Unsure how to read Dr's advice

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Unsure how to read Dr's advice

Postby simonjester » Sat Apr 03, 2010 10:59 pm

I had LASIK done about 9 months ago. From the first day after I'd noticed that the left eye's vision was not as good as the right. I can focus perfectly (more or less) with the right eye, but I can only begin to focus with the left eye when the right eye is closed or obstructed, and then only by straining can I get something resembling a sharp image.

Early on the Dr's tech mentioned there was an astigmatism in the left eye and during the follow-up visits over the next few months suggested I use eye drops to see if the condition improved. It never did. During these visits I was seeing a tech that worked for the Dr who performed the surgery. About 5 months in I was evaluated by the Dr. again, and she suggested an enhancement. When I came in for what I thought was pre-surgery measurements, I was evaluated by the tech again, who again suggested that we give the eyedrops more time and scheduled another appt 3 months out. At this point I was beginning to feel like I was being jerked around, but I couldn't think of a good reason for them to do so, and these guys are the doctors, and so I deferred to their advice.

Three months later there was still no change. During this meeting both the Dr and the tech started talking about potential complications with the enhancement, and seemed to be making a big deal about it. This was the first time either had expressed anything resembling reservations, so I asked why the sudden concern. They got all defensive and said they were simply providing the advice they were legally required to give (e.g. that things could go wrong in a variety of ways). I told them I understood and asked if there were any specific issues they had with me having an enhancement; they said "No" and we scheduled it for a couple weeks out.

About a week later the office called and said they needed to take more measurements in prep for the enhancement. This time when the tech measured my eyes he said my vision in the left eye had improved significantly (it doesn't seem that way to me at all) and that he no longer felt an enhancement would be useful. When I asked what he thought my options were, he actually suggested that I go to CVS, get the weakest prescription I could find, poke the right lens out, and give that a shot for a month and let him know what I thought.

This wasn't some fly-by-night $200 an eye chop-shop operation; the Dr. is someone who's been in the business for over a decade, performed thousands of operations, and came highly recommended. But at this point I'm extremely frustrated. I'm a software engineer spend *a lot* of time using a computer, and having double vision is getting really annoying. Each time I explain to the tech that I still can't see clearly with the left eye he has me read the chart yet again, thumbs his chin and says some variant of "Well, it's rare for both eyes to have the same vision." I don't feel like there's any interest in actually trying to solve my problem, and sometimes I even get the impression they don't feel like there even *is* a problem and that I'm just looking for attention.

I'm not really sure how to proceed at this point so I'm curious to know people's thoughts on my situation.
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Re: Unsure how to read Dr's advice

Postby PRKorIntacs » Sun Apr 04, 2010 1:19 am

I am surprised you havent seen an optometrist for a second opinion and to find out what your prescription is now. It's possible glasses can help with the double vision if your astigmatism is regular. What was your prescription and 20/xxx before lasik and what's it now? They may have good reason for refusing to enhance you, from what I know, many surgeons consider 20/40 or better a success and not need enhancement. Some people wear glasses to drive at night or to see details from a mile away. I expect to wear glasses if I get PRK, just far less than full time.
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Re: Unsure how to read Dr's advice

Postby simonjester » Sun Apr 04, 2010 2:12 am

I didn't seek a second opinion because, up until 2 weeks ago, the office was suggesting I get an enhancement.
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Re: Unsure how to read Dr's advice

Postby PRKorIntacs » Sun Apr 04, 2010 5:44 am

I don't know why they suggested an enhancement till now. What was your prescription and 20/xxx before lasik and what's it now? They may have good reason for refusing to enhance you, from what I know, many surgeons consider 20/40 or better a success and not need enhancement.
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Re: Unsure how to read Dr's advice

Postby simonjester » Sun Apr 04, 2010 12:38 pm

PRKorIntacs wrote:I don't know why they suggested an enhancement till now.
This is really what I'm trying to understand though. I've been getting mixed signals from the Dr and her tech pretty much the whole time. It was the Dr who initially suggested enhancement 5 months ago; she has never retracted this suggestion (although I've rarely seen her since the initial screenings and surgery). Her assistant, OTOH, *never* gave a straightforward opinion, 'least not until the last visit when he recommended against enhancement and suggested I pop one lens out of a cheap pair of glasses instead. His behavior reminds me of someone who's trying to hide something, and it's a bit unsettling.

PRKorIntacs wrote:[...]many surgeons consider 20/40 or better a success and not need enhancement.
My prescription is OS +1.00 DS.

