Impartial Advice on Laser Eye Surgery

[968]

crossy67 said:

Good call resurrecting this thread, it just reminded me of a question I wanted to ask to.

I was talking to a friend who has a friend (isn't it always ) who has cataracts. He's been to the doctor but apparently they can't do anything with them because he had laser eye surgery in the past. Is there any truth in this?

Hi,

No there's no truth in what you've heard. If you have laser refractive surgery you can certainly have cataract surgery in future, but the calculation of the lens that will be implanted into the eye becomes slightly more complex and unpredictable as a result of laser refractive surgery altering the curvature of the cornea. Perhaps his doctor (presumably a GP) misunderstood something they read.

[13m]

968 said:

Mad March Taffy said:

968

Looking for advice in this area - could you tell me what information I need to provide? Quick summary:

54 years old - live in Hampshire
Age-related degeneration means that I now wear varifocals - about +1.5 at the top and +2.5 at the bottom (can't remember my exact prescription at present) - wear contact lenses for sport which are +1.75 in the left eye and +2.00 in the right eye - I can see fine to play tennis etc in these but cannot read small text.

Ideally would be able to dispense with glasses altogether, but would be OK with just having to wear reading glasses and being able to play sport etc without.

Any pointers would be appreciated, even to just help me know what questions to ask!

Many thanks

Mike

Hi

You could have refractive lens exchange whereby your (very early) cataract would be removed and a new lens inserted. A multifocal lens would enable you to improve your distance and near vision. Alternatively a monovision arrangement could be made whereby one eye fixed for near the other for distance. Any good cataract surgeon could do that surgery for you as a private patient. PM me for recommendations.

I had this surgery in both eyes - I was below 50 at the time. I had multifocal lenses.

The negatives:

1. It takes up to a year for one's brain to "learn" the new lenses.

2. There is a risk of complications and accelerating other forms of degeneration.

3. It's irreversible.

4. You won't have the vision of a teenager.

The positives:

1. You will probably have good eyesight without the need for glasses.

[968]

13m said:

I had this surgery in both eyes - I was below 50 at the time. I had multifocal lenses.

The negatives:

1. It takes up to a year for one's brain to "learn" the new lenses.

2. There is a risk of complications and accelerating other forms of degeneration.

3. It's irreversible.

4. You won't have the vision of a teenager.

The positives:

1. You will probably have good eyesight without the need for glasses.

What are the 'accelerated degenerations' you refer to? I'm not aware that there are any to be honest. Complications certainly can occur, as with any intervention, including contact lenses. Multifocal lenses have become much improved over the last year or 2 with newer models which are better tolerated. Having said that, a monofocal lens is also very good and with monovision can obviate the need for glasses at all.

[13m]

968 said:

13m said:

I had this surgery in both eyes - I was below 50 at the time. I had multifocal lenses.

The negatives:

1. It takes up to a year for one's brain to "learn" the new lenses.

2. There is a risk of complications and accelerating other forms of degeneration.

3. It's irreversible.

4. You won't have the vision of a teenager.

The positives:

1. You will probably have good eyesight without the need for glasses.

What are the 'accelerated degenerations' you refer to? I'm not aware that there are any to be honest. Complications certainly can occur, as with any intervention, including contact lenses. Multifocal lenses have become much improved over the last year or 2 with newer models which are better tolerated. Having said that, a monofocal lens is also very good and with monovision can obviate the need for glasses at all.

I am aware that this is your field and I wouldn't presume to educate you about eyes. However, posterior vitreous detachment and post capsular opacification are the main ones I believe. Though the latter is more a complication than an accelerated degeneration. There are also risks around sub-optimal positioning of the lens or errors in prescription, which are less easily corrected than with spectacles obviously!

For those who aren't medical, the practical implications of these things are (and forgive me 968 if my explanation isn't spot on)

1. Posterior vitreous detachment - the vitreous, or jelly-like substance in the eye, shrinks and pulls away from the back of the eye. This can cause flashes and floaters - the latter are irritating more than anything else. But they ARE irritating - I have them and speak from experience.

2. Post capsular opacification - some of the old natural lens gets left behind and causes cloudy vision. If the problem is bas enough a yag laser can be used to correct the problem quickly. Though it is another intervention and there are risks.

