Scarred and scared..!

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Scarred and scared..!

Postby meowculpa » Sat Dec 26, 2009 11:02 pm

I'm a 32 y/o M who had B/L epi- lasik procedure on 08/19/2009 using Wave Light 500 Hz Concerto Laser [abroad].
reason for opting for epilasik - thin corneas to begin with.
Post op I was put on a 4 week taper of FML; 1 wk of Moxifloxacin and regular artificial tears [ arund 5 times a day]

early on, in the first 2 weeks of the procedure , my vision was not very clear especially during the night. this was attributed to the healing process taking place actively and I was told that it'd get progressively better as the days went by. and so it did ! and how !! [was back and working] at around a month's time, my vision was better than ever before. at 5 weeks the vision was real good in the day and it was substantially better at night time too. My driving was much better and I was more comfortable now that I had no problems with "glare".

early October [ at 6 wks- I had to change jobs] in my quest to get things set up and move from one state to another, I did a lot of driving [ especially at night]. I started noticing that there was a fine haziness around lights with associated blurriness that would disappear with me blinking frequently or applying eye drops.I assumed that this was a result of dryness and continued to use the drops hoping that it'd not bother me. the acuity was still impeccable. gradually, as time passed, I came to realise that the "fogginess" around the lights started getting worse and visual acuity wasn't as sharp as before and it wasnt relieved with the drops.

this started to get me worried. i tried to keep a close watch on the progress but figured that since it was still within the 3 mths at the time, the healing wasn't complete and I didn't want to trouble the surgeon. however, after more than 3 mths the deterioration continued. I now had significant haziness at night and that affected my driving a lot. I was no longer as confident as I was even when i was on glasses. the images were no longer crisp and clear like they were and instead it seemed like I was developing a refractory error.

Around this time, I got in touch with my eye surgeon and he assumed that it might be a dryness issue, asked me to use a +0.75 diopter computer reading glass, apply the eye drops frequently and get my eyes checked after 2 weeks. therefore 2 weeks after following his recommendations, i went to a corneal refractory surgeon for a complete eye exam [12/8/2009]

Right eye vision; -1.00/ 1.75/ 25 [thinnest portion of the cornea = 403]
Left eye vision; -2.50/-0.25/150 [thinnest portion of cornea = 394]
“Both” cornea had significant scarring in the field of vision. [reticular scarring]

the doc who examined me said that a trial of steroid at this point to see if it stops / reverses is more hopeful than anything else given the extent of the scarring [kinda like shooting in the dark] but suggested that at some point the scarring might need to be treated either by scraping / superficial laser treatment + Mitomycin in a few months and until then use glasses to help with getting by. Needless to say, my vision is terrible. I don’t drive at nights anymore and even daytime driving is bad. [ just go to work and I have the road memorized]. it's peculiar that "both" eyes have scarring and I don't even remember doing anything wrong. it also seems progressive and faster now than before.

After conveying this msg to my surgeon, he was surprised and told me that perhaps I did not follow the 12 week schedule for the FML . wha?/ OK, so someone blundered and put me on FML for 4 weeks only as a taper [qid for the 1st wk, tid for the nxt , bid therafter and od for the last wk and stop] . at this stage, i was more concerned about rectifying this problem that finger pointing. He asked me to restart FML [ Fluorometholone] qid right away for a 12 week tapering course and said that the vision should start feeling better quickly.

Alright, so now we are back on the FML drops [almost 3 weeks now]. X'mas happened and yet there is not a semblance of improvement. He now feels that it should be continued for 6 mths since the scarring is not responding quickly. [ the guy who did my 2ndexma didn't think they'd respond to steroids anyway and he also had the benefit of seeing the scarring first hand]

question is, what do i do?
Would greatly appreciate any helpful advice.
thanks
meowculpa
 
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Re: Scarred and scared..!

Postby LasikExpert » Tue Dec 29, 2009 10:30 pm

Number one on your list of things to do is to wear glasses that correct the right eye vision of -1.00/ 11.75 @ 25 and left eye vision of -2.50/-0.25 @ 150. Haze or not, you are not going to see well either night or day with this much refractive error.

Four weeks of steroids can be enough for some patients, but a surface ablation that does not include an application of Mitomycin C (MMC) often requires a longer treatment. Steroids are used to reduce inflammation and control the wound response. Inflammation (corneal edema) would thicken the cornea and would thereby reduce the amount of correction. The edema may be irregular, which can cause or exacerbate astigmatism. Without full wound response control, white cells will move toward the surface of your cornea and present as haze or scar. This is not like a scar on your arm and its resolution will be different.

Put simply, your corneas had an aggressive or under-treated wound response. A part of that wound response would be hazing (scaring) and a shift toward myopia (nearsighted) vision.

