Overcorrection using Intralase and Allegretto

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Overcorrection using Intralase and Allegretto

Postby siberianaussie » Sat Oct 21, 2006 2:56 pm

I have been reading the informative responses on the website and decided to post.

I recently had LASIK surgery on my left (dominant) eye. My right eye is an excellent contact lens wearer so I decided to play it safe and just try the left eye.

Prior to surgery my corneal thickness was 607. The Doctor personally took 4 eye measurements on 2 days (no optometrist, no technicians). He did all of the work himself. He is also, as of now, the only doctor in my area (a major city) that ONLY uses Intralase, no blade at all, although he used to use the blade.

My pre-lasik SPH readings were:
-4.00
-3.75
-3.75
-3.25
and CYL of -1.25. I do not remember the pre-lasik axis.
This correlated roughly with my optometrist which revealed a
SPH -4.00, CYL-0.75, AXIS 85

The doctor said he was shooting for a –3.75 correction, which made sense to me.
I stopped wearing my daily wear disposable contact lenses 2 weeks prior to surgery.

The surgery included:
1) Custom wavefront eye mapping.
2) Intralase.
3) Allegretto Wave.
4) A Nurse in the Operating room.

After the surgery my eye was blood red, much worse then the pictures I have seen of people with a red dot, or, a red section of the eye. In the next week it got worse as the blood dripped down and has now covered 60% of my eye (1 week later). I am not in severe pain. No starbursts, etc. but my prescription according to the doctor is now

SPH+0.75 CYL –0.75 AXIS 20.

I am 41 years old so regression is unlikely for me. It is disappointing. Distances are blurry although not as bad as before the surgery, AND I can’t read without reading glasses for my left eye. I had to ask the Doctor for an eyeglass prescription which I thought he would have thought of on his own once he knew the results. Since distances and reading are now difficult doesn’t this indicate that there was an over-correction more significant then the prescription he gave me? I tested my left eye in the drug store with off the shelf reading glasses and saw better with a +2.0 for short and medium range. The "off the shelf" reading glasses did not help my left eye see distances better.

During the surgery there was a pause (10 minutes? I don’t really know how long) between the Intralase and the Allegretto Wave. I believe it was to allow the bubbles under the Intralase created flap to dissipate. I think someone on this message board wrote that time allows the cornea to dry out which can lead to over-correction. Do you think this is what happened? I am concerned because if this was the Doctor's or Nurse’s error, I will be using the same people and equipment for a correction in 3 months. If there was an error in technique or machine settings perhaps it can be avoided this time. Any ideas would be greatly appreciated.
siberianaussie
 
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Postby LasikExpert » Tue Oct 24, 2006 6:21 am

The bloodshot eye that you describe indicates an irregular swelling that may be contributing to the problem. You really cannot come to a conclusion about your outcome during this healing period.

There is a waiting period between creation of the Lasik flap with the Intralase femtosecond laser and lifting the flap for the excimer laser to reshape the cornea. Because the flap is not lifted until you are positioned under the excimer laser, it is not likely that the bed under the flap became dehydrated and contributed to an overcorrection. It is possible, but if your doctor has performed several IntraLasik procedures before yours, this minor change would be accommodated in the doctor's nomograms.

The plus 2.00 diopter reading glasses would be expected to provide good near and near-mid distance vision. With your current hyperopia (farsighted, longsighted) vision at 0.75 diopters, the reading glasses would make you about 1.25 diopters myopic (nearsighted, shortsighted). This would provide reasonably good near vision, but dreadful distance vision.

The overcorrection could be an artifact of the bruising that caused the bloodshot eyes, it may be something that will resolve with healing, and it may be a permanent change that would require corrective lenses or enhancement surgery (if appropriate). You really are not going to know until at least three months postop, and waiting longer is almost always better than sooner.

Please do report back regarding your progress.
Glenn Hagele
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Postby siberianaussie » Tue Oct 24, 2006 5:35 pm

Hi Glenn, thank you for the response.

I had my eyes checked very carefully by my optometrist. He knows about the surgery and he checked me 2x’s. The readings he came up with were

SPH+2.00 CYL -1.50 AXIS 165 (The OD readings, left eye)
VS.
SPH+0.75 CYL -0.75 AXIS 020 (The MD readings, left eye)

These seem like vastly different numbers to me.
The MD has admitted that there was an overcorrection and will probably require an "enhancement".

Although an optometrist is not an MD I have often found their eye exams for eyeglass to be as good or superior to the MD because they do so many of them, particularly this O.D. who I trust.

I think the MD was afraid to tell me the true readings as they are much worse then he indicated.

I am hesitant to go back to my MD if I need corrective surgery although I will continue to see him for follow-up care for the short term.

Would it be better to have another surgery in the other direction now, before the flap heals being careful to only take –1.0 or so? Does moving the same amount of diopters in a given direction remove the same amount of tissue if divided into 2 surgeries using the same laser? So, if you took –1.0 and a second -1.0 does this equal 1 surgery of –2.0 in terms of total tissue removal??

Thanks again.
siberianaussie
 
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Postby siberianaussie » Tue Oct 24, 2006 5:36 pm

TYPO
eyeglass=eyeglasses (probably because my near vision is so poor now!)
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Postby LasikExpert » Tue Oct 24, 2006 5:52 pm

siberianaussie wrote:SPH+2.00 CYL -1.50 AXIS 165 (The OD readings, left eye)
VS.
SPH+0.75 CYL -0.75 AXIS 020 (The MD readings, left eye)

These seem like vastly different numbers to me.


