Opinion on enchancement please.

Post your questions and start your research in this forum if more than three months ago you had any type of surgery to reduce the need for glasses and contacts.

Opinion on enchancement please.

Postby irata » Thu Apr 05, 2007 5:47 am

Thank You Mr. Hagele for your insight and expertise on the problems and concerns we have. This foruma nd website has helped understand a great deal on what is going on with my eyes post lasik. I would like your opinion on my case if you may.

I have custom wavefront lasik july 2006
I am now 8.5 Post op
Main concern is low light/night vision problems and floaters
My Rx pre was right: -3.25 .75 180 left: -5.00 .50 180 myopic
My Rx at 8.5 months is right: .50 1.00 170 left: .50 .75 180 hyperopic

At 2 months i experienced a regression in both acuity and night vision. I was a contact lens wearer for 13 years prior so my eyes were dry and still are to a small extent today. The regression in regards to the acuity does not concern me as i am quite happy, but it does not compensate for my terrible night vision.

It seems that a lot of my low light/nightime issues are related to the obvious culprits (halos, startbursts, and glare). Also, i have more astigmatism than i originally came into the surgery with! But a major concern for me is loss of contrast. I can not longer see objects at night in my room i once did, it is simply black/grainy/washy etc. I have a poster on my wall and i could remember seeing the outline of the face with no problem prior to the surgery, but now, its just a black blur. Lines and curvatures are not longer crisp or even identifiable for that matter. I can no longer see the road far ahead of me when driving at night. I used to squint when i saw the new HID headlights coming my way, now i dont. I cant tell what is blue or black in very low light areas. I did not see one floater pre op, now i see over 10. This is contrast, correct?

Ive explained these problems to my surgeon last december. He asked me to wait another couple months to see if things progress. They did not. He explained to me then that sometimes it takes longer to resolve some of these night issues. I feel that these problems will no longer resolve. I have not seen any progress in almost 7 months!

Ive explained to my surgeon what I stated before, in regards to the contrast loss, and he seems a tad puzzled. He sees the halos, etc as something that can try to be corrected in an enhancement, but im wondering if the contrast issue can be corrected as well. Ive tried alphagen P which did very little and even new contacts which i could not tolerate physicallybut I did see some improvement with the halos/startburts etc.

Could this be a 'treatment area' issue? Pupil size? I dont seem to understand why i had such a loss of contrast. I am schedualed to see him again in a couple weeks and i must come to a resolution. I understand the risks for an enhancement and i am willing to take a those risks because my night vision is not adequate. I find it difficult to function properly, as I had lasik in order to pursue a particular career; i needed to have refractive surgery done.

What can be done, and what else can i ask him? is a custom wavfront enhancement suitable?

Thank you kindly.
irata
 
Posts: 6
Joined: Sun Mar 25, 2007 5:49 am

Re: Opinion on enchancement please.

Postby LasikExpert » Thu Apr 05, 2007 8:15 am

irata wrote:Could this be a 'treatment area' issue? Pupil size?


If the Alphagan P was working at reducing the size of your naturally dilated pupils and you did not see significant change in your vision quality while using Alphagan P, then this is not a pupil size/treatment size issue. If it was, you would see the difference straight away.

irata wrote:I dont seem to understand why i had such a loss of contrast.


This may be due to the small residual myopia (nearsighted, shortsighted) vision and astigmatism. This is enough to cause blur. Blur can reduce contrast sensitivity. If the contact lenses were well fitted with the correct power and fully corrected your astigmatism, then vision should have improved.

irata wrote:I am schedualed to see him again in a couple weeks and i must come to a resolution.


Request a wavefront diagnostic. This should provide an objective measurement of your vision symptoms and may provide some insight whether wavefront-guided enhancement may be appropriate. You will be at nine months postop by then. While you may experience continued improvement, it would appear that the majority of your healing has completed.

Your dry eyes will most certainly contribute to poor vision quality.

Please report back after your next exam.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California

Postby irata » Thu Apr 05, 2007 5:33 pm

thank you for your reply.

Perhaps did not give the drops and contacts enough time, i will try them again and truly note any changes and relay this to my surgeon.

You said that my loss of contrast could be due to residual myopia and astigmatism. My surgeon corrected me into hyperopia, as i am +.50 both eyes, correct? Can I still be myopic?

I will certainly do as you requested during my next visit.

Thank You
irata
 
Posts: 6
Joined: Sun Mar 25, 2007 5:49 am

Postby LasikExpert » Fri Apr 06, 2007 2:24 am

Hyperopia, (farsighted, longsighted) is the opposite of myopia (nearsighted, shortsighted). You cannot be both myopic and hyperopic. I apologize that I missed your previous reference to hyperopia.

