depth perception haywire after wavefront LASIK

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depth perception haywire after wavefront LASIK

Postby GeneralPatientInquiry » Sun Jun 04, 2006 3:29 pm

Hi Glenn,

I read a response of yours to a hyperopia question on another bulletin board.

I had LASIK with Wavefront 10 months ago. I had few problems up until last week.

Last week, my depth perception went a bit haywire, both for looking at close range and at distances. My LASIK doc then checked if I had any over-correction, and he found that I was +1.25 in my eyes (I was -5 and -4.25 before). He said that often this "accomodative spasm" goes away after 6 to 8 months but sometimes takes a few years. Have you ever heard of someone having this surgery-induced hyperopia 10 months after the original surgery?

My LASIK doctor suggested that I could have another corrective surgery to correct the hyperopia, but I'm not sure how the risks of that surgery compare to the risks of my original LASIK, and it seems like I didn't have too much luck with LASIK the first go around.

He has suggested using reading glasses and closing my eyes frequently - do these factors contribute to the end of the accomodative spasm or are they merely palliative?And does this hyperopia always go away, or only in some cases?

Regards,
Jon
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Postby LasikExpert » Sun Jun 04, 2006 3:32 pm

Jon,

What is happening is indeed quite odd. There are several possibilities, but few probabilities.

Your doctor is able to paralyze the natural lens in the eye so you do not accommodate (change focus from distance to near). In this cyclopegic state, you can be measured to determine your true refractive error without your lens trying to "focus around" your myopia (nearsighted, shortsighted) or hyperopia (farsighted, longsighted) vision. Most doctors use this measurement when calculating how much correction to provide with surgery. Most doctors agree that correcting to the true refractive error is better than correcting to the error that is diminished by accommodation.

If your surgeon corrected you based upon cyclopegic measurements, then your natural lens has suddenly and unnaturally shifted its shape. This is something that would be difficult to predict preoperatively, and the 10 months of good vision would indicate that the doctor's original calculations were appropriate.

If the doctor calculated the amount of correction to provide without the lens paralyzed, then you would have good vision until the natural lens is no longer able to accommodate. This can be appropriate in some cases, but even this scenario would not explain the sudden 1.50 diopter hyperopic shift. Accommodation normally occurs slowly and is not usually noticeable until around age 40.

Depending upon the appropriateness of your original surgery calculations, I would think that the problem is less related to your LASIK and more related to pathology. I am also assuming that your doctor has eliminated other ocular problems such as vitreous detachment, etc.

I'm sure your doctor has grilled you on this, but is anything in your health different? Are you talking new meds or had you just started meds prior to having LASIK? Does your family have a history of hormone, thyroid, or similar disorders? Are there other hereditary issues that may seem unrelated, such as family history of MS or Parkinson's? What I suggest is that you look at places other than your eyes to determine the cause of this unusual change.

Is it possible that this will self-correct? I cannot intelligently respond to that until what caused it is accurately determined. What I would caution against is having surgery to correct the new hyperopia. A sudden onset of refractive change without explanation is too unstable a situation to have surgery to correct refractive error.

Would you like a second opinion? I see that you are in New York. I can recommend someone in Manhattan and someone in Rochester who would have multiple resources available to attempt to diagnose the problem.

In any case, please do keep me informed of your progress and if/when the cause is found. This is the first I have heard of such a change that may not be related to normal cyclopegic accommodative functions. I am very interested in learning the cause.
Glenn Hagele
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Postby GeneralPatientInquiry » Sun Jun 04, 2006 3:33 pm

Glenn,

Thank you so much for the prompt and thorough response.
I would be interested in a second opinion, preferably in Manhattan (or in this case it would be a third opinion because I'm going for a second opinion with a Dr. C next Wednesday). I'm not encouraged by the fact that my original LASIK doctor seems to have little curiosity about my condition and has merely told me to see him again in 3 months, despite the fact that I told him that I'm almost to the point of staying home from work.

He used Wavefront technology and a VISX machine, but I'm not sure if that means that he paralyzed my lens before measuring for my refractive error. He seems to think that these sudden changes are an "accomodative spasm" which in my understanding has something to do with the eye muscles getting tired of accomodating. Perhaps my eye muscles have been accomodating from +1.25 from immediately after the surgery and then finally gave out. Could that be possible?

The only other health issues I have are that I was diagnosed with blepharitis four months after the LASIK surgery, and, although my surgeon says blepharitis is not linked to LASIK, I have read another doctor's opinion that blepharitis is almost always a consequence of dry eyes which are of course linked to blepharitis. Also, I did start taking some medication 6 months ago for an arthritic condition (methotrexane and mobic) but I mentioned these vision problems to my rheumatologist, who is top notch and unbelievably thorough, and he said to stay on the meds for now.

In any case, I will keep you appraised of my progress/lack thereof, and of the eventual outcome of my condition. I applaud your cause and please let me know of anything I can do on my end to assist you - I would be open to volunteering if you are in need of manpower.

Thanks again,
Jon
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