My experiences -- one month post-op -- lots of questions!

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My experiences -- one month post-op -- lots of questions!

Postby JR » Sun Mar 11, 2007 5:47 pm

I had custom wavefront Lasik on 2/9/07. Here is my story. I have some questions at the bottom. So please respond if you can.

My pre-surgery eyesight was as follows:

OD: Sphere -400, Cylinder -075, Axis 140, ADD +100
OS: Sphere -375, Cylinder -025, Axis 093, ADD +100

Not sure what these all mean, but I can tell you I could not see clearly more than three or four feet away.

I had my consult on Tuesday 2/6/07. Surgery was on 2/9/07 at 11am. During the pre-surgery check-up I chose to try monovision, with my left eye being set to 20/40 and my right eye to 20/20. We also talked about corneal thickness. My right eye was within the limits for Lasik, but was near the borderline. The doctor said I could do Lasik, but said he would also recommend PRK. I went ahead and chose Lasik.

I had gone to another surgeon's Q&A session the previous week, and he went on and on about how they check the eye multiple times with the Wavefront device before surgery -- once during the consult, and then at least once (if not twice) on day of surgery. I ended up choosing another very reputable doctor in town on a recommendation from a friend. The doctor I chose has the Allegretto Wave laser, which is apparently the best in the business. This doctor only did the Wavefront measurement on Tuesday, and did not re-check my eyes on the day of surgery. That seemed odd to me, but I trusted they knew what they were doing.

During the surgery, the weirdest thing was the flap being put back in place. Other than that, the experience was not too bad. Immediately post-op I did not get a chance to "test" my vision because the tech put shields on my eyes right away. With the tape and holes obscuring some of my vision, it was hard to tell whether I could see clearly. I went home and slept, and kept the shields on the rest of the day and night.

When I woke up the next day, I removed the shields and could see OK. However, I did notice blurry distance vision. It felt like there was a smudge or something on my right eye. When I went in for my post-op visit, the left eye was pretty sharp, but my right eye was really bad. I don't even know if I could read the second or third line down on the chart. The surgeon said something about "the laser gets its readings from the wavefront, so it did what it was supposed to do."

I wrote off my blurry right eye as a result of the "healing process," hoping things would get better. At my one-week checkup, the eyes were the same. However, the doc said my eyes were really dry, and prescribed Restasis. I've been using that about three weeks now, and can't say I see much difference. I AM using a lot more eye drops just in case, but am not noticing a lot of improvement. I can tell you that the first day I used Restasis I had horrible vision in both eyes for about four hours. That has happened about three times total. Not sure what it was, but the side effects noted on the Restasis web site say blurry vision is possible.

The doctor also mentioned the possibility of an enhancement in my right eye if things did not improve.

Halos and starbursts are still pretty bad, but hope they will calm down in six months or so.

My next post-op appointment is Tuesday, and I want to be prepared. Here are some questions for the group:

Is it standard practice to only do one Wavefront reading prior to surgery? Could my eyes have changed between Tuesday and Friday, thus causing the laser to undercorrect my right eye?

Should I expect that one-month post-op my eyes should have stabilized to the point where any major problems would have disappeared? In other words, should I assume my right eye still could improve, or am I stuck with what I have?

If indeed my right eye was botched, how comfortable should I be getting an enhancement from the same doctor? I know enhancements will be free for up to two years, but these are my eyes. I want to make sure I am treating them well. How worried should I be? Should I insist on multiple wavefront readings, or is that overkill?

My right eye was the one with some corneal thickness issues. Is it safe to try Lasik again if I have to have an enhancement, or should I opt for the more painful PRK?

Sorry for the long post, but I thought you should have all the info before responding.

Thanks!
JR
 
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Re: My experiences -- one month post-op -- lots of questions

Postby LasikExpert » Sun Mar 11, 2007 6:55 pm

JR wrote:I had custom wavefront Lasik on 2/9/07.


You are early in the normal six month healing process.

JR wrote:My pre-surgery eyesight was as follows:

OD: Sphere -400, Cylinder -075, Axis 140, ADD +100
OS: Sphere -375, Cylinder -025, Axis 093, ADD +100


You had moderate myopia (nearsighted, shortsighted) vision with low astigmatism (cornea not spherical like the top of a ball, but elliptical like the back of a spoon).

JR wrote:During the pre-surgery check-up I chose to try monovision, with my left eye being set to 20/40 and my right eye to 20/20.


If you elected to have monovision correction, your left eye should not be able to see distance very crisply, but you should be able to see near objects relatively well. The right eye should be able to see distance clearly, but not near objects as well.

JR wrote:The doctor I chose has the Allegretto Wave laser, which is apparently the best in the business.


There are two versions of the Allegretto. One is wavefront-optimized and the other is custom wavefront-guided. It is not exactly clear from your information which laser version was used.

JR wrote:This doctor only did the Wavefront measurement on Tuesday, and did not re-check my eyes on the day of surgery.


If the Allegretto is the wavefront-optimized version, then this would not be unusual.

JR wrote:When I woke up the next day, I removed the shields and could see OK. However, I did notice blurry distance vision.


If you have monovision, some blur with distance vision would be expected. After several weeks the brain can adapt to monovision and "ignore" the blur.

JR wrote:The surgeon said something about "the laser gets its readings from the wavefront, so it did what it was supposed to do."


That is true with both wavefront-optimized and custom wavefront-guided because they would both use the same diagnostic device, but the wavefront diagnostic determined prescription is normally compared to the manifest refraction (which is better, one or two?) for consistency.

JR wrote:However, the doc said my eyes were really dry...


Dry eye can explain your difficulties, slow healing, reduce clarity, and cause edema (swelling). You may want to read about Lasik dry eye treatment.

