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

Hello All!

I need vision correction. I know I won’t pass the next drivers test and I want the best solution for altitude / backcountry. Contacts and glasses are out of the question (too queasy, too hyper, too many concerns re: hygiene and other issues).

Please comment on your experience / knowledge regarding the best eye surgery alternatives.

An extensive bibliography follows – I’m not a doctor and a lot of this is confusing. My major, amateur conclusions to this point:
1. Right now I consider Photorefractive Keratectomy (“PRK”) (ideally Wave-Front Guided) as best, followed by any Wave-Front Guided all-laser LASIK.
2. At altitude, “Dry eye” might be the most pronounced problem w/ LASIK
3. Phakic intraocular lenses might be a good solution but the added expense, recovery times and complications eliminate this alternative.

Here are some of the research highlights. There is some contradictory information, both in journal articles and in the body of conventional wisdom (and why your thoughts are important). These highlights are ranked according to what seemed to me to be most convincing (and coincidentally in chronological order).

5/27/07 – the USAF OKs LASIK for the first time (previously, only PRK was OK), and specifically “…the recommended refractive surgeries are wavefront-guided PRK, or wavefront-guided All-Laser Lasik…” If eye surgery is OK for warfighter personnel you’d think it would be OK for us terrestrials.
- the USAF Press Release: here
- the USAF policy (the second is a PDF): here and here

March 2007 - Training & Conditioning: PS – this journal is widely used by pro and college athletic trainers – I’ve been a reader for years and it is quality…here are my notes from this article: LASIK - painless and quick recovery times, but make sure the ophthalmologist uses Wave-front guided software, but LASIK not the best choice for athletes who risk being hit in the eye. Alternatives: phakic intraocular lenses. Another alternative if eye trauma is likely: PRK (photrefractive keratectomy) - no cutting of permanent flap like LASIK, but the outer layer of the cornea is removed and discarded (is this Bowman's membrane??) then the laser is applied - longer healing time (2-4 weeks = 90% healing). The authors recommend going to a doctor who does multiple procedures to increase the chances of an objective evaluation, and, choose a doctor who has done many thousands of eyes

2003 “The Ascent of Mount Everest Following Laser in situ Keratomileusis” in the Journal of Refractive Surgery (Dimming et al. 2003; 19:48-51). A summary of the article appears here . The actual article is here . Among the authors is Dr. G. Tabin, who in 1988 became the first ophthalmologist to reach the top of Everest. This research was done with a group of LASIK patients on Everest. It is absolutely a gushing endorsement of LASIK at high altitude (referring the comment made in the first link - he also says Beck Weathers created his own problem on Everest).

2001-2003. These studies indicate that after LASIK, at high altitude problems include eye blurring, impaired vision due to hypoxic corneal swelling (but no hyperbaric effect) as well as the dry eyes. Here’s an abstract from the NIH regarding a study from the Journal of Cataract Refractive Surgery, 2001 Dec;27(12):1937-41. Here’s another from the journal “High Altitude Medicine and Biology” vol. 4, number 4, 2003 – here .

1996 – 1999 literature. RK (radial keratotomy) is a problem but PRK is cool. In these studies there was comment that in this time frame LASIK hadn’t been conclusively studied.
1. Mader TH, Blanton CL, Gilbert BN, Kubis KC, Schallhorn SC, White LJ, Parmley VC, Ng JD. Refractive changes during 72-hour exposure to high altitude after refractive surgery. Ophthalmology 1996;103(8):1188-95. The NIH listed some additional comments in Ophthalmology here .
2. Winkle RK, Mader TH, Parmley VC, White LJ, Polse KA,. The etiology of refractive changes at high altitude after radial keratotomy. Hypoxia versus hypobaria.Ophthalmology 1998;105(2):282-6.
3.. Mader TH, White LJ. Refractive changes at extreme altitude after radial keratotomy. Am J Ophthalmol 1995;119(6):733-7.
4. Wiedman M; Tabin GC, High-altitude retinopathy and altitude illness. Ophthalmology 1999;106(10):1924-6; discussion 1927


AND HERE ARE THE PREVIOUS THREADS SUBMITED ON WPS:

Re: Another altitude problem to be aware of - rixco99 15/09/05 04:00 PM
Re: Question on youngest age to take someone up Above the treeline 27/05/03 05:44 PM
Re: LASIK at Altitude Kashcraft 12/05/03 08:44 AM

Does this mean you don't wear sunglasses?

