LASIK/PRK and altitude

Does anybody have experience at high altitudes (>20,000, >25,000 ft) with LASIK or PRK? Or are you an ophthalmological buff? I found a couple threads in the forums, but they are all at least 3 years old. I'm hoping there's some new information, as I'm thinking of having one of these procedures in the next few months.

My experience at that altitude was prior to getting LASIK so I can't comment directly.

However, I urge you to go with a reputable (i.e. more expensive) surgeon. I went mid-range in price ($950 per eye). The place ended up being more of a factory, hell bent on quick procedures (they actually gave me the morphine tablet 10 minutes before the procedure and suggested I chew it up so it would take effect faster).

Since my procedure I've had significant issues with dry eyes and starbursts at night (driving has become somewhat of an issue). The dry eye's can really be an issue in windy/cold environments.

I would imagine some of these issues can be alleviated by a doctor who actually knows what the hell they are doing.

I seem to be the outlier though, most of the other people I've talked to have been pretty happy wit their decisions.

Tom,
I got LASIK done in 2009 and Im very pleased with it. Although I haven't been over 20,000 feet, Im between 16,000-18,000 feet pretty much every year in the Karakoram. Here are the cons to having LASIK done:

1. Eyes get super dry - this coupled with the dry air at altitude means you have to keep your eyes lubricated. These are drops my doc recommended:

walgreens.com/store/c/systa… ext=gooPersonal_Care_PLA_Drops_ampersand_Ointments_prod6003971_pla&adtype=%7Badtype%7D&kpid=prod6003971&sst=4e97b37d-944e-cb48-1af0-000047b4fe4a

As log as you put a few drops in a few times a day this is not a major issue. If you don't use the drops, vision can get funky.

2. Eyes get really sensitive to sunlight - before LASIK I could easily get by without sun-glasses, now I cant even think about it.

This is still wayy better than having glasses. I broke my glasses on one of my trips down the Baltoro Glacier and that was an experience Id never like to repeat. Down there its so dusty that contact lenses are out of the question.

Hope this helps.
Ali

I had RK for relatively mild myopia (2.5 diopters) and have been on three expeditions above 20,000 ft (up to almost 23,000) without any problems.

Possibly the effect at altitude depends on the magnitude of the original correction?

Locker, what were the downsides of it not working? Were you just out the money and no improvement, or has it made things worse?

I got LASIK with The Laser Center (TLC) in San Diego in 2009. They were far from the cheapest, but I couldn't be happier with the results. As others have said, don't skimp.

This year, I went up to 21,500 on Aconcagua and 20,300 on Denali. I had zero issues on either.

FWIW, I had mild dryness issues for a few months following the surgery. Since then, I haven't thought twice about dry eyes, even on Aconcagua, which is insanely dry. YMMV.

David Appelhans wrote:Locker, what were the downsides of it not working? Were you just out the money and no improvement, or has it made things worse?

I've had a wonderful experience after Lasik with only altitude being up to 14,500'. My eyes were dry at first but now not an issue. My doc prescribed me Restasis (which somehow causes your eyes to naturally lubricate) and a drop that was lubricant for 6 mo. Two years later I am still better than 20/20. I paid about $1800/eye out of pocket + some of the overhead (about $800) covered by my health insurance.

One of my friends did not have such a good experience. He experienced headaches afterwards and they lased him again for another minor correction. He still experienced headaches and eye strain (he is a coder so sits in front of a computer screen a LOT). He was doing it more for a vanity reason so is frustrated that he has to wear yellow tinted glasses to help alleviate the eye strain.

I'm considering an eye procedure as my vision is quite bad, and I can't get by without contacts (or glasses, which I've avoided ever since getting contacts). I'm particularly tired of putting in contacts with dirty fingers while camping (it's pretty hard to get your fingers REALLY clean after a week of camping. try it.), and also I'd worry about losing or damaging contacts/glasses on longer expeditions. Also, I'm currently in Colombia, where 1) the procedure was invented, 2) they have incredibly high standards for medical training, and 3) the procedures are less expensive. Seems like a good time to do it.

