger price to pay, of course, was for the surgery - $2000/eye at the time. The surgery was performed at the one cllinic in Encino that owned the LASIK equipment, and all of the eye surgeons in the Valley who had gotten the training to do the procedure booked time on that one machine to do it. This greatly reduced the expense of buying and maintaining the necessary equipment, the biggest barrier to offering the surgery, and once they had the training, all of the doctors were more or less equal, IMO. The staff at the clinic assisted each doctor, so their expertise went into every operation.

That was still pretty close to the "bleeding edge" of the technology, though, so the procedure was relatively expensive (always the case for early adopters). It was, however, half the quote I received from a westside surgeon who had gained a reputation in the city as the guru of LASIK.

That business model has, I'm sure, penetrated the Latin countries at this point, so I wouldn't be at all surprised to learn that you could have the procedure performed there by equally competent surgeons at a fraction of the US cost.

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Old 19-08-2007, 19:17   #3
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Regardless of the country, there are "mills" and there are professionals and the pros will charge more--and give you a better result. Equipment varies as to the quality of the result, the best creates a topographic map measuring the light path distortions INSIDE your eye and the shape of your retina as well as the cornea, to give a much better correction. The mills may not do that. Your eyes may or may not benefit from that.

If you have astigmatism, or a high myopic RX, you are more likely to need a pro. And if you have wide pupils (over 6mm fully dilated) you need the new equipment or you will have problems.

I strongly suggest you check out Lasik complication help, bad lasik results to see what complications can be involved. Folks who need only minor corrections, and folks who aren't very critical about their vision, are easily satisfied but there is still a lot of damage and unsatisfactory LASIK being done. Even in the US by alleged professionals. This is a medical procedure--an irreversible medical procedure--and you want to check out the practitioner very carefully, before you take your one chance to do it right.

Among other things, a "redo" vastly increases your chance of cutting the nerves in the surface of the eye (yes, there are nerves) and having permanent problems with dry eye (ears will never tear properly again, and you may require eye drops for comfort--even with just one LASIK procedure.
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Old 20-08-2007, 00:55   #4
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I will comment on Asia only.

I would readily consider having a broad variety of work done in Asia from dental work to "cosmetic" surgeries. However I only have 2 eyes and I would never hunt for a bargain in doing anything to them.

In fact if I were working on my eyes I would damn the price and find the absolute best person to do the job I could, bar none. If I couldn't afford the best I'd wear glasses. Thankfully, I am the only one of 7 siblings and two parents that does not yet need corrective lenses. Reading the fine print (<6 point) is starting to become a problem but this calls for reading glasses in my case not surgery.

There is excellent quality work to be had in asia but you need first hand referals and local knowledge.

The final aspect is what happens if something goes wrong? One thing about the litigious US society is that it keeps everyone on their toes and everyone has lot's of malpractice insurance.

I would hate to be both blind and unable to sue for damages.

Good luck in your decision.
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Old 20-08-2007, 04:47   #5
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Sorry, but not all doctors in the U.S. have lots of malpractice insurance. In fact, Florida allows doctors to "go bare" as long as there is a sign in the waiting room alerting patients to that fact. And frankly, if eye surgery goes badly, I'm not sure there's enough money in any malpractice policy to make up for that.
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Old 20-08-2007, 04:47   #6
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Sorry, but not all doctors in the U.S. have lots of malpractice insurance. In fact, Florida allows doctors to "go bare" as long as there is a sign in the waiting room alerting patients to that fact. And frankly, if eye surgery goes badly, I'm not sure there's enough money in any malpractice policy to make up for that.
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Old 20-08-2007, 05:47   #7
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Lasik surgury has far less to do with the doctor involve and far more to do with the hardware the doctor has available. Doctors do not perform this surgury, they merely evaluate the patient in order to property setup the machine to do the automated procedure correctly.

Advances in the technology of the laser machines that actually perform this surgury is rapid and ongoing. The top doctors spend lots of money to purchase and maintain the absolute cutting edge hardware, sometimes upgrading every couple of years to the latest very expensive devices. The older machines? Often sold overseas....

From my understanding of this (my brother is an optometrist) the advances in the harware over the past several years have been dramatic thus seriously decreasing the risks and increasing the overall quality of results. He says its definitely worth it to ensure whomever your using has the newest and best equipment.

I believe that in general the health care a cruiser is likely to get in foreign nations while out cruising is going to be equal to or better than the care here in the states (The world health organizations ranks the US 37th in the world.... just ahead of Serbia). But this is one procedure where I doubt this is the case because the very latest technology is expensive and thus likely to be sold here first.


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Old 20-08-2007, 20:51   #8
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Quote:
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Lasik surgury has far less to do with the doctor involve and far more to do with the hardware the doctor has available.
Exactly the point. There was a Doctor back home who advertised having done over 1,900 Lasik procedures. I would be looking for this guy. Latest equipment, most experienced and probably "does" have malpractice insurance.

