Dry Eye or Focus Problem?

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Dry Eye or Focus Problem?

Postby movingblur » Tue Nov 28, 2006 3:45 pm

I had custom wavefront Lasik about 5 weeks ago (monovision - I'm 54). Prior to surgery my eyes were -3.75 and -3.5 with significant astigmatism in both eyes. I did not have any real issues with dry eye before the surgery and have been diligent about using eye drops since. I have been reading others experiences on this forum (excellent resource) and I am trying to be patient.

I woudl like to know if my problem is simply dry eye or if I'm having trouble with my focus or if it sounds like something else. I find that when I'm at my computer all day (at work), I can see very well, both distance and near. However, when I move around (like just up walking around), things are blurry, particularly for my middle and distance vision. It also seems to take quite a while to regain clear vision if I'm moving around any length of time. This is quite annoying when I'm shopping or driving. I tried monovision gas permeable contacts before the surgery to see if I'd like monovision and I loved them, so perhaps this is just dry eye. It doesn't seem quite like when I was getting used to my monovision contacts, but I thought having a surgical correction might be different.

Thanks for your time and your help on this great forum.
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Postby LasikExpert » Wed Nov 29, 2006 2:50 am

There is probably a combination of issues that are contributing to your vision limitations.

The slow ability to change focus (accommodation) when you move from a mid-distance environment like computer work to a distance vision environment like walking around the house indicates that presbyopia is at fault. Presbyopia is when the natural lens of the eye is less able to accommodate to see objects near. This is when reading glasses, bifocals, or monovision become necessary. At age 54 you are probably quite presbyopic, but may have some accommodation.

In many ways the eye is like a camera. One of the similarities is depth of focus. Depth of focus is the range of distance you are able to see clearly without change in accommodation. When the pupil is small, the depth of focus is increased. It may be that the light from your working environment and/or the light from your computer monitor are causing a natural reduction in pupil size and you have a greater depth of focus. You can test this theory yourself. When next you are experiencing these focus problems, shine a flashlight across (not at) your eyes to get pupil reduction. If you achieve a significant change in mid-distance vision, it may be due to an increase in the depth of focus. Another way to test this is to move to a very well lit environment when you are having these focus problems.

Although the target of your monovision Lasik was what you had with contacts, I suspect that your dominant eye may be just a bit myopic (nearsighted, shortsighted). This would improve your mid distance vision for your computer, but could make your distance vision a little less excellent.

Dry eye can contribute by causing refractive error or reducing vision quality, however dry eyes would affect vision quality at your computer as well as walking around.

At your next exam, ask the doctor to provide a manifest refraction (which is better, one or two?) to give you a prescription. This can be compared to your corrected vision before surgery and with contacts. Have the doctor check for dry eyes. Five weeks is way too early to come to any conclusions about your final outcome and you may have continued changes, but be sure to report your symptoms to your doctor so they can verify what may be the cause.

Thanks for the kind words about our website. Be sure to tell your friends and add a link. See Lasik Help.
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Postby movingblur » Wed Nov 29, 2006 5:41 am

Thank you for your response. I do see better in a well lit environment and my office has very bright natural light. I have also noticed that my vision is better outdoors than indoors. It is dusk and night driving that give me problems. Any lower light situation causes me not to see as well as I do in a bright light situation. Will that resolve some over time?

Also, I am quite presbyopic, but didn't seem to have the accomodation issues with my contacts.

It does seem that my distance vision is not quite as good as it was right after my surgery and I sometimes feel that my eyes aren't working together quite as well as they did - if that makes sense.

I'm making a list of questions for my next visit to the doctor and will ask for a manifest refraction. I know that it will be three to six months before I know where my vision will land. Again, thank you for your help and I am telling others about the forum
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Postby movingblur » Wed Jan 17, 2007 6:12 pm

I'm coming up on 3 months post customvue lasik at the end of this week. My intermediate close vision ( 2 to 3 feet) is very good, I've lost some of the close, small print ability since a few days after the surgery. I've also lost some of my distance clarity on things further away than 3 or 4 feet - maybe dry eyes - and there's my problem.

I have been using pf eyedrops very diligently since the surgery. They help clear things up for about 5 seconds. I've tried the longer lasting drops/gels (also pf) and have found that those really irritate my eyes. I have observed something and want to see if others have had this experience as well. While the regular pf eyedrops really crisp things up both close up and far away, they only work a very short time as I have noted above. The really odd thing is that the more I use them, the drier my eyes feel. Over the last couple of days, I have pretty much stopped using them and my eyes feel much better. I also think that I am seeing a little better although still not with the clarity I get that first 5 seconds after the eyedrops.