3. Lens positioning and prescription issues can be corrected but it is, again, another intervention.

The advances in lens technology present a dilemma for anyone considering surgery. Once a lens is in, it's in, unless something goes badly wrong and it's explanted fairly swiftly. It's not possible to "trade up" in a few years when technology has improved.

When I had mine done the Lentis M-Plus was one of the most popular and successful lenses. But it is basically a bifocal lens (one for distance, one for near). A new lens called the Finevision was getting some good reviews and it had better intermediate capabilities. I opted for the M-Plus because it was tried and tested, had some better reviews from male patients and it was the preferred lens of my preferred practitioner.

The outcome for me has been slightly less than 20:20 in one eye, slightly better than 20:20 in the other. I can read newspapers comfortably even in poor light and only the text on tubes of ointment etc defeats me, unless the light is very good.

It took me 6 months to "learn" the lenses, 12 months to master them. Intermediate is the trickiest to learn with bifocal lenses, but I am okay now. Though I need to work at it sometimes.

Edited by 13m on Monday 28th September 14:12

[968]

13m said:

I am aware that this is your field and I wouldn't presume to educate you about eyes. However, posterior vitreous detachment and post capsular opacification are the main ones I believe. Though the latter is more a complication than an accelerated degeneration. There are also risks around sub-optimal positioning of the lens or errors in prescription, which are less easily corrected than with spectacles obviously!

For those who aren't medical, the practical implications of these things are (and forgive me 968 if my explanation isn't spot on)

Ok, I think you've been slightly misinformed, though not massively.

13m said:

1. Posterior vitreous detachment - the vitreous, or jelly-like substance in the eye, shrinks and pulls away from the back of the eye. This can cause flashes and floaters - the latter are irritating more than anything else. But they ARE irritating - I have them and speak from experience.

This is a natural process that occurs to all adults eventually. It would occur whether you have surgery or not, but there are some who believe that removal of the natural lens creates a potential space in front of the anterior vitreous which the vitreous herniates into (sort of) thereby making a PVD more likely to occur.

13m said:

2. Post capsular opacification - some of the old natural lens gets left behind and causes cloudy vision. If the problem is bas enough a yag laser can be used to correct the problem quickly. Though it is another intervention and there are risks.

This is not a degeneration really but a consequence of surgery in 20% of patients. It's easy to treat with a simple and quick laser procedure which takes 5 minutes and has extremely low risks.

13m said:

3. Lens positioning and prescription issues can be corrected but it is, again, another intervention.

It shouldn't need to be repositioned. It should be inserted correctly first time.

13m said:

The advances in lens technology present a dilemma for anyone considering surgery. Once a lens is in, it's in, unless something goes badly wrong and it's explanted fairly swiftly. It's not possible to "trade up" in a few years when technology has improved.

That's not strictly true. You can have a lens explant but it's a bit of a faff to do and yes there are risks, though they're very small when done by a good surgeon.

13m said:

When I had mine done the Lentis M-Plus was one of the most popular and successful lenses. But it is basically a bifocal lens (one for distance, one for near). A new lens called the Finevision was getting some good reviews and it had better intermediate capabilities. I opted for the M-Plus because it was tried and tested, had some better reviews from male patients and it was the preferred lens of my preferred practitioner.

The outcome for me has been slightly less than 20:20 in one eye, slightly better than 20:20 in the other. I can read newspapers comfortably even in poor light and only the text on tubes of ointment etc defeats me, unless the light is very good.

It took me 6 months to "learn" the lenses, 12 months to master them. Intermediate is the trickiest to learn with bifocal lenses, but I am okay now. Though I need to work at it sometimes.

Lens technology is constantly evolving and the newer generation of lenses offer very good results and allow patients to be spectacle independent in most cases and results are more predictable even in very high prescription errors. Also it can correct presbyopia making it by far the best choice in patients over the age of 45 where laser refractive procedures are not appropriate.

[13m]

968 said:

13m said:

I am aware that this is your field and I wouldn't presume to educate you about eyes. However, posterior vitreous detachment and post capsular opacification are the main ones I believe. Though the latter is more a complication than an accelerated degeneration. There are also risks around sub-optimal positioning of the lens or errors in prescription, which are less easily corrected than with spectacles obviously!

For those who aren't medical, the practical implications of these things are (and forgive me 968 if my explanation isn't spot on)

Ok, I think you've been slightly misinformed, though not massively.

