Refractive power of artificial tears

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Refractive power of artificial tears

Postby tlwilson » Wed Jun 24, 2009 12:55 am

I have a weird observation and question. I am 2.5 weeks postop after having had Wavelight lasik. I have been very disappointed in my vision but everyone says to be patient. My visual acuity at a doctor's visit on Friday was 20/30 in the left and 20/60 in the right. My eyes are very dry and I am on the computer a lot and under fluorescent lights all day long. I printed an eye chart and put it in a well lit room and my vision stays 20/30 & 20/60 consistently. Here's the weird thing. Tonight I put drops in and immediately thereafter I could see 20/20 in the left and 20/30 in the right. The tears weren't pooled in my eyes, my eyes were just very moist. Could the dryness be causing me that much blurring? I already go through tears like crazy. I need an automatic eye lubricator attached to a ball cap or something! Or was it merely that the liquid in my eyes was providing some refraction?
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Postby Tom » Wed Jun 24, 2009 8:54 am

I experience pretty much the same thing.

My right eye is clear. My left eye remains blurry, however, whenever I put the artificial tears into my left eye it becomes as clear as the right but just for a few seconds. One or two blinks and it goes back to being blurry.

I'm very interested to hear what the LasikExpert has to say. Is the 2 second window of clarity I experience after applying artificial tears due to the refaction of the artificial tears, or is it simply because my eye is not being lubricated enough without them? And if the short lived clarity is due to the artificial tears, why does it fade with a few blinks when surely the eye remains moist for longer than that.

I am 2 weeks post op. Would you expect my left eye to eventually stabilise so that I can see as clearly through it as I do my right eye.
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Postby It's Just Me » Wed Jun 24, 2009 3:35 pm

It smoothes out the cornea when you apply tears. simple answer really :) Just like lasik smoothes it out, so do the tears. Temporarily, though.
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Postby LasikExpert » Wed Jun 24, 2009 4:09 pm

In addition to smoothing the refractive surface of the cornea by filling in all the crevices of a dry cornea, artificial tears also thicken the refractive properties of the cornea slightly. This can create a myopic (nearsighted, shortsighted) shift.

It is much more likely that the improvement in vision is due to improved quality of vision from smoothing than improved quantity of vision from thickening. Any effect of thickening can be duplicated with lenses. The effect of smoothing will not be changed by lenses.
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Postby tlwilson » Wed Jun 24, 2009 4:41 pm

Since a flap is created with Lasik the outer surface of the cornea wasn't altered, correct? The smoothing effect is taking care of dryness then? I assume I had a smooth corneal surface before Lasik since drops didn't have this effect. If this is correct, then I should be able to see better with improved tear production. Artificial tears just aren't as good as one's own tears.
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Postby LasikExpert » Wed Jun 24, 2009 5:03 pm

Your analysis and assumptions all seem to be correct.
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Postby Tom » Thu Jun 25, 2009 7:48 am

So would I be correct is saying that as your eyes lubricating ability improves (i.e. as you start to produce more of your own tears) your vision should clear as the "dry corneal crevices" are "smoothed out" naturally?

Is it usual to have "corneal crevices" causing blurriness after Lasik and do they heal?

How long does it take for "dry eye" to subside? Can you have dry eye without knowing you have dry eye - my eyes don't feel dry at all but yet the blurriness in my left eye remains.

Typically where one eye is blurry and one eye is clear, how long does it take for the blurred eye to clear?

Is this all really part of the healing process? Everyone I've spoken to that has had this procedure has talked of an instant fix. My experience so far has been quite stressful.

Some survivor stories would be good comfort if anyone has them.
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Postby LasikExpert » Thu Jun 25, 2009 4:14 pm

Tom wrote:So would I be correct is saying that as your eyes lubricating ability improves (i.e. as you start to produce more of your own tears) your vision should clear as the "dry corneal crevices" are "smoothed out" naturally?


Yes

Tom wrote:Is it usual to have "corneal crevices" causing blurriness after Lasik and do they heal?


Lasik related dry eye is probably the single most common complaint in the immediate healing period.

Tom wrote:How long does it take for "dry eye" to subside? Can you have dry eye without knowing you have dry eye - my eyes don't feel dry at all but yet the blurriness in my left eye remains.


