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91
General Discussion / Re: ANP Abducen Nerve Palsy
« Last post by splatty on February 22, 2020, 10:21:30 PM »
Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI (the abducens nerve), which is responsible for causing contraction of the lateral rectus muscle to abduct (i.e., turn out) the eye. The inability of an eye to turn outward and results in a convergent strabismus or esotropia of which the primary symptom is diplopia (commonly known as double vision) in which the two images appear side-by-side. Thus the diplopia is horizontal and worse in the distance.

SIGNS AND SYMPTOMS

The nerve dysfunction induces esotropia, a convergent squint on distance fixation. On near fixation the affected individual may have only a latent deviation and be able to maintain binocularity or have an esotropia of a smaller size. Patients sometimes adopt a face turned towards the side of the affected eye, moving the eye away from the field of action of the affected lateral rectus muscle, with the aim of controlling diplopia and maintaining binocular vision.

Diplopia is typically experienced by adults with VI nerve palsies, but children with the condition may not experience diplopia due to suppression. The neuroplasticity present in childhood allows the child to 'switch off' the information coming from one eye, thus relieving any diplopic symptoms. Whilst this is a positive adaptation in the short term, in the long term it can lead to a lack of appropriate development of the visual cortex giving rise to permanent visual loss in the suppressed eye; a condition known as amblyopia.

CAUSE

Because the nerve emerges near the bottom of the brain, it is often the first nerve compressed when there is any rise in intracranial pressure. Different presentations of the condition, or associations with other conditions, can help to localize the site of the lesion along the VIth cranial nerve pathway.

The most common causes of VIth nerve palsy in adults are:

More common: Vasculopathic (diabetes, hypertension, atherosclerosis), trauma, idiopathic.
Less common: Increased intracranial pressure, giant cell arteritis, cavernous sinus mass (e.g. meningioma, Brain stem Glioblastoma aneurysm, metastasis), multiple sclerosis, sarcoidosis/vasculitis, postmyelography, lumbar puncture, stroke (usually not isolated), Chiari Malformation, hydrocephalus, intracranial hypertension, tuberculosis meningitis.
In children, Harley reports typical causes as traumatic, neoplastic (most commonly brainstem glioma), as well as idiopathic. Sixth nerve palsy causes the eyes to deviate inward (see: Pathophysiology of strabismus). report that benign and rapidly recovering isolated VIth nerve palsy can occur in childhood, sometimes precipitated by ear, nose and throat infections.

MANAGEMENT

The first aims of management should be to identify and treat the cause of the condition, where this is possible, and to relieve the patient's symptoms, where present. In children, who rarely appreciate diplopia, the aim will be to maintain binocular vision and, thus, promote proper visual development.

Thereafter, a period of observation of around 6 months is appropriate before any further intervention, as some palsies will recover without the need for surgery.

Symptom relief and/or binocular vision maintenance

This is most commonly achieved through the use of fresnel prisms. These slim flexible plastic prisms can be attached to the patient's glasses, or to plano glasses if the patient has no refractive error, and serve to compensate for the inward misalignment of the affected eye. Unfortunately, the prism only correct for a fixed degree of misalignment and, because the affected individual's degree of misalignment will vary depending upon their direction of gaze, they may still experience diplopia when looking to the affected side. The prisms are available in different strengths and the most appropriate one can be selected for each patient. However, in patients with large deviations, the thickness of the prism required may reduce vision so much that binocularity is not achievable. In such cases it may be more appropriate simply to occlude one eye temporarily. Occlusion would never be used in infants though both because of the risk of inducing stimulus deprivation amblyopia and because they do not experience diplopia.

Other management options at this initial stage include the use of botulinum toxin, which is injected into the ipsilateral medial rectus (botulinum toxin therapy of strabismus). The use of BT serves a number of purposes. Firstly, it helps to prevent the contracture of the medial rectus which might result from its acting unopposed for a long period. Secondly, by reducing the size of the deviation temporarily it might allow prismatic correction to be used where this was not previously possible, and, thirdly, by removing the pull of the medial rectus it may serve to reveal whether the palsy is partial or complete by allowing any residual movement capability of the lateral rectus to operate. Thus, the toxin works both therapeutically, by helping to reduce symptoms and enhancing the prospects for fuller ocular movements post-operatively, and diagnostically, by helping to determine the type of operation most appropriate for each patient.

