Pre-and Post-Surgery Lasik Medical Records-Input Appreciated

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.

Pre-and Post-Surgery Lasik Medical Records-Input Appreciated

Postby dan1966 » Mon Jun 15, 2009 2:36 am

I'd like to share some of the medical records from my Lasik surgery with the hope that someone (Glenn, perhaps?) can help me to better understand my results. The surgery was performed a little over a year ago; I was a week shy of 42 at the time.

Would you say that my Lasik provider did everything that they should have? Does anything jump out at you, like perhaps the discrepancy between the pre-surgery Wavefront readings for the astigmatism of my left eye and the measurements they used for the actual surgery?

The results are not what I had hoped for; I'm curious if the unsatisfactory results could have been anticipated based on any of the records I've shared here. I'd like some opinions besides just my Lasik provider's. I'm afraid they might put as positive a spin as possible on, well, everything. Thank you.

Wavefront Readings

Pre-Surgery

Right Eye

OD PreOp undilated 5.39mm

Subjective Refraction: -3.00 -0.75 6°
PPR 3.50mm: -3.21 -1.28 171°
Difference: +0.21 +0.53 15°
PPR 5.39mm: -2.75 -1.25 2°

Wavefront diameter 5 mm: 0.60um 0.60um 3.37um
Wavefront diameter 6mm: ----- ----- -----

Left Eye

OS PreOp undilated 4.94mm

Subjective Refraction: -2.75 -2.50 166°
PPR 3.50mm: -2.83 -2.77 170°
Difference: +0.08 +0.27 -4°
PPR 4.94mm -2.85 -2.77 173°

Wavefront diameter 5mm: ----- ----- -----
Wavefront diameter 6mm: ----- ----- -----


Post-surgery

Right Eye

OD PostOp undilated 6.08mm

Subjective Refraction: 0.00 -0.50 145°
PPR 3.50mm: -0.11 -0.88 150°
Difference: +0.11 +0.38 -5°
PPR 6.08mm: -0.57 -0.40 149°


Wavefront diameter 5mm 0.23um 0.23um 0.71um
Wavefront diamter 6mm 0.33um 0.31um 0.97um

Left Eye (first scan)

OS PostOp undilated 5.47mm

Subjective Refraction: 0.00 -0.75 175°
PPR 3.50mm: +0.43 -2.48 176°
Difference: -0.43 +1.73 -1°
PPR 5.47mm: -0.17 -1.98 179°

Wavefront diameter 5mm 0.34um 0.33um 1.73um
Wavefront diameter 6mm ----- ----- -----


Left eye (second scan)

OS PostOp undilated 5.25mm

Subjective Refraction: 0.00 -0.75 175°
PPR 3.50mm: +0.25 -2.95 179°
Difference: -0.25 +2.20 -4°
PPR 5.25mm: -0.13 -2.23 3°

Wavefront diameter 5mm: 0.46um 0.45um 2.06um
Wavefront diameter 6mm: ----- ------ -----


Pre-surgery readings

VD=13.75mm

Right Eye

Sphere Cyl Astigmatism

-3.00 -0.50 17 8
-3.25 -0.75 5 9
-3.00 -0.75 6 9
-3.00 -0.75 6

millimeter D deg
R1 7.59 44.50 22
R2 7.41 45.50 112
AVE 7.50 45.00
CYL -1.00 22

Left Eye

Sphere Cyl Astigmatism
-2.75 -2.00 161 9
-2.75 -2.50 166 9
-2.75 -2.75 166 9
-2.75 -2.75 166 9
-2.75 -2.50 165 9
-2.75 -2.50 166

millimeter D deg
R1 7.60 44.50 171
R2 7.32 46.00 81
AVE 7.46 45.25
CYL -1.50 171

PD 66

MARCO ARK-700A


Post-surgery Readings

VD=13.75mm

Right Eye

Sphere Cyl Astigmatism
+0.00 -0.25 157 9
+0.00 -0.75 159 8
+0.00 -0.75 164 7
+0.00 -0.75 159>

millimeter D deg
R1 7.97 42.25 155
R2 7.89 42.75 65
AVE 7.93 42.50
CYL -0.50 155

Left eye

Sphere Cyl Astigmatism
+0.00 -2.00 175 9
+0.00 -1.75 178 9
+0.00 -1.75 178 9
+0.00 -1.75 178

millimeter D deg
R1 8.04 42.00 179
R2 7.73 43.75 89
AVE 7.89 42.75
CYL -1.75 179

PD 66

MARCO ARK-700A




Pre-LASIK Evaluation

Lensometry: OD: -200 -100 X 083
OS: -250 -075 X 100
(My glasses were twelve years old and I was told that the prescription was quite a bit off)