If you are hyperopic and presbyopic (reading glasses), you may experience poor quality vision at all distances. The hyperopia is very low, but it certainly could reduce contrast sensitivity - especially with the astigmatism.

You should be able to do well with corrective lenses if the loss of contrast relates to refractive error. This can be tested in the doctor's office too.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California

Postby irata » Mon Apr 09, 2007 4:02 am

Mr. Hagele:

I thought I would give you and update before i see the surgeon this friday. Ive tried the alphagan P and contact lenses again and noted the changes.

1. alphagan p
pros
-fair amount of reduced glare and halos
-better night acquity, crisper, a bit of restored contrast

cons
1. Did not seem to rectify my starbursts, as it made the actual 'bursts' more pronounced, not bigger, just that i am able to see the bursts more finely. Perhaps this was due to the reduced halos?
2. i cannot tolerate this med physically as it dries out my sinuses; which throws me into sneezing fits.

2. Contacts (toric +.25 -.75)
pros
-slightly reduced halos and glare and starbursts
-better night acquity and restored contrast (same amount of alphagan p)

cons
-not enough reduction in starbursts
-distorts my starbursts slightly (unlike the alphagan P, these kind of smudge the bursts together


while i dont mean to sound over particular here, these are just observations ive made from these two methods of correction, which did not satisy me to an extent which i would continue using these methods as stated before; however some of its small, but noticeble night vision enhancing properties made me feel somewhat more comfortable at night visually.

I will request a wavefront diagnostic as you mentioned and explain to my surgeon that smaller pupils and astigmatism correction through contact lenses have given me some improvement.

Could these problems be the subjects of higher order abberations?
irata
 
Posts: 6
Joined: Sun Mar 25, 2007 5:49 am

Postby irata » Thu Apr 19, 2007 6:49 am

I saw my surgeon and i decided i would go with an enhancement. I had a precise reading done it turns out im actually -1.00 astigmastism in my other eye as well. He said that likely hood of higher order abberations causing most of my problems is around 10%, the other 90% going towards the astigmatism.

one thing i forgot to ask him was the overcorrection part. i understand that i will be overcorrected because of the expected regression, and i have a few questions regarding that:

1. will i try to be corrected back to myopia?
2. Does a hyperopic person notice floaters more than a myopic?
3. Can you explain the overcorrection process for me?

thanks
irata
 
Posts: 6
Joined: Sun Mar 25, 2007 5:49 am

Postby JPD » Thu Apr 19, 2007 2:56 pm

irata wrote:He said that likely hood of higher order abberations causing most of my problems is around 10%, the other 90% going towards the astigmatism.


I'm not trying to hijack your thread here. But curious, your doctor said it's a 90% chance that halos and starbursts could be caused by an astigmatism?
JPD
 
Posts: 160
Joined: Mon Mar 19, 2007 3:09 am
Location: Southern California

Postby irata » Thu Apr 19, 2007 5:24 pm

JPD wrote:
irata wrote:He said that likely hood of higher order abberations causing most of my problems is around 10%, the other 90% going towards the astigmatism.


I'm not trying to hijack your thread here. But curious, your doctor said it's a 90% chance that halos and starbursts could be caused by an astigmatism?


yes, that is correct
irata
 
Posts: 6
Joined: Sun Mar 25, 2007 5:49 am

Postby irata » Thu Apr 26, 2007 4:30 am

Mr. Hagele, is there any information that you could possibly add in regards to my questions in the previous? I have no further questions and im delighted youve been so helpful thus far.
irata
 
Posts: 6
Joined: Sun Mar 25, 2007 5:49 am

Postby LasikExpert » Tue May 01, 2007 1:38 am

Higher Order Aberrations (HOA) are a system of measurement of optics using wavefront analysis converted into mathematical models using Zernike or Fournier polynomials. HOA do not cause aberrations any more than a yardstick causes a three foot length of yarn. They are measurement devices.

There are three states of sphere in human optics. Emmetropia means no light entering the eye is focused at the retina with refractive error and the eye is "normal". Hyperopia (farsighted, longsighted) means the light entering the eye focuses primarily behind the retina. Myopia (nearsighted, shortsighted) means the light entering the eye focuses primarily in front of the retina.

Overcorrection means changing a person from myopia to hyperopia, or hyperopia to myopia.

The surgeon will undoubtedly "reverse correct" any expected overcorrection caused by the coupling effect during astigmatism correction. Discuss this with your surgeon for a detailed explanation, but it is likely you will not be overcorrected.

I do not know of any studies that indicate a hyperopic person sees floaters any differently than a myopic person.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


Return to Had It A While Ago

Who is online

Users browsing this forum: No registered users and 1 guest

cron