LASIK Aug 15 - Steroid Induced High IOP & Uveitis

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LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Fri Sep 18, 2009 7:32 pm

Hello from Kuwait

Thank you for this forum. It really was helpful reading all the experiences here

I had LASIK on Aug 15. Doctor put me on TobraDex 2 Drops every 2 Hours for the firs day. Second Day he reduced the dosage to 4 drops a day but I mis understood & but 2 drops in each eye 4 times a day. After a week the doctor measured My eye pressure & noted it was a little high. He gave me Alphagan 2 drops a day to control the IOP and asked me to take the topradex 4 times a day for 1 week (one drop each time), then gradually reduce the dosage by one drop every week.

By the end of the 4th week I started to have blurred vision & went to see the doctor. My IOP was 40-Right Eye 42-Left Eye so he told me to stop the Tobradex immediately (I`m a steroid Sensitive) and gave me TIMOPTOL 2 Drops a day & increased the Alphagan to 3 drops a day. After 3 days he measured my IOP & it was 10-12. He also noticed that I have developed Uveitis in both my eyes. He said I must take FLUCON 6 times a day to heal the Uveitis & keep taking the other medication to reduce my IOP.

IS this the right course of treatment? is there any other medications (Non-Steroid) to use instead of FUCON? Will my Uveitis take long to heal with this medicine? Will the high IOP for a few weeks cause Glaucoma? The doctor checked my retina & says its OK for now but will it get damaged while I use the steroid?

I`m 42 years old & cant really remember my measurement before the operation. I think I was 4 something & 5 something with astigmatism in both eyes. My las measurement post OP was +.25 in both eyes

Also I have a problem when my eyes are dilated for the exam. I was tested 3 days before my operation & until the day of the OP I was having Starburst & blurry vision. I told the Doctor about that just before the OP & he told me it would not effect the outcome of the operation. After my last check 2 days ago I`m still having blurry vision & major Glare & Starburst. I called the doctor yesterday & he told me that the effect of the dialation will last for 48 hours. Will, its 48 hours now & the effect is still there. What is bothering me is that the effects are similar to the ones I had when my IOP went high so now I would not know if my IOP goes high

We have 10 days holiday now. My appointment with the doctor is after 10 days & I`m really terrified that something might go wrong during this time.

Actually since my operation I never had a clear vision. Allways blurry in all distances

I really appreciate some help with this before I go crazy :)
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Thu Sep 24, 2009 11:32 am

I really panicked two night ago

I had a severe headache that prevented me from sleep. By 4 in the morning I decided to go to the emergency room in the Ophthalmology hospital thinking that my eye pressure was so high that I will go blind.

I told the doctor there my story & the medications I`m taking. He checked my eye pressure & it was normal 16-18 & the Uveitis has subsided considerably & only a spec or 2 still remaining.

He asked me for the name of the doctor whom did my LASIK & when he heard the name he smiled. He told me that my doctor is one of the leading Glaucoma specialist in the country & that the course of action taken by him was the safest one.

He suggested that my headache might be due to Sinuses or high blood pressure & suggested I see an ENT specialist.

Well, this news really made most of my fears go away. I had my blood pressure checked & it was normal. I still didn't go to an ENT specialist yet but I think I know what caused the severe headache. I went for over 30 hours a day prior without sleep & the night before I really didn't get much sleep. Combine that with me thinking all the time about my eye pressure & that might have caused the dramatic increase of my headache. After a good sleep my headache is much less now but I have noticed that when I`m in front of the computer my headache gets worst.

I will see my doctor after 3 days & hopefully by then my Uveitis is gone & I can start to reduce the steroid gradually.

I will keep on reporting my progress to help others whom might have the same complications I have.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Mon Oct 05, 2009 11:14 am

Some good news

The Uveitis had subsided considerably & now my doctor has reduced my steroids to 2 drops a day while maintaining the same dosage of the Glaucoma meds. I`m to see him next week to see how things develop.

Can`t believe the mental relieve I got after this development. Finally my constant fear of my eye pressure being high is gone & able to have some normality in my life. My blurry vision dues not seem to bother me anymore as it seems like something I can live with compared to the fear of losing my eye sight completely. Actually my last test was 20/20 though the line was not clear. There is still some over correction +0.5 in both eyes but I`m not really worried that much about it as my eyes never really got the chance to heal correctly since my operation. Hopefully when I`m off all the medications my eyes will heal properly & will reach plano.

