Help - ghosting and other serious issues

[richbron]

I really am hoping somebody can give some directioal advice. In November 2005 I underwent Lasik surgery for a severe astigmatism - astigmatism in both eyes of -5.75.

Post Lasik the measured astigmatism was L -1.0 and R-1.25. I immediately noticed a hige difference between the Left and RIght eye. The left eye was blurry but I could read number plates etc. With the right I noticed ghosting (slight double vision).

I was prescribed temporary glasses which fully corrected the astigmatism. In the meanwhile the Dr advised I have an astigmatic keratotomy (AK) to address the remaining bit of astigmatism which I did in March 2005.

Following the AK my prescription was astigmatism L-0.75 and R-0.5. Which the Dr was very pleased about HOWEVER I could not notice much of a change in my vision. Close up vision was slightly better but distance vision seemed the same as my post Lasik vision. My glasses prescribed after the Lasik still seemed to fully correct my astigmatism (even though these were prescribed for a higher astigmatism).

The Right eye which now measures the lower astigmatism offers the weakest vision and the ghosting/double vision is still exactly the same. I tried contacts which helps but is not perfect - and due to the level of comfort have gone back to glasses. The glasses I am wearing are at the new prescription (ie L-0.75 and R-0.5) but they do not fully correct the blurriness. I find that my prescription seems to change through the day, the vision with my glasses early in the morning is OK and decreases as the day progresses.

My Dr and Optometrist do not believe I should be wearing glasses ....

I am going back to my Laser Surgeon on the 29 Jan as I am just not happy with the quality of vision - my corrected vision is worse than it was pre-Lasik.

What do you think is the cause of this?
Why is my prescription so mild and yet I have difficulty seeing?
Why do my glasses not correct my vision?
What should my Dr be testing on Monday?

Any help/advice will be greatly appreciated - I am going mad!!

Many thanks
Richard

[LasikExpert]

Hyperopic (farsighted, longsighted) correction is more challenging than myopic (nearsighted, shortsighted) vision, and astigmatism is more challenging to correct than hyperopia. High astigmatism, as you have demonstrated, can be very challenging with limited results.

The fluctuation in vision quality during the day may related to dry eye issues. You may want to schedule your doctor appointment in the afternoon when vision tends to be worse. Dry eye would explain the poor vision quality, poor correction with glasses, and even some of the ghosting effects.

Your surgeon will probably perform a wavefront diagnostic to determine the current state of your higher order aberrations. This test will help determine if additional laser assisted surgery would likely be beneficial and appropriate.

[richbron]

Glenn,

Thanks for your reply. I do hope it is something simple such as dry eyes. If it is indeed dry eyes, it must be a real severe case, without exagerrating, for the first 15 minutes when I wake up my eyes are pretty good, thereafter I honestly cannot read a number plate with my right eye (which is tested as the "better" eye). I cannot read text on TV without my glasses and by the end of the day, I struggle to read text on TV WITH my glasses on - could this really be dry eyes?

Eye drops clear vision for 5 seconds and then its back to blurriness.

I noticed that looking through a pin-hole my vision is pretty good (without my glasses) - this I did in the evening when my eyes are at their worst.

Its difficult to believe that I have almost zero astigmatism (my prescrip is L -0.75 x 63 and R -0.5 x 10) and yet everything is extremely blurry.

If I do indeed have dry eyes, how will this be treated and will it return to normal eventually? It has been 14 months since Lasik and 10 months since Astigmatic Keratotomy.

Thanks again for your input - this site is very useful.
Richard

[LasikExpert]

The fact your vision clears up with artificial tears and is clear in the morning is not only a good sign, but almost certainly would attribute the poor vision to dry eyes. It is possible that there is some night-time edema (swelling), but my bet is on dry eye problems. Read our article at the Lasik dry eye link above for details regarding cause, prognosis, and treatment.

[richbron]

I met with my Doctor yesterday. He suggested that the oils in my eye were not very effective and has suggested I massage the eye lid with a warm cloth morning and night. He has given me an antibiotic and 2 creams to clean the eye lid. Will confirm the name of the anti-biotic and creams later as I do not have them in front of me now.

He has also suggested that the reason I am getting such poor vision (cannot read a number plate of the car directly in front without corrective lenses) is due to the fact that I have a spherical equivalent of -0.625 (I have an astigmatism in this eye of -0.5). Is this sufficient minus to give me such poor vision?

He also tested me for accomodation which is fine - I am going back in 6 weeks time during which he will perform a wavefront test.

He suggested the only way to improve the vision was to make my eye slightly longslighted.

Any thoughts on the dry eye and Spherical Equivalent?

Thanks

[LasikExpert]

I met with my Doctor yesterday. He suggested that the oils in my eye were not very effective and has suggested...

The outermost layer of the tear film is the lipid layer, which is essentially oil. Your tears will evaporate very quickly if there is an underproduction of the natural oils that constitute the lipid layer, if the tiny channels that carry the oils to your tears are clogged, and/or if these channels are squeezed closed due to inflammation. This problem would cause a short Tear Breakup (TBU) time.

Artificial tears will provide short-term relief, but do not resolve the underlying problem. In our article about dry eye treatment we discuss the possible advantage of taking flax seed oil supplement to increase oil production and the uses of Restasis to decrease inflammation.

He has also suggested that the reason I am getting such poor vision (cannot read a number plate of the car directly in front without corrective lenses) is due to the fact that I have a spherical equivalent of -0.625 (I have an astigmatism in this eye of -0.5). Is this sufficient minus to give me such poor vision?