It appears that the difference is because your ophthalmologist is using minus cylinder and your optometrist is using plus cylinder. See How To Read Eyeglass Prescription for details. You may want to ask for an explanation from your doctors as well.

siberianaussie wrote:Would it be better to have another surgery in the other direction now, before the flap heals being careful to only take –1.0 or so?


The flap will not be an issue for enhancement surgery. Lasik flaps have been lifted by skilled surgeons as much as 12 years postop. There is no reason to rush your decision regarding enhancement surgery.

siberianaussie wrote:Does moving the same amount of diopters in a given direction remove the same amount of tissue if divided into 2 surgeries using the same laser? So, if you took –1.0 and a second -1.0 does this equal 1 surgery of –2.0 in terms of total tissue removal??


To change 1.00 diopter of refractive error, about 12 microns of tissue is removed. Myopic (nearsighted, shortsighted) correction removes this tissue from the center of the cornea. Hyperopic (farsighted, longsighted) correction removes this tissue from a ring around the periphery of the cornea. More tissue is being removed with enhancement surgery to resolve overcorrection, but not likely in the same area - although there may be some overlap.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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Postby siberianaussie » Wed Oct 25, 2006 12:14 am

Glenn:

I am amazed at how clear and knowledgeable you are. Probably because you are not a doctor! You should have been.

Today, at the MD’s office he told me he removed 75 microns + a 130 micron intralase flap. At 12 microns per diopter wouldn’t this equal 6 diopters of removal? He told me out loud he removed 75 microns, without hesitation. He knows I was –3.75 as per his measurements and 10 years SPH of –4.00 to –3.75 of eyeglass wearing and contact lenses would verify this. It seems like he does not know how to calculate how much to remove! If he made a 1 time mistake and realized it later I would think he would tell me he removed 50 microns, but he did not hesitate to say 75 microns. When explaining this to me he added and subtracted some numbers out loud to tell me my remaining corneal depth (I think its 511) and made a mathematical error out loud by 100 microns (I am a Tax accountant and am pretty good with adding and subtracting without a calculator,). I corrected him and he was visibly flustered. I’m getting really nervous. I scheduled a visit to another ophthalmologist for Thursday.

I think I better do a second review of this persons credentials. I'm now wondering if he is a real Doctor.
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Postby LasikExpert » Wed Oct 25, 2006 1:30 am

I appreciate your kind words, but if I had become a doctor I would probably not be so good at communicating with patients! 8^)

The 12 microns per diopter is for conventional ablation with a 6.0mm treatment. If the treatment is larger, the ratio of microns per diopter is larger. If the ablation is wavefront-guided, the ratio of microns per diopter is larger. If the doctor removed 75 microns with a target of 3.75 diopters correction, then the ratio is about 20 microns for each 1.00 diopter of correction. If the treatment zone was wavefront-guided and/or about 7.0-7.5mm, this would make sense.

If your surgeon was reading the calculations off of your medical record and missed by 100 microns, I'd be nervous too. If he was attempting to calculate it in his head, I'm not surprised he got it wrong. No doctor I know uses the calculations from his head to plan a treatment. There are computer programs and even automated systems that will do this for him and report to him the amount to be removed.

A second opinion is a good idea. You need the peace of mind that your current doctor is competent, or you need a different doctor who actually is competent.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
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Postby siberianaussie » Fri Oct 27, 2006 5:09 am

Hello Glenn:

I tried converting the 2 prescriptions mentioned in the prior post to spherical equivalents. I came up with:

2.0+(1/2*-1.5) = 1.25 for the optometrist
and
0.75+(1/2*-0.75)=0.375 for the opthologist.

The most recent script from the ophthalmologist came out to even less;
A Spherical equivalent of 0.125 which I believe is supposed to be nearly perfect.

This is in stark contrast to my visit to my 2nd opinion ophthalmologist who agreed almost exactly with the optometrist.
I am going to get complete copies of all my records this week.
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Postby siberianaussie » Fri Oct 27, 2006 5:12 am

typo
opthologist=ophthalmologist.
Also, my astigmatism is worse then before the surgery, not a desired result.
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Postby paz » Mon Oct 30, 2006 10:55 pm

Hi Siberian Aussie -
Sorry to hear about you bad experience. I hope things work out for you.

I am considering LASIK via the Intralase /Allegretto Wave laser similar to you.

To be quite honest, I was wondering if you would at least divulge the State you had your LASIK performed in if you feel uncomfortable naming the Dr. Quite frankly, based on your outcome, I want to make sure this isn't the Dr. I'm considering. Your description of the surgeon/practice sound very similar to the place I'm considering.

Thanks,
Paz
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Postby siberianaussie » Sat Nov 04, 2006 7:05 am

Sorry for the delay.
Yes, the facility I went to was in pennsylvania.
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Postby paz » Sat Nov 04, 2006 6:04 pm

Now I'm worried - Philadelphip area?
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Postby siberianaussie » Sat Nov 04, 2006 11:30 pm

Hi.

Unfortunately, I can't really say much more right now and it might be 6 months before I can. I would probably hold off on the surgery if I were you. There are risks involved and you must feel totally comfortable with your doctor. There is no harm in waiting for more information. If you paid for the surgery already, get your money back.
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Postby paz » Sat Nov 04, 2006 11:42 pm

I hope things turn out for the best with your situation. Please understand, I'm not trying to be nosy. Just trying to figure out if the place you went to is the same place I'm considering. It never hurts to look into patient feedback (both good and bad).

Would be comfortable telling the name of the place if I provided you with my email address?

Thanks,
Paz
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Postby siberianaussie » Sat Nov 04, 2006 11:50 pm

Where are you thinking of going?
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