Trouble focusing after LASIK

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Trouble focusing after LASIK

Postby jspridge » Tue Aug 01, 2006 10:01 pm

Four days ago I had Custom Wavefront LASIK done to both eyes (left eye was -4.5, and the right was -5.25). I am now able to easily read the 20/20 line on the eye chart with either eye individually, but with both eyes uncovered, only my left eye is completely in focus. My right eye only focuses completely when the left eye is covered. This difference in focus is most obvious in low light or when reading in any light, and I am experiencing headaches and fatigue as a result. I would characterize the symptoms as something similar to amblyopia, although I never had any similar issues prior to LASIK. I asked both surgeons at the LASIK center about the issue, and both of them told me that it was probably nothing to worry about. The headaches and fatigue tell me the opposite. Any thoughts on what might be happening?
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Postby LasikExpert » Tue Aug 01, 2006 11:40 pm

What is your age? Did you use reading glasses or bifocals before Lasik?
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Postby jspridge » Tue Aug 01, 2006 11:59 pm

I am 36, and prior to LASIK surgery, I never needed bifocals or reading glasses, only soft contact lenses.
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Postby LasikExpert » Wed Aug 02, 2006 1:08 am

Most important is that it is way too early to make any decisions about your Lasik outcome. Lasik is more of a six month process than a "20-Minute Miracle". You will need to be patient and it is reasonable to expect some (if not full) resolution of your problems as you heal.

It appears that there is an imbalance in refractive error between your two eyes. As an example, one may be a bit farsighted and one a bit nearsighted. It may also be that there is a bit of irregularity in the cornea or in the epithelial cells that are the outer layer of the cornea.

The problem may be as simple as a bit of Lasik induced dry eye or a bit of swelling from the surgery. About half of Lasik patients have dry eye problems in the first few weeks to months and this can cause vision like you describe. You may want to read about Lasik and Dry Eye.

Keep your doctor informed of any sudden changes in vision and be patient. Many have had similar symptoms that fully resolved with healing. At the one month checkup you will have a much better idea of exactly what is going on. Be sure to visit us then and tell us what the doctor says.
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Postby jspridge » Wed Aug 02, 2006 1:25 am

Thanks for the advice. I will check in a month from now and let you know my progress.
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Postby LasikExpert » Wed Aug 02, 2006 1:39 am

When there is no pain and the procedure is relatively quick, it is easy to forget that you just had microsurgery on your eyes. Sometimes your eyes won't let you forget it!
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Postby jspridge » Tue Aug 15, 2006 4:23 pm

Two week checkup was today.

Prior to the procedure I was:

OD -6.0
OS -4.5

Today I am:

OD +.75
OS -.25

The surgeon believes that the overcorrection may have been caused by reading or straining my eyes on the day of the surgery and prior to the final wavefront measurement. The good news is that the mild astigmatism that I had prior to surgery is gone, and I am quite comfortable with the vision in my left eye. I am now wearing a contact lens in my right eye, which appears to perfectly correct the imbalance problems I have experienced since the procedure. If my overcorrected eye has not regressed significantly within the next three months, I will have an enhancement done at that point.

Can you tell me if the difference in refractive error is within the normal range where people generally seek an enhancement? My doctor gave me the impression that he thought I was being a little picky when I told him that I wasn't comfortable with my vision as it is today, which is sort of odd considering that I just spent a bunch of money with him to correct it, and it clearly isn't perfect. I understand that it takes time to properly heal, but between now and then I would like to have the best vision possible.
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Postby LasikExpert » Tue Aug 15, 2006 6:25 pm

Every person's tolerance for less than perfect is different. What is most important is your requirement for a successful outcome. While 0.75 diopters off target may seem at first a small amount, you are now 0.75 diopters hyperopic (farsighted, longsighted) in one eye with the other eye being 0.25 D myopic (nearsighted, shortsighted). This situation is more complicated than it may at first appear.