This varies greatly. You may want to look at our article on Lasik dry eye.

Tom wrote:Typically where one eye is blurry and one eye is clear, how long does it take for the blurred eye to clear?


This too varies greatly.

Tom wrote:Is this all really part of the healing process?


Absolutely.

Tom wrote:Everyone I've spoken to that has had this procedure has talked of an instant fix.


Ahhhhh. The grace of poor memory. My bet is that if you talk with your friends who had Lasik you will find that they too had transient problems like you describe, but perhaps not as bad. Everybody heals differently.

Tom wrote:Some survivor stories would be good comfort if anyone has them.


See Lasik Results. On the second page you will find a graph for the dry eye complaint.
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Postby It's Just Me » Wed Jul 01, 2009 4:45 am

Not necessarily. I don't have dry eyes now, and my eyes are very clear without using artificial tears. When I needed an enhancement, I used the tears and noticed that for about 2 minutes after I applied them, I could see very clearly, they "smoothed out" the cornea...that's my take on it, and what my doctor told me.
since my enhancement on April 30th, my eyes have been totally clear 20/20 vision. The blurriness meant I needed further correction, not that my eyes were dry....
:)

Tom wrote:So would I be correct is saying that as your eyes lubricating ability improves (i.e. as you start to produce more of your own tears) your vision should clear as the "dry corneal crevices" are "smoothed out" naturally?

Is it usual to have "corneal crevices" causing blurriness after Lasik and do they heal?

How long does it take for "dry eye" to subside? Can you have dry eye without knowing you have dry eye - my eyes don't feel dry at all but yet the blurriness in my left eye remains.

Typically where one eye is blurry and one eye is clear, how long does it take for the blurred eye to clear?

Is this all really part of the healing process? Everyone I've spoken to that has had this procedure has talked of an instant fix. My experience so far has been quite stressful.

Some survivor stories would be good comfort if anyone has them.
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Postby DocH » Tue Jul 07, 2009 12:08 pm

I am now about 4 weeks from surgery and I am just now having the 'better vision with drops effect'. Before they just made things even more blurry.
I am looking at this as a good sign in that I may be producing tears myself.
My vision is still not great (20/30 ish and 20/50-6ish) but I feel it is now getting a bit better daily rather than getter worse (ie last last week!)
Hang on it there and please post an update on your current vision.
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Postby tlwilson » Tue Jul 07, 2009 12:44 pm

I am seeing progress. I have tried a lot of different drops, gels and ointments and find that Thera Tears works the best for me. Thera Tears recommends saturating the eyes with the contents of an entire preservative free application in a 5 minute span, 4 times a day. By using the saturation method, I can see 20/15 all the time in the left. I can usually see 20/20 to 20/30 in the right after saturation, but it doesn't last very long, but it is more than just a couple of blinks now. I have only been doing the saturation with Thera Tears for a short time. I will keep it up and report progress.

Any kind of gel or ointment keeps me blurry. I suspect they are keeping the drops from "soaking in". I'm interested in whether others think this is a possibility.
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Postby DocH » Tue Jul 07, 2009 5:15 pm

Interesting, what is your av without the 'tear advantage' in your Right?
I asked my Doc about preservative free and he didn't seem to think it made too much difference aafter Lasik.
I am using 'thick drops' hourly (1 drop) how much are you using for your saturation method?
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Postby DocH » Tue Jul 07, 2009 8:41 pm

Addition to last comment.
I was going to try and adapt the drops I already have but I think the volume you use must be quite large
Did you find a big improvment (in comfort) with the saturation technique?
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Postby It's Just Me » Wed Jul 08, 2009 1:05 am

I really think that if you need drops to see well....the surgery wasn't as successful as it could have been. Drops worked for me for a couple of minutes until I had my enhancement. No more drops needed. 20/50-60 in one eye is a candidate for enhancement in the clinic I had mine done in.
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Postby DocH » Wed Jul 08, 2009 12:05 pm

To itsjustme
It's much too soon to even think of an enhancement. I am only 4 weeks post-surgery.
Also I know it worked well for you but with my eyes the risks may be too high.
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