13m said:

1. Posterior vitreous detachment - the vitreous, or jelly-like substance in the eye, shrinks and pulls away from the back of the eye. This can cause flashes and floaters - the latter are irritating more than anything else. But they ARE irritating - I have them and speak from experience.

This is a natural process that occurs to all adults eventually. It would occur whether you have surgery or not, but there are some who believe that removal of the natural lens creates a potential space in front of the anterior vitreous which the vitreous herniates into (sort of) thereby making a PVD more likely to occur.

13m said:

2. Post capsular opacification - some of the old natural lens gets left behind and causes cloudy vision. If the problem is bas enough a yag laser can be used to correct the problem quickly. Though it is another intervention and there are risks.

This is not a degeneration really but a consequence of surgery in 20% of patients. It's easy to treat with a simple and quick laser procedure which takes 5 minutes and has extremely low risks.

13m said:

3. Lens positioning and prescription issues can be corrected but it is, again, another intervention.

It shouldn't need to be repositioned. It should be inserted correctly first time.

13m said:

The advances in lens technology present a dilemma for anyone considering surgery. Once a lens is in, it's in, unless something goes badly wrong and it's explanted fairly swiftly. It's not possible to "trade up" in a few years when technology has improved.

That's not strictly true. You can have a lens explant but it's a bit of a faff to do and yes there are risks, though they're very small when done by a good surgeon.

Your opinion appears to differ from that of the two ophthalmic surgeons who have advised me. They both conduct RLE surgery in younger patients and both report a high incidence of PVD. One mentioned, as I recall, 50% of patients below age 50 experiencing it. Though, as you point out, most people will eventually experience it, but at a greater age.

I did point out that PCO is less degeneration and more a complication. But yag laser capsulotomy whilst pretty safe is still another intervention with associated risk.

As for explant after a number of years to upgrade to a better lens, do you really think it is viable?

[Mad March Taffy]

968 said:

Lens technology is constantly evolving and the newer generation of lenses offer very good results and allow patients to be spectacle independent in most cases and results are more predictable even in very high prescription errors. Also it can correct presbyopia making it by far the best choice in patients over the age of 45 where laser refractive procedures are not appropriate.

So, assume that I were to go down this route - what should I budget for this procedure? Appreciate that costs etc might vary but I have no idea of even a ballpark figure.

I will sit down before I read the response!

Many thanks

[13m]

Mad March Taffy said:

So, assume that I were to go down this route - what should I budget for this procedure? Appreciate that costs etc might vary but I have no idea of even a ballpark figure.

I will sit down before I read the response!

Many thanks

Based upon my experience two years ago, an ophthalmic surgeon at Moorfields or similar will want £3-5k per eye for multifocal lenses. Optical Express will do it for circa £2k per eye. There are others like Optimax who price similarly I believe.

Price is the least important reason to choose one route over another, obviously. However, don't assume that the higher the price the better will be the outcome.

Edited by 13m on Tuesday 29th September 19:09

[968]

13m said:

Your opinion appears to differ from that of the two ophthalmic surgeons who have advised me. They both conduct RLE surgery in younger patients and both report a high incidence of PVD. One mentioned, as I recall, 50% of patients below age 50 experiencing it. Though, as you point out, most people will eventually experience it, but at a greater age.

That's interesting, but given I'm a retinal specialist who carries out RLE as well, with all due respect to them, I think I'm in a better position than them to know about the causes of PVD. It's controversial at best that lens exchange 'causes' it.

13m said:

I did point out that PCO is less degeneration and more a complication. But yag laser capsulotomy whilst pretty safe is still another intervention with associated risk.

As for explant after a number of years to upgrade to a better lens, do you really think it is viable?

PCO is not a complication. It's a consequence of lens replacement in 1 in 5 patients. Capsulotomy is extremely safe. The risk is extremely small, less than 1 in 2000 risk of retinal detachment. Yes explantation is viable, and I have carried it out successfully but is not something I would recommend, on the whole.

[968]

Mad March Taffy said:

So, assume that I were to go down this route - what should I budget for this procedure? Appreciate that costs etc might vary but I have no idea of even a ballpark figure.

I will sit down before I read the response!

Many thanks

You should expect to pay upwards of £2500 per eye. Avoid high street chains at all costs. Depending on the lens and method of surgery the costs can be higher. PM me if you want any recommendations of where to go.

[davepoth]

Since everyone else is having a go...