Unaided DVision OD: 20/80 OS: 20/400 OU: 20/80
NVision OD: 20/20 OS: 20/20 OU: 20/20

Aided DVision OD:20/30 -1 OS: 20/25 OU: 20/25

Dry Refraction: OD -3.00 -0.75 X 017 20/20 OS -2.75 -0.75 X 135 20/20

NVA: OD: 20/20 OS: 20/20

Wet Refraction: OD: -2.75 -0.75 X 022 20/25 OS: -2.75 -0.75 X 138 20/25 +3

Anterior Segment Examination

Schirmer: OD: 10 mm OS: 10 mm
Pachymetry: OD: 569 OS: 569
Pupil Size: OD: 7.0 OS: 6.0
DPA's: 1 gt 1% Tropicamide/1gt 2.5% Phenylephrine/1gt 1% Cyclogyl OU @ 11:45 T(a): OD: 14 OS: 14 @ 11:44 am


Post-Lasik Follow-Up (about a year after the surgery)

OD: DVA Unaided: 20/20 Dry Refraction: pl -.50 X 145 20/N1 NVA Unaided: 20/20

OS: DVA Unaided: 20/20 Dry Refraction: pl -.75 X 175 20/15 -1 NVA Unaided: 20/30

OU: 20/15 ADD +100 NVA Unaided: 20/20


SURGICAL PLAN

Pre-Operative Measurements

OD: Dry RX: -3.00 -0.75 x 017 BCVA: 20/20 Wet Rx: -2.75 -0.75 X 022 BCVA: 20/25 Avg K's:45.00 WTW:11.9 Orbs Pach: 569 Pupil Size: 7.0mm Tx Zone: 6.5mm Dominant Eye: OD

OS: Dry Rx: -2.75 -0.75 X 135 BCVA: 20/20 Wet Rx: -2.75 -0.75 X138 BCVA: 20/25+ Avg K's:45.25 WTW: 12.0 Orbs Pach: 569 Pupil Size: 6.0 mm Tx Zone: 6.5mm

OD Full: -2.70 -0.75 x 017 OS Full: -2.48 -0.75 X 135

OD: Flap: 110 Ring: 9.0 Vac.:650
OS: Flap: 110 Ring: 9.0 Vac.:650
Bed: Dry

OD: Ablation/Total Pulses: 74 um / 2144
OS: Ablation/Total Pulses: 69 um / 2028
Last edited by dan1966 on Fri Jun 19, 2009 7:28 pm, edited 2 times in total.
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More Medical Records (Orbscan and Ziemer)

Postby dan1966 » Fri Jun 19, 2009 7:17 pm

And even more medical records. I figure it's better to provide too much information than too little.

Make of these what you will:


Orbscan

One Week Prior to Surgery

OD

7.72 mm/43.7D 6.24mm/54.1D

Diff: 0.005 mm Diff: 0.033 mm
Meridian: 195° Meridian: 195°
Radius: 0.9 mm Radius: 0.9 mm

Sim K's: Astig -0.4 D @ 96 deg
Max: 45.2 D @ 6 deg
Min: 44.8 D @ 96 deg

3.0 MM Zone: Irreg: +/- 2.7 D
Mean Pwr: 44.4 +/- 1.9 D
Astig Pwr: 1.3 +/- 1.8 D
Steep Axis: 97 +/- 41 deg
Flat Axis: 15 +/- 41 deg

5.0 MM Zone: Irreg: +/- 2.8 D
Mean Pwr: 44.6 +/- 2.0 D
Astig Pwr: 1.5 +/- 2.0 D
Steep Axis: 89 +/- 44 deg
Flat Axis: 7 +/- 44 deg