David Appelhans wrote:Locker, what were the downsides of it not working? Were you just out the money and no improvement, or has it made things worse?

Look at the post just below this one and you'll see what LASIK did to his eyes! He looks like the serpent on Jungle Book. Poor Locker - post that picture again if you can Stich. I can't copy/post as I'm on my mobile.

Haven't posted hear much but this got my attention. I considered doing Lasik up until I went through the "test" procedures to determine if I was a candidate. Note all of the below happened in the same visit and with the same doctor who has performed surgeries on the likes of Tiger Woods and other pro athletes:

Test 1 - right eye mostly good, left eye test was in the "red" area of the graph. The nurse says this could be due to dry eyes during the test.

Test 2 - same results, same explanation.

Test 3 - Here, put some eye drops in, re ran the test - Congrats, you are a perfect Lasik candidate.

I bolted out of there with the quickness - no Lasik for this guy.

Eric Kunkel wrote:Haven't posted hear much but this got my attention. I considered doing Lasik up until I went through the "test" procedures to determine if I was a candidate. Note all of the below happened in the same visit and with the same doctor who has performed surgeries on the likes of Tiger Woods and other pro athletes: Test 1 - right eye mostly good, left eye test was in the "red" area of the graph. The nurse says this could be due to dry eyes during the test. Test 2 - same results, same explanation. Test 3 - Here, put some eye drops in, re ran the test - Congrats, you are a perfect Lasik candidate. I bolted out of there with the quickness - no Lasik for this guy.

Wow that is a bit sketchy. I had LASIK done about 3 months ago with absolutely no issues other than dry eyes for the first 2 weeks. I surf regularly, swim in the ocean, have spent time at just over 13,500' since. Everything is fantastic - I don't know about those altitudes but I hope to find out next year!

I ran a refractive laser center for many years and no one has said anything that specifically needs correction.

In general, you DO get what you pay for, much of which is determining how good a candidate you are. (For instance, many of us have moderate dry-eye to begin with. It's so simple, but can impact your recovery.) It will take much longer to determine where along the PRK-LASIK continuum you fall and what you're comfortable with to treat it than the actual surgery.

I'm a slow texter. Don't rule out PRK for mountaineering. If you have questions, pm me. (I'm retired and won't try to sell you anything.) Maybe I can help?
Rob

Locker wrote:Due to LASIK.

Sorry to see that Locker - a least you can see 270 degrees now. And you don't have to keep wearing those belay glasses

Good article on the state of eye surgery in the military special operations world, where tons of procedures are done on guys who can't have them buggering up: bmctoday.net/crstoday/pdfs/…

Consider skipping LASIK in favor of PRK or LASEK. The flap created in LASIK is a liability in committing situations. I had PRK done on one eye and EK done on the other (the intention was to have EK done on both, but I was in the military and they were trying a new procedure that failed to perform EK correctly so they had to salvage it with PRK). I have 20/20 in the PRK eye, with the EK eye being notably better at 20/15. My night vision is not great, but I have had no problems with dryness or halos in many years (surgery in 2004). I have been up to ~15,000 feet and in extreme cold to -55F with sustained exposure to -40F and high winds. One of the best decisions I've ever made.

I should say that for the first ~18 months after surgery dry eyes were a regular concern. My night vision was also worse than it is now with 'starburst' effect on lights and poor contrast. After that period (really the first 3 months are the worst) I have improved a lot.

Consider that I think it makes me safer in dangerous situations. Lost or broken glasses mid lead or on a ski descent could spell disaster.

Ironically, I had Lasik done 2 years ago (by top notch surgeon/clinic) specifically because glasses and contacts (which I never wore before) seemed less compatible with active sports like climbing, kayaking, etc. Results were technically perfect in that goals were achieved -- better than 20/20 vision both eyes, and no dryness. Problem is I did not expect the near vision and night vision to take such a hit. Before, I took great night vision for granted, but now I need reading glasses and a bright headlamp to read maps or route topos or whatever (try to get a sliver out) especially in low light conditions. Guess I need to get faster and stay in daylight. All in all I guess I feel I should have waited a bit till I really needed the distance improvement.