A Cochrane Review on interventions for eye movement disorders due to acquired brain injury, last updated June 2017, identified one study of botulinum toxin for acute sixth nerve palsy. The Cochrane review authors judged this to be low-certainty evidence; the study was not masked and the estimate of effect was imprecise.

LONGER TERM MANAGEMENT

If adequate recovery has not occurred after the 6 month period (during which observation, prism management, occlusion, or botulinum toxin may be considered), surgical treatment is often recommended.

If the residual esotropia is small, or if the patient is unfit or unwilling to have surgery, prisms can be incorporated into their glasses to provide more permanent symptom relief. When the deviation is too large for prismatic correction to be effective, permanent occlusion may be the only option for those unfit or unwilling to have surgery.

SURGERY

The procedure chosen will depend upon the degree to which any function remains in the affected lateral rectus. Where there is complete paralysis, the preferred option is to perform vertical muscle transposition procedures such as Jensen's, Hummelheim's or whole muscle transposition, with the aim of using the functioning inferior and superior recti to gain some degree of abduction. An alternative approach is to operate on both the lateral and medial rectii of the affected eye, with the aim of stabilising it at the midline, thus giving single vision straight ahead but potentially diplopia on both far left and right gaze. This procedure is often most appropriate for those with total paralysis who, because of other health problems, are at increased risk of the anterior segment ischaemia associated with complex multi-muscle transposition procedures.

Where some function remains in the affected eye, the preferred procedure depends upon the degree of development of muscle sequelae. In a sixth nerve palsy one would expect that, over the 6 month observation period, most patients would show the following pattern of changes to their ocular muscle actions: firstly, an overaction of the medial rectus of the affected eye, then an overaction of the medial rectus of the contraletral eye and, finally, an underaction of the lateral rectus of the unaffected eye - something known as an inhibitional palsy. These changes serve to reduce the variation in the misalignment of the two eyes in different gaze positions (incomitance). Where this process has fully developed, the preferred option is a simple recession, or weakening, of the medial rectus of the affected eye, combined with a resection, or strengthening, of the lateral rectus of the same eye. However, where the inhibitional palsy of the contralateral lateral rectus has not developed, there will still be gross incomitance, with the disparity between the eye positions being markedly greater in the field of action of the affected muscle. In such cases recession of the medial rectus of the affected eye is accompanied by recession and/or posterior fixation (Fadenoperation) of the contraleral medial rectus.

The same approaches are adopted bilaterally where both eyes have been affected.

https://en.wikipedia.org/wiki/Sixth_nerve_palsy

One of my friends had this! It was only temporary for him and went away within a month.
93
General Discussion / Re: ANP Abducen Nerve Palsy
« Last post by ophresearch on February 20, 2020, 09:56:26 PM »
Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI (the abducens nerve), which is responsible for causing contraction of the lateral rectus muscle to abduct (i.e., turn out) the eye. The inability of an eye to turn outward and results in a convergent strabismus or esotropia of which the primary symptom is diplopia (commonly known as double vision) in which the two images appear side-by-side. Thus the diplopia is horizontal and worse in the distance.

SIGNS AND SYMPTOMS

The nerve dysfunction induces esotropia, a convergent squint on distance fixation. On near fixation the affected individual may have only a latent deviation and be able to maintain binocularity or have an esotropia of a smaller size. Patients sometimes adopt a face turned towards the side of the affected eye, moving the eye away from the field of action of the affected lateral rectus muscle, with the aim of controlling diplopia and maintaining binocular vision.

Diplopia is typically experienced by adults with VI nerve palsies, but children with the condition may not experience diplopia due to suppression. The neuroplasticity present in childhood allows the child to 'switch off' the information coming from one eye, thus relieving any diplopic symptoms. Whilst this is a positive adaptation in the short term, in the long term it can lead to a lack of appropriate development of the visual cortex giving rise to permanent visual loss in the suppressed eye; a condition known as amblyopia.

