Eye muscle problem, can I still do Lasik?

[Lee]

Hi Glenn,

I am near-sighted and my prescriptions are:

L: Sphere: -6.25 Cylinder -0.75
R: Sphere: -5.25 Cylinder -0.75

I had a Lasik pre-screening check last week. The doctor didn’t see me until the end. So basically his assistant did all the checks. She told me couple of things:

1. There are some problems with my eye muscles. She told me there is a name for it but I forgot. (Should’ve asked her to write it down) She said basically it means that my eyes cannot converge onto one focus. Or, I tend to do cross eyes a lot and as a result of that I’d see double visions. This is known to myself because I can feel that when I see double images. She said that this might have negative impacts on the healing process so she recommended to over correct my vision so that when it regresses it will regress to normal, say 20/20, rather than down to minor myopia.

2. My pupil size is at the large side. 7+mm? She said I may suffer some night vision problems so I may have to wear glasses while driving at night. I told her that my night vision is not good even now. Sometimes I see halos or starbursts around the lights.

3. Blepharitis. I get this kind of infection very often (upto once every month). I use diluted baby shampoo to clean the eye lids twice a day and hot compress twice a day as well. If I skip for couple of days, the infection will sure come back.

4. Very dry eyes. I use artificial tears about 6-8 times a day. It’s hard to open my eyes without a bit of struggling when get up in the middle of night or in the morning. Had tried plugs but did not work on me.

The assistant told me that she is not sure if I was a good candidate but she said she will leave the doctor to decide.

But the doctor did not say anything about my eye muscle and things like these, he only asked me one question, which is, is it OK if I had to wear glasses to drive at night. I said of course it is not ideal but I can put up with it. Then he said he thought I had more than 90% chance to achieve desirable results and I was a good candidate for the surgery.

My question is, is the eye muscle problem serious? Why would it affect the healing process? Also, based on what I have provided, does that make me a real good candidate? Or does the doctor just want to get me to sign up for the surgery? Oh, besides, I still have the infection on my upper eye lid at the moment. But the doctor didn’t seem to care much about it. He basically said I can have the surgery done anytime.

Sorry this is long. Really appreciate your opinion and honestly, this is the best website I found on this topic and I couldn’t thank you more for giving all of us the chance to have our questions answered. But it also means that there are so many doctors/surgeons out there who just do not bother to answer questions to their patients, even though we pay them!

Thanks heaps,
Lee

[Button1]

Glenn will give you THE answer but if I could interject for a minute...

I can't believe with your severe dry eye issues and chronic blepharitis, the doctor would be willing to perform this surgery on you!!!!!!!!!! he sounds like a money hungry idiot. The techs may not have a medical degree but they know enough and see enough complications to have a valid opinion on who is a bad candidate.

Tell me to shut up, Glenn, if I am way off base here...

[LasikExpert]

L: Sphere: -6.25 Cylinder -0.75
R: Sphere: -5.25 Cylinder -0.75

This is moderate myopia (nearsighted, shortsighted) vision and well within the range of correction with refractive surgery.

The doctor didn’t see me until the end. So basically his assistant did all the checks.

In many instances the technician who is well trained with the testing instruments is equal or better than the surgeon.

1. There are some problems with my eye muscles...

This sounds like convergence/divergence deficiency or possibly strabismus. If everything goes okay with surgery, your vision should not be any more affected than you are when you wear contact lenses, however you should be evaluated by a strabismus specialist before having any elective eye surgery.

She said that this might have negative impacts on the healing process so she recommended to over correct my vision so that when it regresses it will regress to normal, say 20/20, rather than down to minor myopia.

It looks like you received too much information and put it together in the wrong context. The strabismus is one issue. Expected regression is another. Visit planned overcorrection for details. A minor overcorrection for someone with your refractive error is a common technique to resolve expected regression.

2. My pupil size is at the large side. 7+mm? She said I may suffer some night vision problems so I may have to wear glasses while driving at night. I told her that my night vision is not good even now. Sometimes I see halos or starbursts around the lights.

Two potentially big red flags. One is that your pupils are large and the other is that your night vision is already not good. You need to read up about Lasik night vision problems. Your doctor is making the rather large assumption that glasses would resolve any night vision problems induced by surgery. That is not always the case.