FWIW, I am in the process of getting second and third opinions.
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Re: Unsure how to read Dr's advice

Postby isa » Sun Apr 04, 2010 6:05 pm

hi
what was your prescription BEFORE?
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Re: Unsure how to read Dr's advice

Postby simonjester » Sun Apr 04, 2010 7:18 pm

Pre: OS -5.50 sph
Post: OS +1.00 DS
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Re: Unsure how to read Dr's advice

Postby isa » Sun Apr 04, 2010 8:40 pm

i think they have over corrected ur eyes from mypic to hyperopic
and when you get over 40 years old it could present a bigger problem
because you will get more hyperopic
definetly get a second openion
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Re: Unsure how to read Dr's advice

Postby simonjester » Sun Apr 04, 2010 9:20 pm

Yes, that certainly seems to be the case. Is the overcorrection significant enough that the Dr's office would act all shifty and potentially try to hide it?
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Re: Unsure how to read Dr's advice

Postby PRKorIntacs » Mon Apr 05, 2010 12:21 am

Why pop out a lens? Are you a +1 in only one eye and not both? Were you a -5.5 in both eyes? I would really try reading glasses next time you are at a store. They probably will help for near and computer and possibly for distance too. Being overcorrected in one or both eyes is a bummer. I would be really upset if that happened to me as id need reading glasses and possibly bifocals. Im asking for at least -1d undercorrection in both eyes to greatly reduce the risk of overcorrection. Im also going to ask if they have some sort of "guarantee"(not 20/20, just 20/happy) and what's the cost.

From what I read, correcting for hyperopia does not achieve good results and many people develop poor quality vision afterwards. I will probably have to live with reading glasses if I end overcorrected and just hope I regress back to plano in 10 years and not need bifocals. Was asking for a small undercorrection an option? At my laser center, the doctors say I can ask for whatever makes me happy. I can ask for a -1d or even -1.5d undercorrection. He did say ill need a thin pair of distance glasses, well that's fine if itll keep me out of reading glasses and greatly reduce risk of being hyperopic. They said overcorrections are rare but im not taking any chances.
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Re: Unsure how to read Dr's advice

Postby simonjester » Mon Apr 05, 2010 7:56 am

PRKorIntacs wrote:Why pop out a lens? Are you a +1 in only one eye and not both? Were you a -5.5 in both eyes?
I'm not currently experiencing any significant issues with my right eye. I was OD -4.5 / OS -5.5 pre-surgery. The Doc says the right eye is now 20/15; using my old glasses-corrected vision as a baseline I'd call it 20/25, but I'm not complaining.

PRKorIntacs wrote:I would really try reading glasses next time you are at a store. They probably will help for near and computer and possibly for distance too. Being overcorrected in one or both eyes is a bummer. I would be really upset if that happened to me as id need reading glasses and possibly bifocals. Im asking for at least -1d undercorrection in both eyes to greatly reduce the risk of overcorrection. Im also going to ask if they have some sort of "guarantee"(not 20/20, just 20/happy) and what's the cost.
Tried out the prescription the doc offered this afternoon; it helps, but only out to about 3 to 5 feet. There's a gap between ~5ft and ~30-ish ft that just doesn't focus in on the left side: glasses-adjusted and plain-sight vision are identical. After that both eyes seem to have similar vision. I can see why farsightedness is harder to fix.

PRKorIntacs wrote:From what I read, correcting for hyperopia does not achieve good results and many people develop poor quality vision afterwards. I will probably have to live with reading glasses if I end overcorrected and just hope I regress back to plano in 10 years and not need bifocals. Was asking for a small undercorrection an option? At my laser center, the doctors say I can ask for whatever makes me happy. I can ask for a -1d or even -1.5d undercorrection. He did say ill need a thin pair of distance glasses, well that's fine if itll keep me out of reading glasses and greatly reduce risk of being hyperopic. They said overcorrections are rare but im not taking any chances.
This doctor was open to any correction I chose. Since incidence of permanent overcorrection is rare I didn't ask to undercorrect. If fixing hyperopia is as difficult as your research suggests you are probably wise to hold back.
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Re: Unsure how to read Dr's advice

Postby PRKorIntacs » Tue Apr 06, 2010 5:08 am

simonjester wrote:I'm not currently experiencing any significant issues with my right eye. I was OD -4.5 / OS -5.5 pre-surgery. The Doc says the right eye is now 20/15; using my old glasses-corrected vision as a baseline I'd call it 20/25, but I'm not complaining.


Guess that's where all those "20/15" results come from. Ive been told that 70% of people achieve 20/15, but you say it's 20/25. How is he calling it 20/15? What kinds of measurments does he use?

Tried out the prescription the doc offered this afternoon; it helps, but only out to about 3 to 5 feet. There's a gap between ~5ft and ~30-ish ft that just doesn't focus in on the left side: glasses-adjusted and plain-sight vision are identical. After that both eyes seem to have similar vision. I can see why farsightedness is harder to fix.


That's strange, maybe you need bifocals or progressives so you can focus at all distances? What's your 20/xx in the left eye with and without glasses for distance? If glasses don't help your +1 eye, I could see why they can't enhance you.

This doctor was open to any correction I chose. Since incidence of permanent overcorrection is rare I didn't ask to undercorrect. If fixing hyperopia is as difficult as your research suggests you are probably wise to hold back.


I also was told overcorrections are "rare" but im reading of too many people who say they are overcorrected in one or both eyes to the tune of +0.5 or +1 that im playing it safe. A young, nonpresbyopic person could probably accomodate a small overcorrection(they in fact aim for +0.25) but presbyopes will have terrible vision being farsighted, much worse than being nearsighted. In fact, being slightly myopic will give great near and intermediate vision to a presbyope.
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