Have to concentrate more now on my dry eyes. Have tried every preservative free tears I could find but none of them gives me more than a few minutes of relieve. Mind you I live in a desert environment so everything is conspiring to make my dry eyes worst. Hot dry sandy weather outside & constant A/C indoors. My work environment is even worst being a smokey workplace. Its something I have to live with & I`m sure I will overcome it & with time it will get better.

Will keep updating this thread as thing develop
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Fri Oct 16, 2009 12:20 pm

Been to my Doctor last Tuesday

Uveitis is almost gone & now I`m on 1 drop of steroid a day with Alphagan 3 times to control my IOP. No more Timolol which was increasing the symptoms of my dry eyes but was really effective in lowering my IOP. Just hoping that Alphagan will be enough to keep my IOP low.

After complaining about my blurry vision the Doc but two lenses in front of my eyes & asked do you see better now. When I said yes he said that I`m over corrected by +1 in both eyes & that it will regress to plano. Mean time I can use a +1 reading glasses to help with my vision. Well, the readers do help with my short & middle vision to a degree but dues not really help while driving at night except making my car dashboard clearer.

Don`t really know about this regression thing. I`m 2 months post-op & +1 looks like a big number for my eye to regress. Could my eye really regress by 1 diopter in the coming weeks? has anyone else had this kind of over correction that regressed after 2 months?

The Doc tells me its a good thing that I`m over corrected. In this way my eye will regress down toward plano but if I was under corrected I will not reach 20/20. Well I understand from what I read here that the Doctors will plan such over correction but mainly for patients with high refractive error over -6 but my eyes were -5 & -4 & the doc should not expect my eyes to regress enough to justify the 1 diopter over correction !!

As for my dry eyes, during the last 2 weeks a have been aggressively managing the symptoms. I have used every brand available here of preservative free eye lubricants & use them whether I feel my eye dry or not. The best I found is a German brand called Artelac Advanced but it`s so expensive that I cant afford to use it all the time. The second best is BLINK Intensive Tears. It`s thick enough to coat the eye but dues not make my vision blurry. It`s not cheap so I stick to 2 or 3 vials a day & able to get 3 or 4 drops in each eye from each vial. Systane is ok but it makes my eye a little blurry. I do get a lot of drops from each vial so I tend to use it when I don't really need that much of a clear vision & could use the whole vial within 2-3 hours. Refresh Plus it the cheapest of the lot. I use it when I`m out of the house or when I`m driving. I also use it to wash my eyes after using my medication. It dues not effect my vision but its lubricating effect dues not last more than 5-10 minutes. My doctor also suggested a Gel that contain preservative that I can use 3 times a day. This Gel really help especially at night. Since using it I wake up in the morning with my eyes feeling less dry than I ever felt since my operation. The amazing thing about it is that it dues not blurr my vision.

I also bought a Google to wear while in the house to help keep my eyes moist. The A/C in the house is a must but really bad for my eyes. It helps to a degree but cant really use it when I`m in front of my PC as I need to wear my reading glasses. I cant control my work environment & that where my real problem is. So I stick to lubricating my eyes as much as possible to keep them wet & taking as much breaks as I can.

I`m to see my doctor by the beginning of November. Hopefully there will be some good news then & I can finally be off all the medications & let my eye heal naturally.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby LasikExpert » Wed Nov 04, 2009 4:38 pm

alwaleed wrote:Don`t really know about this regression thing. I`m 2 months post-op & +1 looks like a big number for my eye to regress. Could my eye really regress by 1 diopter in the coming weeks? has anyone else had this kind of over correction that regressed after 2 months?


Because of the strong steroid response your eyes are likely very angry. High IOP can induce refractive changes, commonly a shift toward hyperopia (farsighted, longsighted) vision. As the elevated IOP resolves and your corneas heal it is very likely you will see a reduction in your refractive error.

alwaleed wrote:As for my dry eyes, during the last 2 weeks a have been aggressively managing the symptoms. I have used every brand available here of preservative free eye lubricants & use them whether I feel my eye dry or not. The best I found is a German brand called Artelac Advanced...


