Glenn - Please explain an optimal outcome for me -

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Glenn - Please explain an optimal outcome for me -

Postby rosecmd » Tue Aug 28, 2007 11:15 pm

Glenn,

I've been following a lot of the posts on this board for several weeks now. I had custom lasik on July 9th. I'm 47 years old, and had excellent corrected vision (nearsighted, progressive lenses, good near vision without glasses except helped by progressive lenses for reading, etc.). My pre -surgery prescription was -3.00 in each eye, +1.00 cylindrical/175 axis one eye, +1.75 cylindrical/180 axis in the other eye.

I was told that I would have good distance vision and need reading glasses after surgery. The "need reading glasses" was not fully explained and I was very surprised by my sudden presbyopia after surgery. Devasted actually, but I am now forced to cope with my decision and my surgeon's poor pre-surgery counseling and information. I had mild dry eye prior to surgery that the dr. was not too concerned about. My wavefront analysis results did not jive up with my drs. manual refraction which she did about three times. The wavefront was repeated the day of surgery and she seemed confident with whatever she decided to set the laser at.

To be brief, my recovery has been hard, much like Judy's who has been posting. I have severe dry eyes that are being treated with Restasis, flax, Refresh Plus, and ointment at night. they seem to be improving a bit, the right more than the left at this point. I was overcorrected, dr says .5 dioptors in each eye, optometrist who made me a new pair of temp. glasses at 1 month says it's closer to .87 dioptors of overcorrection and that I still have an astigmatism. My new temp. glasses prescription is +1, -.25, 075 in one eye and +1, -25, 050 in the other eye.

In bright good outdoor light I see quite well for distance with no glasses. The day after surgery it was 20/20 in one eye and 20/25 in the other. One month later my optometrist said I was 20/40 and 20/50. I am more blurry at all distances in the morning for two or so hours until my eyes have woken up and been watered with lots of drops. My night vision is poor with mild halos and starbursts. I use my prescription glasses in the morning to see as I move around the house and get my kids ready for school, and at night when my vision decreases. I see great with my new glasses. They seem, however, too strong for outdoor use when my eyes are at the best.

My question is, with further healing and resolution of my dry eye and my "normal 47 year old presbyopic vision", what kind of near, mid-range, and distant vision should I even expect? I may have an enhancement in the future, but only if it would improve my mid-range vision. Also, what is considered near vision, 1-2 feet? What is considered mid-range. How many feet out does is vision affected by presbyopia? Shoudl I be able to peer out over my reading glasses and see clearly 3 -10 feet out? In other words, what is the best I could have expected given my circumstances? I should add that at three months after I go back to see my dr, I am then going for a second opinion with another lasik surgeon. Many thanks, I've learned a lot here.
rosecmd
 
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Hi Rose

Postby Judy » Wed Aug 29, 2007 12:06 am

Reading your post makes me realize how important it is that lasik surgeons make more effort to explain what sudden presbyopia really means. You got the same simplistic explanation I got. "You will need readers for computer and reading" There is so much more to losing the clarity of near vision that those of us that had it, could not imagine.

Waking up in the morning and everything on the night stand or on the bathroom counter is blurry......in the kitchen preparing a meal or cleaning up.....I have to turn on all the lights to make it even feasible to work...I often have to put on my 1.5 or 2.0 readers to see clearly...

Going to the store is a blur field of product.

Trying to pluck my eyebrows....forget about it. I went to the local nail salon and had them wax the dudes since I could not see to pluck......ha ha....

Putting on makeup....you have to buy a lighted 10X mirror to see your face.....

That is sudden presbyopia....it is also the sudden fear of being caught out somewhere knowing without your glasses you are hopeless at reading anything or seeing to even sign you name.

As to near vision...the Doc says that is about 3 feet out. Just to the end of your outstretched fingertips. From about 3 feet out to 20 is your midvision. Mine if finally getting a bit better.

Far vision of course is the famous 20 ft mark that they grade us by.

I hope you are finding some improvement as the weeks go by. I notice small improvement each week. Some days I seem blurry and some fairly decent.

I think I will do better when I am settled and finally get optical grade reading glasses that are custom fit to the needs of my eyes. The drug store readers are adequate but not really wonderful My eyes get tired using them too long.

Same with dryness....some days I do wonderful....other days....sting, achey, feeling of dried contac lenses that I want to take out.

Many folks post a big change at 4, 6, 8, 12 weeks.....I read all the comments with interest and as I approach my week 5, I hope to continue to see improvement. I am practicing patience like I never knew I had.
It is good we post for all the ones coming behind us, as they need to see there is improvement.....even if it is slower than we might want.

I read all your posts, and continue to follow your progress. Hang in there girl.....make sure you take time each afternoon to close your eyes for a bit and let them rest. This really seems to work. Judy
Judy
 
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Re: Glenn - Please explain an optimal outcome for me -

Postby LasikExpert » Thu Aug 30, 2007 6:23 pm

rosecmd wrote:My new temp. glasses prescription is +1, -.25, 075 in one eye and +1, -25, 050 in the other eye.


