Had epi-lasik 03/15/07

Research your concerns in this forum or post your questions if you have had Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL within the past three months.

Had epi-lasik 03/15/07

Postby DaveS » Sun Apr 29, 2007 4:43 pm

Hey Guys,

I have been reading this forum for a few weeks and have found a lot of good information that has helped me along. During the first week or two post-op, I couldn't read the forum though. I had to copy each post and paste it in to Word and bump the font up to 32 point to read it and I was still struggling.

My doctor said that experiencing the blurry, hazy vision was normal, but that the amound and duration that I have been experiencing it is not common. Great.

So, I started with myopia. My pre-op contact prescription was betwee -3.25 and -3.50 in both eyes. I chose the epi procedure because of the chance of the flap from lasik re-opening if I get hit in the eye, etc, etc.

Anyhow, the day of the surgery and part of the day after, I saw very well. The first three weeks or so after, however, were extremely blurry. Riding down the Interstate, I couldn't even read the exit number on the sign as we exited. Not even as we drove right by it. I couldn't really work for two weeks since I work with computers. After about the third week, the doctor took me off the Flarex drop and put me on Pred Forte. The doctors explained that the reason I was not seeing as well as they hoped in the given time frame was because my eyes were healing too fast. They said the Pred Forte should help and that if they would have known this, they would have likely put me on it sooner.

The second, third, fourth, and fifth day after starting the Pred Forte, my vision got quite a bit better. Since then, however, it seems to have leveled off. Better means -- I can drive down the road and see that other cars are on the road too. I can finally tell the difference between makes of cars. I can read the license plate of the car in front of me when we are at a stop sign. I cannot read it farther away. I can't read street signs, etc. I have a lot of ghosting. If I cover one eye, I see three images with the other eye and vice versa. I guess this means that I'm actually probably seeing five "ghosts" with both eyes open. This is really annoying. I think I would see a lot better if the ghosting was less.

Anyhow, I had a doctor visit at about 5 weeks and I think they said my eyes were 20/40 and 20/50. Now, when I read the lines of letters for 20/40 and 20/50, I was guessing at most of the letters, so I don't necessarily agree with those numbers.

My doctor is supposed to be one of the top 5% in the country and he still seems confident that everything will heal like it should.

Are these results at this point pretty normal? I know that most people say wait three months and they decide if a touch-up is needed. But what I'm asking is if this is normal at 6 weeks post-op for epi.

They looked into giving me a loaner pair of glasses, but the machine that they test your prescription with yielded the result that no prescreption can help my vision. They said it wasn't a problem with the "prescription", but that my cornea is trying to look through a rough and healing outer layer of the eye.

Oh -- and I do not believe dry eyes is an issue. I was on thera tears 6 times a day, but now moved to Systane. I'm taking 2000mg Flax seed oil every day and I drink a lot. The only time they are dry at all is when I first wake up in the morning.

Thoughts?

Thanks,

David
DaveS
 
Posts: 11
Joined: Wed Apr 04, 2007 7:15 am
Location: U.S.A.

Postby LasikExpert » Mon Apr 30, 2007 10:36 pm

What you describe is rather common with Epi-Lasik. The process mortally wounds the outermost layer of corneal cells (epithelium), but they do not die for several days and need to be replaced by new healthy cells. Then the whole layer needs to thicken and smooth. At five weeks much of this process should be nearing completion, so it would appear that there is something else going on.

Another typical situation with Epi-Lasik is a bit of a roller coaster in vision restoration. It can get pretty good, worse, and then move back up again. This too should resolve with continued healing.
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

Postby DaveS » Thu May 10, 2007 4:48 am

Glenn,

Thanks for the info. Since my last post, the vision has gone back downhilll a lot. I'm having problems using the computer and driving again. I'm going to go see the doctor tomorrow to see what he/she recommends.

How often do surgeries get mixed up? My eye doctor gave me a copy of my surgery video and the eyes were not mine. One of my eyes is bliue and the other is green and brown. The eyes in the photo were both blue. I also noticed that the procedure steps were not the exact ones I went through. I called them to tell them they gave me the wrong video. Today, I found out that the video I received has my name on it in their records also. I sure hope they carved the right prescription into my eyes. :?
DaveS
 
Posts: 11
Joined: Wed Apr 04, 2007 7:15 am
Location: U.S.A.