CAUSE

Because the nerve emerges near the bottom of the brain, it is often the first nerve compressed when there is any rise in intracranial pressure. Different presentations of the condition, or associations with other conditions, can help to localize the site of the lesion along the VIth cranial nerve pathway.

The most common causes of VIth nerve palsy in adults are:

More common: Vasculopathic (diabetes, hypertension, atherosclerosis), trauma, idiopathic.
Less common: Increased intracranial pressure, giant cell arteritis, cavernous sinus mass (e.g. meningioma, Brain stem Glioblastoma aneurysm, metastasis), multiple sclerosis, sarcoidosis/vasculitis, postmyelography, lumbar puncture, stroke (usually not isolated), Chiari Malformation, hydrocephalus, intracranial hypertension, tuberculosis meningitis.
In children, Harley reports typical causes as traumatic, neoplastic (most commonly brainstem glioma), as well as idiopathic. Sixth nerve palsy causes the eyes to deviate inward (see: Pathophysiology of strabismus). report that benign and rapidly recovering isolated VIth nerve palsy can occur in childhood, sometimes precipitated by ear, nose and throat infections.

MANAGEMENT

The first aims of management should be to identify and treat the cause of the condition, where this is possible, and to relieve the patient's symptoms, where present. In children, who rarely appreciate diplopia, the aim will be to maintain binocular vision and, thus, promote proper visual development.

Thereafter, a period of observation of around 6 months is appropriate before any further intervention, as some palsies will recover without the need for surgery.

Symptom relief and/or binocular vision maintenance

This is most commonly achieved through the use of fresnel prisms. These slim flexible plastic prisms can be attached to the patient's glasses, or to plano glasses if the patient has no refractive error, and serve to compensate for the inward misalignment of the affected eye. Unfortunately, the prism only correct for a fixed degree of misalignment and, because the affected individual's degree of misalignment will vary depending upon their direction of gaze, they may still experience diplopia when looking to the affected side. The prisms are available in different strengths and the most appropriate one can be selected for each patient. However, in patients with large deviations, the thickness of the prism required may reduce vision so much that binocularity is not achievable. In such cases it may be more appropriate simply to occlude one eye temporarily. Occlusion would never be used in infants though both because of the risk of inducing stimulus deprivation amblyopia and because they do not experience diplopia.

Other management options at this initial stage include the use of botulinum toxin, which is injected into the ipsilateral medial rectus (botulinum toxin therapy of strabismus). The use of BT serves a number of purposes. Firstly, it helps to prevent the contracture of the medial rectus which might result from its acting unopposed for a long period. Secondly, by reducing the size of the deviation temporarily it might allow prismatic correction to be used where this was not previously possible, and, thirdly, by removing the pull of the medial rectus it may serve to reveal whether the palsy is partial or complete by allowing any residual movement capability of the lateral rectus to operate. Thus, the toxin works both therapeutically, by helping to reduce symptoms and enhancing the prospects for fuller ocular movements post-operatively, and diagnostically, by helping to determine the type of operation most appropriate for each patient.

A Cochrane Review on interventions for eye movement disorders due to acquired brain injury, last updated June 2017, identified one study of botulinum toxin for acute sixth nerve palsy. The Cochrane review authors judged this to be low-certainty evidence; the study was not masked and the estimate of effect was imprecise.

LONGER TERM MANAGEMENT

If adequate recovery has not occurred after the 6 month period (during which observation, prism management, occlusion, or botulinum toxin may be considered), surgical treatment is often recommended.

If the residual esotropia is small, or if the patient is unfit or unwilling to have surgery, prisms can be incorporated into their glasses to provide more permanent symptom relief. When the deviation is too large for prismatic correction to be effective, permanent occlusion may be the only option for those unfit or unwilling to have surgery.

SURGERY

The procedure chosen will depend upon the degree to which any function remains in the affected lateral rectus. Where there is complete paralysis, the preferred option is to perform vertical muscle transposition procedures such as Jensen's, Hummelheim's or whole muscle transposition, with the aim of using the functioning inferior and superior recti to gain some degree of abduction. An alternative approach is to operate on both the lateral and medial rectii of the affected eye, with the aim of stabilising it at the midline, thus giving single vision straight ahead but potentially diplopia on both far left and right gaze. This procedure is often most appropriate for those with total paralysis who, because of other health problems, are at increased risk of the anterior segment ischaemia associated with complex multi-muscle transposition procedures.

