Second Opinions

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.

Second Opinions

Postby DryEye » Mon Jan 29, 2007 2:23 am

How many people on this forum have gone to another surgeon (for another opinion and/or enhancement) after their original lasik treatment? Any thoughts on the whole process?
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Postby Mack » Mon Jan 29, 2007 8:01 am

I had primary lasik in 1999 with enhancements in 2000. Final refractive error of about +1.25 astig in each eye. Had CK enhancement a year ago in both eyes with good lasting results, less than 0.5D error remaining and 20/20 BUCVA in each eye. Your ability to get improvement of residual refractive error after primary lasik will be dependent on how much time has expired since your lasik, the kind and amount of error and more importantly the skill of your surgeon. Anything beyond a year makes it difficult to relift a claan flap altho many have had it done successfully. Most responsible docs will not advise cutting a second flap. Lasek or PRK may be an option. I chose CK becuase it is the least invasive of all RS procedures and is particularly suited to correcting hyperopia and hyperopic astigmatsim up to 2.5 diopters. Refractec, the inventor of the technology confirms that with the improved "Light Touch" technique with more advanced probes, the effects are very long lasting, although they only have about 2 years of hard followup data to prove that. You have to do a lot of research and investigation to find the very best doc who is skilled at post RS enhancements whp can truly help you.
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Postby DryEye » Mon Jan 29, 2007 5:36 pm

Thanks for your input.
Knowing what you know now would you have done initial lasik and/or the other two enhancements?
Did you go to a few docs before deciding on the enhancements?
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Postby Mack » Tue Jan 30, 2007 9:43 am

DryEye wrote:Thanks for your input.
Knowing what you know now would you have done initial lasik and/or the other two enhancements?
Did you go to a few docs before deciding on the enhancements?


As Hillary Clinton just observed, "Life doesn't offer redos". Hindsight with problematic lasik always turns out 20/20, unfortunately. If I had it to do over, I know now I should have waited til about now to do it and allowed about a year to do the enhancements as the regression from +5 with astig was significant and took longer to stabilize than the doc predicted. My only real regret about my entire ordeal is that if I had waited to do this now, I likely would have gotten a little better end result and not given up one line of BCVA. I had a very sharp 20/15 corrected prelasik but now cannot quite see enough letters on that line to score it even with slight correction. But overall, I would say for me that minor loss is worth being glasses free. I could never get sharp correction with contacts when I tried them plus they were just too much of a hassle. I had complete faith in my doc at the time to get the enhancement correct, but regression had the last laugh. Since I did my lasik "off-label", no other doc would have touched me for a lasik relift enhancement anyway.
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Postby DryEye » Tue Jan 30, 2007 3:07 pm

Thanks
I agree with you on waiting a year before doing any enhancements.
I think in some cases it does take longer than 6 months.
Ultimately, I guess it's one's gut feeling on the whole thing.
But, it does help to gather as much info. as possible.
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Postby richbron » Tue Jan 30, 2007 4:06 pm

I have had lasik and had an Astigmatic Keratotomy (AK) enhancement. My astigmatism pre lasik was -5.75 and after the AK my right eye was -0.5 and Left -0.75.

My vision is so poor in the right eye (least amount of astigmatism) that I cannot read a car number plated without corrective lenses. I have a spherical equivalent of about -0.625 (ie minimal amount of created myopia). Did you have any problem with your vision with your astigmatism of 0.5 diopter??

Regards
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Postby DryEye » Tue Jan 30, 2007 4:14 pm

I believe I am slightly undercorrected in both eyes. More so, in my right eye.
The right eye was always drier even in my contacts, so I am willing to wait it out a bit more.
There is some residual astigmatism. For me, certain things are just not crisp and clear like in my glasses or contacts. There are some other weird things here and there, but coming from where I started I think I am willing to give it more time and then get a couple of more opinions in order to make a decision. I started around -3.25 and -1.25. After waiting for about 7 years on doing this and knowing lots of people who did it and loved it i thought it would go well immediately considering i did custom. Nothing to do now, but look forward and try to make good decisions. This forumn and all of our shared experiences helps with that.
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Postby Mack » Fri Feb 09, 2007 8:42 am

[quote="richbron"] Did you have any problem with your vision with your astigmatism of 0.5 diopter??