Postby LasikExpert » Thu May 10, 2007 5:03 am

Epi-Lasik - and to a lesser extent LASEK - have an up and down recovery. It's good to see your doctor, but don't be surprised if he says it is all normal.

Getting anything wrong that relates to your surgery is never a good sign, but it could be just a mixup of the videos. I would suspect that the doctor will be reviewing your file and the laser computer data post haste.
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

Postby JPD » Thu May 10, 2007 2:58 pm

DaveS,

How is your night vision now as compared to pre-surgery? Maybe with your current problems it's too early to tell?

I'm always curious how someones night vision turns out, that has had one of the surface ablation procedures.
JPD
 
Posts: 160
Joined: Mon Mar 19, 2007 3:09 am
Location: Southern California

Postby DaveS » Fri May 11, 2007 2:06 am

It's too early to tell for sure how the night vision will end up. I had extremely good night vision prior to the procedure. From what I can tell, I think it will be good when the healing is complete. I see a lot of ghosting right now that makes it difficult to see, but I also see it during the day.

Glenn --

My original contact prescription was between -3.25 and -3.50 prior to the surgery. Today after a grueling eye test that seemed to take a half hour, the doctor determined that today I am -4.25 with an astigmatism (sp?).

Is it common to be worse than I was originally for a while, nearly two months post-op?

Thanks again
DaveS
 
Posts: 11
Joined: Wed Apr 04, 2007 7:15 am
Location: U.S.A.

Postby LasikExpert » Fri May 11, 2007 2:50 am

David,

No, this is not normal. I’m going to discuss some possibilities. These are in order from the worst and least likely, to the least worst and most likely. In other words I’m probably going to stress you out a bit at first, but we need to consider all these issues.

My first thought was that you are experiencing ectasia, but that is unlikely. Ectasia is when the corneal vaults forward due to weakness induced by tissue removal too deep. Ectasia does not make sense in your case because you had Epi-Lasik, which only removes tissue from the surface of the cornea. The probability of Epi-Lasik induced ectasia is very, very low. I know of only one case presented at a medical convention.

The next educated guess would be keratoconus. Keratoconus is a disease that can cause a forward vaulting, normally starting with the lower portion of the cornea and presents as progressive astigmatism. Keratoconus normally presents before the fourth decade of life, but can be masked if you wore rigid gas permeable (RGP) contact lenses. It also tends to run in families.

A much more likely cause is edema (swelling). Your eyes may not be responding well to surgery or the postoperative care. This can cause an accelerated wound response that would include edema. Edema can induce myopia (nearsighted) vision and is often irregular, effecting irregular astigmatism. Edema can be exacerbated or caused by dry eyes. The edema may be at the epithelium, in the underlying stromal layer of the cornea, or both.

I doubt that your refraction of 4.25D myopia is accurate. You are looking through a rough and irregular surface. The 4.25D undoubtedly provided the best possible vision, but that is probably because you are overcorrecting with lenses to compensate for the poor vision quality. As you said, the automated machine did not find refractive error, just poor quality.

You say that your doctor noted an aggressive healing response. That explains a lot, but perhaps not everything. You may have experienced an allergic reaction to the Flarex. It’s rare, but possible.

I’m not a doctor and I have not seen your eyes, but based upon the information you have provided I think ectasia and keratoconus are suspects, but unlikely. Edema and dry eye are highly probable and diagnosed, respectively. A reaction to the meds is possible, as is your natural healing response being quite aggressive. I suspect your reported refractive error is actually an artifact of a poor quality corneal surface and not your true refractive error.

It sounds like you have a well respected doctor. In a situation like this, that is your best asset. You should discuss openly with your doctor your concerns and he can describe his findings that may have already excluded some of the issues I’ve raised.

Please be sure to keep us informed.
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

Postby DaveS » Tue May 29, 2007 8:32 pm

Glenn,

I had an appointment with the follow-up doctor Friday. She said that my vision in each eye is 20/60. I'm still having great difficulty seeing detail at any distance and the ghosting is very bad.

I'm taking the Pred Forte four times daily, Systain frequently, and Cosopt twice daily. In two weeks I will have reached the three month mark. It was my understanding that in nearly all cases, vision should pretty much be clear by the end of the third month. In my case, however, it is worse than pre-surgery.

