LASIK and PRK enhancement - still can't see very well

[cantseewell]

I had LASIK last October and was initially very pleased with the results. Within 6 weeks however, my vision began to deteriorate as I healed, and I became more and more near sighted. My doctor assured me that it was normal for my vision to fluctuate and I would see improvements over the next several weeks once my eyes “settled down”. Over the next few months, my vision worsened to the point that I had to wear glasses or contacts if I wanted to see clearly for tasks such as driving or reading the menu behind the counter at a fast food restaurant. After several weeks and several post op visits, my doctor began to talk about an enhancement if I did not improve after the next 6 months or so. After my vision showed that it had indeed stabilized (and not improved) over the course of several months, my doctor scheduled me for a measurement to determine how thick my flap was to determine if I had enough material remaining for the enhancement. After determining I was border line, he wanted to perform PRK, using the laser to remove the epithelial tissue. The procedure went smoothly, and I had virtually no discomfort or problems post op – just as with the LASIK. I healed quickly, and had my contacts removed after 3 or 4 days with my tissue filling in nicely. The only problem was that I was now significantly more near sighted than before the enhancement. After 8 weeks, my vision is now 20/100 in my right eye and 20/40 in the left, with barely any improvement over the last 4 weeks. I did improve slightly, as expected, over the first few weeks, but after that, zilch. I am also having significant ghosting with my right eye and less serious ghosting with my left. It seems as though I see four or five superimposed images with my right eye and two images with my left. My doctor is at a loss to explain how I am more near sighted after the PRK at this point. Initially, he was calm and was sure we would see the slow improvement expected. Now we are both discussing finding a specialist. I am a bit worried………any suggestions? BTW, no dry eye, no pain, followed all instructions for meds. Help! I can understand me being worried, but now that my doc is.......yikes!

[LasikExpert]

A visit to a corneal specialist is in order. Ask for your doctor to make a referral.

There is something quite unusual going on here. The fact that your vision stabilizes is very important, even if it stabilizes in a less than optimal quality. I suspect that there is some underlying corneal health issue that was not recognized before surgery.

The ghosting indicates an irregular cornea. Multiple ghosting indicates irregular astigmatism. After you have been examined, investigate rigid gas permeable (RGP) contact lenses. These often do a good job of resolving irregular astigmatism.

Please provide some additional information. Your age, sex, original refractive error (manifest and cycloplegic), current refractive error (manifest and cycloplegic), any medications of any kind over-the-counter or prescription, any supplements of any kind, where do you live, what kind of work do you perform, what kind of social/recreational activities to you perform, any family history (ancestors or descendants) of any ocular problems.

Please be certain to return and tell us what the specialist says.

[cantseewell]

Thank you for the quick response - I am in the process of finding a corneal specialist now; I'm currently looking into doctors involved with two different teaching hospitals in larger cities close by.

As for the additional info, I am not familiar with the proper terminology, so the best I can do on the refractive info at the moment is that I was
-7.0 in both eyes before LASIK with very little astigmatism. I believe he told me I was around -1.5 in my left and -2.5 in my right (I think) - I will find out exactly. Both eyes are worse than before the enhancement. I know I also have much more astigmatism than before either of the procedures, especially in my right eye. As for the cycloplegic readings, I don't know other than 1 week after the PRK, the doc thought I was likely having ciliary spasms and that was what was causing my vision problems. After dialating me, the readings were virtually the same.

I am a 42 y/o male, living in Alabama. I work in an office environment in front of a computer for 4-6 hours/day. My social/recreational activities are the usual outdoor stuff with my kids with not much else exciting. I consider myself very healthy, with a daily dose of Allegra as the only medication I take. I have no knowledge of any ocular problems in my family.

[LasikExpert]

Allergies can cause inflammation around the eyes, which can upset the balance and quantity of tears, which can cause dry eye, which can cause edema of the cornea, which can cause all sorts of vision problems. Even worse, many allergy medications can exacerbate dry eye.

Computer use also exacerbates dry eye problems because we tend to blink less and rarely rest our eyes while looking at a computer monitor.

When you say that your vision is worse after enhancement surgery, this may be because you were overcorrected from myopia (nearsighted, shortsighted) vision into hyperopia (farsighted, longsighted) vision. Even a small amount of hyperpia can provide poor vision quality for someone who is also presbyopic (lack of ability to change focus to near objects). You may want to drop by your local drug store and try a pair of reading glasses. Start with the lowest power and check both distance and near vision. You should also ask your doctor for your current perscription.

[cantseewell]

Thank you for the response - it's good to have some dialog with someone else knowledgeable, even if the news isn't always what we want to hear.

I was not aware of the possibility of Allegra possibly contributing to a dry eye problem, however, I did let my doctor know I was on Allegra and, I have been told that from his examination, I have not had any signs of dry eyes since a week or so after the LASIK. In fact, I specifically asked if that could have been the issue when my sight deteriorated slowly a few weeks afterwards. He said that my eyes showed no signs of dryness. I have suspended my Allegra use since this is the time of the year that I can do that with little or no effect to my allergies. We'll see if there is any difference. I have read some of the other posts on the board, and I do have something in common with some - once I do use either my Flarex, a drop of artificial tears, or simply yawn and have my own tears fill my eyes, my vision does improve a bit until the liquid is gone - not perfect, but better. I can also see the small print on the TV, e.g. a football score, if I use my fingers to look through a "pinhole".

As for the hyperopia, I have no problem at all seeing within a very close range if needed. My trouble is only in distance vision.

I will get my prescription and post as well.

[LasikExpert]

The fact that a bit of excess tearing improves vision and that you are having trouble primarily with distance vision are both very good signs. They indicate that your problems can be resolved with change of refractive error.

The pinhole effect will increase the depth of focus. It does not change your refractive error, but can improve the vision quality. Also, a pinhole will block light passing through an irregular area of the cornea from reaching the retina and distorting vision.

If your vision is vastly superior in brightly lit environments, you may want to discuss with your doctor the propriety of using Alphagan P. This is a glucoma eye drop that has the side effect of causing pupils to constrict. With smaller pupils, you may get a minor pinhole effect that helps vision quality.

Talk with your doctor about Alphagan P.

[cantseewell]

OK here's the latest - I've been off of Allegra for 2 weeks now - I did not notice any change at all in my vision. Also, no change in my prescription at my appt yesterday, although the doctor was pleased that he was able to correct me to 20/15, which had been a challenge in previous visits. My prescription post the PRK enhancement is now: R - -2.00 sph, +.50 cyl, 085 axis; L - -1.50, +.50, 110. As I noted earlier, this is worse than before the PRK.

I asked my doc about the possibility of some corneal edema either caused by or exacerbated by dry eyes - hence stopping the Allegra - but he was pretty emphatic that my corneas showed absolutely no signs of dryness and that I had no reason to stop the Allegra from what he could tell.

A big high five for the Alphagan P suggestion - although my doc did not think it would matter much, my sight improved dramatically within an hour or so, and it was fabulous all day today, especially in the office, after only one drop this morning. My vision is not perfect, but it is so much better. I am going to use it for another couple of days and see if it continues. I will then stop use and see if I digress. I only got a sample, so I may only have enough for a week or so anyway. I also want to be off of it when I see the corneal specialist in two weeks.

Any suggestions?

[LasikExpert]

Yours is a most unusual situation. I am very interested in what your corneal specialist has to say.