White-to-White (mm): 11.9
Pupil Diameter (mm): 3.6
Thinnest: 554 um @ (-0.9, -0.2)
ACD (Ep): 3.80 mm
Kappa: 6.36° @ 186.90°
Kappa Intercept: -0.76, 0.32

Power: 45.29 D
Thick: 555 mic
Meridian: 195°
Radius: 0.9 mm

OS

7.63 mm/44.2D 6.20 mm/54.4D

Diff: 0.005 mm Diff: 0.021 mm
Meridian: 355° Meridian: 355°
Radius: 1.3 mm Radius: 1.3 mm

Sim K's: Astig -2.0 D @ 167 deg
Max: 46.1 D @ 77 deg
Min: 44.0 D @ 167 deg

3.0 MM Zone: Irreg: +/- 2.2 D
Mean Pwr: 44.9 +/- 1.6 D
Astig Pwr: 2.4 +/- 1.5 D
Steep Axis: 82 +/- 30 deg
Flat Axis: 171 +/- 30 deg

5.0 MM Zone: Irreg: +/- 2.2 D
Mean Pwr: 44.7 +/- 1.4 D
Astig Pwr: 2.4 +/- 1.7 D
Steep Axis: 86 +/- 28 deg
Flat Axis: 174 +/- 27 deg

White-to-White (mm): 12.0
Pupil Diameter (mm): 3.8
Thinnest: 562 um @ (0.6, 0.4)
ACD (Ep): 3.81 mm
Kappa: 4.83° @ 1.12°
Kappa Intercept: 0.08, 0.63

Power: 43.94 D
Thick: 571 mic
Meridian: 355°
Radius: 1.3 mm


Day of Surgery

OD


7.71 mm/43.8D 6.25 mm/54.0D

Diff: 0.006 mm Diff: 0.022 mm
Meridian: 243° Meridian: 243°
Radius: 1.0 mm Radius: 1.0 mm

Sim K's: Astig -0.6 D @ 8 deg
Max: 44.9 D @ 98 deg
Min: 44.3 D @ 8 deg

3.0 MM Zone: Irreg: +/- 1.7 D
Mean Pwr: 44.5 +/- 1.2 D
Astig Pwr: 1.3 +/- 1.2 D
Steep Axis: 92 +/- 39 deg
Flat Axis: 4 +/- 38 deg

5.0 MM Zone: Irreg: +/- 1.8 D
Mean Pwr: 44.4 +/- 1.2 D
Astig Pwr: 1.1 +/- 1.4 D
Steep Axis: 91 +/- 43 deg
Flat Axis: 175 +/- 43 deg

White-to-White (mm): 12.0
Pupil Diameter (mm): 3.8
Thinnest: 561 um @ (-0.5, -0.6)
ACD (Ep): 3.80 mm
Kappa: 6.60° @ 185.86°
Kappa Intercept: -0.71, 0.23

Power: 44.98 D
Thick: 562 mic
Meridian: 243°
Radius: 1.0 mm

OS

7.65 mm/44.1D 6.26 mm/53.9D

Diff: 0.017 mm Diff: 0.022 mm
Meridian: 343° Meridian: 343°
Radius: 1.1 mm Radius: 1.1 mm

Sim K's: Astig -1.7 D @ 174 deg
Max: 45.9 D @ 84 deg
Min: 44.2 D @ 174 deg

3.0 MM Zone: Irreg: +/- 2.1 D
Mean Pwr: 44.8 +/- 1.4 D
Astig Pwr: 2.4 +/- 1.5 D
Steep Axis: 86 +/- 29 deg
Flat Axis: 180 +/- 28 deg

5.0 MM Zone: Irreg: +/- 2.3 D
Mean Pwr: 44.8 +/- 1.4 D
Astig Pwr: 3.0 +/- 1.8 D
Steep Axis: 84 +/- 26 deg
Flat Axis: 176 +/- 26 deg

White-to-White (mm): 12.1
Pupil Diameter (mm): 3.9
Thinnest: 578 um @ (0.4, 0.0)
ACD (Ep): 3.81 mm
Kappa: 5.42° @ 353.80°
Kappa Intercept: 0.56, 0.33

