I'm asnwering my own question here, so this post is really for the information and benefit of anyone searching on this topic.
Originally Posted by AlexEvans
Hi. Sorry for the life story, but the details are necessary
.
Does anyone have direct experience of having LASIK on an eye that is showing some signs of changes in the endothelium or that
may be the early signs of Fuch's dystrophy? Or are you a medical professional with an opinion on this subject?
Here's the story:
I have a problem. I can't get a CAA class 1 medical because of the 4.0 diopters of astigmatism in my left eye exceeds the CAA limit (2.0 diopters).
I've been to aviation house for an 'eyes only' medical, which is the eyesight portion of the initial class 1 medical examination. Although advising against having LASIK (like they always will do as you know) they did confirm, in writing, that if I had successful LASIK to reduce the astigmatism to less than 2.0 diopters then they would issue a class 1 medical.
Unfortunately, they also spotted an abnormality in the endothelium (layer of cells at back of cornea) that does not affect me now and is unlikely to affect me in the future - but that may be affected by having LASIK. One eye doctor that I have seen (Ultralase, Tottenham Court Road, London) is of the opinion that LASIK can cause the rate of degeneration of the cells in the endothelium to accelerate and will not perform the LASIK procedure for that reason. This is also the opinion of Adrian Chorley, the optician at Gatwick AMD. Another eye doctor in Cambridge has advised me that there is no real risk of this happening and said he would be happy to perform the LASIK procedure, leaving me pretty confused. He also diagnosed that my eyes had 'subtle discreet anterior lesions that were not characteristic of Fuch's Dystrophy'.
So I'm faced with a tough decision. Do I have LASIK so that I can be issued a class 1 medical and run the risk of losing my medical (and cornea) permanently at some indeterminate time in the future due to endothelial dystrophy (as well as running the normal, more immediate risks of having LASIK such as corneal haze, infection, partial flap formation etc...) or do I give up on ever getting a JAA CPL/IR fATPL?
I know no-one can answer this question for me, but has anyone been in a similar situation or are you a medical professional with an opinion on this subject?
I believe that the FAA route of instructing in America and working in Africa is still open to me, but I'm considering giving up on my ambition to become a pilot if I will never be able to fly for a living in the UK.
At the moment, my only idea is to see another eye doctor for another opinion.
Any comments?
I posed this question to a number of opthalmic surgeons: Does LASIK increase the rate of degeneration of the cells in the endothelium of a person who is showing some signs of endothelial changes that are not characteristic of Fuchs Dystrophy?
Here are the responses:
1)The long terms risks to the endothelium are unknown, but there is no evidence to suggest harm with meticulous surgery. The detemination as to the current health of your endothelium is based on specular microscopy. Make sure this test is performed before any ocular surgery is contemplated.
2)No one knows for sure?
3)If your career hangs in the balance, I would not chance it. There have been studies done that show that the LASIK does not harm the endothelium, but I would be careful.
4)There is evidence that LASIK can slightly accelerate the loss of cells. Very slight. If you have no corneal edema, AND your current cell count is acceptable (you should have this measured), I think LASIK is a viable option. Know that contact lenses also cause loss of endothelial cells, so if you are currently a contact lens wearer, you are already taking a risk...
5)You could have a endothelial cell count performed to resolve the question. The issue is not whether the endothelial cell would be reduced from the procedure, which I belive the risk is not high, but whether the endothelium is sufficient to allow you to have good healing and excellent vision. Endothelial dystrophy naturally progresses regardless as to whether you have the surgery or not. If it progresses, your vision will be compromised either way. If your cell count is borderline or low, do not have the procedure done.
6)I am not aware of any endothelial porblems from LASIK.
7)LASIK surgery should not have any impact on the endothelium, but I am curious if there is an underlying cause as to the changes that are present. You should certainly have your corneal thickness checked to make sure that is normal.
If you have a career where your visual acuity has an impact on your ability to work- you may not want to take the risk of elective LASIK surgery because there is always the risk of a complication, even if your endothelium is normal.
Jon Dishler, M.D.
8)Patients with Fuchs dystrophy should probably not have the surgery, because the results tend to be slightly unpredictable. Also, people with Fuchs dystrophy who had Lasik can have some addtional problems with the Fuchs in the future. But Lasik does not affect the health or degeneration of the endothelium. So other minor irregularities with the endothelium are probably not a risk.
So there you have it.
I'm going to have to get used to the idea that doctors do not always agree with each other, or have equivalent knowledge.