Lasik, then PRK, now vision worse

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Lasik, then PRK, now vision worse

Postby meridon » Tue Jan 02, 2007 8:03 pm

I began with a presc of -12.75 R and -13.50 L. I had Lasik 1/2000 with excellent results. Then in early 2006 my vision started worsening with no apparent reasoning. By summer 2006 it was bad enough that I went back to the doctor, who performed an enhancement via PRK since my flap wouldn't lift. From August until October my vision gradually improved and I thought I had my end result - about 20/25.

About a month later end of November my vision got increasingly worse within about a 2 wk time period and has stayed at about -1.75 R and -1.50 L since then. I have been on Alphagam (sp?) and Restasis with no improvement but apparently no regression either in the past 6 weeks. This vision is worse than before I had the PRK done in the first place.

The doctor can give me no reason why this happened. They do tell me there is no major problem with my cornea or retina. I now have had to go purchase glasses for $250 out of my pocket or wear the temp contact lenses they gave me which don't improve the vision like the glasses do.

Anyone know what is up with this or if my vision will ever resolve or any ideas what I should do now?
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Postby LasikExpert » Tue Jan 02, 2007 11:03 pm

For many reasons the name of your Lasik facility was edited.

This is indeed an unusual situation. Your pre-surgery refractive error was very high. Regression after such a large change would be expected during the normal six month healing period, but not six years later.

I'm surprised that your doctor suggested your flap could not be lifted. Lasik flaps can be lifted (more like separating the cornea at the location of the original incision) as much as 12 years after surgery. It may be that the flap should not be lifted. By having PRK and using the laser to remove tissue on the flap, the strength of the cornea would remain virtually the same after enhancement surgery.

The doctor undoubtedly used Mitomycin C with the PRK on Lasik flap. Mitomycin C is a medication that changes the way the cornea heals and reduces the probability of corneal haze developing. It may be (I'm speculating) that Mitomycin C changed your healing response and this resulted in the current myopia (nearsighted, shortsighted) vision.

Alphagan P is a glaucoma medicine that has a side effect of reducing the size of the dilated pupil. A drop in the evening is often used to reduce night vision problems. It is possible that the Alphagan P is reducing the size of your pupil to allow only light that is undercorrected to enter your eye and be "seen". It may be that a larger pupil that allowing light refracted through a larger portion of the cornea would provide better refractive error. Again, this is just speculation.

Restasis is an anti-inflammatory that is FDA approved for the treatment of dry eye. Dry eye can cause edema (swelling) that can contributed to myopia. You may want to review our article on Lasik dry eye issues.
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Lasik then PRK now what

Postby meridon » Tue Jan 02, 2007 11:21 pm

Thank you so much for your quick response. The surgeon did try to lift the flap on both eyes at the time of the enhancement and was unable to do so. The other option was to cut a smaller flap inside the current flap but he was hesitant to do so due to the original flaps being so tiny. That is why we did the PRK for the enhancement.

I guess due to normal life changes (I have had a great deal of stress this past year with my job and my father's illness) that is originally why I though my eyes worsened all of a sudden after the lasik 6 yrs ago. My real concern is that after the PRK (6-8 wks out) I was seeing great for about a month and then all of a sudden within a week or two I am worse than before the PRK was done. I have been like this now (worse) for 6 wks. Any clue as to why this occured? Is this normal? Is this what is probably my final result or do I need to wait longer? Could this drastic and sudden decline be due to stress?

Should I go somewhere else for a second opinion? If so, what type of surgeon/opthamologist should I see?

Thanks for all your help, I didn't know where to turn so I started searching the internet and found your great site!
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Postby LasikExpert » Wed Jan 03, 2007 1:50 am

Be sure that your surgeon (not only the managing optometrist) has examined your eyes since you had the sudden change in vision.

"Worse" is a relative term. Are you able to see well at any distance, such as near? Is your vision able to be fully corrected with lenses?

Depending upon where you reside, it may be possible to have one of the senior surgeons with the national chain that you used for surgery examine you. This may be a good "internal" second opinion.

Have you changed or started any medication of any type since surgery? Have you changed the use of supplements or vitamins? If female, are you possibly pregnant or entering menopause? All of these can affect vision.

If you elect to have a second opinion, contact the ophthalmology department of a university affiliated teaching hospital.
Glenn Hagele
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USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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Postby peakaboo » Thu Jan 04, 2007 12:59 am

Has the doctor ruled out ectasia? That's a lot of correction (originally) and might explain the vision shift years later. How much ramaining stomal bed after the initial lasik?
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Postby LasikExpert » Thu Jan 04, 2007 2:08 am

Ectasia is the forward vaulting of the cornea due to weakening or excessive thinning. Ectasia normally presents within the first year after surgery - commonly within the first few months. Ectasia does not seem probable.
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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