Power: 44.94 D
Thick: 584 mic
Meridian: 343°
Radius: 1.1 mm


One Year After the Surgery

OD


7.96 mm/42.4D 6.16 mm/54.8D

Diff: -0.004 mm Diff: 0.031 mm
Meridian: 180° Meridian: 180°
Radius: 0.3 mm Radius: 0.3 mm

Sim K's: Astig -0.3 D @ 141 deg
Max: 42.0 D @ 51 deg
Min: 41.7 D @ 141 deg

3.0 MM Zone: Irreg: +/- 2.2 D
Mean Pwr: 41.9 +/- 1.5 D
Astig Pwr: 1.1 +/- 1.6 D
Steep Axis: 84 +/- 40 deg
Flat Axis: 174 +/- 40 deg

5.0 MM Zone: Irreg: +/- 2.2 D
Mean Pwr: 42.3 +/- 1.4 D
Astig Pwr: 1.2 +/- 1.7 D
Steep Axis: 95 +/- 41 deg
Flat Axis: 177 +/- 41 deg

White-to-White (mm): 12.0
Pupil Diameter (mm): 3.3
Thinnest: 482 um @ (-0.3, -0.3)
ACD (Ep): 3.64 mm
Kappa: 6.24° @ 187.35°
Kappa Intercept: -0.64, 0.15

Power: 41.26 D
Thick: 484 mic
Meridian: 180°
Radius: 0.3 mm


OS

7.90 mm/42.7D 6.17 mm/54.7D

Diff: -0.000 mm Diff: 0.038 mm
Meridian: 322° Meridian: 322°
Radius: 0.8 mm Radius: 0.8 mm

Sim K's: Astig -1.7 D @ 1 deg
Max: 43.1 D @ 91 deg
Min: 41.4 D @ 1 deg

3.0 MM Zone: Irreg: +/- 1.7 D
Mean Pwr: 42.5 +/- 1.1 D
Astig Pwr: 2.1 +/- 1.3 D
Steep Axis: 90 +/- 23 deg
Flat Axis: 1 +/- 23 deg

5.0 MM Zone: Irreg: +/- 2.0 D
Mean Pwr: 42.9 +/- 1.2 D
Astig Pwr: 2.4 +/- 1.7 D
Steep Axis: 88 +/- 24 deg
Flat Axis: 2 +/- 24 deg

White-to-White (mm): 12.0
Pupil Diameter (mm): 3.5
Thinnest: 484 um @ (0.6, -0.4)
ACD (Ep): 3.61 mm
Kappa: 5.37° @ 351.70°
Kappa Intercept: 0.44, 0.06

Power: 41.46 D
Thick: 485 mic
Meridian: 322°
Radius: 0.8 mm



Ziemer Galilei Dual Scheimpflug Analyzer

Day of Surgery

OD

Axial Curvature

n=1.3375 ROI=1-4(mm)

SimKavg: 44.75 D (7.54 mm)
SimKf: 44.46 D (7.59 mm)
SimKs: 45.04 D (7.49 mm)
Astigmatism: 0.58 D @ 91.0°
E^2 = 0.09

Posterior Axial Curvature

n=1.376 ROI=1-4(mm)
Kavg: -6.61 D (6.05 mm)
Kf: -6.39 D (6.26 mm)
Ks: -6.84 D (5.85 mm)
Astigmatism: -0.45 D @ 84.0°
E^2 = 0.13

Total Corneal Power (Ray Traced)

ROI=1-4(mm)

Mean: 44.20 D
Flat: 44.04 D
Steep: 44.36 D
Astigmatism: 0.32 D @ 125.0°

Corneal Pachymetry

Central Avg: 576 um (ROI=0-4 mm)
Paracentral Avg: 632 um (ROI=4-7 mm)
Peripheral Avg: 725 um (ROI=7-8 mm)

Thinnest Pachymetry:
Location x,y -0.82 mm, 0.37 mm
Thickness: 560 um

Axial Curvature

n=1.3375

Central Avg: 44.81 D (ROI=0-4 mm)
Paracentral Avg: 44.63 D (ROI=4-7 mm)
Peripheral Avg: 44.18 D (ROI=7-8 mm)

Pupil

Avg Diameter: 2.33 mm
Center x,y -0.10 mm, 0.83 mm

Limbus

Nasal-Temporal: 12.55 mm
Superior-Inferior: 11.54 mm



OS

Axial Curvature

n=1.3375 ROI=1-4(mm)