Where some function remains in the affected eye, the preferred procedure depends upon the degree of development of muscle sequelae. In a sixth nerve palsy one would expect that, over the 6 month observation period, most patients would show the following pattern of changes to their ocular muscle actions: firstly, an overaction of the medial rectus of the affected eye, then an overaction of the medial rectus of the contraletral eye and, finally, an underaction of the lateral rectus of the unaffected eye - something known as an inhibitional palsy. These changes serve to reduce the variation in the misalignment of the two eyes in different gaze positions (incomitance). Where this process has fully developed, the preferred option is a simple recession, or weakening, of the medial rectus of the affected eye, combined with a resection, or strengthening, of the lateral rectus of the same eye. However, where the inhibitional palsy of the contralateral lateral rectus has not developed, there will still be gross incomitance, with the disparity between the eye positions being markedly greater in the field of action of the affected muscle. In such cases recession of the medial rectus of the affected eye is accompanied by recession and/or posterior fixation (Fadenoperation) of the contraleral medial rectus.

The same approaches are adopted bilaterally where both eyes have been affected.

https://en.wikipedia.org/wiki/Sixth_nerve_palsy
94
General Discussion / Re: Retina - Residency
« Last post by ophresearch on February 20, 2020, 09:50:41 PM »
Disclaimer: this list is not comprehensive and I did not interview at every program. It's not in a specific order, but I think the general groupings are reasonable. Obviously, a program can be better or worse depending on whether you are interested in academics or private, location, surgical volume, call schedule, etc.

Top 3, which I think the majority of people would agree with, in no order:
Beaumont
Duke
Wills

rest of my personal Top 15, in a loose but by no means exact order:
Bascom
UCLA
Cleveland Clinic
Tufts/OCB
Emory
UMich
MEEI
Wilmer
UIC
Columbia
NYEEI
Casey

Another set of great programs, in a general order but very extremely difficult to rank these given some are more surgically oriented and others are more academic. Many could be argued should be in the top 15 as well:
Iowa
Rush
UPenn
The Retina Institute (STL)
RGW
Baylor
CPMC
UAB
MCW
Vanderbilt
WashU
Stanford
Mayo
Utah
UCSF
Northwestern
UC Davis
UCSD
Cornell
Kresge
UC Irvine
USC
U Kentucky
95
General Discussion / Re: Rods and Cones
« Last post by docmed123 on February 20, 2020, 09:46:13 PM »
Maybe look to Dr. Neena Haider at Schepens Eye Research Institute at Massachusetts Eye and Ear Infirmary. https://www.macular.org/latest-research

Or look here for potential job and internship opportunities depending on your location ... https://www.indeed.com/q-Eye-Research-jobs.html
96
General Discussion / Re: LASIK
« Last post by Curiousgeorge on February 20, 2020, 09:42:31 PM »
https://www.mayoclinic.org/tests-procedures/lasik-eye-surgery/in-depth/lasik-surgery/art-20045751

LASIK surgery: Is it right for you?
LASIK eye surgery may mean no more corrective lenses. But it's not right for everybody. Learn whether you're a good candidate and what to consider as you weigh your decision.
By Mayo Clinic Staff

If you're tired of wearing eyeglasses or contact lenses, you may wonder whether LASIK surgery is right for you. LASIK is a type of refractive eye surgery.

In general, most people who have laser-assisted in-situ keratomileusis (LASIK) eye surgery achieve 20/25 vision or better, which works well for most activities. But most people still eventually need glasses for driving at night or reading as they get older.

LASIK surgery has a good track record. Complications that result in a loss of vision are rare, and most people are satisfied with the results. Certain side effects, particularly dry eyes and temporary visual disturbances, are fairly common. But these usually clear up after a few weeks or months, and very few people consider them to be a long-term problem.

Your results depend on your refractive error and other factors. People with mild nearsightedness tend to have the most success with refractive surgery. People with a high degree of nearsightedness or farsightedness along with astigmatism have less predictable results.

Read on to learn more about what to consider as you decide whether this surgery is right for you.

