Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Eye Surgery and Altitude

Hey Greg, how many fingers?

See you up there on the 16th, I have extra passes.

Bob K-

This is way off any climbing topic, but wanted to respond to your questions. The main uncontrolled variable in LASIK results is the experience and skill of the physician doing the procedure. For example, here are the official clinical trial data from one LASIK equipment manufacturer using trained physicians with all of the data captured correctly and audited by the FDA - 99.4% of the patients had their vision corrected to 20/40 or better, 91.5% to 20/20 or better: http://www.bausch.com/en_US/consumer/surgical/zyoptix_system.aspx

As someone pointed out earlier, you should do your homework before selecting a physician to do this or any medical procedure. I know that I found a ten fold difference in adverse events in another surgical procedure recently and I would not be surprised to find a similar 10x different in physicians doing LASIK.

Sierra Sam, Thanks for your response. Good hiking to you.

Gregf, Good hiking to you too. I hope everything works out for you no matter what you choose to do.

Lasik surgeons are not considered experts until they have done 500-100 eyes. Obviously a specialist with the best equipment and 10000+ eyes is going to get better results.

There is also a difference in the equipment. Some use the newest lazer and take their time. Others use last years models and rush people through. In fact some get lasik who should never have it, making the results poor.

I have know of other Doctors who reuse blades and cut corners.

From what I would guess a careful specialist who has the right equipment has a redo rate of maybe 5%. A cheap doctor who rushes people through and is not being as careful has a complication rate up to about 20%.

So as with anything, there is a huge difference in both patients and Doctors involved with Lasik. That really matters.

Thanks again everyone.

From all of the above, one would have to conclude there is little evidence that altitude would negatively affect any eye surgery (with the possible exception of RK). LASIK appears distinguished from the remaining methods as being least reversible.

The success statistics insufficiently address the risk since a bad outcome could create immeasurable problems. For example a 10% chance of losing $10 is a lot different than a 10% chance of a slow, agonizing death. Still, people often accept the small chance of horrific outcomes if the benefit is perceived to be worth it (e.g., mountaineering).

As comments came in, a major benefit of this discussion was that it caused me to examine my motivations. I realized surgery provided these benefits vs. dealing with corrective eye wear:
- vanity
- laziness
- nostalgia for the cool eyeballs of bygone days
Amazing the power these have in the face of added cost and risk.

I’m still not sure which way I’ll go on this, but altitude effects are no longer a concern, now replaced by other considerations.

I had PRK myself, in the early 90ies.
FWIW, I have not had any negative effects, neither in normal life nor at high altitude.

JoeF2, you mentioned FWIW.

Sorry, I don't mean to pick on you, but I'd like to illustrate some statistical insight.

Your good experience (FWIW) was offered to be supportive. Thanks. It is considered "anecdotal" evidence, meaning based on limited numbers of patients (you), or not part of a controlled scientific study. Of course, anecdotes are all that the poster could really hope to find at this message board, a non-official collection of people.

Sierra Sam's and Bob K's good comments look at the bigger picture. The prospective eye patient should not make his or her decision based on an individual's experience, but rather on the risks overall.

Again, my comments are not to belittle you, but to expose the interpretation of statistics.

For example, if my Aunt Susie said she had a fine time flying to Denver, but if the history of crashes there was "only" 4%, then I would take the train.

I wear glasses.

Harvey

Yes, as somebody who has done PhD work, I understand that. That's why I put the FWIW there...
As a side note, I should mention that the PRK on my eyes was performed by Dr. Seiler (then in Germany, now in Switzerland, if I remember right), who is credited with performing the first PRK ever, in 1985. With this kind of stuff, a lot depends on the quality of the work, and the experience of the person doing the work, and as always, you get what you pay for...

From the link that Sierra Sam mentioned [Ref1], the following should be checked before deciding on LASIK surgery.

"Preoperative evaluation for dry eye should be performed. Patients should be advised of the potential for worsening of symptoms associated with dry eye syndrome post-LASIK surgery.

Pupil size should be evaluated under mesopic conditions, and patients with large mesopic pupils should be advised of the potential for negative effects on optical visual symptoms after surgery such as glare, halos, and difficlty with night driving." (Mesopic conditions are light conditions that are less than normal daylight but more than low light conditions. [Ref2]) -- What I understand this to mean is that if someone's pupils tend to dilate more than normal when the light is a little dim, then they are more likely to get problems from LASIK.