SimKavg: 45.33 D (7.45 mm)
SimKf: 44.71 D (7.55 mm)
SimKs: 45.94 D (7.35 mm)
Astigmatism: 1.23 D @ 88.0°
E^2 = 0.19

Posterior Axial Curvature

n=1.376 ROI=1-4(mm)
Kavg: -6.59 D (6.07 mm)
Kf: -6.35 D (6.30 mm)
Ks: -6.82 D (5.87 mm)
Astigmatism: -0.46 D @ 90.0°
E^2 = 0.05

Total Corneal Power (Ray Traced)

ROI=1-4(mm)

Mean: 44.81 D
Flat: 44.36 D
Steep: 45.26 D
Astigmatism: 0.91 D @ 87.0°

Corneal Pachymetry

Central Avg: 581 um (ROI=0-4 mm)
Paracentral Avg: 632 um (ROI=4-7 mm)
Peripheral Avg: 725 um (ROI=7-8 mm)

Thinnest Pachymetry:
Location x,y 0.79 mm, 0.13 mm
Thickness: 568 um

Axial Curvature

n=1.3375

Central Avg: 45.14 D (ROI=0-4 mm)
Paracentral Avg: 44.68 D (ROI=4-7 mm)
Peripheral Avg: 43.66 D (ROI=7-8 mm)

Pupil

Avg Diameter: 2.30 mm
Center x,y 0.34 mm, 0.51 mm

Limbus

Nasal-Temporal: 12.63 mm
Superior-Inferior: 11.58 mm
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Postby LasikExpert » Fri Jun 19, 2009 8:46 pm

There is nothing here that jumps at me, but emember that I'm not a doctor.

You had mild myopia (nearsighted, shortsighted) vision pre surgery. After surgery you have astigmatism and the paracentral cornea is slightly more myopic than center. Your vision should be good, but not quite perfect. You should be able to be corrected with glasses or contact lenses.

This may be a very small amount of change for enhancement surgery, but you may want to discuss this and other options to your surgeon.
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Nidek Ark-700A measurements

Postby dan1966 » Thu Jul 02, 2009 8:59 pm

I gave so much information that I think it probably was overkill. I'll try to narrow it down here.

For the right eye, there were four dry readings, with the sphere at -3.00 for three and -3.25 for one, cylinder was -0.75 for three and -0.50 for one, and axis was 17, 5, 6, and 6. For the left eye, there were six dry readings, with the sphere at -2.75 for all six, the cylinder at -2.50 for three, -2.75 for two, and -2.00 for one, and an axis of 166 for four, 165 for one, and 161 for one. Cyclopegic was -1.00 for astigmatism at an axis of 22 (there were two readings, one was 22 and one was 112-for some reason they went with 22) for the right eye and -1.50 at an axis of 171 for the left eye (one reading was 171 and one was 81).

On the Surgical Plan sheet, the right eye's Dry Rx is listed as -3.00, -0.75 x 017 and the Wet Rx is -2.75, -0.75 x 022. The left eye's Dry Rx is listed as -2.75, -0.75 x 135 and the Wet Rx is -2.75, -0.75 x 138. The Tx (treatment) for the right eye is listed as -2.70, -0.75 x 017 and for the left eye as -2.48, -0.75 x 135.

Questions:

1. Given that the cylinder measurements for the left eye ranged from -2.00 to -2.75, why would they have listed it as -0.75 on the surgical plan? I also don't know where the axis of 135 and 138 came from, given that they were 22 and 171 according to Nidek. I suspect they made a careless mistake. I can't figure out any other explanation. Why else would they have used the Nidek measurements for the right eye but not the left?

2. Is it common for measurements to range so much? It seems far from precise. Cylinder measurements ranging from -2.00 to -2.75 seems like a significant difference. Of course, when they then disregard those measurements and use -0.75, I guess it doesn't matter much.

3. Based on the dry and wet Rx, why did the surgeon decide to go with -2.70, -0.75 x 017 for the right eye and -2.48, -0.75 x 135 for the left?