The follow-up doctor has tried and tried to get me a prescription pair of glasses to help me out, but the test results differ even when the test are one right after another. She said she has not had a patient with this much trouble recovering in the past and basically said that she is at a loss as to why my vision is so bad at this point. She said she thinks that the corneal shape may have changed. She also said that the "cloudiness" that they were seeing in my eyes during the exam is almost gone at this point. She said everything inside of the eye looks great.

So, she did not have anything comforting to say, but to just stay on the drops for now. She set up a follow-up appointment of June 5th for me with the doctor that performed the surgery.

I'm not sure what to expect him to say. Last time that I met with him, he said that it is possible that the part of the epi where they remove the surface may have to be re-done to allow it to heal in a more controlled manner. Is the surface just rough? Will it ever smooth out without re-doing this? I have not seen ANY signs of improvement since the original post of this thread.

What questions do you think I should ask the doctor when I see him?

Thanks again,

Dave
DaveS
 
Posts: 11
Joined: Wed Apr 04, 2007 7:15 am
Location: U.S.A.

Postby LasikExpert » Tue May 29, 2007 9:07 pm

An exam by the surgeon is needed. I recommend that you phone the surgeon's office and let staff know that you are having long-term complications with poor vision at all distances. Ask that they schedule extra time as this is a complex case. Ask that they retrieve a copy of your optometrist's chart for review. You may even want to pick up the copy and take it with you.

I will be interested in learning what your surgeon says. We have discussed some possibilities, but another may be a reaction to the meds you are using. Long-term use of steroids can cause undesired changes for some people.

If your surgeon is equally at a loss, request a referral to a corneal specialist for evaluation. Your surgeon will probably have suggestions, but you may want to consider someone at a university affiliated teaching hospital.
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

Postby DaveS » Sun Jun 17, 2007 6:01 pm

Glenn,

I went back to the doctor on June 5th. I met with the surgeon for about an hour and went over a lot of things.

At this visit, my vision has not changed. It is still 20/60. He said that I currently have a prescription of +1 -1, however that is read. He gave me a set of temporary lenses for my glasses. When I got outside the office, they didn't seem to help at all, whether they are on or off, even though I was able to read the 20/40 chart pretty well in his office.

They did a scan of the surface of my eye and determined that instead of being somewhat round like a basketball, it was more the shape of a football. He said to come back in three weeks and see if the shape was still changing. If it was still changing, we would wait a couple more weeks and try again. If it was not, they could discuss a touch-up surgery.

Here is a new question that I have. If they can not get me to see the 20/20 line, and I have an astigmatism that looks (to me) like it is pretty bad. And if the temporary set of lenses doesn't help me see better at all -- Then how in the world can they determine the correction amount needed in a touch up surgery?

At this point, would it be best to try a surgery with a correction, or to try to just re-remove the surface of the eye and let it heal again using drops that slow down my rapid healing process?

I'm just afraid that they are not going to get an accurate enough reading from me to be able to perform an accurate correction. How can they tell what is "right" when I currently can not see better than 20/40 with any correction? :?

Thoughts?

Thanks,

Dave
DaveS
 
Posts: 11
Joined: Wed Apr 04, 2007 7:15 am
Location: U.S.A.

Postby LasikExpert » Sun Jun 17, 2007 7:26 pm

DaveS wrote:At this visit, my vision has not changed. It is still 20/60. He said that I currently have a prescription of +1 -1, however that is read.


A prescription of +1.00 indicates you are moderately hyperopic (farsighted, longsighted). The following -1.00 indicates that you also have moderate astigmatism. That is the football shape component. This explains a lot.

I assume that you are at or over age 40 and are presbyopic (need reading glasses or bifocals). The combination of hyperopia and presbyopia tends to provide poor vision quality at all distances and is difficult to correct with glasses. Contact lenses may do a better job, but many hyperopic presbyopes find vision quality poor even with corrective lenses. The doctors may be able to determine your refractive error with objective measurements, but with hyperopia and presbyopia glasses are not necessarily going to correct the problem.

If you are not presbyopic then your natural crystalline lens inside the eye is probably constantly attempting to "focus around" the hyperopia and your hyperopia may actually be a bit worse than your current prescription indicates. The doctors can do a cycloplegic examination that will paralyze the natural lens and give a true refractive error.

