Dim light and night vision problems

Post your questions and start your research in this forum if more than three months ago you had any type of surgery to reduce the need for glasses and contacts.

Dim light and night vision problems

Postby jazzy_jeff_1986 » Wed Mar 09, 2011 8:37 pm

Hello,

It's my first post here. I'm from Poland and I'm 24 male. In march 2008 I had LASEK eye surgery in Warsaw (the machine was MEL-70). My prescription was about -5D in both eyes. After all examinations my doctor told me that my fault is easy to correct. About 1 month after surgery my daily vision was perfect and it is still good. But my vision was perfect in good lighted environment only. Otherwise I have problems such as halo, starburst, ghosts, poor contrast etc. I can see some kind of fuzz around things in dim light enviroment and starbursts around car lights, street lights and LED lights. I am afraid to drive a car at night. Street lights, car lights and every other lights looks horrible in the night. When I am in rooms where the light is not strong enough edges of the objects are not sharp and I can see a few edges instead of one or some kind of foggy edges. It concerns especially white, silver and other bright objects. It makes me lots of trouble in my work(I am a HVAC enginneer at the building). I am more and more depressed lately.
I think that my problems are caused by to small ablation zone (6 mm) and to get better vision in low lighted enviroment I should enlarge it (I often use an Alphagan P and it makes my nigth and especially dim light visiom much better). On the other hand I am really afraid to have re-treatment, because i have good daily vision and I don't want to break it down. During my examinations my pupils are not so big - they are about 6,5mm, so my doctor is surprised that I have so serious problems with dim ligth/night vision. On the other hand I do not believe that my pupils are 6,5 mm, because when I look at the mirror in dim light I can see that they are pretty big, so propably I need to get a second opinion. I am looking for people who already had such a re-treatment, because I would like to know as much as possible about it. If anybody knows such a person please let me know. My doctor in Poland doesn't know if she would take on such a re-treatment...
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Re: Dim light and night vision problems

Postby jazzy_jeff_1986 » Thu Mar 17, 2011 9:59 pm

Glenn, could You give me some advise?
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Re: Dim light and night vision problems

Postby LasikExpert » Fri Apr 08, 2011 8:08 pm

Jazzy_Jeff,

I am sorry to hear about your night vision difficulties after Lasik. Is the doctor able to get you to good low-light vision when you have a refraction (which is better, one or two?).

Much of the following is from one of our certified doctors' posts at another forum, but applices directly to your situation. There are several potential causes to your described problem, and many options to resolve the issue.

The night vision problems you describe are often technically described as Spherical Aberration (SA). Put simply, SA means the outer edges of your area of vision have a different refractive error (prescription) than the center. SA can be caused by any component of the eye’s focusing ability including the natural crystalline lens inside the eye or the cornea (the clear front of the eye).

In some patients, moderate and high light levels cause the pupils to constrict enough that light passing through the outer edges of the area of vision is blocked by the iris (colored portion inside the eye). Because the SA is blocked by the iris, it does not reach the retina (light sensitive membrane inside the back of the eye) and is not “seen”. Inversely, sometimes in low light environments the pupils become so large that the SA is allowed into the eye. The fully focused light mixes with the poorly focused light and can cause the big blurry stars around light sources like headlights and traffic lights that you described.

If you have had your pupils dilated and experienced really bad vision, some of that may be attributed to SA.

SA occurs naturally and can be altered by cataract surgery or laser vision surgery such as LASIK. Someone with natural SA or SA exacerbated by surgery has several options available.

OPTION: ENHANCEMENT SURGERY

Natural SA and SA exacerbated by surgery can often be resolved with laser vision correction surgery. A Lasik “touchup” may be able to create a greater balance between the refractive error of the center and the outer edges of your area of vision. You say your Lasik doctor is uncertain if she would be able to make an appropriate enhancement. This is probably not the doctor for you. Ask your doctor for a referral to someone with more experience in Lasik enhancement surgery. You may want to visit the International Society for Refractive Surgery website and see if they list a doctor nearby. Of course, you can contact me directly for some guidance on who may be approprite to continue your care.