My left eye has been a problem ever since I had the surgery. Maybe the explanation is as simple as that they used the wrong measurements for the procedure. I will give them a call about this soon. I'd like to hear what anyone here (and that pretty much means Glenn Tagele) thinks about this. As I stare at the computer screen, I feel the all-too-familiar strain on my left eye, which leads to a feeling of pressure on my left temple. If this is a result of their carelessness, well, it's a tough pill to swallow. Both eyes are also dry, have poor contrast sensitivity, and ghost imaging. As you might guess, I'm not real thrilled with the outcome.

I did my homework (or so I thought) and went with what I thought was the best Lasik provider in my area. There's only so much you can do, though. Then it's in their hands.
Last edited by dan1966 on Thu Jul 02, 2009 10:52 pm, edited 1 time in total.
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Re: Nidek Ark-700A measurements

Postby LasikExpert » Thu Jul 02, 2009 9:15 pm

dan1966 wrote:1. Given that the cylinder measurements for the left eye ranged from -2.00 to -2.75, why would they have listed it as -0.75 on the surgical plan?


I cannot think of a reason for this. A small reduction in cyl correction when the cyl and sphere are nearly the same would be reasonable, but not this much reduction.

dan1966 wrote: I also don't know where the axis of 135 and 138 came from, given that they were 22 and 171 according to Nidek.


This may be an artifact of the laser they use and/or an issue with plus and minus cyl prescriptions.

dan1966 wrote:2. Is it common for measurements to range so much?


Surprisingly, yes. A fluctuation of 0.25 diopter is normal for humans. From machine to method and from hour to hour a change like this can occur. It may also relate to the amount of dilation of you pupils - thereby exposing more of the astigmatic irregularity when dilated.

dan1966 wrote:3. Based on the dry and wet Rx, why did the surgeon decide to go with -2.70, -0.75 x 017 for the right eye and -2.48, -0.75 x 135 for the left?


Except for the cyl correction, I suspect that the differnce relates to that specific surgery and machine. Even the atmoshperic pressure and relative humidity can affect the outcome and most doctors make small changes to accommodate these issues, based upon their previous experiences.

What you really need are straight answers from your surgeon. That is the only one who can explain the thinking behind the decisions. Why not give a copy of this thread to him/her? There may be more method in this madness than you or I realize.
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Postby dan1966 » Thu Jul 02, 2009 9:25 pm

Thank you, Glenn. I think I'll do that. Up to this point, I have only dealt with people who work at his office since the surgery. There is an optometrist there who takes care of the post-operation stuff. I met my surgeon right before the procedure and haven't seen him since. The woman who takes care of the post-op stuff answers my questions but doesn't seem to have enough curiosity to try to figure out what went wrong. She's very passive in her attitude. Other than when I've been in the office, I'm guessing my files haven't even been looked at. It's easy for them to move on. It's harder for the patient when his eyes tell him every day that something is wrong. Vision is hard to ignore. It's always a part of your life.

One more question: You say that a fluctuation of 0.25 diopters is normal. What about 0.75 diopters, which was the range for my left eye's cylinder? What would account for such a difference? These were taken one right after the other. It doesn't really matter since they didn't make use of those measurements, anyway. I'm just curious. It shows that the measurements are less precise than I had thought. There can only be one correct measurement, right? I guess not.

If I knew then what I know now I would have asked many more questions prior to the surgery. The problem is that I didn't know enough to know what questions to ask. I did my share of research, but apparently not enough. I didn't even think to ask to see the various measurements they had taken. Only then would I have seen that they fluctuated. Warning bells would have gone off immediately in my mind. Hmmm, this is more of an art than a science, I would have thought.

On a personal note, it was three years from the time I decided to get Lasik to when I actually wound up getting it. Part of this delay was fear of the unknown. I did my share of research on the net and decided to go with someone I thought was well-qualified. My sister, on the other hand, did very little research, and went with the first Lasik provider she came across. Her eyes turned out perfect. No problems at all. Her vision was slightly worse than mine prior to the surgery, too. Never underestimate the power of chance (or luck) in people's lives. You can only control so much.
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Postby LasikExpert » Sun Jul 05, 2009 10:31 pm

dan1966 wrote:One more question: You say that a fluctuation of 0.25 diopters is normal. What about 0.75 diopters, which was the range for my left eye's cylinder?