Some docs in Thailand may not even have a laser and do it the old fashioned way with TIG or Oxy/Acetylene
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Old 20-08-2007, 22:17   #9
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Although I am an ophthalmologist, I don't perform lasix. I have been seeing patients who have had lasix for the past ten years, and for the most part, they do very well.

Lasix is quite predictable for small refractive errors, but larger refractive errors over 8 diopters of myopia have a less predictable outcome. The operation works best for near sighted patients and less well for far sighted patients.

There are some unscrupulous doctors who are performing lasix on patients who should not have lasix - like some keratoconus patients.

Complications are infrequent. From the patients point of view, the rate of complications is either zero or 100 percent. If it happens to you it's 100 percent. If it doesn't happen to you, then it's zero. Sometimes opacities develop in the bed of the lasix operation - "sands of the desert" opacities.

The worst complications happen when someone puts the wrong numbers in the computer, and so the visual acuity ends up worse than you started out with. They may have right and left confusion and laser the wrong eye, or they may use another patient's setting for yours. Since it's basically a one shot deal, if they make a big mistake, you are stuck with the result.

We don't know the results of the procedure thirty or forty years down the road. Will there be long term damage to the cornea that will result in corneal decompensation and need for a corneal transplant later on in life?

The other variability is the psychology of the individual patient. People who are uptight and irritated by smaller complications will go absolutely crazy if things don't work out perfectly. Engineers and accountants looking at small figures often go crazy if things don't turn out to their satisfaction.

It does make a difference whether you have lasik on a 1st generation, 2nd generation, or 3rd generation machine. The machines have gotten better and the computer programs running the machines are more sophisticated and do a better job these days.

Of all the eye doctors that I know personally, only about 2 out of 50 have gotten lasix on themselves. Since our job is visually dependent, any loss of vision would have serious ramifications in the way we make or living.

Lasix isn't for everyone, but most people do fine. I wouldn't let anyone do my eyes. Wearing glasses is just fine with me.

If the lasix operation had been performed for the last 500 years, and someone developed a new invention called "glasses" that you could wear on your face, the entire world would be clamouring for this new miracle. No worries about the complications, potential risks, and expense associated with lasix surgery. All you need to do is get a pair of glasses for $50 at Walmart and life is good. Glasses would be the latest and greatest leap forward in the history of medicine. At least, that's the way the advertisements would read.

Did you ever notice how you change your glasses every couple of years? Did you ever wonder what happens to people who have had lasix and their eyes change?

Glasses versus lasix. Monohull versus multihull. Usually it's a lifestyle choice. I'm sticking with my glasses and my multihull.

Life is good.
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Old 20-08-2007, 23:05   #10
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Quote:
Originally Posted by maxingout
Did you ever notice how you change your glasses every couple of years? Did you ever wonder what happens to people who have had lasix and their eyes change?
I was hoping you would respond to this thread, Dave. Your unique insight (no pun intended) into this field will provide Intentional Drifter with an informed opinion for helping him make his decision on having the procedure performed.

I am puzzled by the two questions from your piece quoted above. I wore glasses from the time I was in second grade, but I am not familiar with the notion that people changed their glasses every two years.

As the youngest of four boys, my glasses only changed when one of the lenses was cracked (which, come to think of it, was probably more often than every two years). It seemed like half the family pictures had at least one of the four of us wearing glasses with tape holding the frame together at the bridge, and tape holding one or both temples together was more the rule than the exception.

And though I lived in either Denver or LA from the time I was 11, with optometrists nearby, I still changed glasses much less frequently than every couple of years. As a child, that was primarily due to a limited amount of money to take care of the needs of a growing family.

But even as an adult, with money no longer an impediment, I doubt I ever changed glasses that frequently. Of course, I poured money into hard contacts, soft contacts, Ortho-K - you name it, I tried it. I did, however, draw the line at RK (is that the correct term?). The idea of having someone take a scalpel to my eyes was too intimidating.

So when LASiK (the acronym for Laser-Assisted in Situ Keratomileusis, per Wikipedia) came along, I was really amped-up to have it done. So far (nine years), the results have exceeded my expectations. Any eye-dryness, diminished night vision, necessity of reading glasses, etc. that I have experienced is no worse than before the procedure, and might be expected with advancing age in any event.

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Old 21-08-2007, 00:13   #11
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Quote:
Originally Posted by maxingout

Of all the eye doctors that I know personally, only about 2 out of 50 have gotten lasix on themselves. Since our job is visually dependent, any loss of vision would have serious ramifications in the way we make or living.