"Cataracts are a form of eye damage in which a loss of transparency in the lens of the eye clouds vision. If left untreated, cataracts can lead to blindness. Research has shown that UV radiation increases the likelihood of certain cataracts. Although curable with modern eye surgery, cataracts diminish the eyesight of millions of Americans and cost billions of dollars in medical care each year. Other kinds of eye damage include pterygium (i.e., tissue growth that can block vision), skin cancer around the eyes, and degeneration of the macula (i.e., the part of the retina where visual perception is most acute). All of these problems can be lessened with proper eye protection from UV radiation." http://www.epa.gov/sunwise1/uvandhealth.html#cat

Personally, I would be very wary about elective eye surgery of any kind. There are mistakes that can be made with LASIK. For example, if the eye tissue is more easily ablated than expected then the LASIK can make your eyesight worse. I think this is one reason why they do one eye at a time.

Here's a link to some info from the FDA on Lasik. http://www.fda.gov/cdrh/LASIK/risks.htm

Here's the incidence of some adverse events from LASIK according to this webpage http://www.aapecs.com/cp-lasik-5.html

11.9% Significant Undercorrection
4.2% Significant Overcorrection
3.5% Severe Halos
3.0% Loss of more than 1 line of best corrected vision
1.9% Loss of more than 2 lines of best corrected vision
1.7% Severe Glare

I'm no expert in LASIK. Basically all I know is what I posted above.

My buddy has had LASIK. He has no problems with the Sierra altitude. He did mention that his coworker also had LASIK & her vision blurred on Kilimanjaro. I wear contacts. Outdoors maintenance is a pain for a total of max 4 mins/day. It's no big thang. Better than having my eyeballs permanently altered.

Geoff Tabin is a good friend of mine and a long time climbing partner as well as an accomplished opthomologist. We've had many discussions about LASIK and other eye surgeries for high altitude climbers and the data points to it being safe and effective. Beck Weathers did not have LASIK (I believe that he had RK). Neal Biedelman saved Weathers that fateful day after summiting Everest without supplemental oxygen and also had RK surgery without it adversely affecting his vision. Though debated, it appears that Weathers' issues had little or nothing to do with his eye surgery.

I can ask Geoff about PRK for high altitudes if you'd like. I will note for the record that Geoff wears glasses.

Sam, this might be a good time to acknowledge Geoff Tabin's Himalayan Cataract Project.

For those people who don't use sunglasses, the plight of third-world people from sun-induced cataracts is very instructional. Harvey

http://www.cureblindness.org/who/tabin.html

Bob K. - I absolutely wear sunglasses, especially at altitude and when skiing. Fried corneas are no fun. Corrective eye wear is an all-the-time thing, however and I'd rather avoid that.

I'm very wary of surgery, too. But now that many millions of eyes have been done I'm less concerned. The best guidance I've seen on this is a doctor with "hundreds of eyes" experience is not a good bet but one with tens of thousands is.

Not that poor eyesight doesn't have it's upside - like last week when I noticed that the car in front of me was a Cancer, when upon closer inspection it turned out to be a Lancer.

Sierra Sam - you are right, Beck Weathers had RK. The literature shows that there are major refractive changes at altitude from this largely obsolete procedure. I've seen articles that say PRK, however, is the method of choice for mountaineers. I hope you can discuss this w/ Geoff Tabin - it seems he gives a fairly strong endorsement for LASIK and I'm nearly indifferent between PRK and WFG all-laser LASIK. And by all accounts Geoff Tabin would have to be considered one of the world's experts on this, if not the leading authority.