This is not within the normal range and would indicate that a third measurment would be wise to determine what is most correct.

dan1966 wrote:If I knew then what I know now I would have asked many more questions prior to the surgery. The problem is that I didn't know enough to know what questions to ask.


That is a major reason why we are here and our 50 Tough Questions For Your Lasik Doctor.

dan1966 wrote:I did my share of research, but apparently not enough.


At some point one must accept that the expert knows what the expert should know, and that some details may be best left up to the expert. You are paying for the doctor's knowledge. Selecting the best available doctor is the most important research.

dan1966 wrote:Never underestimate the power of chance (or luck) in people's lives. You can only control so much.


It is often said that it is better to be lucky than good.
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Postby dan1966 » Mon Jul 06, 2009 9:31 pm

This is not within the normal range and would indicate that a third measurment would be wise to determine what is most correct.

They actually took six measurements. It was -2.50 for three of them, -2.75 for two, and -2.00 for one. The cyclopegic reading was -1.50. After all that, they inexplicably (to me) had it listed as -0.75 on the surgical plan. Since my left eye still is quite astigmatic I'm wondering if that's the main problem. As it turned out, both eyes were about as astigmatic as they had been prior to the surgery. And they were that way immediately after the surgery so it wasn't because of regression.

That is a major reason why we are here and our 50 Tough Questions For Your Lasik Doctor.

I actually had visited this site prior to the surgery and was satisfied that my surgeon had met all of the requirements.

At some point one must accept that the expert knows what the expert should know, and that some details may be best left up to the expert. You are paying for the doctor's knowledge. Selecting the best available doctor is the most important research.

My surgeon was certified by USA Eyes, which added to my confidence. I think I did everything I could reasonably have been expected to do before choosing surgeons. Sometimes things just don't work out as we want them to. This isn't a case where I'm kicking myself over what I should have done. At this point, I just want to figure out why my eyes aren't quite right-particularly the left one-and whether they did everything they should have done to maximize the chances of the optimum outcome. If they did everything they should have and my eyes were destined to have issues no matter what, that's ok. If they didn't, though, that's another story. And if they made a careless mistake and actually used the wrong measurements for the surgery (-0.75 rather than -2.50), that's REALLY another story. I'm not sure what options are open to me if I find out that my problems have more to do with their carelessness than anything else.
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Postby LasikExpert » Mon Jul 06, 2009 10:21 pm

The surgery target being so low for the astigmatism is odd and needs to be explained by the surgeon.

Using our 50 Tough Questions For Your Lasik Doctoror selecting a surgeon whose Lasik results have been certified by our organization ar two steps to help find the better surgeon, but a sad reality is that surgery is surgery and there is no such thing as a perfect surgery any more than there is a perfect surgeon. Even if you are in a minority, it's 100% if it is you.

Much of your vision difficulties are going to relate to the uncorrected astigmatism. Your potential vision after enhancement surgery can be simulated with a refraction (which is better, one or two) and getting glasses while your eyes settle and you decide what to do will undoubtedly be helpful.
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Postby dan1966 » Wed Jul 08, 2009 6:59 pm

I asked this in another post but it hasn't been answered yet so I'll ask it here. Given that the results of the Schirmer test given to me prior to the Lasik procedure were 10 mm for both eyes, why would I still have dry eyes over a year after the procedure? I think my eyes may have been drier than they thought, though. I couldn't keep my eyes open for very long without needing to blink.

After reading some things on the net, I now know that the Schirmer test can be misleading.

I rarely have any of the symptoms associated with dry eyes-burning, itching, pain, redness. My main symptom is that my vision gets worse during the course of the day. I also have noticed that my eyes seem to feel dry if I watch TV in the dark, even if I do this early in the day.