Right +6.5 -1.75 90
Left +7.0 -3.75 70

34 y/o, recent squint surgery to right eye to correct exotropia. I tried contacts (30 day soft ones) and I guess they're OK, but the faff is annoying. I'm pretty sure my eyes are far too rubbish for laser, but are there any other options?

[13m]

968 said:

13m said:

Your opinion appears to differ from that of the two ophthalmic surgeons who have advised me. They both conduct RLE surgery in younger patients and both report a high incidence of PVD. One mentioned, as I recall, 50% of patients below age 50 experiencing it. Though, as you point out, most people will eventually experience it, but at a greater age.

That's interesting, but given I'm a retinal specialist who carries out RLE as well, with all due respect to them, I think I'm in a better position than them to know about the causes of PVD. It's controversial at best that lens exchange 'causes' it.

13m said:

I did point out that PCO is less degeneration and more a complication. But yag laser capsulotomy whilst pretty safe is still another intervention with associated risk.

As for explant after a number of years to upgrade to a better lens, do you really think it is viable?

PCO is not a complication. It's a consequence of lens replacement in 1 in 5 patients. Capsulotomy is extremely safe. The risk is extremely small, less than 1 in 2000 risk of retinal detachment. Yes explantation is viable, and I have carried it out successfully but is not something I would recommend, on the whole.

You cannot possibly know whether you are better qualified to comment, when you don't know which surgeons I have dealt with!

With regard to PCO you're being pedantic. It's a consequence of RLE surgery that requires further intervention to correct. It is, therefore, a complication as far as any lay person is concered.

As for your comment about avoiding high-street outfits: I had a better experience with Optical Express than I did with Moorfields or Bristol Eye Hospital surgeons. I've had a good outcome and the after care has been superb.

One of my major concerns, having known people who experienced problems after surgery, was to be able to obtain swift support if I needed it. Fortunately I didn't, but on a couple of occasions when I did need minor assistance I was seen within a few hours of phoning them (50 minutes on one occasion). By contrast, an acquaintance of mine who used a well-known surgeon at Bristol had a rather rougher ride, in part because of the distance he needed to travel, I think.

I am no fan boy for OE, by the way. But I have six friends who have been very happy with their outcomes, and I too am happy. The only criticism I can level at them really is that the process is something of a conveyor belt service. But then, at least everyone I dealt with knew what they were doing. Unlike the secretary of one of the surgeons at Moorfields who, when I asked her what type of multifocal lenses the surgeon used said, "well what sort would you like, love?".

Edited by 13m on Tuesday 29th September 22:17

[968]

13m said:

You cannot possibly know whether you are better qualified to comment, when you don't know which surgeons I have dealt with!

You're quite right I've no idea who've you've spoken to, however as a retinal specialist who does RLE and cataract surgery every week and has treated thousands of patients, I doubt there are many who would have greater experience than I. So making the statement that PVD is caused by RLE is not supported by evidence, is anecdotal at best. As said before it's an inevitability anyhow so shouldn't dissuade people too strongly.

13m said:

With regard to PCO you're being pedantic. It's a consequence of RLE surgery that requires further intervention to correct. It is, therefore, a complication as far as any lay person is concered.

No I'm not being pedantic at all. It is not a complication and I'll bet you weren't consented for it as a complication of surgery. It's a consequence of surgery and it extremely common and extremely simple to resolve with extremely low risk and to suggest otherwise is simply alarmist.

13m said:

As for your comment about avoiding high-street outfits: I had a better experience with Optical Express than I did with Moorfields or Bristol Eye Hospital surgeons. I've had a good outcome and the after care has been superb.

I'm glad you had a good result from them, however I've seen the results of such outfits first hand and have had to deal with their complications of surgery due to poor surgery, poor preoperative assessment and poor post op care. I've seen this many times and would never recommend them to friends or family and would not let them touch my eyes. If asked as a professional for my opinion I can only give the answer that I would give any person. Your best bet is to be seen by a uk trained consultant who will take ownership of your care. If you want to take your chances elsewhere, that's your choice.

[13m]

968 said:

I'm glad you had a good result from them, however I've seen the results of such outfits first hand and have had to deal with their complications of surgery due to poor surgery, poor preoperative assessment and poor post op care. I've seen this many times and would never recommend them to friends or family and would not let them touch my eyes. If asked as a professional for my opinion I can only give the answer that I would give any person. Your best bet is to be seen by a uk trained consultant who will take ownership of your care. If you want to take your chances elsewhere, that's your choice.