OPTION: REDUCE PUPIL SIZE

More Light
The pupils react to visible light intensity. An easy way to reduce the effects of SA is to increase the light in the environment and allow the pupils to naturally constrict. You mention problems with oncoming headlights and traffic lights. Turning on the interior courtesy light, the vanity mirror in the sun visor, or even making your dashboard lights brighter may introduce enough additional light that the SA is resolved. Of course, adding light is not always possible or convenient.

Eye Drops
For years eye doctors have used Pilocarpine (parasympathomimetic alkaloid) eye drops to cause pupils to constrict, but Pilo, as it is often called, is rather strong medicine and its use would likely not be necessary for what you describe. Alphagan P (brimonidine tartrate) is a prescription eye drop used to control glaucoma (pressure inside the eye). Alphagan P also has a side effect of moderately and gently constricting pupil size. A drop of Alphagan P in the evening may reduce or eliminate the night vision problems you describe. Many patients find Alphagan P a satisfactory resolution to SA problems. You mention using Alphagan P. Does this resolve the problem?

OPTION: CONTACTS

Refractive error is simply light out of focus or focused off center. SA is when the refractive error in the center of the area of vision is different than the outer edges. Conventional contact lenses may correct the refractive error that is exasperating SA and resolve your night vision problem completely. Of course, you didn’t have LASIK so you could wear contact lenses, but disposable contacts in the evening may resolve the problem.

Rigid Gas Permeable (RGP) contact lenses not only can correct refractive error, but can also reshape the cornea. A little bit of reshaping can stay even after the RGPs are removed. Wearing RGPs may resolve your SA when they are on, and for several hours after the RGPs are removed. This technique is called Orthokeratology (Ortho-K) and is commonly provided by an optometrist.
Extreme cases of SA (not what you describe, but for other readers) may require special contacts designed specifically to resolve SA.

Glasses do not work well for SA because when you move your eyes, the refractive correction does not move with them. For conventional, RGP, or special contacts, contact your eye doctor.

OPTION: TIME

As we age our pupils tend to naturally constrict. With time the SA may be blocked by naturally smaller pupils
The brain is very good at ignoring bad vision information. An example is the blind spot. There is a very large spot in your area of vision that has no vision at all; it is where the optic nerve enters the eye and attaches to the retina. Although you have this blind spot, you don’t “see” it. That is because the brain has learned to ignore the blind spot. Similarly, the brain may learn to ignore SA. This is called Neuroadaptation. It may not sound like a solution, but Neuroadaptation is a solution that may occur without you even trying.
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

Re: Dim light and night vision problems

Postby jazzy_jeff_1986 » Sun Apr 10, 2011 2:59 pm

Hello,

I had my initial surgery in Warsaw in CMO LASER clinic, which is one of the best and the oldest in Poland I think. It was LASEK not LASIK surgery. The laser was MEL-70 (a half year later they bought MEL-80). I have beed reading a lot about cases similar to mine on this forum and in other places. I think i understand my situation pretty well. I pretty sure that the main reason of my problem is to small ablation zone. I understand also that even small refractive error increases night/dim light vision problems.

Option 1:
Enhacenment surgery.
I am thinking about it more more lately, because i do't want to live like this for the rest of my life. But I am afraid potential risks also. I can be overcorrected or undercorrecteg after re-treatment. Possible second treatment would be also LASEK i suppose, so there is also a risk of haze. Of course they use Mitomycine C (is it safe in Your opinion?), but it doesn't guarantee that haze will not occur. I'm afraid also that after 2 procedure i could have problems with dry eyes (now i don't have problem with that). Generally if I would decide to undergone enhacement it would be definitely only one eye a time. I was e-mailing with English doctor known from complicated re-treatments. And he told me he can help, but cannot guarantee anything. I know one man in Poland, who was lasered by him. He had problems after initial surgery in Poland in 1998 I suppose. He had -10 D before initial procedure. Some time after it he had about -3 D and horrible starbursts, halos etc. He decided to undergone re-treatment in England. He told me that almost all night and dim light problems dissapeard, but he has now other problems. He is overcorrected in one eye and undercorrected in another. Besides he has a litlle haze in one eye. Another thing is money. Cost of "complicated re-treatment" (he named it exacly like this) is 2500 English pounds. My doctor told me once that she's not sure if she would manage it, but some time later she told that we can make it. She's pretty experienced surgeon, but she never made such a re-treatment. On the other hand she knows the best how my eyes react and how are they healing. I really don't know what to do. Glenn can You reccomend me any specialists in my region? What kind of laser would be best in my situation in your opinion? What do You think about T-CAT platform?

