enhancement done - blur vision on Left

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enhancement done - blur vision on Left

Postby jeffrylim27 » Mon Apr 02, 2007 9:31 am

I had my LASIK done 15Jan07. Vision improved significantly for me (R 5.50 to 0.7, L 7.50 to 0.75 with astigmatism). However, I still had problems indoors and during the night - Double vision on the left eye, I couldn't see clearly roadsigns, recognize faces beyond 20 feet, couldn't read signboards clearly in the mall. After 10 weeks, and with no further improvements in the eyesight, the doctor recommended that I have a enhancement surgery.

I did my enhancement 8 days ago on both my R and L eye. Contact lense bandage was fixed on both eyes. After the enhancement, my L eye cornea was significantly more swollend than the R. Vision on the L eye was blur and started to clear up after 48 hours. On the 4th day, the contact lense bandage was removed. My R eye healed very fast and I have very good vision with it now, I can see so much better than before and there are no problems now indoor and during the nights. However, my L eye is having a very slow healing process - vision is still not as sharp (both near and far vision, i think I still have about 1.00 grade, but no more double vision). The doctor is saying that he intentionally overcorrected the eye because as it heals, it will regress, and the L eye will catch up.

Here are some of my observations of my left eye - when I wake up, I seem to have good vision with the L eye also but it tends to deteriorate after about an hour to where it was the day before. I am still using the following drops - Zymar, Pred Forte and Cellfresh. The vision is the same, from the day the contact lense bandage was removed.

Questions (i) with one good eye and one not so great, will I develop lazy eyes? (ii) if regression is going to occur, does that mean that my R eye will also deteriorate in the next couple of weeks? (iii) why do I experience the phenomenon - good eye sight when I wake up, but deteriorates after an hour? (iv) How long does the eye take to heal and why does it continue to change through to the 6th month? (v) Should i exepct significant changes over the next 6 months? I read somewhere that after the first 2 weeks of surgery, there will be very minimal change in the eyesight (vi) do the drops really have any effect? I have been applying them, but don't experience any significant changes.
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Re: enhancement done - blur vision on Left

Postby LasikExpert » Mon Apr 02, 2007 5:05 pm

Before surgery were you hyperopic (farsighted, longsighted) or myopic (nearsighted, shortsighted)? Are you currently myopic or hyperopic?

From your description it sounds like you may have had PRK on the Lasik flap. Is this the case, or did you have Lasik enhancement surgery where they lifted the flap?

jeffrylim27 wrote:(i) with one good eye and one not so great, will I develop lazy eyes?


Not likely if you are an adult. This kind of correction is deliberate with monovision.

jeffrylim27 wrote:(ii) if regression is going to occur, does that mean that my R eye will also deteriorate in the next couple of weeks?


That is a very good question to ask your doctor. To some degree regression can be managed with the amount and duration of steroid eye drops. It may be that this will be a factor.

jeffrylim27 wrote:(iii) why do I experience the phenomenon - good eye sight when I wake up, but deteriorates after an hour?


There could be several reasons. If one cornea is swollen (edema), then it may be less after a night's rest. If dry eye is contributing, it may be less after hours with your eyes closed. If you are at or near age 40, presbyopia may be less severe when you are well rested and you are "focusing around" the refractive error in the morning.

jeffrylim27 wrote:(iv) How long does the eye take to heal and why does it continue to change through to the 6th month?


Normal Lasik surgery recovery is about six months with vision recovery within a few days/weeks. If you had PRK on the Lasik flap, vision recovery will be much slower than with Lasik. The eye continues to change past six months because the human body is very adept at fixing things it does not like, especially something used as much as vision. The cornea itself may change, and the way the brain processes data may change.

jeffrylim27 wrote:(v) Should i exepct significant changes over the next 6 months? I read somewhere that after the first 2 weeks of surgery, there will be very minimal change in the eyesight


Everybody heals differently and you have had two surgeries, not one. It may also be that you have had two different kinds of surgeries with two different rates of recovery. This is one where your surgeon would be much better able to advise.

jeffrylim27 wrote:(vi) do the drops really have any effect? I have been applying them, but don't experience any significant changes.


They have a huge effect and need to be applied exactly as prescribed by the doctor. You don't want to suddenly change steroid usage until the doctor has determined it is okay.
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Postby jeffrylim27 » Tue Apr 03, 2007 2:30 am

Had Customvis Lasik with flap opened (not PRK). I am 34. When enhancement was done, the flap was re-lifted.

Before surgery I am myopic (cannot see far). Right now, I don't have any problems with the R eye, I can see clearly near and far.

However with the left eye, near and far distance are both not clear.

Thanks for your speedy response :D
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Postby LasikExpert » Tue Apr 03, 2007 2:43 am

jeffrylim27 wrote:...with the left eye, near and far distance are both not clear.


This indicates that you have a quality of vision problem, not refractive error. It is likely that your vision through corrective lenses would not be much improved. Dry eyes, irregular edema (swelling), early stage of Lasik flap healing, and just early stage of general healing would all be the usual suspects.
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enhancement done

Postby richbron » Fri Apr 13, 2007 12:40 pm

Hi Glenn

Very interesting.

I too experience good vision upon waking up in the morning, within an hour my vision blurs.

I underwent Lasik in November 2005 and an astigmatik keratotomy in March 2006.

My current prescription is:
L +0.25 -1.00 x 50
R plano -0.75 x 10

Could I still be recovering - ie could my blurriness be due to endema. Could it be at all possible that my eyes are still recovering.

I have glasses and contact lenses at my new prescription but these do not fully correct - mid afternoon glasses are hopeless .....

I too underwent 2 surgeries.