3. Blepharitis. I get this kind of infection very often (upto once every month). I use diluted baby shampoo to clean the eye lids twice a day and hot compress twice a day as well. If I skip for couple of days, the infection will sure come back.

Another red flag. Blepharitis is commonly exacerbated by Lasik and if you have reoccurrences once a month, it is barely being managed.

4. Very dry eyes. I use artificial tears about 6-8 times a day. It’s hard to open my eyes without a bit of struggling when get up in the middle of night or in the morning. Had tried plugs but did not work on me.

Yet another red flag. Lasik will exacerbate dry eyes at least temporarily for the majority of patients. Lasik induced temporary dry eyes will commonly resolve within the normal six-month healing period, that is for healthy eyes. Your eyes are really not very healthy. You may want to read about Lasik Dry Eyes and consult with a dry eye specialist. You do sound like a good candidate for Restasis.

But the doctor did not...

There does not seem to be much discussion about your multiple eye health and vision quality issues that can be exacerbated by Lasik.

Then he said he thought I had more than 90% chance to achieve desirable results and I was a good candidate for the surgery.

I have two important points. One is that 90% positive also means 10% negative. The other point is what does the doctor mean by "desirable results"? There is little doubt that Lasik could correct your refractive error, but it may also exacerbate your night vision, blepharitis, dry eyes, and could (although not terribly likely) contribute to your convergence/divergence/strabismus problem.

My question is...

I'll cut to the chase. In my opinion you have described several issues that significantly elevate your risk of making your marginally healthy eyes worse and contributing to a degradation of your vision quality.

The most you can expect from Lasik is the convenience of a reduced need for corrective lenses. To achieve that convenience you must accept some risk. You have pointed out many issues that elevate that risk dramatically. Yes, you could have Lasik without complications, but your odds of a positive uneventful outcome appear to be well below the norm.

You have asked for my opinion. I have never privately or publicly told anyone that they should have refractive surgery, but in my opinion you should not.

Now you need to get some opinions that actually count. See a dry eye specialist and a strabismus specialist. There are many techniques to manage blepharitis and dry eye, including some relatively new medications. You may benefit greatly from glasses that include special optics for your eye muscles. If (big if) you get these problems resolved and if (bigger if) a wavefront diagnostic reveals that your night vision problem relates to something that can be resolved with Lasik (or at least not made worse) and if (biggest if) a corneal specialist who is affiliated with a university teaching hospital says that refractive surgery is appropriate, then you may want to revisit the issue of Lasik.

[Lee]

Hi Glenn,

Thank you so so much for such detailed answer! I was just expecting few lines from you. Had been checking the website everyday. Just when my hope almost diminished, here came your answer! Thank you for saving my eyes!

Honestly if you said yes I think I would just go ahead and get it done. I did not worry too much about the dry eyes and blepharitis because they did not get the optometrist/doctors concerned. Now I know these symptoms are BAD. I’ll go to see my GP tomorrow to get an ophthalmologist to do a proper checkup.

Words can’t express my appreciation. But again, a big Thank You! God bless you!

Lee

[LasikExpert]

Hopefully these issues can be properly diagnosed and fully treated, your eyes will be healthy, and then you can revist the idea of Lasik later.

[DryEye]

Glenn:
You often say checking with a corneal specialist at a teaching/university hospital is a very good idea for tougher cases and/or complications. Is this a good rule of thumb - that they are better corneal doctors than the many lasik doctors who perform the surgeries?
If so, wouldn't it be best for the tougher cases or threading the needle type enhancements to go to these types of doctors first and use them for the procedures since it sounds like if something goes wrong they are the ones who are best suited to fix the problem.
Thanks!

[LasikExpert]

Keep in mind that many doctors who specialize in Lasik are also corneal specialists, and the other way around.

What is often valuable when considering a doctor for surgery is how well rounded is that doctor's knowledge. There are doctors who do only Lasik (a lot of it) and rarely do anything else. I lovingly refer to these doctors as "Lasik Jockeys". Due to their large amount of practical knowledge, with Lasik, they are likely excellent surgeons for Lasik, but if the patient needs anything else they are not nearly as knowledgeable.

Many of the Lasik doctors certified by our organization are affiliated with teaching universities.