What does LASIK eye surgery involve?
There are several variations of laser refractive surgery. LASIK is the best known and most commonly performed. Many articles, including this one, will use the term "LASIK" to refer to all types of laser eye surgery.

Normally, images are focused on the retina in the back of your eye. With nearsightedness (myopia), farsightedness (hyperopia) or astigmatism, they end up being focused elsewhere, resulting in blurred vision.

Nearsightedness (myopia) is a condition in which you see nearby objects clearly, but distant objects are blurry. When your eyeball is slightly longer than normal or when the cornea curves too sharply, light rays focus in front of the retina and blur distant vision. You can see objects that are close more clearly, but not those that are far away.

Farsightedness
(hyperopia) is a condition in which you can see far objects clearly, but nearby objects are blurry. When you have a shorter than average eyeball or a cornea that is too flat, light focuses behind the retina instead of on it. This blurs near vision and sometimes distant vision.

Astigmatism causes overall blurry vision. When the cornea curves or flattens unevenly, the result is astigmatism, which disrupts focus of near and distant vision.

Traditionally, blurry vision is corrected by bending (refracting) light rays with glasses or contact lenses. But reshaping the cornea (the dome-shaped transparent tissue at the front of your eye) itself will also provide the necessary refraction and vision correction.

Before a LASIK procedure your eye surgeon will assess detailed measurements of your eye. Then he or she will use a special type of cutting laser to precisely alter the curvature of your cornea. With each pulse of the laser beam, a tiny amount of corneal tissue is removed, allowing your eye surgeon to flatten the curve of your cornea or make it steeper.

Most commonly, the surgeon creates a flap in the cornea and then raises it up before reshaping the cornea. There are also variations in which a very thin flap is raised or no flap is used at all or no flap at all, is raised. Each technique has advantages and disadvantages.

Individual eye surgeons may specialize in specific types of laser eye procedures. The differences among them are generally minor and none are clearly better than any others. Depending on your individual circumstances and preferences you may consider:

Photorefractive keratectomy (PRK). With PRK, rather than forming a flap, the top surface (epithelium) is scraped away. This corneal abrasion takes three or four days to heal, resulting in moderate pain and blurred vision in the short term.

It was thought that these drawbacks were outweighed by the theoretical advantage that PRK was safer for people who are more likely to be struck in the eye for example, those involved in contact sports, law enforcement or the military. But even with standard LASIK, the risk of eyeball rupture is still very low, so there is probably no significant advantage with PRK. LASIK is also a better option than PRK for correcting more severe nearsightedness (myopia).

Laser-assisted subepithelial keratectomy (LASEK). LASEK is similar to LASIK surgery, but the flap is created by using a special cutting device (microkeratome) and exposing the cornea to ethanol. The procedure allows the surgeon to remove less of the cornea, making it a good option for people who have thin corneas. For people at greater risk of eye injuries, LASEK does not have any significant advantages over LASIK.

Epithelial laser-assisted in-situ keratomileusis (epi-LASIK). In an epi-LASIK procedure, your surgeon separates the epithelium from the middle part of the cornea (stroma) using a mechanized blunt blade device (epikeratome) and reshapes the cornea with a laser. This procedure is similar to LASEK.

Implantable lenses. Corrective lenses can be surgically inserted in the eye to improve vision. This is routinely done as part of cataract surgery (in which the old, cloudy natural lens is removed). It may also be an alternative to LASIK for older adults who may need cataract surgery in the future.

Younger people with high degrees of nearsightedness that cannot be satisfactorily treated with corrective lenses may also be offered implantable lenses. But this is not a routine option for most people.

Bioptics. Bioptics combines one or more techniques, such as implantable lenses and LASIK, to treat nearsightedness or farsightedness. Again, this is not an option for most people seeking refractive eye surgery.

Are your eyes healthy?
In general, laser eye surgery is most appropriate for people who have a moderate degree of refractive error and no unusual vision problems.

