LASIK w/ Intralase - 3/27/2007 (Large Pupil / Med Myopic)

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LASIK w/ Intralase - 3/27/2007 (Large Pupil / Med Myopic)

Postby gcarlson » Sat Apr 07, 2007 8:51 pm

I had been researching LASIK for about 3 years before I decided to go for it. I had actually gone in for an evaluation last year in October to see if I was a good candidate, and once the tests were done, I maxed out my healthcare spending account at work for the next year. I ended up going back in for a second wavescan on 3/20 and had surgery scheduled for 3/27.

Left eye:
Manifest Ref: -5.75DS / 0.00DC / 12.5mm
Wavescan Ref: -5.13DS / +0.09DC x 102* / 12.5mm
Pupil size: 7.00mm

Right Eye:
Manifest Ref: -6.50DS / 0.00DC / 12.5mm
Wavescan Ref: -5.90DS / +0.09DC x 50* / 12.5mm
Pupil size: 7.00mm

coneal thickness was about 580-588 on both eyes, can't remember exactly, but in that range.

I arrived about 7:00am, and signed all of the I-won't-sue-you paperwork, and paid the fees. One of the assistants took me into an exam room where the surgeon took another look at my eyes to make sure things still looked good, and make sure I had used Vigamox 4x a day the day before. I was then taken back to the torture chamber... I mean operating room.

It basically looked like a dentist chair with a mini beanbag for a head cushion, with 2 large robotic looking devices on either side. They offered a sedative (can't post the V word), which I declined (big mistake). They put a few different drops in my eyes, including some sort of numbing drops. Only one really stung, but not badly.

I'm really glad I found this site, because it was the only thing that prepared me for the Intralase laser cutting the flap. I have major problems with things in my eye, and when they put the suction ring on, there was no way I could keep from blinking. My right eye was first, and I broke suction soon after it was on, so they used the lid speculum to keep my eye open. They then put me under the laser, and I had to look at the light. I swear I was looking right at it, but the doc didn't think so, so after repositioning my head, he was satisfied and the laser proceded to crush my head back in the chair by way of my eye. Everything was kind of a blurry white/grey, but I could see about 6 circles in a circle, and as the laser cut, i could see each of those little circles etching away from left to right, and it only took about 20 seconds.

Once that was over, they lifted the flap, which was a little painful. This might be a good time to mention that when adrenelin kicks in, for me it seems to negate the effects of any topical anisthetic, so I could feel all of this to some extent. Once the flap was back, it was really easy from there. They moved me under the LASIK laser, and I had to look at the red light. That light was so blurry, it filled most of my field of view, so I wasn't sure if I was looking at the right point or not. I was hoping the iris registration would take care of that. I tried to stare at the middle, and they started up the laser. Yes you smell the burning, but after years of cooking on a BBQ, the ocassional smell of burnt hair doesn't bother me.

The LASIK laser was done in about 30 sec, and they irrigated the eye. The doc then scraped away the residue, irrigated again, put in a drop or two (I think this was either antibiotic, steroid, or both), and slid the flap back over. They did have to put on a bandage contact lens due to some irritation or scarring of some sort. That eye was taped shut, and it was on to the next eye.

The left eye went about the same. I ended up breaking suction halfway through the Intralase cut, and at that point they decided I needed the sedative. They gave me 2 pills, which seemed to kick in pretty quick. Once I was more relaxed, they finished the cut. I felt a ton of pain when they lifted the flap. They hit me with a ton of numbing drops, and tried again. It was a little less that time, but I still was in a good deal of pain. I just tried to put it out of my mind know it would be over shortly, and eventually it was lifted and things were ok. The rest was pretty much normal on that eye, except no contact lens. He then put in colagen plugs, 2 in each eye, which he said he does for everyone.

I was taken to another room to rest for a little while. The doc came in, looked at my eyes and said everything went well, and he didn't see any problems. He had me try to read a chart, but I could only see the first line or two, as it looked like I was seeing through plastic wrap.

I went home but didn't sleep that much. I was on Vigamox and Pred Forte 4x a day, plus some other anisthetic that I forgot the name of, for 2 days, twice a day. I was using Refresh Plus about ever hour or two, but since I kept my eyes closed 99% of the time, and had the plugs in, they didn't dry out that much.

My follow up visit the next day really impressed me, and him I think. He said the flaps looked good, and that they contact would come out in about 5 days. He then tested me, and I saw 20/10 in each eye! I still had the Intralase Haze, but other than that I felt pretty good.

Over the next few days, much of the irritation died down, and I was seeing pretty good with both eyes. The haze was still there, especially around anything producing light (windows, lamps, TV, etc.), but I kept my eyes closed again for a second day. Thank goodness for 60gig IPOD and audio books...