If you are just at age 40 and a little presbyopic, then you may be dealing with a combination of focusing around, presbyopia, and hyperopia. Add to that astigmatism and your vision would likely fluctuate and should not be very good at all. Fortunately if refractive error is your only problem - and it likely is the only problem - then you are within the treatable range. I believe giving your eyes a bit more time to heal and see where they settle is wise.
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

Postby DaveS » Sun Jun 17, 2007 10:19 pm

Let's change the assumption. Let's assume that it will be a few years before I turn 30. My prescription prior to the surgery was -3.25. I wore contact lenses for several years and with them, my vision was perfect, both during the day and at night. Prior to the surgery, with the contacts I never had a problem reading the VERY fine print on anything. I could also read things far far away. Now, everything is bad.

I'm just really frustrated. I can't express how let down I am EVERY moment of EVERY day. The final thing that led me to the epi rather than normal lasik is because it was described as the "safer" of the two procedures.

Was that wrong or what? My job requires travel out of town. I cannot see the screens at airports. I cannot legally drive and if I do drive, I cannot read the signs. I also have to work on the computer constantly which is very hard. To top it off, I'm trying to build a house. I have had to hire out some of the work that I was going to do myself because I cannot see well enough to do a good job.

I started staining cabinets today and was also going to paint. I have come to the realization that I will have to hire that out as well since I cannot see the detail well enough. In addition to the cost of the surgery, I will be over my original budget on our new home by at least $10k because of my new-found disability.

This is just frustrating.
DaveS
 
Posts: 11
Joined: Wed Apr 04, 2007 7:15 am
Location: U.S.A.

Postby JPD » Sun Jun 17, 2007 11:33 pm

DaveS wrote: The final thing that led me to the epi rather than normal lasik is because it was described as the "safer" of the two procedures.

Was that wrong or what?


No, not wrong. Epi-lasik is more than likely superior to Lasik. The problem is with the ablation, and whether your perscriptions was or was not a tricky one. Had you had Lasik, you would most definately being experiencing these same problems, plus there's a chance you could also have some sort of flat issue. I'm on the complete other side as you. Everyday I wish I had had Epi-lasik instead of lasik, and maybe I wouldn't being having the issues I am having (night vision). Most likely, I would be having the exact same experience, but I'll never know. Based on my own research, in my opinion, Epi-lasik is the superior procedure over everything else out there. I just wish I had done that research before my procedure.

I can't fully relate to your problems, but if you're kicking yourself and making yourself feel worse by thinking you picked the wrong procedure, then I'm just trying to put you at ease a bit and say you did very well with procedure you picked. Your issues aren't from the Epi-Lasik, but the laser correction, and possibly an error on your doctors part.
JPD
 
Posts: 160
Joined: Mon Mar 19, 2007 3:09 am
Location: Southern California

Postby LasikExpert » Mon Jun 18, 2007 12:01 am

DaveS wrote:Let's change the assumption. Let's assume that it will be a few years before I turn 30.


That eliminates presbyopia as the issue. You were overcorrected from myopia (nearsighted, shortsighted) vision into hyperopia. Because you are relatively young, your crystalline lens has the ability to change shape and change focus (accommodation). Your eyes are undoubtedly attempting to accommodate around the hyperopia. If your exam that provided the +1.00 diopter prescription was not cycloplegic, then your script would not include however much you are accommodating. Your hyperopia may be worse than this prescription reveals. This would help explain the poor vision quality at all distances and fluctuation.

DaveS wrote:I'm just really frustrated.


I have no doubt. In fact frustration is just one of the emotions you should be experiencing. In addition to every waking moment providing poor vision quality, you are dealing with the fact that this was an elective surgery. It’s real easy to beat yourself up (or your doctor) because you could have continued using contact lenses and never had surgery. The lack of a definitive explanation for all your symptoms, no solid prognosis, and/or little in the way of a plan of action just makes things worse. Don't kid yourself; this is a miserable time, but you need to keep a few things in mind.

Everything that was done to your eyes was done on the surface of the cornea. Let's say everything goes as bad as possible (it won't, but let's discuss it). The worst that you would be facing is a corneal transplant. Corneal transplants are nothing to take lightly, but thousands are done successfully every year. You will not go blind because of this. It is certainly disruptive, irritating, frustrating, and downright depressing, but an expectation of a good final result is reasonable...and I’m not one to offer false hope.

Another very important point is that it appears you made your decision about refractive surgery with solid information and due diligence. You even elected for a surface ablation technique over Lasik because of the reduced risk. Your decision process does not appear to have been flawed, even if the result thus far has not been as expected. Sometimes you can do everything right and still not get the result you want.