I only really notice the effects of the half diopter of astig as light decreases and my pupils get larger, approaching the edges of my corrected ablation zone. Short light rays start flaring out from around light sources, one at 2 o'clock and one at 4:30. As it gets darker, the flare lines get a bit longer. Annoying but I've gotten used to it. The astig also causes slightly reduced sharpness and clarity in low light conditions, noticeable in unlit rooms. In good light daytime outdoors or inside under good lighting the effect is unnoticeable. I am guessing that I have no astig with pupils at 3 mm, but at 5 or 6 mm, it increases to 0.5 or even 0.75 diiopters. Good luck
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Postby bada5150 » Fri Feb 09, 2007 4:05 pm

DryEye,
Are you currently wearing glasses or contact to correct your astigmatism? Does it help? Does your astigmatism on your right eye have any improvement at all? Because my aunt had problem for over year she said. Just wondering if you have seen any improvement for first 6 months.
I see ghosting on my right eye which my doctor told me it is astigmatism. But Glenn said that it will improve as eye is healing.
Just want some of your opinion.

Thank you
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Postby LasikExpert » Fri Feb 09, 2007 5:06 pm

Astigmatism that is caused or exacerbated by dry eye or edema (swelling) is likely to improve as the edema subsides and the dry eye is managed. Astigmatism that is not caused by another issue and is simply a cornea shaped like the back of a spoon will not "heal" as this is the stabilized state of the eye.

It is common during the recovery period for people to have astigmatism that is induced by the effects of surgery. This is surgery after all, and there will be a healing response. That healing response can include edema and dry eyes.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Postby DryEye » Fri Feb 09, 2007 5:10 pm

Glenn:

The astigamtism differences you mention are quite easily differentiated by a surgeon looking at a topography or orbscan of your eye? What about seeing edema swelling/inflammtion)?

Bada:
I do not wear glasses or contacts. It isn't bad enough yet it isn't good enough - if that makes sense. That defeats the whole purpose of lasik, but I do understand that in some cases people need to because they didn't get a good enough correction.
I am willing to wait it out until one year (June of 07) to make an informed decision and allow for lasik to continue to heal. If in fact things can just get a little bit better and my morning vision issue clears up I think I'll be ok.
The stoplight issue during the day (seeing 1 1/2 green lights) seems to have gotten better just the past 3 weeks. The night vision seems to still be the same (stop lights) and a little more starbursting of car headlights (mainly the newer ones). It's weird though because I see clearly evrything except for the light scenarios (stoplights,etc) everything around that is clear and for the most part always has been.
Great that you posted that information about your Aunt for all to know and learn from.
If you just had it give it time to fully heal up. You can always consider enhancements later after learning as much as you can about the whole process like all of us have had to do post lasik - Too Bad we didn't know about this site before!
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Postby bada5150 » Fri Feb 09, 2007 5:49 pm

Glenn,
Then how do you determine if the eye is stablized after surgery? Does edema (swelling) can continue during the healing period? How do you determine if there is edema?

DryEye,
It is really hard to understand not bad enough and not good enough. For me, I am not seeing right because of astigmatism on my right eye. Everything is unbalanced due to astigmatism. It bothers me all day at work after work. Just like Glenn said. I have to wait and see.
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Postby bada5150 » Fri Feb 09, 2007 6:03 pm

It seems like there are two different astigmatisms. One from cornea shapted like back of the spoon (foot ball shape) and one from irregular surface of the cornea.
Does astigmatism vary depending on distance? I see more ghosting when it is far away. As I get closer, it disappear. But still vision can be blurry due to astigmatism?
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Postby DryEye » Fri Feb 09, 2007 6:24 pm

Bada:
My vision was better in contacts and didn't require me having to spend thousands of dollars on artfiicial tears and post lasik follow ups with eye docs.
What's done is done and going forward hopefully it gets better to where I use less artificial tears and my vision equates or is better then when I was in contacts. Hopefully, come this summer I can update for all to read that things are better and life goes on.
Also, for the longest time my stoplight scenario was similar to what you describe in that from a far I would see 1 1/2 green lights and as I got closer the light would turn into one.
Bottomline, my gut feeling was that things would get better and was willing to wait albeit in a way that hasn't been the most pleasant experience of my life.
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Postby bada5150 » Mon Feb 12, 2007 3:52 am

Dryeye,
Did you have blurred vision for a while because of astigmatism? Or you didn't notice blurred visoin at all? you half ghosting problem seems like just mine. But I also have blurred vision. Did you have blurred vision as well for a while?
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