The imbalance of being hyperopic in one eye and myopic in the other can cause many problems. The hyperopic eye will be attempting to "focus around" the refractive error and this can cause headaches, nausea, vertigo, and occasional dizziness.

The size of the images at the retina may be different for one eye than the other, causing blurred vision when used together. You may want to read about Lasik and Aniseikonia

The amount of hyperopia required to be disruptive to vision is much less than what would be required from myopic refractive error. Some argue that the ratio is about three to one. Your 0.75 hyperopia would be more like2.25 myopia in its effect on vision. The disruption is magnified as we pass age 40 and presbyopia becomes a problem. As you get older and become more presbyopic, the natural lens within the eye will no longer be able to accommodate around the hyperopia and you will get its full effects. The combination of hyperopia and presbyopia can provide poor quality vision at all distances.

Wearing contact lenses will probably provide the best temporary relief from the problem. Whether or not you should have enhancement surgery is a decision only you and your doctor can make, but I can totally understand the motivation to have resolved what at first appears to be a small problem.
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Postby jspridge » Tue Aug 15, 2006 6:54 pm

Thanks for the quick reply. Although I have yet to test my new contact-aided vision at night, presently I can see quite well with a single contact lens correcting the +.75 eye, so it may be possible that the other eye is in fact plano. When I went in today I specifically requested an auto refraction to get a non-subjective measurement of the true refractive error in my eyes. The surgeon told me that it wasn't necessary, and that the subjective measurements were more accurate than the device. Is there any truth to that statement?
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Postby LasikExpert » Tue Aug 15, 2006 7:36 pm

Subjective refractions are always better than objective measurements because vision is more than just the physics of the eye. Vision is the entire process including the nervous system and the brain's interpretation of the information it receives.

As an example, at the University of Rochester a device was built that could dynamically remove all higher order aberrations and refractive error. The patient sat at one end of a table covered with mirrors and optic devices and looked through the system. The system could adjust to zero out virtually all higher order aberrations and refractive error. The patient had "perfect" optics...and complained that vision was poor. When some of the perceived imperfections were added back into the vision system, the patient could see better.

The brain learns how to use optic imperfections to its advantage. That can only be known with a subjective response. On a purely optic level, the patient had "perfect" vision, but on a subjective level the patient could not see well.

A refractive error of 0.25 D is within the normal fluctuation. You can blink a few times and create that much change in refraction.
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Postby jspridge » Tue Aug 15, 2006 7:41 pm

Thanks again for the helpful information.

If only the people performing these procedures were as willing to give complete answers as you are, we (the patients trusting our vision to them) would be much better off.
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Postby LasikExpert » Tue Aug 15, 2006 8:21 pm

I agree, but keep in mind that our funding comes from refractive surgeons through certification fees. In a roundabout way, they provide this service.
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Postby jspridge » Mon Jun 04, 2007 5:56 pm

Good afternoon.

I wanted to provide an update to this situation for any interested forum viewers. Ten days ago I had a Lasik enhancement performed on my overcorrected eye. The procedure was quick, and the results are quite pleasing. While it is unfortunate that it took a year longer and $500 more than planned to get to a point where contact lenses were no longer necessary, the saga is finally over, and I have made it to the finish line. My vision is very good - meaning there is now balance between the vision in both eyes, and I can read the 20/15 line with either, and all of the headaches and blurred vision are now gone.

Would I do it again? Probably. Would I prepare better if I had it to do over again? Absolutely. Probably the best advice I can give anyone is to make sure that you stop wearing your contact lenses at least a week if not more before your initial exam, and to be very careful the day of surgery not to do a lot of reading or intensive focusing on the television, etc. The outcome of the procedure is only as good as the data that comes out of the measurements, so don't let anyone rush you through that part.

Thanks for all of the advice. It was quite helpful.

Good luck to anyone with similar post operative difficulties. With patience and a good doctor, you'll get through it and eventually you will love your new vision.
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Postby LasikExpert » Mon Jun 04, 2007 6:17 pm

Congratulations on your great final outcome. Your 20-Minute Miracle took a year, but at least you achieved the goal!
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