Corrective lenses should be able to correct both the astigmatism and the small amount of myopia (nearsighted, shortsighted) vision. If you can see well with them but poorly without, it is probably the astigmatism that is most troublesome. You apparently have very little myopia.

Astigmatism means that the cornea is not spherical like the top of a ball, but is elliptical like the back of a spoon. When light passes through the "tip" of the spoon, it can be out of focus or slightly off center when it reaches the retina at the back of the eye. A small amount of astigmatism can cause blur and a larger amount can cause doubled vision.

The astigmatism may be exacerbated by the dry eye problem and might even resolve somewhat after you get into a good dry eye treatment regimen. You will want to wait until your dry eye problems are resolved or managed before considering additional surgery.

He suggested the only way to improve the vision was to make my eye slightly longslighted.

I think there may be a miscommunication here. I believe what may be meant is that an attempt to resolve your astigmatism with Lasik enhancement surgery may cause you to become hyperopic (farsighted, longsighted). Being hyperopic would not be a desired outcome, but may be a consequence of an attempt to correct the astigmatism due to an issue called coupling.

The physics of laser refractive surgery are that with astigmatism corrected there is an automatic correction of myopia...even if myopic correction is not desired. The coupling ratio is about 0.25 to 0.40 myopic correction to each 1.00 diopter of astigmatic correction. I believe the doctor is concerned that an attempt to resolve your astigmatism with surgery would overcorrect your myopia and make you hyperopic. You may want to read our article about Lasik and astigmatism and then discuss this further with your doctor.

It appears that what will be most valuable at this point is getting your dry eye under control.

[richbron]

Thanks Glenn - as usual very helpful.

The mediation that I have been prescribed fro my dry eyes (oil levels) is:
Doxycel (anti-biotic)
Blephagel and Tobradex (cleansers).

How long does it take before the oil levels are correctly functioning (and I notice a difference in my vision).

Thanks once again
Richard

[LasikExpert]

The lid scrubs, the warm compresses, and the antibiotics will probably provide some change in a matter of days or weeks. Much depends upon the exact nature of the problem.

[DryEye]

Let us know how the new regimen works out for you.
Thanks

[richbron]

Well three days into my "dry eye regime" the improvement is extremely noticable. Its now 19h45, I have removed my contacts and my vision appears as good as it does first thing in the morning.

The terrible ghosting/double image seems to have disappeared as well. Obviously my eyes are not perfect, I can notice the bit of residual astigmatism, but not like before!!

I am also finding my contacts more comfortable.

Long may this last.

Glenn - thanks for this wonderful web site, I really thought that my eyes had been damaged via Lasik and I am so thankful I came across this site. Your diagnosis seems to have been spot on!

All the best
Richard

[DryEye]

Tell us again your specific daily regimen?
This is great news and I am printing out the whole string of posts to read later.
Thanks

[richbron]

I have beeen strictly following the Doctors routine (and medication) to treat my apparent dry eyes. According to the Dr I have Roscea in my eye and suggests that the oils are not very effective.

My post Lasik prescription is:
R: -0.25 -0.75x10
L: +0.50 -1.25x60

First thing in the morning my vision is fair to good, within half an hour my Right eye (which has the smaller astgmatism) develops ghosting/double vision and I struggle at all distances, including PC work. As mentioned before, by mid morning my vision through my glasees starts to get blurry and by later afternoon I struggle to read number plates with my glasses on. My best corrected vision has therefore diminished.

Contact lenses offers slightly better vision through the day, but still far from perfect and are from from comfortable.

My confusion is why is the vision clear (ish) first thing in the morning. If it stayed like that for the day I would be ok and would most probably get by without corrective lenses.

I am going back to my Dr in a few weeks time when he will do a wavelength and topography.

Do these symtpoms sound like dry eye or could I perhaps have developed irregular astigmatism or someother issue.

This really is effecting my quality of life and have serious regrests for having the surgery. The Dr has suggested lasering my eyes again, however I am concerned by the radical fluctuation of my vision from 1st thing in the morning to an hour later when it decreases.

Thoughts and advice - I do continue to do the dry eye routine (warm compressers, scrubs, anti biotic etc etc).

Thanks
Richard

[richbron]

In my previous post i suggetsed that the improvement of my vision after following the Dry Eye regime of the Doc's was "extremely noticable".

It must be said here that this first few evenings I did the warm compresses immediately after removing my contact lenses - they are new lenses (torics) I had recently prescribed. Up to half an hour after removing the lenses my vision seemed as clear as it does first thing in the morning - either this is due to the fact that the lens temporarily changes the shape of my cornea giving good vision for a short while after removing them OR the other reason, the lens "traps" good quality tear ducts (and oils) and when I remove the lens these tears are present giving the confusing vision.

Thoughts?

[LasikExpert]

The contact lens is probably smoothing the outermost layer of soft epithelium cells. Additionally, the contacts can protect the underlying cornea from dehydration.

I'm glad to hear you are getting vision improvement with the dry eye treatment.

[richbron]

Glenn

Maybe I was not clear - I have not seen ANY improvement in my eye dry eye, no change in vision. What I was saying was my contact lenses and glasses are not correcting my vision. Why is this I am going mad?

First thing in the morning my vision is fairly good, thereafter I ahve double vision/ghosting that is NOT fully corrected by glasses - I get slightly better vision with contacts but still very poor!

Does this sound like dry eye or other issues ie irregular astigmatism etc etc....

Your thoughts

Richard