Also, there was a section on adverse events in Sierra Sam's link. It was somewhat incomplete because it only mentioned that adverse events occurred in at least 1% of the people but it didn't say what the percentage was.

"ADVERSE EVENTS: ... The following subjective patient adverse events reported as "significantly worse" occurred in at least a 1% of the subjects at 6 months post final treatment: fluctuation of vision, blurring of vision, glare, halos, dryness and double vision, headache, redness, and night driving difficulty."
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Disregard these two paragraphs because of Gregf's comment in a following message: There's another interesting point from one of Gregf's USAF links [Ref3]. "Currently, only anterior surface ablation (PRK) is authorized for AF aviation career and undergraduate pilot applicants. All other refractive surgery procedures are disqualifying for applicants for aviation related careers."

For example, if JoeF2 applied to be a pilot with the USAF he wouldn't be disqualified because he had PRK. But if he had LASIK, he would be disqualified for duty as a USAF pilot.
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Talk about dark humor: Pilot Crashes Into Hospital Emergency Room After Undergoing Lasik

BTW, I'm just learning about this stuff as I go along. The subject sure has a lot of surprises!

Bob K. - the other Air Force citation (the PDF) is a new policy - a couple months old - that now makes certain LASIK procedures OK for warfighter or high performance and high altitude aviation.

Actually, I have a Private Pilot certificate, and the FAA knows about my PRK surgery. They are ok with it as long as there is no deterioration of my eyesight. And, knock on wood, my eye doctors haven't seen any deterioration (they don't even notice that I had any eye surgery, I have to tell them.)

Thanks Gregf for the correction.

Here's a link to a USAF article http://www.af.mil/news/story.asp?id=123036058 and here's some excerpts.

"Military members requesting the surgery must first fill out an application, have their commander's authorization and an eyeglass prescription that is at least one to two years old. On average, only ten to fifteen percent of patients who apply for the surgery will not qualify. "

"'The risk isn't zero, there is always a risk,' said Colonel Reilly, 'and there are never any guarantees when it comes to surgery.'

Wilford Hall has a tremendous success rate with refractive surgery, and has never had an aviator not return to flight status after surgery.

Colonel Reilly says that patients here have a 96 to 98 percent chance of achieving better than 20/20 vision after surgery."

From the above, it looks like they have had excellent results. I suspect that this is partly due to good doctors and partly due to good screening of patients which reduces the chance of adverse events.

Edit: This thing has some twists and turns to be careful about. Since LASIK has only recently been approved for USAF pilots, the excellent results mentioned above for pilots must be for the PRK procedure, not LASIK, which may or may not give similar success. Also, it's not clear which procedure the doctors would choose to use for pilots in the future. Seems like there would have to be a very good reason for them to change to LASIK from the tried and true PRK for pilots.

As Harvey says, this is a fascinating decision. I’ve made mine.

Almost 20 years ago I found myself in a design review for one to the two LASIK innovators at that time. Someone noted that liability for a wrongful death would cost $200K but if someone was blinded the going litigation rate was $1MM per eye (probably 5X that, these days). Then came the suggestion that we ought to fit the laser with a switch so that if something went awry in surgery the doc could flip the switch, vaporize the patients head and save anywhere from $800K –to- $1.8MM.

That led to further possible systems changes, like adding a beam splitter and another switch so the doc could simultaneously vaporize his own head for estate planning purposes, and so on.

Law and economics put a value on the decision, but the litigation value comes from disinterested third parties – that’s a lot different than individual choice. How much money would you take to have your eye poked-out, or your life taken?

Gambler’s logic and statistics fail. If out of 100 people only one was willing to take $100MM to have his eye poked-out or life ended, that would mean on average the value would be $1MM. So, if you offered $2MM to a group of 100 you’d expect 50 people to say yes. You’d never find 50 people to take that offer. Even the $100MM guy would say no.

The determinant for me was options value. Some of these procedures are reversible or can be remediated, some less so. LASIK has limited options value and so does PRK. Technology will change all of this as time passes so for the next couple years I’m wearing specs