I need proper diagnoses and treatment - please help!

Post your questions and start your research in this forum if more than three months ago you had any type of surgery to reduce the need for glasses and contacts.

I need proper diagnoses and treatment - please help!

Postby rebabecka » Thu Jan 04, 2007 3:39 am

I began with a prescription of -9.00 -2.75 x 012 R and -10.00 -1.50 x 175 L. I don’t understand exactly what all of these numbers mean, but know I was severely nearsighted with an astigmatism in both eyes.

My Lasik surgery was on 1-14-2000. There were no complications. My daytime vision was near 20/20 and I was very pleased with the BIG difference in vision. The downside was that I was experiencing halos and a lack of color perception at night.

Correction one year later was -25.50 x 95 R and -50 L.

Correction two years later was 20/25 R and 20/25 L.

My vision was pretty constant until 2005. I realized that I needed glasses in order to drive safely at night. With my glasses on I also realized a big difference in my day to day activities, so I began wearing them all of the time.

In March of 2006 I went to the eye center that performed my original surgery to inquire about an enhancement. The doctor tested my eyes and said that because my eyes had changed so drastically in a short period of time he would not consider an enhancement until my eyes were stable for at least one year. He also recommended that I make an appointment with my optometrist for new glasses because he said that I needed a new prescription. My glasses were less than a year old! He also suggested I make an appointment with my MD to check for diabetes. I was tested and thank goodness diabetes was not the case.

I went to my optometrist to have my eyes retested. At this point I decided to give contacts a try (again). I had worn gas permeable for 14 years prior to my surgery. And also soft contacts for about two months pre-surgery to allow my eyes to regain their original shape.

I asked my optometrist about the gas perm, but he suggested I try the soft again. I told him I had always liked the gas perm, but he said the soft would be more comfortable. He gave me a trial pair, but said it did not take into account my astigmatism. He said my “real” pair would. When I was ready to order my “real” pair I decided to order green colored contacts. Bye-the-way the perscription currently is -2.25 in both eyes.

I struggled with these contacts. My vision was medicore. Because I was not used to the soft contacts I thought maybe I wasn’t cleaning them properly. I ripped several pair rubbing them. I was pretty used to having less than perfect vision and thought my eyes were still changing. After serveral months I called my optometrist and explained my frustration. I was then informed that the green color of the contacts could be causing my vision to be less sharp.

Since this past November, I’ve been wearing a new pair of trial clear soft contacts. This has helped somewhat with everyday vision, but not with night vision.

Although I like my current optometrist I feel he is not able to properly diagnose me. I feel that I need to go to a specialist who understands my specific problems. Who do I go to? I don’t know where to begin.

I would love to have my night vision improved with possibly gas perm lenses or another treatment. Also, I feel that I have what I would describe as glare during the day when looking at any type of light - including a computer monitor.

I don't know if it makes a difference, but I'm 35 years old.

Please help! Thank you!
rebabecka
 
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P.S.

Postby rebabecka » Thu Jan 04, 2007 4:04 am

P.S. I am not pregnant and have had no other health issues.
rebabecka
 
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Re: I need proper diagnoses and treatment - please help!

Postby LasikExpert » Thu Jan 04, 2007 6:45 am

rebabecka wrote:Correction one year later was -25.50 x 95 R and -50 L.


Please confirm the prescription. I believe that there may be an error. I believe that your current prescription at -2.25 would be closer to what you realized after surgery.

It would be reasonable to expect some regression considering your high preoperative refractive error. I suspect that you were slightly undercorrected with surgery and regression brought you back to your current -2.25 diopter myopia (nearsighted, shortsighted) vision.

I suspect that the size of the laser treatment area in 2000 was somewhat smaller than your naturally dilated pupils. Read our article about Lasik and pupil sizefor details.

From the description of your symptoms I suspect that you may find rigid gas permeable (RGP) lenses to be helpful for both day and night vision, but an appropriate fit will take skill and practical knowledge of fitting RGPs in post-Lasik patients.

I recommend that you contact the ophthalmology department of the nearest university affiliated teaching hospital and ask to be evaluated by their refractive surgery or corneal specialist. The doctor may recommend enhancement surgery, but there are many issues that need to be evaluated before any recommendation about surgery can be made.

When you learn who the university recommends and you have your appointment scheduled, contact the facility who did your surgery and ask that they send a copy of your medical records to the specialist. Request that any color charts be reproduced in color. Call a week before your appointment with your specialist to verify the records have been sent. If not, make arrangements to pick up a copy and take it with you. The records from your original surgery are not required, but will undoubtedly be helpful. Your surgeon may charge a nominal fee for copying.

Make a list of any medications, supplements, and vitamins you have taken since about six months before your surgery. Yes, I know that can be a daunting task, but this can be an important issue regarding your ocular health. You may find it helpful to ask your general physician for a list of meds if you have had a number of prescription medications in the past 6+ years.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Postby rebabecka » Thu Jan 04, 2007 6:39 pm

Thanks for the quick response and helpful information! I am planning on calling The Cleveland Clinic - Cole Eye Institute and making an appointment for a consultation.

I was undercorrected in one eye. Can you explain why they undercorrect and why they choose to only do this in one eye?

The prescription you questioned is accurate, to the best of my knowledge. I double checked and had copied exactly what my optometrist wrote. My vision tested very well for the first four to four and a half years. I was not even prescribed glasses until 2005.

The prescriptions that reduce pupil size... are there any side effects and can they be used in conjunction with either soft or gas permeable lenses?
rebabecka
 
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Postby LasikExpert » Thu Jan 04, 2007 6:54 pm

You have selected exactly the right place for a second opinion.

The undercorrection was probably not intentional, however there may have been a limit to the amount of tissue that could be safely removed and keep the structural integrity of your cornea. About 12 microns of tissue are removed for each diopter of refractive change desired. It may be that the combination of the depth of the Lasik flap and the total amount of tissue removal would have brought you too close to the minimum 250 microns of untouched tissue required for safety. If corneal thickness is an issue for potential enhancement surgery, discuss with your second opinion surgeon if PRK on the Lasik flap is appropriate.

Alphagan P and pilocarpine are the prescription eye drops that are often used to reduce the size of the naturally dilated pupil. Pilocarpine is used almost exclusively for this purpose and has a rather strong pupil constriction response. Alphagan P is actually a glaucoma medication that has the side effect of reducing pupil size. Alphagan P is considered more benign by many and does not constrict the pupils as severely as pilocarpine.

It is my understanding that both can be used with soft and hard contact lenses, however your doctor will determine if this is appropriate for you.
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


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