The next day I watched a little TV, but tried to keep my eyes closed as much as possible. Over the next few days, I was keeping my eyes open more and more, and upped the refresh plus to once an hour or so. At some point, the plugs disolved, since I started tasting the drops a little while after I put them in (nasty!).

I went in for my next follow up on Monday 4/2, but the doctor was not available. One of the fellowes saw me, checked my eyes, and took off the bandage contact, by brushing it to the outer corner of my eye before taking it out. I have nasal hinge flaps, so I guess this was the best method. They tested my vision, and I was a blurry 20/20 in my right, and about 20/15 in my left. I was a little disappointed coming down from 20/10.

The next day I noticed vision in the right eye was significantly reduced, and I was seeing some ghosting. The left eye seemed fine. I gave it a day to see how it went, and the next day was as bad if not worse. I called into the office, and was told to come in the next morning. I showed up Thursday as soon as the office opened, but found out my surgeon was not available that day. I had a couple of other doctors take a look at me, and they didn't see any wrinkle in the flap, which was my biggest fear. One of them was the head of refractive surgery (my surgereon is head of the corneal dept, and this is a well known teaching hospital). He said it looked like I had some flap irritation, and my eyes were a little dry, and after consulting with my doc over the phone, upped the Pred Forte to every 2 hours, from Thursday until I come in for my next appointment on Tuesday, and see how I am then.



Since then, I have good days and bad days, and my left eye seems to go down to the level of right eye. I can still see to get around and drive, but it's not where I think it should be. Right now, if I had it to do over again, I definitely wouldn't. I'm thinking that this is partly healing, partly regression, and have a bad feeling I have a touch up in my future. I came into this with virtually no astigmatism, and not it seems like I have some in my right eye. Was it from the contact being removed? Did I accidently bump something while trying to remove all the junk building up on my eyelashes? Is it just the messed up way my eyes are healing? I probably won't know until well down the road, but I'm nowhere near the 20/20 they thought I would very like see when I came in. The haze seems to have plateaued, and does not seem to be decreasing much. I can drive at night. The halos are definitely there, but as long as I concentrate and take my time I can get where I need to go. Hopefully this experience gets better, but I really don't have my hopes up at this point. For quite a few of my coworkers, I have become a very convincing reason for them not to consider having LASIK.

This was a lot longer than I intended, but hopefully it will help someone.
gcarlson
 
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Postby jclark104 » Sat Apr 07, 2007 10:32 pm

Hello and I had some of the same experiences you did with the ups and downs and STILL have them a month post op... You are less than 2 weeks out and the best thing to do is give it time! Most people I talked to said it will take awhile and interlase takes longer from what I hear.
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Postby gcarlson » Sat Apr 07, 2007 11:29 pm

I know it's all a wait and see game, but it's just way more down than up right now. Hopefully that does change, but it seems like it would be a miracle if I got back to 20/20 from where I am now.

I know the haze and halos will be there for a while, and that I can accept since it's so common with the all laser method. I hope that if they can get the inflamation under control I have a shot at coming back to good vision.

I almost wish I had gone the microkeratome route instead of Intralase since it seems most of the problems I'm facing are flap related. It seems like the only good thing Intralase did for me was make me some money when I bought stock in them a couple of years ago.

Hopefully something improves soon to get me out of this pessimistic train of thought. I guess I should be thankful that I can see well enough to function and drive (as long as I don't need to read road signs).
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Postby JPD » Sun Apr 08, 2007 2:42 am

gcarlson wrote:I almost wish I had gone the microkeratome route instead of Intralase since it seems most of the problems I'm facing are flap related.


Same here, and for the same reason. Even more so, I'm with you when you said, at this point if I had it to do over again I definately would not.

Post lasik I've tested 20/15 on the eye chart. For whatever reason, the days I have eye appointments have also been the days where I've had my best vision. I'm 7 weeks post op and still have some serious moments of brilliance when it comes to visual acuity(20/15 or better), but most of the time I know I'm worse then 20/20. That makes it pretty difficult to function from day to day, most notibly while at work.

Let's stick it out and see what happens. As if we have choice, ha.
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Postby gcarlson » Mon Apr 09, 2007 5:53 pm

Well, I had a little positive experience this morning. When I woke up, I did the normal couple of drops of refresh plus in each eye to get the gritty feeling to go away, and just sat there with my eyes closed for a bit. Once I finally got up to get ready for work, I noticed my vision was 10x better than the night before. I kept looking outside because I was amazed to be able to see twigs on the branches of the trees behind my house.

Right before I left for work, a drop of Pred Forte in each eye, and my vision went back to the crummy norm it had been. At least this makes me think it's either my eyes are tired from being on the computer or watching TV, or maybe the Pred Forte is screwing them up even though it's helping to get the inflamation down. This morning was proof that at least 20/20 is still in there somewhere.