Apparently Bausch & Lomb's Artelac has Hydroxypropyl Methylellulose, which is the same active ingredient in several artificial tears. The Artelac Advanced EDO and Artelac Advanced MDO use Hyaluronic Acid as an active ingredient, which is the same as Blink Tears.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Thu Nov 05, 2009 9:01 am

Thank you so much Glenn for the information

I was told the same thing by my doctor during my last visit a few days ago. The high IOP has caused the overcorrection & astigmatism

The good news is that my Uvities has resolved completely & my IOP is at 11 which is where the doctor wants it. But I'm not off Steroids yet. He wants me to keep using it one drop every other day for the coming month & Alphagan 2 time a day.

Don't know why he still want me to use steroids but I think he wants to delay my eyes healing for as long as possible in the hope that my eyes will regress toward plano before healing completely. Is this a correct assumption Glenn?

The doctor says that my left eye has regressed a little & now it`s at +.75 instead of +1 but my right eye is still the same at +1. When I asked for a time frame for the regression he failed to comment. I think he him self does not know for sure how things will end up or how long will it take.

I still see halos & starbursts & the doctor also failed to explain to me why or for how long. He said the symptoms are caused by my pupils being large after the operation & that Alphagan is supposed to help in reducing their size but apparently this is not working for me. He said is will resolve with time but also did not give me any time frame.

Dry eyes is still a major concern. No matter what I do it seems to get worse rather than better. During the last visit the doctor noted that my eyes are extremely dry & gave me a sample of blink gel tears & Avitears to try out. So I think he is telling me to go ahead & use whatever I like & not stick to preservative free only. blink gel is OK but dues not last long. I used it a few times but did not notice any large difference between it & blink intensive tears I'm using already. Did not use Avitears yet so I don't know how effective it is.

I bought a humidifier for the house. It's not really helping that much though I keep it next to me & the steam plowing right on my face. The goggles are irritating my face already. I think I need to go buy a different type that is more comfortable to wear.

The only option I have left is to use punctal plugs but I have to wait till I stop all topical medications first as my doctor insists that I should not do it while I'm on medical drops. So I have to wait till my next appointment at the beginning of December to do it.

Lets hope that I will see some improvement with regards to my overcorrection & dry eyes during the next few weeks as my life style has really been effected to a large degree by these complication.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby LasikExpert » Sun Nov 08, 2009 9:10 pm

alwaleed wrote:Don't know why he still want me to use steroids but I think he wants to delay my eyes healing for as long as possible in the hope that my eyes will regress toward plano before healing completely. Is this a correct assumption Glenn?


Not so much delay as control the healing response.

alwaleed wrote:When I asked for a time frame for the regression he failed to comment. I think he him self does not know for sure how things will end up or how long will it take.


Not when it comes to a healing response regression. It is very much a wait and see (excuse the pun) issue.

alwaleed wrote:I still see halos & starbursts & the doctor also failed to explain to me why or for how long. He said the symptoms are caused by my pupils being large after the operation & that Alphagan is supposed to help in reducing their size but apparently this is not working for me. He said is will resolve with time but also did not give me any time frame.


Only a part of the halo issue relates to pupil size. It is more likely that the culprit is the residual refractive error that will remain until you regress it away or until you have enhancement surgery. That and the dry eyes.

Dry eyes is still a major concern. No matter what I do it seems to get worse rather than better. During the last visit the doctor noted that my eyes are extremely dry & gave me a sample of blink gel tears & Avitears to try out.

alwaleed wrote:So I think he is telling me to go ahead & use whatever I like & not stick to preservative free only.


The gels utilize a very different system to preserve the lubricant that is not normally problematic.

alwaleed wrote:The only option I have left is to use punctal plugs but I have to wait till I stop all topical medications first as my doctor insists that I should not do it while I'm on medical drops.


This is a wise decision. Although you may suffer from dry eyes a bit longer, the current drainage system is moderating the absorption of the steroids. If you change that, you change the dosage of the steroids even if you use the same amount of drops.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Thu Nov 12, 2009 8:37 am

Thank you so much Glenn for the great information you are giving me. It really help when one knows the facts & able to make more informative decisions.

Don’t know why the doctors don’t take enough time to give their patients such information.

If the night vision problems are caused by refractive error, can it be solved with glasses?

