Question on Dry Eyes & Ghosting/Double Vision

[noodles]

I did custom lasik in March, yesterday was my 4 month anniversary. My vision right after surgery was poor, however, it has gotten very, very gradually better. My eyes were very dry in the beginning where I was putting in drops every 10 - 15 minutes, now, I do so every 1-3 hours. I am 40 years old, so my doctor did not want to over-correct me. He was focussed on getting me as close to 20/20 as possible even if I remained very slightly myopic to ensure I had no issues with my close visionand to prolong the need for reading glasses. My short and mid range vision is great. However, my distance vision still has some issues. In my left eye I see ghosting and/or double vision, and in my right, dominant eye, I don't see as far and/or sometimes it is hazy. When I put in drops, I can see very clearly, however, once they dissapate, I have the same problem. My doctor says that he does not think I need an enhancement and that my syptoms are as a result of dryness and will all resolve over time. At last check up, I could see 20/20 with both eyes, 20/30 with each eye individually and my left eye showed 2"tics" of astigmatism and my right showed "1" -- I'm not very technical so I don't have the exact numbers. I go back to see the doctor on Friday, so here are my questions: does ghosting/double vision resolve after 4 months and is it caused by dry eyes? From what I can tell, my doctor has not done any tests for dry eyes like to see if it is quantity or quality, should I be requesting that now that it is 4 months? Also, I suggested to him that maybe my vision is better when I put in drops because it is correcting for a small refractive error, however, he said that drops have no refractive power at all and that would not be it. My hopes have been o.k. because I continue to see very, very, gradual improvement week after week. How long can I realistically expect to see this improvement continue, and when should I start thinking about alternatives for the left eye which sees double/ghosting. I can live with the right, but if the double vision doesn't go away in the left, I'm not sure I can go on where anyone standing 20 feet or more away from me has 1 1/2 heads. Any thoughts or advice?

[noodles]

Hi,
Anyone have any thoughts or insights that might help me? I went back to my doctor and he continues to say that my issues will resolve overtime. That my eyes are "type A" and that they are overfocusing. Each check up my eyes improve slightly and he said my flaps are healing excellent. He said based on my healing to date, I may continue to see improvement for months. When is it reasonable to be concerned with the double vision/ghosting in my left eye -- in that it may not go away. I am reading 20/20 with both eyes and between 20/25 - 20/30 with each eye individually and am showing slight astigmatism.

[JPD]

Dryness can cause those symptoms, but that doesn't mean for certain that is what is causing your problem. Since you have some residual astigmatism, that is probably your problem, and dryness is just making it worse. You could have your doctor test your tear production just see what category your dry eye fits into, i.e. mild, moderate, severe, but if you have dryness, you know it and you don't need any test to tell you that. You can expect your quickest amount of recovery to occur up to the 6 month point, where after that it really slows down. For most issues, once you reach the one year mark you'll have little to no healing left. Dry eye is probably an exception, since I've read it takes a full 5 years for your nerve density to return to 100% after Lasik. 2 years after PRK.

The issue regarding artificial tears changing your refractive error to improve your vision is debatable. Glenn says it is the case, where as a number of people on this board, such as yourself, have been told by their doctor that artificial tears have no refractive power. It may be that both are correct. It could be that artificial tears alone have no refractive power, but when they are inserted into a dry eye they absorb, changing the shape of the cornea, in turn altering the refraction and improving overall vision. If that is the case, then both sides area correct. However, I know the natural tear film on the eye is actually part of the natural refraction of the cornea, so that would sort of go in favor of Glenn's theory that changing the thickness of your tear film with eye drops can improve your vision. I really don't know, it's debatable, and I'm sure there is a reasonable explanation.