Option 2:
More light.
I've been trying it and it helps indeed. But as You can imagine it's not perfect solution. I don't even know if driving with indoor lighting switched on is legal here in Poland. And it is good solution only in cose of night driving. I need to see properly when I am at building site at work. There's lot of places with poor or dim lighting and my vision there is poor. I can see some kind of fuzz around things and have poor contrast. I cannot recognize people faces and see a few edges of things instead of one. It's making me sick. I like my work, but when I go to darker places I just can't manage it.

Option 3:
Eye drops.
Yes, I used to use them when I go to the party or so in the evening. It helps me pretty much. Starburts are generally gone for a few hours, but halos a maybe just a little bit smaller. My dim light vision after using Alphagan is perfect I think. Even after 10-14 hours my interior vision is really good. But it makes worse with time as my pupils dilates... So it is good solution, but only if go somewhere in the evening. When I use in a daytime I can feel light sensivity which is tiresome. Besides Alphagan is making my eyes and throat dry and I feel a little bit dizzy (like I would drink 2 beers or so) for about 4-5 hours, so using it in the morning before work it's not a good solution.

Option 4:
Contacts.
I have to admit that i didn't tried using contacts after surgery, but I've been using it for about 5 years fefore it. Some time ago I tried night driving with my mother glasses (they are -0,5 D I suppose) and it made my driving better. Not very good, but better. On the other hand I suppose that they made my central vision a little bit overcorrected. I think I have to order some contacts of about -0,5D i try how it will effetc on my night vision. Glenn can You recommend me some special kind of contacts, beyond RGP's?

Option 5:
Time.
I understand that our brains addapt to new conditions, but I don't believe that anything will change after 3 years after my initial treatment. I know that our pupils tend to dilate less as we get older, but it's usually in mid 40's I suppose.

Glenn I would like to thank You very much for Your help in advance.
Last edited by jazzy_jeff_1986 on Wed Apr 30, 2014 3:44 pm, edited 1 time in total.
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Re: Dim light and night vision problems

Postby LasikExpert » Sun Apr 10, 2011 5:51 pm

jazzy_jeff_1986 wrote:Possible second treatment would be also LASEK i suppose, so there is also a risk of haze.


I suspect the treatment would be either LASEK or PRK. The risk of haze would be minimual. The amount of correction for retreatment would be very small. Mitomycin C is a strong medicine that should be avoided if possible, but is appropriate when necessary.


jazzy_jeff_1986 wrote:I'm afraid also that after 2 procedure i could have problems with dry eyes (now i don't have problem with that).


Your eyes are most likely going to respond to the second surgery in the same manner they responded to the first.

jazzy_jeff_1986 wrote:My doctor told me once that she's not sure if she would manage it, but some time later she told that we can make it.


I'd want to know what has changed her mind.

jazzy_jeff_1986 wrote:Glenn can You reccomend me any specialists in my region?


Visit the International Society of Refractive Surgery and check their listing. Also, ask your current surgeon for a referral.

jazzy_jeff_1986 wrote:What kind of laser would be best in my situation in your opinion? What do You think about T-CAT platform?


It would be inappropriate for me to speculate what you need in your special circumstances. A surgeon's skill trumps technology.


jazzy_jeff_1986 wrote:Yes, I used (Alphagan P) to use them when I go to the party or so in the evening. It helps me pretty much. Starburts are generally gone for a few hours, but halos a maybe just a little bit smaller.


That is a very important clue. If you still have vision quality disruption with reduced pupils, then it seems likely that the centermost area of your vision is not fully corrected.

jazzy_jeff_1986 wrote:Some time ago I tried night driving with my mother glasses (they are -0,5 D I suppose) and it made my driving better. Not very good, but better.


Another clue that your problem is not just SA, but also is simple refractive error.

jazzy_jeff_1986 wrote:Glenn can You recommend me some special kind of contacts, beyond RGP's?