This is Dr. Mohammadi from San Diego (LASIK) Laser-Vision Eye Center . In those altitudes, certainly dryness can be a factor for some people after LASIK. As others mentioned, this is due to dryness of the air and wind. Be sure to have your tear production objectively measured prior to having LASIK. You can look at my LASIK and Dry Eyes page for more details on dry eye treatment. Also PRK is better for avoiding dry eye issues compared to LASIK as it affects corneal nerves less than LASIK. As others have mentioned, some glare and haloes can happen after LASIK particularly at nights. However, the extent of it depends very much on your eye (i.e. size of your pupil, your prescription, etc.). Hope this helps:) Please feel free to visit my San Diego LASIK website diego for more information.

Tom, my wife & I got LASIK done in 1998 and 1999 I think. Initially, halos at night were annoying. Dryness affected my wife much more than me. I never needed drops. A buddy of mine got his done around that time. My buddy & I went to 22.8K a few years later without trouble. He's been back to about that altitude without trouble.

A friend of mine had it done, but the keratome didn't cut correctly on his cornea and basically shredded his cornea requiring his ophthalmologist to stitch it back down. He can never have that procedure done, and he's left with his thick glasses. That's one of the scary complication that can happen. The other scary complication is that the wrong blow/scratch to the cornea can lift the flap and you can lose the corneal flap, requiring corneal transplant (super rare).

The end result of lacking the need to use contacts or glasses and no grit/sand caught under contact lenses causing corneal abrasions made it well worth it for me, but there are risks that you have to be willing to take.

Just wondering if anybody has any updates on this thread?

I have been getting along well with bifocal contacts but am having trouble sleeping in them now, so
May finally need to consider LASIK or prk. Hope to get back to high altitude some day, so that's a concern.

I have been alternating my contacts between a pair for climbing with a distant focus and a pair for work with a near focus, but could use reading glasses if required. Optimization for climbing is paramount.

I would also love to hear recommendations for specific surgeons in the boulder/Denver/Ft Collins area.

I've heard that PRK is better than LASIK in terms of high altitude

Night vision, not altitude was a problem...

I almost spent the night on top of the wind-tower in eldo because my partner completely shut down in low light conditions (he had the lasik operation over 6 months earlier). I had to place his hands and feet for him at some points between the summit and the rappel anchors (found them at 2AM in the starlight as we were settling in for a cold night). Of course, it would have not been an issue if we had a headlamp or two, but you don't always get to plan for these night-time incidents.

I found a great review article on this issue, but I can't find a free source online, so will briefly summarize.

Refractive Surgery Safety at Altitude
Thomas H. Mader and Lawrence J. White. High Altitude Medicine & Biology. March 2012, 13(1): 9-12.

Refractive surgery works by reshaping the cornea. Altitude causes the cornea to swell, but normal eyes aren't effected because the swelling is uniform.

The old RK procedure changed the shape of the cornea with incisions, but these aren't uniform, so at altitude the effect of the incisions on the cornea can change drastically, leading to drastic vision changes.

PRK reshapes the cornea by shaving off the top, so altitude induced swelling should be uniform and not change vision.

Lasik surgery lifts up a thin flap of epithelium, then selectively shaves off the surface of the cornea, so could have some minor irregularities in swelling at altitude, hence some possible minor changes in vision.

Newer versions, Lasek and Epi-lasik resemble PRK but with an epithelial flap, so no effect with altitude expected, but little real world experience reported so far.

Unfortunately for me, looking at the surgeical websites suggests that you need to avoid contacts for several weeks before surgery, and in the case of PRK, can't drive for 1-3 weeks afterwards! Likewise, vision doesn't stabilize for months. Would be very hard for me to deal with these constraints, so my latest plan is to rehab my eyes so I can go back to abusing them ASAP!