As a person who has spent all of my adult life around glasses, contact lenses, and knowing many people who have had lasik, PRk, Rk and even a few implant lenses, I would offer these suggestions.

If you have a small prescription, such as what you are describing, prescription sunglasses are by far the easiest of all options. You should be wearing sunglasses in the mountains even if you wear contact lenses, or have one of the eye surgeries. Too much UV after Lasik surgery can cause your prescription to change.

Contact lenses, such as the disposible type work well, but they should be used in addition to sunglasses. There is enough UV in the mountains to need the extra protection. Even though the contacts provide UV protection for the light traveling through the pupil, the white part is left unprotected.

The only people doing PRK are people for whom Lasik is not a good option. Healing time is much slower, about 6 weeks, and you normally only do one eye at a time. PRK is just Lasik without the flap.

All lazer lasik, meaning without the keratome blade, is becoming the standard of care for eye surgery. Now that the flap is made faster and better with the intralase lazer, it is becoming the most popular option.

The only people getting the Artizen/ Verise implant lens are those people with thin corneas or people for whom Lasik is not the best option. Usually these people have the worst eyes.
Implants are overkill for a person with a small prescription. They also can cost up to $5000 per eye.


Mt Whitney and the Sierras are not considered high altitude by people undergoing lasik surgery. Mt Denali or the Himilayas would be.

Eye surgery is still surgery. It works well for most people under skilled hands, but it depends on many things.

So the way I see it, step up and get some prescription glasses/ sunglasses. They are the easiest and least troublesome, and you sound like you actually do need them.

Hi GregF,

I think you've done more homework than 99.9% of the people who get elective eye surgery. Good for you. What did your optometrist AND othamologist say? The MD will do your surgery but might be influenced just a tiny bit by the $ you pay. What's your prescription by the way? Don't forget the effects of age on your prescription.

I'm a -2.5 in each eye and use daily disposable contacts. No hassle with cleaning solutions, etc. I used to use regular glasses but that was a major pain in the outdoors. My sunglasses don't seem to have the same issues though- maybe i'm getting older and taking care of them? I used to have squeamish issues with contacts and hygene but you develop a system and it's no longer a big deal. If you go this route it takes a few months to dial it in.

I opted for non-surgery for a couple of reasons:
1) stuff happens even to the best of doctors
2) i'm -2.5, with age and presbyopia my presrciption will get 'better'. And there's no free lunch in life, either i'll need glasses for distance, or glasses for reading. You can't have it both ways.
http://en.wikipedia.org/wiki/Presbyopia
3) daily contacts are really easy.
4) contacts give a small amount UV protection.
5) surgery isn't the cheapest of options
6) no chance of halos, dryness, etc

My issues with contacts:
1) don't sleep in them!
2) remember to order

-lance

I wear non-disposable rigid gas permeable contacts, even on the trail. I take them out nightly. In the morning I clean them, rinse them with a tiny bit of water, and put them back in. It's not much more of a hassle than at home one you have a routine - mine includes making sure I'm right over a bandana in my tent taking them in and putting them out, so they don't get lost. It helps to take them out before dark, but not essential. I also wear sunglasses than block 95% of visible light (plus UV).

I did have surgery in 1996, but not elective. I had both corneas replaced. While it would be possible for me to have refractive surgery, I still remember too much of what I went through in my more serious eye surgery. When the first eye was done the optic nerve did not go to sleep, so I saw the entire surgery. Thankfully the sedation made me happy so I thought it cool rather than freaking out. (Not a description for the squeamish.)

That's why they call me...
AsABat

Thanks all. I guess I should never be surprised at the clarity of thought and perspective from this community.

Certainly the comments have led me to examine my motivations for considering the surgery. Additionally, Lance you are exactly right - another necessary step would be an objective opinion from a non-surgeon.

One of the most interesting comments is that of Sierra Sam: why would a recognized expert in the field be wearing glasses?

Delete. This thread has now covered so much territory that my thoughts on the issue have become a sidelight, with little added value.