Enhancement is out of the question for me now especially that I know how my eyes react to steroids & the fact that there is an increased risk of epithelial ingrowth when relifting the flap. I would rather live the rest of my life with glasses than to risk loosing my eye sight completely.

As for my dry eyes, I tried to look for blink gel tears but apparently it is not available here. I think my doctor got it when attending a conference abroad. I found Refresh Liquigel & asked the pharmacist about the preservative used. He couldn’t find any information on the box indicating this information. Do you think its safe for me to try it out?
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby LasikExpert » Thu Nov 12, 2009 6:10 pm

alwaleed wrote:Don’t know why the doctors don’t take enough time to give their patients such information.


Their job is to diagnose and treat. My job is to discuss. It is a matter of priority.

alwaleed wrote:If the night vision problems are caused by refractive error, can it be solved with glasses?


Yes. Any problem that is exclusively due to refracticve error can be resolved by glasses. Problems that relate to refractive error and corneal irregularity may be resolved with contact lenses.

alwaleed wrote:Enhancement is out of the question for me now especially that I know how my eyes react to steroids & the fact that there is an increased risk of epithelial ingrowth when relifting the flap.


The steroid reaction is now known and can be managed if you elect to have enhancement surgery. The surgeon may recommend PRK on the Lasik flap, rather than a flap lift. This would virtually eliminate the risk of inducing epithelial ingrowth. Although epi-ingrowth is an undesired event, it is normally benign and can be resolved with a flap lift, cleaning, irrigation, and flap repositioning.

alwaleed wrote:I would rather live the rest of my life with glasses than to risk loosing my eye sight completely.


Corrective lenses is certianly a viable option, but unless I'm missing something I don't see that enhancement surgery would put you at an unusual risk of losing your sight completely. You may want to keep your mind open about future options.

alwaleed wrote:As for my dry eyes, I tried to look for blink gel tears but apparently it is not available here. I think my doctor got it when attending a conference abroad.


The manufacturer gives them out by the boxload at the conferences. You may want to look for any artificial tear that uses Hyaluronic Acid as an active ingredient, or consider purchasing them online and having them shipped.

alwaleed wrote:I found Refresh Liquigel & asked the pharmacist about the preservative used. He couldn’t find any information on the box indicating this information. Do you think its safe for me to try it out?


The gel artificial tear lubricants do not seem to affect the eyes in the way a preserved liquid artifical tear can. Verify with your doctor, but they should be safe.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Fri Nov 13, 2009 12:13 pm

My greatest fear now is an increase of my IOP due to Steroids. I was lucky the first time & my optical nerves were not damaged when my IOP reached 42. I think they are somewhat weaker now & I don't think they can take another hit. Enhancement will mean a prolonged Steroid treatment plan & even with Anti-Glaumatic medication there is a risk that they will not be able to control my IOP correctly & therefore my optical nerves will be damaged & that damage is permanent.

I have been on Steroids for 3 months now & don't know when will I stop. To restart an intensive steroid course due to enhancement will increase the risk of developing Cataract & that is another complication I don't want to risk.

Maybe I'm still too shaken by all the complications I had that it's effecting my rational thinking. Maybe most of my fears are not logical & I'm overreacting. Maybe in 6 months my eyes will heal to plano & all what I will need is reading glasses. In any case, I think I should live with what I have now & accept it until the 6 month mark.

I just have to concentrate now on my dry eyes & try to manage it the best way I can.

I don't think I can afford to order blink gel from the US. It will come out very expensive after the shipping charge & tax. The lasik operation & the expenses of the medication & artificial tears has stretched my budget to the limit. I think I will just wait till my next visit to the doctor in the beginning of December & ask him about refresh gel.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby LasikExpert » Fri Nov 13, 2009 6:44 pm

alwaleed wrote:My greatest fear now is an increase of my IOP due to Steroids.


A long-term elevation in intraocular pressure (IOP) can cause damage to the optic nerve, but it takes quite a bit of time. During steroid treatment your doctor can measure the IOP and directly inspect the optic nerve for early signs of distress. Changes in steroids, changes in treatment plan, and anti-pressure meds commonly used for glaucoma can all be used to manage the IOP.

alwaleed wrote:To restart an intensive steroid course due to enhancement will increase the risk of developing Cataract & that is another complication I don't want to risk.