I think I may have had similar experiences other mornings, and just not noticed before I used the Pred Forte.
gcarlson
 
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Postby gcarlson » Tue Apr 10, 2007 5:41 pm

Just came back from my 2 week follow up visit. I test a blurry 2/40 in one eye and about 20/25 in the other. They switched to a pinhole disc, and I went up to 20/20 and 20/15. That's when the assistant let slip that they had seen micro-striae on the previous visit. It was nice of them not to tell me at the time... I guess that's from the theory of telling the patient they're healing normally since they probably wouldn't understand otherwise. The assistant did say that she didn't see much of any left, so things were improving (although my vision tested the same as before).

I asked the doctor if I could expect improvement from this level of vision, and he said I should be ok once everything heals, and to be patient. I don't think he understood exactly how bad things are, even though I kept telling him I can't even read road signs. I just have to wonder if his expectations are a little bit lower than mine.

They did a manifest refraction and I'm -1.00 and -0.50. He said he may have undercorrected a little bit. His theory is that it will delay how soon I need reading glasses. I really don't see the logic in this, as the alternative is needing distance glasses. The whole point was getting out of glasses/contacts, with the knowledge I'm going to need reading glasses down the road at some point.

I was told to go another week of Pred Forte every 2 hours, then back down to 4 times a day for a week, and then come back in.

Has anyone been this bad off and come back to decent vision without an enhancement? I really think it looks like I have more work in store a few months down the road... I don't look forward to going back under that laser.
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Postby JPD » Tue Apr 10, 2007 7:45 pm

gcarlson wrote:Has anyone been this bad off and come back to decent vision without an enhancement? I really think it looks like I have more work in store a few months down the road... I don't look forward to going back under that laser.


It's really impossible to say at the two week point. That's why surgeons won't do an enhancement until a minimum of three months. You're only 1/6th of the way there. My surgeon won't do any enhencements until six months, period. You still have a lot of healing to go through.

With a mid-moderate correction it's reasonable to expect "some" regression, but the fact you tested 20/10 at your one day followup, I would consider a very good sign. It also makes me wonder why your doc would think he undercorrected you. Then again, remember I'm no expert and just another patient like you.

In terms of what your final vision will be like without an enhancement, you really will have to be patient and wait and see. What you're experiencing isn't the ideal Lasik post op healing process, but it's also not abnormal. My post op vision has always tested at 20/15, however most of the time my vision is pretty bad. If I had to guess I would say about 20/30. During most of the day when I put drops in my eyes I'll experience crystal clear brilliant vision, but it doesn't last long. This leads me to believe that the "excellent vision" is still there, but I have dry eyes at this point. Also, my vision is better the more I rest my eyes(weekends), and in a different climate( I live in a very dry area). So, I'm very hopeful that once my tear production picks back up, along with the rest of my eye healing that I will finally realize the excellent vision I have glimpes of here and there. But to be totally honest I'm terrified of the idea of an enhancement and am not sure I would even go through it. I would probabaly op for some alternative. But I remain positive and don't think about any of that at this point because it's not likely I'll have to go through it.

One last thing. Try the preservative free Systane and see if your vision improves. My doctor recommends Systane which I use, however I have tried the Refresh Plus because it's cheaper. My experience is that the Systane works much better, and my vision improves dramatically when I put it in my eyes. Not so much with the Refresh Plus. If you're in the same boat as me, and your vision becomes excellent after using the Systane, then it's likely just a dryness problem. My doctor has also given me Restasis and has me using Refresh Celluvics(very thick) in addition to the Systane. All seem to be helping, but the improvement is immediate with the Systane vials.
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Postby LasikExpert » Mon Apr 16, 2007 9:16 pm

Some doctors consider microstriae to be present in virtually all Lasik and All-Laser Lasik eyes in the immediate postop period, but resolves with healing.

Your low myopia (nearsighted, shortsighted) vision could easily be from corneal edema. Edema can be caused by or exacerbated by dry eyes. This would also explain the fluctuation in vision and would explain why your vision was so great immediately after surgery. The eyes had not had time to be affected by edema or dryness.

You may want to read about Monovision correction to explain the logic of your doctor suggesting a little myopia could be a good thing.

I always recommend taking any relaxing meds the doctor offers. Take it early, and take it often.

Yours is a wait and see. Nobody needs to tell you that Lasik is more of a process than an event.
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Postby gcarlson » Fri Apr 20, 2007 4:18 pm

I feel better that the micro striae are fairly normal, and should go away with time. I'm now back down to Pred Forte 4x a a day, and hopefully will stop next week completely.

The best advice I got, which should have been obvious to me, was trying other tears products. I went to the store and picked up everything that was natural tears and preservative free. I had been strictly using Refresh Plus only, but I should have seen the "for Mild to Moderate Dry Eye" as a sign that it wasn't going to cut it. I'm now using Systane and Refresh Celluvisc, and although I'm not seeing much clearer, the comfort level has gone way up and the frequency of application has gone way down. The Refresh Celluvisc is good during the day as long as you don't mind a little blurring for a couple of minutes (sometimes it actually makes things look clearer instead of blurring... can't figure that one out). If I need to use something such as right before I drive somewhere, I'll use the Systane.

