ghosting

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ghosting

Postby cb » Mon May 26, 2008 9:46 pm

I wrote a while back, and no-one has responded ... here's an update:

I had hyperopic lasik enhancement after 4 months for a +1 sphere/-1 cylinder residual refractive error. I am now over a month post-op. The surgery was much easier than the 1st time (no flap cut, quick recovery). The refractive outcome at my 1 week follow-up is good (+.5/-.5) but my vision in the eye isn't. I've lost a line of best corrected vision, and most bothersome, I have persistent ghosting in that eye, which happens to be my dominant eye. I've tried Alphagan which helps very little. This happened despite using a very reputable surgeon with the latest technology (Intralase, Wavescan guided ...).

A question for anybody with previous experience:

1) Is this ever going to get better ? It hasn't yet, and it's driving me nuts.

2) Solutions? My surgeon says this is due to higher order aberrations and has offered me a 2nd enhancement but I am very scared of losing more vision. I've read about RGPs but I was never a great contact lens wearer to begin with ... I can't imagine much more success with hard lenses.
cb
 
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Re: ghosting

Postby LasikExpert » Tue May 27, 2008 12:04 am

cb wrote:1) Is this ever going to get better ? It hasn't yet, and it's driving me nuts.


This depends upon the cause of the ghosting.

If it is normal corneal astigmatism then it would likely have become better with Alphagan P reducing the size of your pupils. It may be that your pupils do not react to Alphagan P. Your prescription indicates enough regular astigmatism to cause ghosting. Ask your doctor if Pilocarpine would be appropriate to try. You won't want to use it all the time, but it would be good to know if small pupils help the situation.

How is your vision in bright daylight?

If it is irregular astigmatism the epithelium will attempt to make the surface more uniform. If it is due to a flap wrinkle, then a flap lift and smoothing may be recommended, however this type of wrinkle should be able to be seen by the surgeon at an examination.

Hyperopic correction is notorious for being less than spectacular in the early healing stages. This may be something that will resolve with healing.

cb wrote:2) Solutions? My surgeon says this is due to higher order aberrations and has offered me a 2nd enhancement but I am very scared of losing more vision.


Higher Order Aberrations (HOA) are a measurement of an irregularity, they are not the irregularity itself. The ghosting is caused by your cornea catching some of the light and focusing it off-center. This will present elevated HOA numbers, but it is the irregularity in the cornea that is the problem. Elevated HOAs are the symptom.

Depending upon the exact nature of the problem, a wavefront-guided (using HOA data to create a detailed map for the laser to follow) may be appropriate. In any case, you don't want to make this decision until 3-6 months postop.

cb wrote:I've read about RGPs but I was never a great contact lens wearer to begin with ... I can't imagine much more success with hard lenses.


Rigid Gas Permeable (RGP) contact lenses are great at smoothing an irregular cornea. If your problem is irregular astigmatism, then RGPs may be an answer, however you are so early in the healing period that RGPs (hopefully) may not be required.

One more thing. Ask your doctor if CLAPIKS may be appropriate for you.
Glenn Hagele
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Lasik Info &
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ghosting

Postby cb » Mon Jun 02, 2008 7:15 pm

Thanks Glenn:

I'm pretty sure it's irregular astigmatism - I'm back in glasses with little relief, and constricting my pupil (e.g. shining a bright light onto it, bright daylight) helps.

How long do you suggest I wait before trying RGPs? I can't imagine using eye drops the rest of my life !!! Also, do I need a specialized fitting or is any good optometrist adequate?

I'll let you know how things go ... but nothing has changed so far (6 weeks).
cb
 
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