Could I be allergic to preservative free eyedrops in general or just the ones I've been using in particular (Refresh Plus)? As I mention, the gels really don't work for me in terms of irritation.

Again, really have used the forum and appreciate the opportunity to benefit from it.
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Postby LasikExpert » Wed Jan 24, 2007 5:50 pm

Each artificial tear manufacturer has a slightly different blend of agents to reduce dry eye problems. It is possible that your system does not like whatever it is that is in your particular brand of preservative-free eye drops. Trying a different brand may be helpful. We have an artificial tear guide with list of the active intgredients in eye drops that may be helpful.
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Postby GodsClay » Wed Jan 24, 2007 5:57 pm

Now that is paculiar because I have been doing the drops in preparation for upcoming surgery. And I too have noticed that my eyes burn and seem dryer than before I started the drops.

I thought I was just weird so I didn't mention it on the forum. I'm so glad that I'm not alone on this (the dry eyes/drops that is.... not the being weird part)
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Postby LasikExpert » Wed Jan 24, 2007 6:33 pm

If the drops are medicated, then irritiation is not surprising. If the drops are artificial tears that have a preservative, then irritation is not surprising. If the drops are preservative-free artificial tears, then irritation is surprising and you may want to switch brands.
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Postby GodsClay » Wed Jan 24, 2007 6:45 pm

For me, the sample BOX of drops says:

Refresh Tears (Immediate Relief)
Refresh Liquigel (Long Lasting Relief)

and to the sideof the box it says:

Restatsis (Cyclosporine Opthalmic Emulsion) 0.05%'

Under that.... it sats "Ask Your Eye Doctor About RESTASIS"

(1)
Is the box of samples from the MD the prescription version?

(2)
I looked for more at the Drug Store and they too say "Refresh" but there is no mention of Restasis, even though the packaging and labels are the same as the samples.

I am currently using the samples that I received from the MD..... and it is those samples that are kind of burning and seeminly making my eyes feel dryer.
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Postby LasikExpert » Wed Jan 24, 2007 6:55 pm

It appears that the sample artificial tears provided by the manufacturer through your doctor are carrying advertising for Restasis. The artifical tears and Restasis are manufactured by the same company.
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Postby DryEye » Wed Jan 24, 2007 8:39 pm

Try TheraTears Preservative Free Vials

They have worked better for me than Refresh
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Postby GodsClay » Wed Jan 24, 2007 8:44 pm

During lunchtime - I went to the list of Preservative Free Eye Drops provided by this website.

Funny coincidence, but just from looking at the list, I decided on the TheraTears Preservative Free Vials!.... and then your post (above) appeared !! Your suggestion makes me feel better that I've picked a good one :)

Thank you muchly :)
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Postby DryEye » Wed Jan 24, 2007 8:48 pm

For me they have been the best and noticed it from the first day of using them. Too bad I can't buy stock in the company because they have made out bigtime with me so far!
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Postby DryEye » Wed Jan 24, 2007 8:49 pm

They are cheapest at Walmart and Target.
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Postby movingblur » Thu Jan 25, 2007 3:48 pm

Thanks, Glenn, after I posted I looked through some more of the forum and saw the link to the different kinds of eye drops. I saw the active ingredient in Refresh Plus (CMC) and decided to try something with a different active ingredient. I got some Bion Tears and Tears Naturale, both of which use HPMC. I'm kind of switching out between those and the Refresh Plus and that seems to be better. Maybe as much as I'm using them, I just shouldn't use the same kind all the time. All of the kinds I'm using are preservative free. None of them lasts very long, but maybe that will get better in the next few months (by 6 months, maybe?) Again, my eyes don't "feel" dry, it's just that my distance vision isn't good except for that very short period of time before I blink the drops away.

Thanks also to those who responded with your experience. I did notice that TheraTears has the lowest amount of the CMC active ingredient of the ones listed and am going to try those.

I still haven't found one of the longer lasting preservative free gels that doesn't feel like I'm dripping grit directly into my eyes.

Thanks again. I hear patience is a virtue ;-)
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Postby LasikExpert » Thu Jan 25, 2007 5:37 pm

For those who want to compare artificial tears for Lasik, the link is to Lasik artificial tears.

Patience is pretty much a requirement with Lasik.
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