Like the "which laser?" question, I'm going to leave the answer to the "which contact" to your eye doctor. I am not familiar with all contact lenses available in Poland. You may be able to get something much better than what is here in the US.
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

Re: Dim light and night vision problems

Postby jazzy_jeff_1986 » Sun Apr 10, 2011 8:07 pm

I think that she could discuss with someone about possibility of making such a re-treatment and changed her mind. She told me once that she's making enhacenments very rarely, because usually there's no such a need. I am wondering if Carl Zeiss MEL-80 is good enough for me.
I have visited the ISRS page and the is an owner of the clinic where I had my initial treatment and one surgeon of this clinic:

Jerzy Szaflik MD PhD
Specialty: Anterior Segment / Refractive Surgery
Location: Warsaw, Poland / Warsaw, Poland

Iwona Liberek MD
Profession: Solo Practitioner
Specialty: Refractive Surgery / Anterior Segment
Location: Warsaw, Poland

I think that the conclusion is that my surgeon who is working in one clinic with them shouldn't be worse specialist than these two above... My doctor is also pretty experienced - she's working as an surgeon about 15 years I suppose and as I told You before she knows my eyes the best. On the other hand I've heard that surgeons who are experienced in providing complicated re-treatments are setting laser manually little bit. So it's hard to choose the best option. I think I'm gonna wait at least till autumn I get as much information as possible. I need to get a second and maybe third opinion. Maybe I will go to England for consultation. I will be keep informing You. Thank You for for all Your advices.
Last edited by jazzy_jeff_1986 on Wed Apr 30, 2014 3:45 pm, edited 1 time in total.
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Re: Dim light and night vision problems

Postby jazzy_jeff_1986 » Mon Jul 04, 2011 7:43 pm

Dear Glenn,

I am writing to put here an update. A month ago I was in London to see a world class surgeon and ask him if he can help me. After two quick examinations he sad: "Can we help you? YES!" When he looked at my topography map he said: "ajajajaja". It was obvious for him that I have poor quality of vision. One thing was shocking for me. My doctor in Warsaw was saying to me that my optical zone is 6 mm since I had laser eye surgery in march 2008. When I asked this English doctor how big is my optical zone, he said: "4 mm, even less". I didn't know what to say. She was lying to me all teh time. I have scans of my topography one month after surgery in 2008 and my optical zone was so small immediately after surgery. There was no unusual regression. When i was in the clinic in Warsaw and talkin about my night and so on vision problems my doctor was just saying: "I don't know why do you have such a problems. It doesn't look so bad'.
In a month I am goonna have enhacement in London. One eye at a time. Right eye first, which is my dominant eye. Doc said that i will have no longer problems with night and dim light vision and at 95% a will have "0.00" refraction. He made many enhacements like in mine case. I believe he is best choice I could have done. I just need to reserve flight and hotel and fix my eyes. He is just wondering what kind of surgery should it be: EPI LASIK or LASIK. My initial surgery was LASEK, so i think EPI LASIK would be better. I think it is better to not have risks connected with making a flap. What do You think?
Another thing is after a few conversation with my friends I started thinking (I don't why so late) about suing them. The surgery was made wrong from the beginning. I haven't seen properly in the night since march 2008. And now I am gonna spend most of my savings for enhacement and everything connected with that. I'm gonna talk with some lawyer about my case. I think the clinic should help me financially as they cannot help me technically (they haven't done enhacements like this). What are my chances? What should I do? How do You think? Do You know such a cases in US? I don't know if I have any chances with clinic which propably has millions of dollars revenue yearly and can afford best lawyers. Best regards.
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Re: Dim light and night vision problems

Postby LasikExpert » Mon Jul 04, 2011 8:08 pm

Thank you very much for the update.

jazzy_jeff_1986 wrote:My initial surgery was LASEK, so i think EPI LASIK would be better. I think it is better to not have risks connected with making a flap. What do You think?