Delete

Gregf,

I take it you don't now need corrective lenses? I strongly suggest trying glasses and prescription sunglasses. Going from non-corrective to surgery sounds a bit drastic. My opthamologist (torn retina surgery) tells me that the longer you wait for corrective lense surgery the better as techniques are improving rapidly. You only have one set of eyes and they change over time.

My prescription is weak except for the eye that was fixed. If both eyes had the weak prescription(strong enough for DMV exam) I would not wear corrective lenses except for sunglasses while in the back country.

Glasses are not a huge issue and I don't think eyes should be messed with if your eyesight isn't that bad.

Hold off surgery

1 other thought.

Most people that have Lasik Surgery are very satisfied overall. That doesn't mean they see perfect. Nor does it mean their vision will stay the same the rest of their lives. People with moderate to high prescriptions are the most satisfied, since they go from glasses all the time to maybe a little prescription for driving at night some of the time. People with small prescriptions, such as what you are describing, are the most difficult to make really happy. For them the improvement is not as much.

Most children are farsighted when they are young. Between the age of 8 and about 17 genetic factors bring on nearsighted or astigmatism prescriptions. The prescription stays fairly stable until a person gets in his/her 40's, in the absence of a lot of reading or computer work. This can also cause a person to become nearsighted. Then the reading focus shifts out, causing accomodative reading problems, such as Bob R. referred to. Also between 40 and 60 years old a person can loose up to 25% of their nearsightedness if they have a moderate prescription. This means prescriptions are not the same your whole life. Even if your Lasik is perfect, you will still probably need some type of glasses when you get older.

Many of the eye Doctors, opthalmologists and optometrists, have done Lasik themselves. But many have not for a variety of reasons. No one thing is good for everyone.

So you see, overall, you choose the best and easiest option with the fewest risks. That seems like part time glasses or sunglasses if you don't need them all of the time.

Thanks Harvey. I've been working with Geoff for many years on building this program.

The Himalayan Cataract Project is an organization that Geoff started after climbing in the Himalayas and noticing that many people were completely blind from cataracts (the intense UV light at those high altitudes causes cataracts). Blindness there can be a death sentance as people literally walk off a cliff. Geoff and another eye surgeon climb to remote villages and do hundreds of free cataract surgeries in very primitive conditions with very high success rates. Virtually 100% of donated funds go directly to treating these villagers, so an $18 donation will pay for one person to have their vision restored. If anyone would care to contribute to this worthy cause, please go to http://www.cureblindness.org/help/donate.html

Sierra Sam - why do you suppose Dr. Tabin hasn't had corrective surgery himself?

Personal reasons. Neither has George Waring, who is considered one of the "fathers" of Lasik.

I love it - the FDA, EMEA and Japanese Ministry of health require studies involving thousands of patients, hundreds of thousand more receive the treatment post approval and we should take the word of an individual who had a bad outcome at the hands of an unknown physician. Ranks right up there as not a smart thing to do with taking medical advice about high altitude medicine from an anonymous poster on this board.

Sierra Sam, I thought the name of the website was pretty funny. Oh well.

As far as taking that poor guy's word, he apparently successfully defended his comments about the doctors who treated him when they sued him and the doctors lost. To verify this I looked at the consumer advocate website Public Citizen that helped him with legal representation. (Maybe I misunderstood what you were saying?)

Maybe you can help me understand something about the incidence of possible adverse events from LASIK surgery. In my first message I posted some statistics regarding the incidence of adverse effects. I got that info from a website that sells LASIK surgery.[Ref] Here's the incidence of adverse events that don't seem to be correctable with further LASIK surgery.

4.2% Significant Overcorrection
3.5% Severe Halos
3.0% Loss of more than 1 line of best corrected vision
1.9% Loss of more than 2 lines of best corrected vision
1.7% Severe Glare

You wrote, "hundreds of thousand more receive the treatment". Then using the above statistics it looks like tens of thousands of those people end up worse than they were before LASIK surgery. Am I understanding this correctly? Thanks.