Post Lasik Problems

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Post Lasik Problems

Postby fast586 » Fri Dec 01, 2006 2:16 am

I had Lasik performed in March of 2003 to correct farsightedness in my right eye, I'm actually farsighted in both eyes but the Lasik surgeon told me that the right eye was about 100 % more farsighted than the left eye. He said that he thought he could help me so I placed my trust in him and had it done.

While it did help with being able to see things up closer and provide more evenly distributed vision, I have encountered several abnormalities that I did not have prior to Lasik. The first problem is that of the lubricative properties of the corrected eye. The eye now has a wet or glassy look to it all the time and appears to be slightly red and irritated most of the time. The left eye is normal and I have no trouble with it.

Secondly, the pupil of the corrected eye very frequently is larger than that of the left untouched eye. The pupil also opens larger in low light than that of the untouched eye. Many times the pupil is even larger in standard lighting environments. I've even checked pupil size in the mirror coming from a low light environment and noticed that the right pupil is open quite a bit larger than that of the untouched eye but quickly returns pretty much to normal when I turn the lights back on.

Lastly, I have eye pain and tightness very frequently in the corrected eye. I can only describe the tightness as someone twisting a rope in my eye providing a straining feeling in the eye. I had no such symptoms until after Lasik was performed. I was farsighted but that was it; there were no other problems with either eye.

Could this be related to pressure in the eye? Is the retina not the mechanizm that triggers the brain to synchronize the size of each pupil? Obvoiusly light is now being focused on the retina differently than before Lasik, so could this have some effect on pupil size?

I can feel when my right eye misbehaves. This isn't my imagination. I can see people's faces when they look at my right eye; they can tell there is a difference between the two eyes and it bothers me greatly. I don't feel comfortable looking people in the eyes like I once did because my eyes now look freakish. Disparity in pupil size is quite noticable especially when you consider the eyes are the first thing people look at. I fear I"ve made the biggest mistake of my life.

Kevin R.
N.J.
fast586
 
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Postby LasikExpert » Mon Jul 30, 2007 11:28 pm

A possible reason that your pupils are sometimes different sizes is not that your pupil in the right eye is larger...it is that the pupil in the left eye becomes smaller.

A normal eye that has no refractive error (plano) is focused for optical infinity - about 20 feet away and farther - when in relaxed state. To see an object closer than 20 feet, the natural crystalline lens within the eye changes shape and thereby changes focus. This is called accommodation.

Your left eye remains hyperopic (farsighted, longsighted) because it has not had surgery. A hyperopic eye is not focused for optical infinity when in a relaxed state. To achieve the optic properties of normal vision, your hyperopic eye must accommodate up to plano. Since you are always hyperopic in your left eye, you are almost always accommodating to achieve good distance vision.

To see an object closer than about 20 feet, your hyperopic left eye must first accommodate up to plano, and then accommodate more to be able to see the near object. Your hyperopic eye is not only always accommodating to “focus around” the hyperopia, it must accommodate even more to see near objects.

Another component of focusing on near objects is reduction of pupil size. This is called constriction. A smaller pupil provides a greater depth of focus (just like a camera’s iris). When accommodating, the pupil will normally get smaller.

Your corrected right eye is probably plano or close to plano and reaches optical infinity without needing to accommodate. It is in a relaxed state when you are looking at distant objects. In a relaxed state there is no reason for pupil constriction, but your uncorrected left eye needs to accommodate to get the same focus as the right eye. Since you are accommodating in the left eye, pupil constriction would be expected.

When you look at something close - like a person’s face - your right eye does need to accommodate, but not nearly so much as your left eye. Since the left eye is accommodating much more than the right, the pupil is likely smaller. The closer the object, the smaller the size of the pupil in the left eye and the greater the difference in pupil size between the two eyes.

All this accommodation, constriction, and imbalance is a strain on the eyes. That eye strain can cause some of the pain symptoms you describe. You may want to read about Lasik eye strain.

Some of the symptoms you describe may be related to temporarily elevated intraocular pressure (IOP). Your eye doctor can monitor your IOP to determine if there are any problems.

An important note is that for some patients the IOP is not accurate if it is measured through the Lasik flap. More accurate IOP measurement may be made at the edge of the cornea outside the Lasik flap.
Glenn Hagele
Volunteer Executive Director
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Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Thank you

Postby fast586 » Tue Jul 31, 2007 8:28 pm

Thanks very much for providing a possible explanation for my problem. What you say is quite interesting and not something I would have ever thought about. It makes a lot of sense. I was okay with pupil size up until about a year and half post lasik. After that, I noticed the difference in pupil size and a change in the lubricative quality of my corrected eye; this is what caused my concern.

I'm looking to have a cornea specialist check me out to see if he has any ideas and to check the general health of my eyes. I will mention to him what you mentioned in your reply and see what he has to say.

By the way, I emailed the cornea specialist I'm looking to see and asked him the same question; I asked him if he has ever seen a difference in pupil size after lasik. He is the only one that answered yes but he's not sure why it happens. All the others I emailed and asked the same question said no, they have never seen it and it doesn't happen. So that in itself makes me steer clear of them.

Thanks again.

fast586
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Postby DryEye » Fri Aug 03, 2007 1:11 am

Lasik Expert you say above : "An important note is that for some patients the IOP is not accurate if it is measured through the Lasik flap. More accurate IOP measurement may be made at the edge of the cornea outside the Lasik flap."

I have seen 2 corneal specialists, a highly regarded refractive srugeon, my regular eye doctor and one other eye doctor all post lasik and none of them measure the IOP at the edge of the cornea or outside the flap.

I have read that what you are saying is the correct way to do it for post lasik patients.

What gives in that some of the best doctors don't do it that way?
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Postby LasikExpert » Fri Aug 03, 2007 3:31 am

DryEye wrote:What gives in that some of the best doctors don't do it that way?


Uninformed; do not have the correct equipment; indifference; incompetence; don't believe the studies; there are a multitude of reasons why an eye doctor would not measure IOP outside the area of the flap. None of them are very good reasons.
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
Location: California

Postby DryEye » Fri Aug 03, 2007 3:35 am

Not to reassuring considering I've supposedly seen some good docs post lasik.
One more reason your organization needs to be on the forefront of this industry.
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