epi-lasik monvision enhancement

[marion]

I had epi-lasik monovision nearly 3 months ago and am going to need an enhancement.
I started at
R -6.25 / +1.25
L -8.50 / +2.50

I think I'm now at
R -1.25 / +.50
L -2.25 / +.50
although that might be off since the glasses I got for that prescription don't seem sharp enough now.

My surgeon is not so good at communication (I've discovered) and I need advice on what questions I should to ask to avoid needing a third surgery down the raod!

My distance eye - right eye - is awful. I can't see clearly past about 6 feet and yet can't see up close either. Some days I can read out of that eye, others I can't. My monovision eye - left eye- obviously can't see mid-range or distance, but is also really limited for up close. I'm leaning into the computer right now and it's blurry. I can read, but not always and only at one exact spot. I don't have the 1-3 foot range that is considered near vision. I don't even have "arms-length." I wear glasses to see anything important past 6 feet and I shuffle books around and switch from eye to eye to read.

So after being told "be patient" week after week, I burst into tears last appointment and got a real answer. Basically, it's not going to get better. I'm healed (I apparently heal quickly, that's something I guess) and will need an enhancement. We're going to try contacts to correct my distance eye and see if I should keep the monovision. I'm horrified of losing mid-range. I can't imagine taking off my glasses to read or drive and then putting them back on to see my desk, the computer, people at dinner, the dishes in the sink, my shoes, etc. I would think I'd be doing nothing all day but putting glasses on and off. I guess in order to have monovision, you have to give up some range of vision. Mid -range would be the worst in my opinion. If the contact thing doesn't work, we'd enhance both eyes and I would wear reading glasses.

Wearing contcts forever as a solution isn't for me. I'd wear glasses first. Contacts are too uncomfortable and fussy. My goal is as little glasses wearing as possible. That would be reading glasses or night-driving IMO.

Does this sound like a decent way to proceed? I have an appointment in a week. What other questions and concerns should I bring up? He won't offer info on his own. I had to ask about mid-range loss and then he suggested the contact lens trial. He just said, we'll do an enhancement, no mention of possible outcomes or issues.

I'm pretty unhappy to have to have surgery again. It's slow to heal and somewhat painful. Also lots of time off work for follow-up appointments, bad vision and pain. I'd sure like to get the best possible outcome this time.

[LasikExpert]

No matter how bad the outcome, it cannot be so bad that it cannot be made worse by an uncommunicative doctor.

A contact lens trial is absolutely the way to go. You need to get the exact monovision correction that works for your needs. Currently your vison should be good for very close in your left eye and moderately close in your right eye. There should be some distance from your eyes where each eye has excellent uncorrected vision. Contact lenses will adjust that distance closer or more distant to give you the vision you seek for your needs.

A good monovision contact lens trial may take several weeks and require several different powers of contacts one at a time. This process is important so the doctor knows exactly what correction to target for enhancement surgery.

Enhancement surgery is nearly identical in risk except that the flap will be able to be lifted and a new flap will not be required.

I recommend that you ask a member of the doctor's staff if there is some way to assist with the poor communication from the doctor. Perhaps a technicial is willing to take the time to provide the plain-language description of what you need to know. The doctor should be willing/able to do this, but if not, it would be better to get the information from staff than to be without the knowledge you need.

Your outcome problems seem to be primarily related to simple refractive error. This should be able to be corrected with glasses and/or contacts. The contact lens trial will probably be very helpful for you.

[marion]

Thank you for the information! It sounds like I should plan to take lots of time with the contact lens trial. I assume this means an enhancement over Xmas break is not realistic. Should I expect to try lenses in both eyes? I think my doc is planning to just give me a contact for the right eye to correct for distance and see how my eyes handle the difference.

Really, is it realistic to expect results that will allow me to read with monovision and still have 20/25 or better distance? I need to see faces clearly across a classroom and yet glance down to read a textbook. If I have to, I am prepared to enhance both eyes to distance and just go with the reading glasses. They are easier to manage than distance glasses that have to come completely off to read. Obviously though, I'd prefer to see both ways with NO glasses.

I had epi-lasik the first time. He said I'd have PRK for my enhancement. That's why I'm concerned about the slow, inconvenient and painful healing. I was off work for a week per eye the first time. I'm also worried about complications like haze, glare and halos. Is the risk greater for PRK?

Anyway, when pushed, my surgeon is OK, but he has to be pushed! It isn't that his answers aren't in plain language. They are a little too plain. He just makes meaningless reassurances and gives NO detailed information. It's almost like he feels he can't suggest that anything less than wonderful is a possibility. The non-surgeon eye doc is always in the room and it doesn't seem to make a bit of difference.

Thanks for all your help.

[LasikExpert]

It may be that the first or second contact lens fitting works perfectly and within a few weeks you know exactly what you want. It can also take much more time. Christmas is possible, but you won't know until you get there.

Attaining 20/25 distance and being able to read really is not a reasonable expectation with monovision. Being 20/40 or better distance (legal to drive in most states) and able to read is a reasonable expectation. Once presbyopia has limited the ability to focus on objects near, glasses will be needed.

Current understanding of Epi-Lasik is that it requires an intact Bowman's layer of the cornea. Bowman's is removed as a part of the laser ablation. The alternative would be LASEK or PRK. Neither is comfortable, but pain management can make things manageable. Your enhancement will be for a very small amount of change. The risk of corneal haze, glare, halos, etc will not be elevated with PRK or LASEK.

[marion]

Ah well, see that's what I mean by lack of communication. I briefly had 20/40 a week or so after surgery and did not consider that decent distance vision. I KNOW it's legal driving, but really all I could see on the road was shapes of cars and trucks and colors of lights. I couldn't read road signs until nearly under them and certainly couldn't see facial expressions or read a blackboard further than about 10 feet.

SO, monovision was never a good choice for me. Aaargh. It would have been nice to have known that upfront, although in his defense, two other clinics never mentioned that either. They all recommended monovision and said I'd have both reading and distance. I guess many people consider 10 feet "distance."

Well, thank you. This feels like the only real info I've gotten on this topic. I'll try the contacts because at this point, why not, but it looks like enhancements on both eyes for distance and then reading glasses.