This new refractive error is probably contributing to your difficulties more than even the presbyopia. You are now hyperopic (farsighted, longsighted) and at age 47 you are also presbyopic. The combination of hyperopia and presbyopia often provides poor quality vision at all distances - sometimes even with glasses.

Your good vision in bright daylight is undoubtedly due to the pinhole effect of a very small pupil. This provides a greater depth of focus and also reduces the amount of aberration introduced into the eye from the corneal surface. Everyone benefits from this effect. It is also possible that you are less hyperopic in the center portion of your visual axis and when the pupils are small only fully corrected light reaches the retina.

The dry eye is a wild card in the situation. It can be contributing to the vision problem by inducing refractive error and generally reducing vision quality. The dry eye needs to be managed and treated. You can reasonably expect vision quality and quantity improvement as the dry eye improves. You really cannot come to any conclusions - including about having enhancement surgery - until the dry eye is managed.

A real-world guideline is that near vision is from your nose to as far as you can reach, mid-range is from the end of your reach to about 20 feet away from you, and distant vision is beyond 20 feet.

If your problem is only hyperopia and all other factors are resolved, then enhancement surgery would be an option to evaluate to improve the quality of your vision at all distances, with near vision reaping the most benefit.

A second opinion before a decision about enhancement surgery is wise.
Glenn Hagele
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USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Postby rosecmd » Thu Aug 30, 2007 6:39 pm

Thanks Glenn. I appreciate the reply. So, once the dry eye is resolved, is the induced hyperopia correctible with an enhancement? Is this a large amount of over correction? How far off was my surgeon?

I think what I should have expected from my initial surgery was fair near vision, good mid-range and distance vision, and needing reading glasses to see fine detail. Should I have been able to read most print except the really small stuff?

I, too, think it's wise to seek a second opinion and maybe even use a different surgeon. I will certainly make a more informed decision the next time around.
rosecmd
 
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Postby rosecmd » Fri Aug 31, 2007 12:14 am

I should also thankfully note that new corrected vision with my new lenses from my optometrist (who did a new refraction and gave me that prescription) is great.

My surgeon gave me a somewhat different prescription than my optometrist when I went for my one month check up (+.75 sperical, +.75 cylindrical/125 axis in one eye and +.50, +.50, 140 in the other eye with +2.00 near vision correction). She just jotted it out when I insisted on a prescription for new temporary glasses because reading glasses, while they are good for reading, do not help with mid-range or poor night time overall vision.

So Glenn, what causes the poor dim light, indoor light, and nightime vision? Does this improve with time?

I do feel that my dry eye is resolving in my right eye. My left eye is somewhat behind. I've almost been on the Restasis and flax oil capsules for one month. My daytime dryness is not bad after the initial morning "wake up and water the eyes" period I go through. I still use the Refresh Plus every 30 minutes most of the time. My right eye rarely feels strained during the day. My left eye does feel strained many days - it feels a bit tender and achy. Every once in a while, I'll have a day where my left eye feels little discomfort. Both eyes get dry at night, the left one more so. But I load both up with ointment and then if I wake up during the night I use the Refresh Plus drops.

I will be patient and wait for a more final outcome.
rosecmd
 
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Postby LasikExpert » Fri Aug 31, 2007 1:15 am

rosecmd wrote: So, once the dry eye is resolved, is the induced hyperopia correctible with an enhancement?


You won’t know for sure until then, but you are currently in the correctible range.


rosecmd wrote:Is this a large amount of over correction? How far off was my surgeon?


No, it is not a large amount of overcorrection, however the effect of even a small amount of hyperopia is exponentially greater for someone who is presbyopic.

rosecmd wrote:I think what I should have expected from my initial surgery was fair near vision, good mid-range and distance vision, and needing reading glasses to see fine detail. Should I have been able to read most print except the really small stuff?


That was probably expecting a bit too much, considering the amount of presbyopia a normal 47 year old would have. Reading glasses for most near-vision situations would be more reasonable.

rosecmd wrote:I, too, think it's wise to seek a second opinion and maybe even use a different surgeon.


Keep an open mind on the “different surgeon” question until after a second opinion. If it is found that the surgical technique was well performed and the planning was sound, then there would be no reason to part ways with a sound and well performing surgeon.

rosecmd wrote:I should also thankfully note that new corrected vision with my new lenses from my optometrist (who did a new refraction and gave me that prescription) is great. My surgeon gave me a somewhat different prescription than my optometrist...


The 0.25 diopter difference is within normal human fluctuation. Your vision may have fluctuated that much and/or your optometrist may have slightly over-corrected the hyperopia to make you a little bit myopic (nearsighted, shortsighted) to gain a little near vision.

rosecmd wrote:So Glenn, what causes the poor dim light, indoor light, and nightime vision? Does this improve with time?


I suspect that all of this poor nighttime vision relates dry eyes and your refractive error. The nighttime vision is probably much better with the glasses on.

rosecmd wrote:I do feel that my dry eye is resolving in my right eye.


Restasis takes about three months to become fully effective, although you may receive some benefit earlier.

rosecmd wrote:I will be patient and wait for a more final outcome.


That is the key.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


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