Your eye surgeon will ask detailed questions about your eye health and evaluate your eyes to make sure you don't have any conditions that might result in complications or poor outcomes of surgery. These include:

An eye disease that results in a progressive deterioration of your vision and thinning of your cornea (keratoconus). In fact, if keratoconus runs in your family, even if you don't have it, be very cautious about elective eye surgery.
Keratitis, uveitis, herpes simplex affecting the eye area, and other eye infections.
Eye injuries or lid disorders.
Dry eyes. If you have dry eyes, LASIK surgery may make the condition worse.
Large pupils. If your pupils are large, especially in dim light, LASIK may not be appropriate. Surgery may result in debilitating symptoms such as glare, halos, star bursts and ghost images.
Glaucoma. The surgical procedure can raise your eye pressure, which can make glaucoma worse.
Cataracts.

You might also rethink having LASIK surgery if:

You have severe nearsightedness or have been diagnosed with a high refractive error. The possible benefits of LASIK surgery may not justify the risks.
You have fairly good (overall) vision. If you see well enough to need contacts or glasses only part of the time, improvement from the surgery may not be worth the risks.
You have age-related eye changes that cause you to have less clear vision (presbyopia).
You actively participate in contact sports. If you regularly receive blows to the face and eyes, such as during martial arts or boxing, LASIK surgery may not be a good choice for you.

Are you healthy?

Your eye surgeon will also ask detailed questions about your general health. Certain medical conditions, unrelated to your eyes, can increase the risks associated with LASIK surgery or make the outcome less predictable. These include:

Any disease or condition that affects your immune system and impairs your ability to heal or makes you more prone to infections, such as rheumatoid arthritis, lupus, HIV and other autoimmune disorders.
Taking an immunosuppressive medication for any reason.
Diabetes.
Depression or certain chronic pain conditions, such as migraine, irritable bowel syndrome and fibromyalgia. If you have one or more of these conditions, you may have more problems with dry eyes and postoperative pain than other people. The reasons for this are not entirely clear but may be related to how you perceive pain.

Is your vision stable?
If you have myopia, your vision may continue to change throughout your teenage years, or even longer, requiring periodic changes in the prescription of your glasses or contact lenses. Therefore, people must be over age 18, and preferably older, before considering LASIK eye surgery.

Certain conditions and medications pregnancy, breast-feeding, steroid drugs may cause temporary fluctuations in your vision. Wait until your vision has stabilized before considering LASIK eye surgery.

Can you afford it?
Most insurance plans consider laser eye surgery to be an elective procedure and don't cover the cost. Know what the surgery will cost you.

Do you understand possible side effects and complications?
While complications that result in a loss of vision are rare, certain side effects, particularly dry eyes and temporary visual disturbances are fairly common. But these usually resolve after a few weeks or months, and very few people consider them to be a long-term problem.

Dry eyes. LASIK surgery causes a temporary decrease in tear production. For the first six months or so after your surgery, your eyes may feel unusually dry as they heal. Even after healing, you may experience an increase in dry eye.

Your eye doctor might recommend that you use eyedrops during this time. If you experience severe dry eyes, you could opt for another procedure to get special plugs put in your tear ducts to prevent your tears from draining away from the surface of your eyes.

Glare, halos and double vision. After surgery you may have difficulty seeing at night. You might notice glare, halos around bright lights or double vision. This generally lasts a few days to a few weeks.
Undercorrections. If the laser removes too little tissue from your eye, you won't get the clearer vision results you were hoping for. Undercorrections are more common for people who are nearsighted. You may need another refractive surgery within a year to remove more tissue.
Overcorrections. It's also possible that the laser will remove too much tissue from your eye. Overcorrections may be more difficult to fix than undercorrections.
Astigmatism. Astigmatism can be caused by uneven tissue removal. It may require additional surgery, glasses or contact lenses.
Flap problems. Folding back or removing the flap from the front of your eye during surgery can cause complications, including infection and excess tears. The outermost corneal tissue layer (epithelium) may grow abnormally underneath the flap during the healing process.
Vision loss or changes. Rarely, you may experience loss of vision due to surgical complications. Some people also may not see as sharply or clearly as previously.

LASIK versus reading glasses
By their early to mid-40s, all adults lose some ability to focus on nearby objects (presbyopia), which results in difficulty reading small print or doing close-up tasks.