Consider most strongly the advice of your new surgen, but my opinion would be PRK only. The Bowman's layer will have been removed during the initial surgery. This second layer of the cornea provides extra strength - a reinforcement if you will - that is considered necessary by many to maintain a stable flap. The inventor of Epi-Lasik has told me directly that Epi-Lasik is not wise after a previous surface ablation and he teaches that this should not be done.

jazzy_jeff_1986 wrote:Another thing is after a few conversation with my friends I started thinking (I don't why so late) about suing them. The surgery was made wrong from the beginning. I haven't seen properly in the night since march 2008. And now I am gonna spend most of my savings for enhacement and everything connected with that. I'm gonna talk with some lawyer about my case. I think the clinic should help me financially as they cannot help me technically (they haven't done enhacements like this). What are my chances? What should I do? How do You think? Do You know such a cases in US? I don't know if I have any chances with clinic which propably has millions of dollars revenue yearly and can afford best lawyers. Best regards.


There have been malpractice cases in the US that have been successful and unsuccessful. This is not a litigation related forum, but you should probably start at the clinic. Itemize your out-of-pocket expenses and request that amount (if you think cost-only would be appropriate). The clinic may agree that it should be responsible for the cost of complicated enhancement. If not, you would need to seek the opinion of an attorney (solicitor) to determine what rights you may have and the probability of successful litigation in the appropriate jurisdiction.
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

Re: Dim light and night vision problems

Postby jazzy_jeff_1986 » Tue Jul 05, 2011 6:41 pm

Talking about reinforcement You mean crosslinking? Dr said that crosslinking is unnecessary is my case. He is going to use about 25-30 um of my cornea (in the center) and of course more at the peripherial area. He said that they do not use Mitomycin C, because of technology and skills they have. They use WaveLight Allegretto Eye-Q 400 Hz. I have to say that I am a little bit confused now... My dr in Warsaw told me that if she would provide an enhacement in my case it would be definitely surface surgery. The English dr told that he has to think about it and he is wondering between Epi Lasik and Lasik. You are saying that PRK is best solutuion in my case... What is wrong with Epi Lasik after previous surface ablation? Is it too risky or so?
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Re: Dim light and night vision problems

Postby LasikExpert » Wed Jul 06, 2011 1:26 am

jazzy_jeff_1986 wrote:Talking about reinforcement You mean crosslinking?


Not crosslinking; the Bowman's layer is a distinct part of the biomechanics of the cornea that is considered by some as necessary for the Epi-Lasik microkeratome to create a flap of epithelium.
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

Re: Dim light and night vision problems

Postby jazzy_jeff_1986 » Fri Jul 08, 2011 8:26 pm

I think I'm just gonna follow my new dr advices. But on the other hand I am really concerd about creating a flap during the re-treatment.
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Re: Dim light and night vision problems

Postby LasikExpert » Sat Jul 09, 2011 6:34 am

Relate your concerns to your doctor and listen to his advice closely.
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

Re: Dim light and night vision problems

Postby jazzy_jeff_1986 » Thu Aug 11, 2011 12:43 pm

Hello,

I'm going to put here an update. I had re-treatment done last Friday in London. It was EPI LASIK surgery. The aim of the treatment was to enlarge my optical zone so I could have better nigth and dim light vision. I have done my right eye only, which is my dominant eye. After the surgery I felt pretty well - in principle no pain. Next 3 days were much worse - light sensivity, teering and pain. On Tuesday I felt better and have been able to take a short walk in London. Talking about vision is another thing. Both close and distant vision is still poor. I can hardly read anythinng on my mobile phone. Reading anything on the notebook screan with the right eye is almost impossible. I am six days after my treatment and I started to worry if everything is fine. I know it is still early days, but if a remember well after my initial treatment in 2008 (LASEK procedure) I was doing pretty well 6 days post surgery. Glenn what do You think?
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Re: Dim light and night vision problems

Postby LasikExpert » Thu Aug 11, 2011 5:00 pm

Expect limited vision for an extended period of time while the epithelium (outermost layer of corneal cells) regenerates. The cells disturbed by Epi-Lasik are mortally wounded, but it takes time for them to die, slough off, be replaced, and then the epithelium to thicken and smooth. Function fuzzy vision is what you should expect for 3-6 weeks.
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

Re: Dim light and night vision problems

Postby jazzy_jeff_1986 » Fri Aug 12, 2011 9:17 am

Thanks Glenn. It makes me more optimistic. I guess I just need to be patient. Best regards.
jazzy_jeff_1986
 
Posts: 32
Joined: Mon Jan 31, 2011 7:46 pm

Next

Return to Had It A While Ago

Who is online

Users browsing this forum: No registered users and 1 guest