JR wrote:...and prescribed Restasis.


According to the manufacturer, Restasis does not reach full effectiveness until after 90 days of continuous use. You may achieve some relief before 90 days.

JR wrote:The doctor also mentioned the possibility of an enhancement in my right eye if things did not improve.


At about three months postop when your eyes have settled down is the time to seriously consider if this is needed and appropriate.

JR wrote:Halos and starbursts are still pretty bad, but hope they will calm down in six months or so.


Temporary halos and starbursts are rather common in the first few months after Lasik, especially in the presence of dry eyes.

JR wrote:Should I expect that one-month post-op my eyes should have stabilized to the point where any major problems would have disappeared? In other words, should I assume my right eye still could improve, or am I stuck with what I have?


From what you have described, it is reasonable to expect continued changes with healing.

JR wrote:If indeed my right eye was botched, how comfortable should I be getting an enhancement from the same doctor?


That depends on why you did not achieve what was desired. Lasik is microsurgery on biological tissue. Predictability and accuracy is safe and effective by medical standards, but no surgery is perfect. It is possible that everything was performed appropriately, but you do not achieve the desired outcome.

JR wrote:I know enhancements will be free for up to two years, but these are my eyes. I want to make sure I am treating them well. How worried should I be?


At this point what you describe is not dreadfully abnormal. Not desired either, but the symptoms you describe are consistent with Lasik healing.

JR wrote:Should I insist on multiple wavefront readings, or is that overkill?


If you feel you need to tell the doctor how to do surgery, you do not trust the doctor enough to have him/her do the surgery.

JR wrote:My right eye was the one with some corneal thickness issues. Is it safe to try Lasik again if I have to have an enhancement, or should I opt for the more painful PRK?


The doctor is able to determine the amount of untouched corneal tissue and the amount of additional tissue that will need to be removed before surgery to be sure you are within the margin of safety.
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Postby JR » Mon Mar 12, 2007 4:04 am

I realize that electing for monovision will sacrifice some of my distance vision, but the eye that was set to 20/40 is not the eye that is bothering me. In fact, that eye seems to be pretty good at distance vision. It is the right eye that is out of whack. Hopefully the healing process will run its course and the right eye will stabilize even more.

Thanks for the reply.

J.R.
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Postby LasikExpert » Mon Mar 12, 2007 5:56 am

At a month postop it is so very hard to know what will be the final outcome. It is possible that your correction was more than desired, it is possible that dry eye is reducing clarity, it is possible that edema (swelling) of the cornea is changing the refractive error and dry eye is exacerbating all these problems. Some of this can be diagnosed by your doctor, but much requires the most important component...patience. That is not easy when you need to see, but it is important to keep in mind that the symptoms you describe indicate known problems that do tend to resolve with treatment and healing.

Three to six months seems to be an eternity when you are trying to see clearly every minute.
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Postby JR » Tue Mar 13, 2007 8:11 pm

Just had my four-week check-up with my surgeon. He is recommending an enhancement surgery on my right eye. My left eye is 20/20 (but should have been 20/40). My right eye is 1.5 diopters nearsighted. I'm not sure what that translates to in colloquial terms (20/60, 20/80?).

He will re-check me in six weeks, and see where my eyes are at that time. We will then schedule the enhancement at that time.

He will only work on the right eye. If we decide to correct the left eye for monovision, then we will do that at a later date.

I'm a bit disappointed that I have to get an enhancement, but I would rather go through it all once again to get better results.

Now I just have to be patient and wait the six-eight weeks.

J.R.
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Postby LasikExpert » Thu Mar 15, 2007 3:59 pm

Lasik is more of a six month process than a 20 Minute Miracle. Enhancement surgery is sometimes a part of that process.
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Postby mike r » Sat Mar 17, 2007 2:14 pm

Come on Glenn, by now YOU HAVE TO ADMIT that any noticeable initial deficiency noted by patients following a procedure ALWAYS has lingering effects...

So the "20min miracle" should in turn be followed up with "In 20 days you will be that way"....

:wink:

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Postby LasikExpert » Sat Mar 17, 2007 4:52 pm

[quote="mike r"]Come on Glenn, by now YOU HAVE TO ADMIT that any noticeable initial deficiency noted by patients following a procedure ALWAYS has lingering effects...[quote]

That is simply not true. Even in this forum you see people who had noticeable initial deficency following surgery and have no lingering effects after the healing period.
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Postby mike r » Sun Mar 18, 2007 3:22 pm

Let me clarify on narrowing the issue to good clarity...I give an outcome 20 days for quality of clarity after procedure(based on follow through of member comments)...If within this time frame good clarity is not noted thru random posts (wow remarks to an extent) then a patient/member will a majority of the time have a comment regarding less than adequate(blurry vision) outcome that is ongoing(not denying variability)...

Its a given...Based on this forums unbiased responses...

members with initial good results dont appear to regress whereas
those members questioning a less than adequate outcome upfront tend to be back in a few weeks/months etc still making note of there deficiencies...

Its just a no brainer!!!

The forum is beneficail in that it is beginning to supersede controlled testing results (the 3% rule of what we dont know exactly) the industry stands adamantly behind by a"REALITY FACTOR" ...

We cant thank you enough in exposing the truths with usaeyes.org..

As time goes on we will see and rely more heavily on the outcomes presented here...because the statistics here are documented without possible inefficiencies or bias that is not known...

On all our patients behalf,

Thanks Glenn



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Postby tiggy » Sun Mar 18, 2007 9:18 pm

Mike R-

You are forgetting that this is a self selected sub population who are seeking answers after surgery. To get a true unbiased representative group you would have to poll a more diverse group.

MHO.
Best,

Tigs
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