Lasix isn't for everyone, but most people do fine. I wouldn't let anyone do my eyes. Wearing glasses is just fine with me.
Bravo Dave and TaoJones - Two awesome posts! :cubalibre
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Old 21-08-2007, 02:31   #12
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The U.S. Food & Drug Administration has an excellent site, devoted to LASIK surgery.
Read through all the sections, indexed at the left, including:
What is LASIK?
When is LASIK not for me?
What are the risks?
What should I expect?
LASIK Checklist
FDA-approved Lasers
Glossary
FAQs
Other Resources

Goto:
Learning about LASIK ~ US FDA
US FDA/CDRH: LASIK - Learning About LASIK

LASIK is a surgical procedure intended to reduce a person's dependency on glasses or contact lenses. The goal of this Web site is to provide objective information to the public about LASIK surgery. See other sections of this site to learn about what you should know before surgery, what will happen during the surgery, and what you should expect after surgery. There is a glossary of terms and a checklist of issues for you to consider, practices to follow, and questions to ask your doctor before undergoing LASIK surgery.

LASIK stands for Laser-Assisted In Situ Keratomileusis and is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye, using an excimer laser. A knife, called a microkeratome, is used to cut a flap in the cornea. A hinge is left at one end of this flap. The flap is folded back revealing the stroma, the middlesection of the cornea. Pulses from a computer-controlled laser vaporize a portion of the stroma and the flap is replaced. There are other techniques and many new terms related to LASIK that you may hear about.
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Old 21-08-2007, 07:33   #13
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Hi Tao Jones,

Not everyone has glasses that change annually. For most people that are myopic, the size of their eye changes until their mid twenties, and then it stabilizes. As their body grows, their eye changes and matures. So the refraction is unstable until the mid twenties. The problem is that if they get lasix when they are eighteen years old, things are going to change.

Hyperopic individuals tend to have a more stable refractive error in their eyes, but hyperopic lasik isn't as good. Lasix works by vaporizing cornea and making a myopic eye less myopic, which is another way of saying it is making the eye more hyperopic.

Making an eye less hyperopic (lasix on hyperopes) is a bit more difficult and entails lasering a different part of the cornea with different risks to the cornea, and later on in life no one knows what will happen to those eyes.

Finally, there is a subset of patients who have progressive myopia, who develop continually increasing myopia throughout their life. You can laser their eye, and a couple of years later, their myopia will have increased significantly because they have axial myopia in which the back of their eye continues to enlarge and produce posterior staphylomas. Doing lasix on these folks is only a temporary fix.

The real problem is that the people who need the operation the most - myopes over eight diopters - have the greatest risk and the least predictable outcomes.

It's all about patient selection. Select your patients well and don't get greedy, and you become a rich hero doing surgery on grateful patients. Select your patients poorly and be greedy doing surgery on patients who are poor candidates, and you better have an attorney on retainer.

Then there are the patients who lose their lasik flap. The patients who get infected. The patients who get scarring under the flap.

Lasix isn't just an operation. It's an adventure.
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Old 21-08-2007, 08:22   #14
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Wow -- another sterling example of why Cruisers Forum is the best -- it's the people!

I'm one of those who has shied away from the laser. Sure, the idea of losing at least two of my three pairs of glasses is very attractive. The thought of a screwed up procedure, though, is horrifying.

I started wearing glasses at age 14. I'm now 53. Most of my eye problem is astigmatism with a touch of nearsightedness. Of course, with my age, the presbyopia has been happening over the last several years. I understand that lasik (lasix? I hadn't heard that term, before.) can do nothing for that. When I'm doing my usual work, much of which is either in front of a computer or talking to someone within a distance of 6 feet, it is not a great bother and takes only one pair of glasses. But, I find that when I'm sailing, I'm constantly looking for a pair of glasses different than the one I'm wearing. For example, if I'm taking a fix, I need my distance pair, but then when working with a chart, I have to find a different pair. Bugs the heck out of me; and I hate my bifocals and having to turn my head up to focus. A friend had it done a couple of years ago and he was able to get his glasses down to one of the half-lenses he uses for close-up work, like with a chart.

So, thank you all -- you've given me excellent advice on what to consider and the questions to ask.

ID
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Old 21-08-2007, 08:22   #15
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Wow -- another sterling example of why Cruisers Forum is the best -- it's the people!

I'm one of those who has shied away from the laser. Sure, the idea of losing at least two of my three pairs of glasses is very attractive. The thought of a screwed up procedure, though, is horrifying.

I started wearing glasses at age 14. I'm now 53. Most of my eye problem is astigmatism with a touch of nearsightedness. Of course, with my age, the presbyopia has been happening over the last several years. I understand that lasik (lasix? I hadn't heard that term, before.) can do nothing for that. When I'm doing my usual work, much of which is either in front of a computer or talking to someone within a distance of 6 feet, it is not a great bother and takes only one pair of glasses. But, I find that when I'm sailing, I'm constantly looking for a pair of glasses different than the one I'm wearing. For example, if I'm taking a fix, I need my distance pair, but then when working with a chart, I have to find a different pair. Bugs the heck out of me; and I hate my bifocals and having to turn my head up to focus. A friend had it done a couple of years ago and he was able to get his glasses down to one of the half-lenses he uses for close-up work, like with a chart.

So, thank you all -- you've given me excellent advice on what to consider and the questions to ask.

ID
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