2 weeks and waiting...

[lini]

I had LASIK surgery on June 16th (md describes procedure as wave front guided LASIK, using a conventional microkeratome) and am still experiencing a great deal of difficulty in my vision.

The day after the surgery, I went back to the doctor for a check-up and it seems that I had "wrinkles" in the flap of my right eye...not quite sure why this happenend, but the doctor did another procedure to "smooth them out."

Since the procedure, I have have major swings in my vision from day to day and in both eyes...this affects my reading, middle and long distance vision. (I am 30 years old and went into the surgery with -5.5 (R) and -5.75 (L)..never had a problem with my reading!) I have hazing that comes and goes & terrible haloes and starbursts from any light source (computer, cellphone, tv, street lights, headlights, etc). Eventhough I can see well enough to walk from point A to point B (not comfortable driving at all) and get through most days at the office, my vision has no stability and I am simply lacking any kind of sharpness. I am lucky enough to live in a city with taxis, but some days I just can't see the meter. And the glare and starbursts of city lights make it painful to step out at night.

I guess the reason I’m writing is that I am concerned that I have permanent vision loss. Am I ever going to see clearly again? Could this pass with time? If not, do I have non-surgical options to remedy the situation? As I understand it, I will never be able to wear contact lenses again due to the flattening of the cornea…is this true? Am I going to be 30 and in bifocals? What about the hazing, haloes and starbursts…is there anything that can correct that? The doctor has given me predforte drops (steroid), celluvisc (lubricant) and naturale free (artificial tears) and has told me to be patient (it can take months to see properly), but I'm really worried it will never come back. Sorry for all the questions, but its hard to be patient when it comes to your eyes…

Any advice (or encouragement) you can offer would be helpful; aside from affecting my work, this has really started to affect me emotionally.

Regards,
Lini

[LasikExpert]

What you have is called striae, which is the medical term for wrinkles. There are two kinds of striae, macrostriae and microstriae.

Macrostriae are large folds in the Lasik flap. Think of them like a rumpled comforter on your bed. Macrostriae are usually better treated immediately. Treatment is to lift the flap, smooth the folds, and reposition the flap. Because of your doctor’s prompt response I am assuming you have macrostriae, however your symptoms indicate you may also have another kind of striae.

Microstriae are smaller crinkles within the Lasik flap itself. Think of them as crumpled sheets under that comforter. Microstriae are more often left alone and allowed to resolve on their own, however it can be appropriate to treat with a flap lift.

Striae are caused by the internal stresses being released upon Lasik flap creation. We have a detailed article about Lasik and Flap Wrinkles (Striae) that you may find interesting.

The irregularities from striae cause light passing through the cornea to be bent in multiple directions. A loss of contrast sensitivity, poor vision quality at all distances, multiple images, ghost images, halos around light sources, starbursting, and photosensitivity, are all symptoms of striae.

If you have macrostriae, your doctor may recommend an additional flap lift. A contact lens may be prescribed to help resolve these larger wrinkles. If the macrostriae is really stubborn, the surgeon may lift the flap, reposition it, and use sutures to help stretch and hold the flap in place. Whether or not to be this aggressive with microstriae is open for debate. The general consensus is that these smaller crinkles need to resolve on their own as the forces that create them relax, however some doctors have attempted multiple flap lifts and even sutures to resolve microstriae.

You can wear contact lenses after Lasik if it is necessary. Soft lenses do quite well for most people and reverse geometry lenses can be created if necessary.

The reason you cannot see objects near you very well is undoubtedly because of the poor contrast sensitivity and poor vision quality caused at all distances by the striae. It is possible that you were over or undercorrected and this is affecting near vision, but that will be difficult to determine while the striae is interfering with vision. I doubt your vision would be improved much with the use of reading glasses. They may help a little because they tend to magnify images, but it is very highly unlikely that you will need reading glasses or bifocals after this is all resolved.

Your doctor is correct that it can take months for microstriae to resolve. Macrostriae tends to be resolved with surgical intervention, which is an event rather than a process.

I recommend that you get a second opinion. Striae is a rather straightforward diagnosis, is rather obvious, and the proper response is well understood, however whenever vision is degraded due to a complication it is a good idea to get a second opinion. The second doctor will very likely make the same diagnosis, recommend the same treatment, and offer the same prognosis, however that would give you something else you really need now...peace of mind. Knowing that you are getting the proper care can really reduce the anxiety of a problem, and anxiety can cause much more damage than the problem itself.

You bet this will affect you emotionally. You just spent a lot of money. You didn’t require this surgery, it was your decision. You did this for the convenience of a reduced need for corrective lenses and maybe a bit of vanity was involved. Now you have a serious problem affecting your ability to function. You are as angry at yourself as you are at your doctor. You are second-guessing everything and everyone. You have every right to freak out, but it really won’t help much. In fact it can do a lot of harm because you may make poor decisions while stressed out about this. Perhaps a bit of perspective will help.

Let’s look at the absolute worst case scenario. All of the problems you are experiencing involve the Lasik flap. Let’s assume the worst and the worst would be the striae do not resolve. The flap can be replaced with a lamellar transplant. This is not a full-blown corneal transplant, but a transplant of just the flap on the surface of the cornea and that flap is only about 140 microns thick. Don’t underestimate the seriousness of a flap transplant, but this is something that is done every day for patients who have naturally occurring problems and is a highly successful procedure. That is the absolutely worst case scenario and that is not at all likely to happen. What is most likely to happen is that the striae will resolve with healing. If you can handle the concept of the worst case scenario, then what is really going to happen may not seem so bad.

Something you can do to promote healing is to keep your eyes lubricated and moist. Some of the same symptoms of dry eye are the symptoms of striae and dry eye can exacerbate striae. Use only preservative-free eye drops and avoid the “preservative free on contact” drops. The heavier gels are great for nighttime when you have your eyes closed. The less friction on the cornea, the better.

During Lasik the nerves that control tear function are disrupted and Lasik induced temporary dry eye can occur. These also are the nerves that tell you your eyes are dry, so you cannot rely on lubricating just when you think you need it. Create a lubrication regime and stick to it. For most people artificial tears 3-4 times a day is enough, but if you require more, use more. This is the one thing you can do that will really help with striae. The other thing you can do is be patient. That is tough when you can’t see well, but it really is necessary.

[lini]

Glenn,

Thanks so much for getting back to me (and so quickly!) Wish I had found this website before my surgery.

I did in fact go for a second opinion and although no one has used the words 'microstriae,' the consensus is that it my vision, halos, startbursts, etc. will work itself out over time...just have to wait it out and see. I have been religiously using the drops as prescribed (4x daily) and the tears moreso. Hopefully this will aid in the process.

What did come up at the second doctor's visit is that the second flap that was created in my right eye has sealed up, but has jagged edges which is creating irritation in my eye. He thought they should have smoothed themselves out by now, but has asked me to come back in a month's time re-examine. He said he might need to go back into my eye and smooth it out (arrrggghhhh!), but wants to wait it out. To be honest, I don't really have a foreign body or scratchy feeling in my eye...could the irritation be on a level that I'm not aware of?

Anything else I could or should be doing at this point?

Thanks again for your help!

[LasikExpert]

It is possible that the ragged edge of the flap is causing irritation that has not yet presented itself as a problem. I suspect that what your doctor will be looking for in a month is evidence that the flap edge is causing problems, or that the flap edge no longer exists.

It sounds like you are on the right path. Keep your doctors informed of any changes. I hope will will hear from you in a month that all is okay.

[DryEye]

Hi lini
How did things turn out for you?