I have taught furniture design and construction as a hobby (mostly Arts & Crafts period), I work at a computer all day, and I travel quite often to attend medical conferences. I had very delayed healing after my PRK (my fault totally) and was unable to do the same things you discuss. You are not alone. There are quite a few who have dealt with this kind of disruption, but you can prevail. It just takes patience, which is much, much, much easier said than done. You may need additional treatment, but I am certain that your vision will be fine in the long-term. The problem is that we don’t “see” long-term.

Ask your doctor’s office if the +1.00 -1.00 prescription is from a manifest refraction or cycloplegic refraction. If it is from a manifest refraction, ask if a cycloplegic refraction was done and ask for that prescription also. I’d be very interested to know if there is much difference between your cycloplegic refraction and your manifest refraction. This would indicate how much your eyes are accommodating to “focus around” the hyperopia.
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

5 months post-op, still bad...

Postby DaveS » Wed Aug 22, 2007 5:14 am

Glenn, (and anybody else reading this)

Shortly after my post on June 17th, I met with the doctor that had performed the surgery on 3/15. At that time, it was three months post-op and I was seeing very poorly. The doctor determined that the best thing to do was to choose one eye and do a touch-up epi surgery.

In considering this, I was extremely nervous. The primary reason is because the device they use for measuring refractive correction (the eye exam thing...) was not able to help me see much better at all, regardless of what they tried. He used what they referred to as a "manual pack". I'm not sure if I spelled that right. He explained that the device took various measurements on the eye and from those, he was able to determine how much of a touch-up to do. Okay, so I'm freaking out at this point, but I decide to go with it. He's supposed to be one of the top few percent, right? I asked him about his confidence level of it being completely successful. He said he was very confident with his measurements and the addition of Mitomycin-C to eliminate the haze issues that I had the first time. I decided to proceed.

I'm not yet sure if that was the right choice or not. I spent a little time thinking about which eye to perform the surgery on. The right eye (my dominant eye) had the poorest vision at the time, so it made sense to me to keep the eye that had the best vision where it was and operate on the other.

Note: Day of surgery -- Assistant had to administer extra valium to calm my nerves. Post-surgery, with the surface of the eye removed, I expected to see at least a bit clearer since it was not a smooth surface prior to the touch-up. I didn't see better, thus had initial concerns. I decided to wait and see what happened. I waited, and I saw what happened, so now I'm writing this follow-up post.

The results --
My left eye, which originally had the epi on 3/15/07 with no touch-up is not 5 months post-op. I am seeing 20/35 with the eye. Keep in mind that I'm only 28 and saw 20/15 with contacts using both eyes prior to surgery. This is a HUGE step back for me.

My right eye, originally operated on 3/15 had a touch-up on 6/28. If I remember right, I was seeing around 20/40 when I had the touch-up. The first part of the healing process went a bit better with the Mitomycin-C. The haze that I previously had huge problems with was non-existent. The problem is that the touch-up surgery has left me reading one letter off of the 20/30 line. It's better than it was, but still not close to where it should be. I'm a few days shy of 2 months post-op on the touch-up. The vision has not changed in over three weeks.

Driving down the road, it's still not easy for me to identify things such as bikers on the shoulder of the road. I cannot read interstate signs until I am passing them. Those signs are huge and should be easy to read. Billboards are impossible to make out. When sitting in traffic, I can barely read the license of the car in front of me (while sitting still). When looking at an object, person, etc indoors when they have a window behind them, I see primarily a silhouette -- not the person or object. I started pre-med classes this week and it's very difficult to see the class material from my seat. Working on the computer used to be easy. Now, I have to get about 12 inches from the screen to do my work.

I'm beyond frustrated and I honestly don't know where to go from here. The first surgery obviously didn't work. The second surgery seems that it likely was also not a success. My doctor is supposed to be the best in the state and one of the top 5% in the country. Who do I turn to? Two surgeons have worked with me along with the doctor that is doing the post-op checkups. I'm just not sure where I would even have an option of a second opinion that is as or more qualified than the doctor that I already have.

Do you have any suggestions? :(

Thanks,

David
DaveS
 
Posts: 11
Joined: Wed Apr 04, 2007 7:15 am
Location: U.S.A.

Next

Return to Just Had It

Who is online

Users browsing this forum: No registered users and 1 guest