I go back in for a follow up Tuesday, and am interested to see if they still see a good bit of dry eye with the staining test. Hopefully over time I can heal into a little bit clearer vision.
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Postby gcarlson » Tue Apr 24, 2007 9:43 pm

I just had my pretty close to 1 month follow up. 2 other surgeons in addition to my original one took a look at me (hopefully it was just a slow day, not going to read too much into that). All agreed that it I had made great healing progress since my visit 2 weeks ago. I think switching to Systane and Refresh Celluvisc has really helped a lot, since they didn't mention much about dry eye. They said inflamation has really gone down, no striae are visible, and things look much healthier. I'm supposed to taper off the Pred Forte over the next few days going from 4x a day, to 3, then 2, etc.

My vision is still blurry, but hopefully I will heal into more clarity. My doctor said he could do an enhancement later on if I feel I need it. One comment he made is that most optholmogists that go though the procedure choose to under coorrect a little. Since I'm in my early 30's he said it would be good to be just a little nearsighted, and that as I get to a point where I need reading glasses, I will get a little less nearsighed. Knowing that, I think as long as I can get in the 20/20-20/25 area I'll leave things alone.

This visit definitely got me a little more hopeful, and as the last of the halos are now fading, I think I may come out of this close to where I want to be. I guess the lesson is just because some people have the instant miracle does not mean you will be perfect in a week, and even if you have perfect vision the day after surgery, don't be surprised if you get major fluctuations over the healing period.


I go back in 2 months for my next follow up, but I might post another update before then if I notice some major changes.
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Postby LasikExpert » Mon Apr 30, 2007 11:21 pm

Please keep us informed of your progress.

Yes, it can be a dubious honor to have your surgeon plus everyone else in the office want to see your eyes! You are probably correct to not read too much into that, especially when things seem to be going well.
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Postby gcarlson » Tue May 01, 2007 3:27 am

Well, I didn't really plan on posting this soon, but things have been getting noticeably better. I guess I didn't want to jinx myself or get my hopes up too much after my 20/10 day after surgery, then downhill slide experience.

The first thing I notice is that I'm getting some clarity back, and it seemed to start almost immediately after I got off the Pred Forte. I didn't quite follow the directions to the letter, since I tapered off a bit quicker than the doc said due to the fact that I ran out of drops when I was down to 2x a day. It doesn't seem to have hurt anything, so I guess the 4 weeks I was on them was enough. I have to keep myself from doing the left eye, right eye thing to check which one is worse and just accept that at least one of them must be getting better. This is hard because I was *extremely* picky about making sure my contact lenses balanced with the exact same clarity in both eyes... any thing else would drive me nuts.

The way I can tell I'm improving in clarity is when I sit at the other end of the living room watching TV, the receiver in my home theater setup has a display that on my good days I could read, and on bad ones was just a blur. I'm now getting to where I can read it pretty consistently, even at the end of the day (my worst time), which is a definite improvement. Yes, I check every day, and yes I'm an engineer.

Night time is better also. The halos are waaayyy less, almost to the point where I didn't even notice them driving for 2 hours last night. Clarity isn't a whole lot worse than in daytime, or at least not nearly bad enough to need driving glasses like my doctor mentioned I might need at night.

The other really great thing is I am needing the natural tears less. I used to have to have a stack of them near me at all times, and was using them like crazy. I was like a crack addict making sure I had immediate access to my tears fix. I can now go hours from one application, and have backed down from Refresh Celluvisc to Refresh Endura and Systane during the day. I still use Celluvisc at night (trying Genteal PM tonight, since the Refresh PM just felt too oily/greasy). I must sleep with my eyelids cracked open a bit, since I always wake up with dry eyes and have to dump Refresh Plus in.

Now I just have to contend with allergies. Any opinions on allergy eye drops? The tears seem to help wash things out, but I need something to reduce the itching.
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Postby LasikExpert » Tue May 01, 2007 3:08 pm

gcarlson wrote:I have to keep myself from doing the left eye, right eye thing to check which one is worse and just accept that at least one of them must be getting better.


Ah yes, the "Lasik Salute".

gcarlson wrote:Now I just have to contend with allergies. Any opinions on allergy eye drops? The tears seem to help wash things out, but I need something to reduce the itching.


You really need to have your eye doctor prescribe allergy drops appropriate for your situation so close after surgery. Allergy drops tend to cause dry eye symptoms and other reactions that you would want to avoid.
Glenn Hagele
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USAEyes

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I am not a doctor.
LasikExpert
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