I cannot comment upon what you have seen, in terms of the quality of work of "high street" practitioners. But let's not forget that surgeons within private practice and the NHS have been known to do some poor quality work!

What I can do is comment upon what I experienced:

The surgeon that conducted my surgery was trained in Western Europe, the other available was trained in Britain. Both have practiced extensively in private practice and the NHS as consultants for a very long time (longer than you, I believe).

Pre and post-op care was in excess of that experienced by people I know who went down the consultant route. I was seen 24 hours after surgery, two days after surgery, one week and two weeks after. There was also an open invitation to phone them and be seen between these times if needs be.

By contrast, the two people I know who went directly to a consultant were only seen when they went for their second eye to be operated upon. One of them contracted an infection in both eyes during that time, which obviously went undiagnosed. Both of them were left with unaddressed post-op concerns.

I think we need to be clear that "high street" operators use the same surgeons who operate within the NHS and private practice. They aren't a separate breed. These surgeons can be checked out by prospective patients, probably more easily than consultants who only work out of hospitals.

There seems to be a tendency in ophthalmology for practitioners to rubbish anyone that isn't them or their ilk. I recall an optician / optom on here not so long ago advising people against multifocal RLE, saying that the outcome is rarely good. Which is, of course, rubbish. You seem to be suggesting that using a volume commercial operator is very high risk. It isn't.

I would implore anyone considering eye surgery to research whoever it is that will be conducting the surgery. But there are distinct advantages to using a "high street" provider and going directly to a consultant will not guarantee a better experience or outcome.

[968]

13m said:

I cannot comment upon what you have seen, in terms of the quality of work of "high street" practitioners. But let's not forget that surgeons within private practice and the NHS have been known to do some poor quality work!

What I can do is comment upon what I experienced:

The surgeon that conducted my surgery was trained in Western Europe, the other available was trained in Britain. Both have practiced extensively in private practice and the NHS as consultants for a very long time (longer than you, I believe).

Pre and post-op care was in excess of that experienced by people I know who went down the consultant route. I was seen 24 hours after surgery, two days after surgery, one week and two weeks after. There was also an open invitation to phone them and be seen between these times if needs be.

By contrast, the two people I know who went directly to a consultant were only seen when they went for their second eye to be operated upon. One of them contracted an infection in both eyes during that time, which obviously went undiagnosed. Both of them were left with unaddressed post-op concerns.

I think we need to be clear that "high street" operators use the same surgeons who operate within the NHS and private practice. They aren't a separate breed. These surgeons can be checked out by prospective patients, probably more easily than consultants who only work out of hospitals.

There seems to be a tendency in ophthalmology for practitioners to rubbish anyone that isn't them or their ilk. I recall an optician / optom on here not so long ago advising people against multifocal RLE, saying that the outcome is rarely good. Which is, of course, rubbish. You seem to be suggesting that using a volume commercial operator is very high risk. It isn't.

I would implore anyone considering eye surgery to research whoever it is that will be conducting the surgery. But there are distinct advantages to using a "high street" provider and going directly to a consultant will not guarantee a better experience or outcome.

I'm glad you had a good experience at whichever outlet you chose. I'm not going to get into the normal PH arguments that occur about areas of expertise. I think readers can make their own minds up about the kind of experience they wish to achieve. I am not seeking to rubbish anyone or anything however give advice to posters that I would be happy to receive myself. The bottom line is some outfits put profit before service. That applies to all sectors. Most people are canny enough to realised this, and hopefully won't suffer some of the appalling treatment decisions/poor surgery/poor post op care that can occur. As said previously, if readers want to PM for further info they are welcome.

[13m]

968 said:

The bottom line is some outfits put profit before service. That applies to all sectors. Most people are canny enough to realised this, and hopefully won't suffer some of the appalling treatment decisions/poor surgery/poor post op care that can occur. As said previously, if readers want to PM for further info they are welcome.

In my experience (outside of ophthalmology)profit driven decisions are MORE LIKELY when dealing with a consultant than a large operator. I presume that this is because the former basically operate as small businesses and are acutely aware of making a profit. Larger players can suck up losses more easily when necessary.

At no time have I experience any hint from Optical Express that I was experiencing less than top quality care. From the immediate follow-up appointments to bags full of eye drops "just in case you need them" they have been first class. I am aware that they have failed sometimes, but being a vast retail operation their failures are firstly likely to be greater in number due to sheer volume and secondly made more public.