I'm sorry to ask so many questions. I think part of it is that I'm putting off asking these questions of the Lasik provider because I'm afraid that I won't like the answers. This whole thing has been disheartening to me. I had a checklist of things I wanted to do in my life. Lasik was one of the toughest. I thought that the only thing I had to fear was fear itself since it seemed that the overwhelming number of cases turned out well. I'm afraid of the unknown. Always have been, probably always will be. So I finally work up the nerve to have the procedure done and I wind up with issues that are hard to figure out. So I can't move on with my life. As I sit here staring at this screen, I feel pressure on the left side of my temple. This is probably related to a head injury I sustained about twenty years ago-the fact that my vision is off in my left eye may aggravate this condition. I have felt an odd sensation (and it's hard to describe, which only makes things more frustrating) on/in my left eye immediately following the surgery and it hasn't changed. Yes, I have issues with the right eye, too, but at least I don't feel any odd sensation with it. The focus just isn't great with it some of the time and, by the end of the day, it is quite blurry. In fact, by the end of the day, my left eye's vision is almost always sharper than my right one's. Maybe it's better in dim lighting than my right one is. Bright light, go with the right. Dim light, left is beft, err, best.

Worst case scenario: I have a comprehensive eye exam and they can't figure out why I'm having the visual problems that I am. The pressure-mild pain, which often leads to headaches later in the day, just complicates matters. How much of a factor is the head injury? Can this pressure, which I had felt periodically prior to the surgery, also be playing a part in my visual woes? Ugh. It's frustrating to not be able to put things into words. How does one describe a sensation? I shouldn't be feeling the left eye at all. And according to a test given about a month ago, my right eye is drier than my left one, anyway, so it's not likely that the dryness is accounting for the sensation. Maybe it is just the astigmatism, though according to another test, it's only slight more severe in my left eye than my right, subjectively, anyway (-.75 vs. -.50, though there is a big difference in the PPR).

I'm sorry to ramble. For the time being, this is a combination of seeking information and venting. And also working things out for myself as I write them out here. Figuring this all out has been like peeling an onion. I keep finding new layers and it makes me cry.

Thanks for your help, Glenn. I appreciate it. With a little luck, I will eventually find a solution to my problems.
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Postby LasikExpert » Thu Jul 09, 2009 6:30 am

dan1966 wrote:Given that the results of the Schirmer test given to me prior to the Lasik procedure were 10 mm for both eyes, why would I still have dry eyes over a year after the procedure?


Schirmer test measures the quantity of tears. Ten is a bit low, but not so low to be considered seriously problematic.

dan1966 wrote:I couldn't keep my eyes open for very long without needing to blink.


That indicates a short tear break-up time, which indicates a lipid deficency. If you read about dry eye treatment you will see that flax seed oil supplements are often appropriate for low lipids, along with warm compress and/or the medication Restasis.

dan1966 wrote:I thought that the only thing I had to fear was fear itself since it seemed that the overwhelming number of cases turned out well.


This is absolutely true, but it is of little consolation if you are one of the small percentage with a Lasik complication.

dan1966 wrote:The pressure-mild pain, which often leads to headaches later in the day...


Did you read our article on Lasik eye strain?

dan1966 wrote:Can this pressure, which I had felt periodically prior to the surgery, also be playing a part in my visual woes?


Sure. Pressure often relates to inflammation. You may have sinus inflammation, inflammation around the eye globe, etc. This is where non-steroidal anti-inflammatories like ibuprophen can be helpful.

dan1966 wrote:How does one describe a sensation?


The same way one describes the color blue. You cannot. You can only experience it or emphasize.

dan1966 wrote:I'm sorry to ramble. For the time being, this is a combination of seeking information and venting.


This is a pretty good place to vent. It is not likely that anyone is going to try to push any agenda on you and many have been where you are and know the frustration and fear.

dan1966 wrote:Thanks for your help, Glenn.


I'm glad to be of whatever assistance I am able.
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Postby dan1966 » Mon Jul 13, 2009 3:18 am

Do you have any suggestions on who would be willing to take a look at my Lasik medical records and give me some idea of why my results did not turn out very well. Would an opthalmologist do that? An optometrist? Another Lasik surgeon? I want to consult someone who is knowledgable and up on all the latest Lasik research.

Ideally, this person would look at all of my records and let me know whether my provider was thorough in every step of the process. They would also perform a thorough eye exam and advise me on what future action could be taken. Any idea who might fit the bill?

Thank you
dan1966
 
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Postby LasikExpert » Wed Jul 15, 2009 9:19 pm

I'd recommend a corneal specialist or refractive surgery specialist at a university affiliated teaching hospital.
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