One possible benefit of having been nearsighted most of your life is that this condition actually compensates for the presbyopia that inevitability develops as you get older. A nearsighted eye will focus near objects by itself without reading glasses. LASIK surgery removes this near focus because the nearsightedness has been corrected. This means that as you get older you will need to use reading glasses. Many people are happy to trade clear distance vision when they are younger for having to wear "cheaters" for reading when they are older.

If you are an older adult considering LASIK, you might choose to have your vision corrected for monovision, to maintain your ability to see objects close up. With monovision, one eye is corrected for distant vision, and the other eye is corrected for near vision. Not everyone is able to adjust to or tolerate monovision. It's best to do a trial with contact lenses before having a permanent surgical procedure.

Can you go without your contact lenses for several weeks before surgery?
This is usually not an issue, but know that you'll have to completely stop wearing your contact lenses and switch to glasses for at least a few weeks before your surgery. Contact lenses distort the natural shape of your cornea, which can lead to inaccurate measurements and a less than optimal surgical outcome. Your doctor will provide specific guidelines depending on your situation and how long you've been a contact lens wearer.

What are your expectations for LASIK?
Most people who undergo LASIK surgery will have good to excellent vision in most situations, for many years or decades. You'll be able to play sports and swim, or even just see the clock first thing in the morning, without having to worry about your glasses or contact lenses. But as you get older or in low-light conditions, you may still need to wear glasses.

Most people report high satisfaction after LASIK surgery. But long-term results often aren't available or haven't been well-studied. Part of the reason for this is that people are overall satisfied after surgery, so they don't feel a need for repeat examinations and follow-up data is not collected. Also, the LASIK procedure has been refined over time the techniques and technology is continually changing. This makes it difficult to draw conclusions from the data that is reported.

Keep in mind that even when postoperative follow-up is done and reported, vision is measured under optimal testing conditions. Your vision in dim light (such as at dusk or in fog) may not be as good as published reports suggest it will be.

Over time your refraction may slowly worsen with age and your vision may not be quite as good as it was immediately after surgery. This does not seem to be a large problem, but the exact degree of change to be expected is sometimes unpredictable.

How do you choose an eye surgeon?
Most people don't have firsthand knowledge about LASIK or an eye surgeon. A good starting point when choosing an eye surgeon is to talk with the eye professional you know and trust. Or ask friends or family members who have had successful LASIK.

Your eye surgeon will probably work with a team, who may help with your initial evaluation and measurements. But it is your surgeon who takes the ultimate responsibility for determining whether LASIK is an appropriate choice for you, who confirms the measurements to guide the procedure, who performs the procedure, and who provides postoperative care.

Talk with your eye surgeon about your questions and concerns and how LASIK will benefit you. He or she can help you understand the benefits and limitations of surgery.

The final decision
When it comes to LASIK eye surgery, there are no right answers. Carefully consider the factors outlined here, weigh your preferences and risk tolerance, and make sure you have realistic expectations. Talk to an eye surgeon in whom you feel confident and get your questions answered. In the end, if it feels right, then proceed, but if it doesn't, don't rush into anything.
97
General Discussion / Re: LASIK
« Last post by Curiousgeorge on February 20, 2020, 09:36:37 PM »
maybe look to this thread
98
General Discussion / Re: Rods and Cones
« Last post by mortylucky on February 20, 2020, 04:35:16 PM »
Hi, don't want to derail the convo but I've been trying to get involved in eye-related research at school. Could I message you for advice on how you found a mentor, etc.?

I'm also doing research down at the University of Ohio related to age-related macular degeneration so feel free to message me too if you want any tips or info on how to find research!
99
General Discussion / LASIK
« Last post by mortylucky on February 20, 2020, 04:33:52 PM »
Has anyone had any experience with LASIk and can remark on whether or not you think it is worth the cost? Just looking for some general advice
100
General Discussion / Retina - Residency
« Last post by gfpstar on February 20, 2020, 02:22:23 PM »
Hey guys. Its hard to get a sense for which residencies are better than others online as it seems to change with faculty shifts etc. Any ideas what makes up the top 20ish for somebody looking to get into retina? Any opinions very much appreciated. I'm a current medical student by the way.

I know some programs which tend to match well are Stanford, Vanderbilt, Colorado, Beaumont (Royal Oak), Tufts. Im sure there are many others but those are a few that come to mind.
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