Thanks Glenn
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Update on progress of recovery after enhancement

Postby jeffrylim27 » Mon Apr 16, 2007 11:14 am

Its been 4 weeks since I did my enhancement. I am sure glad that I made the decision to do it. My eye sight is so much better than before I had my enhancement. I don't have any more problems seeing in low light conditions, and also no more ghost image effects. My astigmatism problem has also cleared.

I did a test a few days ago, and I now have 20/10 vision when I did the test with both eyes, am so satisfied with the results now. My R eye has no problems and can see very well, my L eye remains a little dry, and it is just lags behind the R eye a little. As mentioned in my earlier posting, I had problems seeing with my L eye in the first 10 days after the enhancement, but it has gradually improved and it is now nearly as good as the R eye.
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Re: Update on progress of recovery after enhancement

Postby LasikExpert » Mon Apr 16, 2007 3:25 pm

richbron wrote:I underwent Lasik in November 2005 and an astigmatik keratotomy in March 2006.
...
Could I still be recovering - ie could my blurriness be due to endema. Could it be at all possible that my eyes are still recovering.
...
I have glasses and contact lenses at my new prescription but these do not fully correct - mid afternoon glasses are hopeless .....


It is unlikely that you are still having edema problems from the November 2005 surgery. The March 2006 astigmatic keratectomy (AK) could be still healing and causing the fluctuations through the day. AK is much more similar to the old Radial Keratotomy than Lasik. An incision is made into the cornea to cause instability with the intention that the instability will change the cornea as desired.

Your prescription shows enough astigmatism to contribute to poor vision quality, but this should be able to be corrected with glasses or contacts.

jeffrylim27 wrote:I did a test a few days ago, and I now have 20/10 vision when I did the test with both eyes, am so satisfied with the results now. My R eye has no problems and can see very well, my L eye remains a little dry, and it is just lags behind the R eye a little. As mentioned in my earlier posting, I had problems seeing with my L eye in the first 10 days after the enhancement, but it has gradually improved and it is now nearly as good as the R eye.


Congratulations on your great final result. Lasik can be a process, not an event. Fortunately all worked out as desired for you.
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Postby richbron » Mon Apr 16, 2007 4:39 pm

Thanks Glenn


You wrote:
The March 2006 astigmatic keratectomy (AK) could be still healing and causing the fluctuations through the day.

How long does the healing for AK generally take?

I am going mad with fluctuating vision - constantly suffering from headches (I am an accountant and hence live in front of a PC).

Richard
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Fluctuations with AK

Postby richbron » Tue Apr 17, 2007 11:20 am

Hi Glenn

Are the fluctuations following (a year later) an Astigmatic Keratotomy normal then? How long will the instability/fluctuations last?

Its due to these fluctuations that I cannot get a stable eye/contact lens prescription. Its amazing how sensitive I am to the slightest change in precription now .... I do so regret having the AK and hope that one day my vision settles.

I would be interested to know whether these symptoms are considered normal so far down the path and whether it will stabilise in order to have corrective glasses / contact lens fitted.

I am going mad with my eyes ....

Thanks for your always informed, prompt and useful information.

Richard
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Astigmatic Keratotomy Fluctuations

Postby LasikExpert » Tue Apr 17, 2007 5:03 pm

Astigmatic Keratotomy (AK) is so very different from Lasik, PRK, or any of the laser assisted refractive surgery techniques that there really is no comparison.

Depending upon the location, depth, and quantity of the AK incisions, instability may be long term. At a year postop the AK incisions will probably have healed as much as they are able.

The instability may not be due to the AK or may only be exacerbated by the AK. Dry eyes can cause the kind of fluctuation of vision quality you describe. A corneal specialist would be good to consult.

IF the problem is fromthe AK, a careful fitting of Rigid Gas Permeable (RGP) contact lenses or hybrid lenses such as SynergEyes may provide additional stability. I know you didn't go through this to wear a contact lens, but tha is a possible resolution.

You may also want to investigate Corneal Collagen Crosslinking (C3-R) for corneal stability.
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AK - Dry eye

Postby richbron » Tue Apr 17, 2007 9:09 pm

Thanks Glenn.

Is it possible that the incisions can create dry eye? I have experienced the same fluctuating vision from the day after the AK (March 2006) and continues ....

My prescription changes -0.5 from morning to afternoon - ie I seem to become more short sighted as the day progresses.

I am currently being treated (without any success) for dry eye - I have been told that occular rosacea and MGD is the cause of my dry eye.

In your opinion would restasis drops and punctual plugs help?

Thanks again for all your useful advice!

Richard
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Re: AK - Dry eye

Postby LasikExpert » Thu Apr 19, 2007 5:13 am

richbron wrote:Is it possible that the incisions can create dry eye? I have experienced the same fluctuating vision from the day after the AK (March 2006) and continues ....


To my knowledged dry eye has not been a common complication with incisional refractive surgery like AK.

richbron wrote:My prescription changes -0.5 from morning to afternoon - ie I seem to become more short sighted as the day progresses.


If you become more nearsighted, that may be related to edema (inflammation) of the cornea. This could be caused or exacerbated by dry eye.

richbron wrote:I am currently being treated (without any success) for dry eye - I have been told that occular rosacea and MGD is the cause of my dry eye.


Ocular rosacea alone can cause many of the symptoms you describe, as can Meibomian Gland Dysfunction. It is likely that you will continue to have fluctuation and vision difficulties until these are managed.

richbron wrote:In your opinion would restasis drops and punctual plugs help?


Restasis is an anti-inflammatory approved for the treatment of dry eye, but not specifically for rosacea or MGD. It may be considered appropriate for off-label use by a physican, but I'm not familiar enough with current rosacea or MGD treatment to offer an opinion.
Glenn Hagele
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