The probability of steroid induced cataracts in the treatment you would likely receive during recovery for enhancement surgery is relatively low. The doctor is able to monitor the IOP and observe changes in the most early stages and change the treatment plan before opacity become problematic. Your particular reaction to steroids is now known because of your prior treatment.

alwaleed wrote:Maybe I'm still too shaken by all the complications I had that it's effecting my rational thinking. Maybe most of my fears are not logical & I'm overreacting.


I think your perspective on your situation is accurate. Stress is devious and can cause rational people to make irrational decisions.

alwaleed wrote:Maybe in 6 months my eyes will heal to plano & all what I will need is reading glasses. In any case, I think I should live with what I have now & accept it until the 6 month mark.


Deciding to not decide until six months postop is probably wise. It gives your eyes and your nerves time to settle.

alwaleed wrote:I don't think I can afford to order blink gel from the US.


Ask your doctor to request samples from the manufacturer. They will provide if they have any intent of selling in your market.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Fri Dec 04, 2009 12:42 pm

Thanks Glenn

Had my visit to the doctor a few days ago

According to the numbers, the doctor is seeing some minor regression in my eyes though I don't see any difference in my eye sight. Don't know if this regression will continue for the next few months or if it will stop. I'm seeing 20/30+ from 20/30- a month ago. There was no proper refractive error done but he is looking at the numbers from the Auto Refractor Machine (is that the right name?)

I'm off steroids & the Alphagan is reduced to 1 drop a day. I think he want to make sure that my IOP remains as low as possible for the remainder of the heeling period.

The doctor noted that there is some improvement in my dry eye since the last visit but it's still very dry. So finally he decided it's time now to have punctal plugs installed. I'm already feeling some improvement in dryness symptoms though its still early to know for sure.

I asked the doctor about the treatment plan. He said what is important now is to control & resolve the dryness & see what will happen within a month. So my next appointment is just after the new year holiday.

I asked about using Refresh Liquigel & was give the OK to use it as much as I need without any restrictions.

I`m still hoping that my eyes will regress to plano & I wont need any enhancement surgery. But just in case I do need one, will it be appropriate to ask the doctor to make me slightly myopic in both eyes instead of full correction?

My experience has shown me how important my short & middle vision is to me & I don't want to go for monovision. So if my eyes are under corrected by a small number like -0.5 will this help me in the long run where I would not need any reading glasses? I would prefer to use glasses for driving at night or when I need to see far rather than use reading glasses.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby LasikExpert » Sat Dec 05, 2009 7:09 am

alwaleed wrote:I`m still hoping that my eyes will regress to plano & I wont need any enhancement surgery. But just in case I do need one, will it be appropriate to ask the doctor to make me slightly myopic in both eyes instead of full correction?

Absolutely.
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby alwaleed » Sun Dec 06, 2009 7:29 am

Can I have more info. on this Glenn?

Any myopic undercorrection will mean I can see close clearly without reading glasses no matter how small that undecorrection is? So being myopic by -0.5 will mean I would not need reading glasses ever?
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Re: LASIK Aug 15 - Steroid Induced High IOP & Uveitis

Postby LasikExpert » Sun Dec 06, 2009 8:15 am

Not quite forever.

If you go to your local drug store you will see a rack of reading glasses. These will range in power from 0.50 D to as much as 4.00 D. This is the range most commonly required for individuals to see near objects. Of course, different magnification is required to see different sizes of objects at different distances, but this shows the amount of induced myopia people commonly need to see near objects after presbyopia has set in.

I am 53 years old and my 1.00D deliberate residual myopia from when I had laser eye surgery is not enough for me to read some type. Even though I'm currently -1.00 myopic, I still need reading glasses on occasion. The advantage of 1.00 D myopia is that it is very helpful for near vision as I can see my cell phone and read menus and newspapers without glasses, and I (just barely) pass the DMV driver's test. I am not required to wear glasses for driving and I can still see near enough to get by.

What works for me may not work for you. I went through several different powers of contact lenses to try real-world effects. When I found what was adequate for my needs, that was the target for my surgery. I am not glasses-free and should not reasonably expect to be, but after age 40 just about everything about vision distances is a work-around.

Although I'm legal to drive without corrective lenses, I almost always wear my glasses when I drive. I prefer excellent distance vision with the consequence of being less able to see the instrument panel and radio clearly.
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