Steroids now may help and unless you have an allergic reaction or severe uncontrollable increase in intraocular pressure (IOP), they would likely do no harm. MMC will very likely resolve any scaring, but MMC is a strong medicine that is appropriate when required, but should be avoided if possible. The epithelium would need to be removed to apply MMC, which would put you through the 3-6 weeks of vision recovery you experienced after your Epi-Lasik. It is reasonable for your doctor to want to try the steroids before MMC.

I personally experienced similar haze due entirely due to not following my doctor's postoperative instructions (yes, I know better). It took several months, but my corneas are now clear. A Lasik patient I know had full DLK that progressed to flap melt with massive scaring. She now has clear corneas, although her extreme case took years to resolve. She did not use MMC. It is very likely that even if you did nothing the cornea will heal itself, but steroids or possibley MMC would be considered treatments to accelerate the process.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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Re: Scarred and scared..!

Postby meowculpa » Thu Dec 31, 2009 7:27 am

thanks a mighty lot for the thoughts. It does help knowing that this problem has been encountered in the past and there is some information about it.
btw, I am wearing glasses now and they do help a lot [especially during driving these days] . I'll continue using the steroid drops and keep this forum updated on the progress or worsening so that others can benefit from the experience too.
meowculpa
 
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Re: Scarred and scared..!

Postby Heather » Sun Mar 14, 2010 6:05 am

Dear Scarred and Scared,

My name is Heather Stone, and I do a blog on LASIK [redacted] discussing the pros and cons, the ups and downs. I link a lot to USAEyes, since I believe it is a good authority on refractive surgery. I would like to do several posts on LASIK or epi-LASIK patients who have had lasting complications and how they've dealt with the battle to regain decent vision. I am wondering, since your last post in December, has your situation improved? If so, what did you do to effect a change? Are you happy with the results now? If things are not better yet, are you on the road to recovery? Are you in limbo? Have you taken advantage of any patient advocacy programs?
I do not need to post any great personal details. I would just like the opportunity to find out more about your situation, write about it as an example, thereby providing a valuable resource for anyone seeking to undergo LASIK.

Hope you post soon, or you can email me at ergo_ergo@yahoo.com

Note: URL redacted. Please email Heather for website blog address.
Heather
 
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Re: Scarred and scared..!

Postby meowculpa » Fri Apr 02, 2010 4:34 am

It's been awhile and I should update this thread especially to those following and the ones interested in the post op sequelae.
Read on Heather.. I'll try and summarize as best I can..

December 09 2009 : -
OD: -1.00/ 1.75 @ 25
OS: -2.50/-0.25 @150
IOP: 9 [bilateral]
After realizing this I was started on FML eye drops QID. followed this regimen diligently and i could sense that the vision was getting slowly but progressively better as was predicted by my Ophthalmologists [ here and abroad] and *lasik expert* too ! obtained glasses to help with vision both at work and driving.. clear instructions were given to me to get the IOP tested regularly to safeguard against steroid induced Glaucoma. [ i was also told that there might be a risk of early cataract in some people - but the dose is not so high as one would expect in someone taking systemic steroids] anyway onwards to the next exam ..

February 03 2010:-
OD: plano / -1.75 @ 95 degrees
OS: -1.75 / -0.50 @ 115 degrees
IOP: 15 [bilateral ]
By this time i was functioning adequately without glasses at work and during daytime driving but still used it while driving both during the day [ slightly increased benefit] and especially at night [ significant benefit]. I never changed the power of the glasses as the power seemed to change tangibly.. the drops were reduced to TID and i was asked to stick to the regimen - again a unanimous decision among all my providers without consulting one another. the most heartening thing was that the dirty windshield feeling was resolving and therefore with the right refractory correction, vision was good.. [ unlike before when the vision was hazy despite the best refractory correction because of the scarring]

March 31 2010:- [yesterday]
OD: Plano / -0.75 @80 degrees
OS: -1.25 / -0.25 @ 95 degrees
IOP: 15 [bilateral]
currently, the glasses need to be changed because wearing them makes my head hurt. the vision is better but i still have the haze and i also lack acuity. granted, astigmatism might have a role to play here and i need to get the correct lenses and then compare vision.. grade 1 reticular scarring in my right eye and the left is slightly worse than that. I've been told by my doc here to slowly taper the steroids over the course of 2-3 months and i haven't heard from my other doc yet.. astigmatism is still bothersome at night but daytime driving is much better despite the spherical refractory error.

I hope this helps your blog Heather, nxt appt is in 2 mths i'll try and update this thread then.
thanks again Glenn [ your timely post inspired hope! ]
meowculpa
 
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