You're right, people can make up their own minds. But I think you should avoid comments like:

968 said:

Avoid high street chains at all costs.

Which are at best ignorant and scare mongering. It isn't good advice.

However, unless you've got anything else to add I suggest we leave it here and allow prospective patients to do their own research.

[968]

13m said:

In my experience (outside of ophthalmology)profit driven decisions are MORE LIKELY when dealing with a consultant than a large operator. I presume that this is because the former basically operate as small businesses and are acutely aware of making a profit. Larger players can suck up losses more easily when necessary.

I don't think this applies to consultants in the medical sector frankly, because as individuals our reputation is at stake and as individuals we are empowered to allow patients to make the right choices for them, rather than be required to fill sales targets, as many high st outfits impose on their optoms and surgeons. As a consultant I can tell you and my patients will also tell you they experience individualised care with a consultant who isn't looking at the clock and isn't looking to do a procedure to them to meet the bottom line of a multinational corporation who pays per procedure or incentivises for procedures sold. Your experience is your own and I'm happy it worked out for you and other posters here can work out what will work for them or who they will trust.

Edited by 968 on Wednesday 30th September 12:25

[968]

davepoth said:

Since everyone else is having a go...

Right +6.5 -1.75 90
Left +7.0 -3.75 70

34 y/o, recent squint surgery to right eye to correct exotropia. I tried contacts (30 day soft ones) and I guess they're OK, but the faff is annoying. I'm pretty sure my eyes are far too rubbish for laser, but are there any other options?

Hi, sorry for the argument and distraction above. In answer to your query. You're quite long sighted but have a lot of astigmatism too. I think LASIK/LASEK would not be an option as you are too hypermetropic. Lens replacement surgery is an option though you may still have residual astigmatism. I would want to be very careful about your squint surgery as sometimes doing lens replacement surgery can worsen your squint and give you double vision. It's not impossible though, but your assessment will need to be done carefully and will need orthoptic input too.

[13m]

968 said:

13m said:

In my experience (outside of ophthalmology)profit driven decisions are MORE LIKELY when dealing with a consultant than a large operator. I presume that this is because the former basically operate as small businesses and are acutely aware of making a profit. Larger players can suck up losses more easily when necessary.

I don't think this applies to consultants in the medical sector frankly, because as individuals our reputation is at stake and as individuals we are empowered to allow patients to make the right choices for them, rather than be required to fill sales targets, as many high st outfits impose on their optoms and surgeons. As a consultant I can tell you and my patients will also tell you they experience individualised care with a consultant who isn't looking at the clock and isn't looking to do a procedure to them to meet the bottom line of a multinational corporation who pays per procedure or incentivises for procedures sold. Your experience is your own and I'm happy it worked out for you and other posters here can work out what will work for them or who they will trust.

Edited by 968 on Wednesday 30th September 12:25

I was referring to consultants in the medical sector.

As for reputation, it's much harder to obtain reviews about consultant performance than it is of a retail operation, such is the opacity of medical performance data and the proliferation of review websites. You could be a bloody awful surgeon and it would be quite difficult for anyone to find out about it. A large operation trading under business name is far more susceptible to public patient feedback.

As for optoms and surgeons in the retail outfits being targeted and clock watching: I cannot speak about anyone but Optical Express, but I can assure you that none of the medical staff ever applied any pressure or tried to persuade me one way or another. The business has separate sales staff, but even after agreeing to the surgery the checks and balances were in place to make sure that I was happy with my decision.

I saw absolutely no hint of clock watching by the surgeon, in fact quite the opposite.

For what it's worth, I think what you are doing here is very useful, in terms of advising people what options are available for their given prescription. However, I think you'd do yourself and everyone else a favour by not scaremongering about retail operations that appear to be making improved eyesight more accessible to the general public. Talk your own book by all means, but don't attempt to diminish others, particularly on bases that are almost certainly untrue and about which I suspect you have little knowledge.

Edited by 13m on Wednesday 30th September 18:02

[Mad March Taffy]

968 said:

You should expect to pay upwards of £2500 per eye. Avoid high street chains at all costs. Depending on the lens and method of surgery the costs can be higher. PM me if you want any recommendations of where to go.

I keep seeing £2,500 per eye - I must need to get my sight checked!




Many thanks for this infor - really helpful and as least I now know which questions to ask - appreciated