9 months Post CustomVue Intralase Lasik

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.

9 months Post CustomVue Intralase Lasik

Postby peakaboo » Fri May 11, 2007 3:07 am

Well, I had my 9 month followup today and things are looking pretty good. I've been somewhat dissatisfied with my night vision due to starbursts and halos, but my daytime vision is pretty damn good so I can't really complain.

My pre-surgery readings according to the Customvue Visx machine were:
OD: -5.69 DS -0.97 DC x 173 deg with scotopic pupil dia 8.3mm
OS: -5.78 DS -0.92 DC x 8 deg with scotopic pupil dia 8.8mm

Cornea thickness was measured at OD 515 microns and OS 516 microns.

HOA pre-surgery were measured at between 3 and 3.5%.

At my visit today I was able to see the 20/20 line pretty clearly and the 20/15 line with both eyes open with sufficient lighting. In dim lighting, my vision decreases substantially and halos become more prominent. I was provided a container of Alphagan P to see if that helps nighttime driving issues, but I have not had a chance to try it yet. Dry eye has become less of a nuisance...I've been on Restasis for 5 months, but I still have some dryness when I first wake up and sometimes at night after a long day at the computer. I'm hoping this resolves over the next 6 months or so.

Options going forward for the night vision may include glasses or possibly an enhancement to attempt to correct residual HOA, which are now at around 70-75%. I'm not looking forward to a flap lift as this would start the dry eye and healing issues all over again, and since I'm seeing quite well with adequate lighting, it could actually cause more harm than good. Next appointment is in 3 months, so there's time to think about it.
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Postby LasikExpert » Fri May 11, 2007 4:17 am

What is your current prescription? Have you tried contact lenses to resolve residual refractive error?
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Postby peakaboo » Fri May 11, 2007 11:10 pm

I don't have the numbers for my current prescription, however, being able to see the 20/15 line must mean I'm pretty close to plano. The doctor did check my eyes with a standard refractive test (which is better, one or two?) but the lense switching didn't really make any difference in improving acuity that I could see. He indicated that I may have a very small amount of astigmatism left and 75% of any correction applied during an enhancement (if I wanted to try to get things a bit more crisp) would be addressing residual HOAs.

I'm not sure re-lifting the flap is worth the risk at this point. Glasses or contacts will most likely not improve my vision.
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Postby LasikExpert » Sat May 12, 2007 12:21 am

peakaboo wrote:I'm not sure re-lifting the flap is worth the risk at this point. Glasses or contacts will most likely not improve my vision.


You are correct, and your doctor would likely not lift the flap. PRK on the Lasik flap is becoming more popular for small enhancement surgery corrections.
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Postby JPD » Sat May 12, 2007 6:08 am

LasikExpert wrote:You are correct, and your doctor would likely not lift the flap.


Is lifting it a second time more risky then doing it the first time? It would seem creating the flap and lifting it would be more risky then doing it a second time.
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Postby peakaboo » Wed May 16, 2007 3:10 am

Well, I tried Alphagan P tonight for the first time...took about 30 minutes to start to kick in, but boy, what a difference with night vision! I guess this proves that the starbursts and halos at night are due to pupil size for me, which is no surprise since the ablation zone (6.5mm) and blend zone (out to 8mm) are quite a bit smaller than my dilated pupil sizes (8.3 - 8.8mm).
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Postby LasikExpert » Wed May 16, 2007 3:22 am

Your pupils are not really the problem. The reason you have night vision problems is because the center of your cornea has a different refractive error than the outer edge and this is enough to affect vision quality when the pupils become larger.

Surprisingly, not everyone with an optical ablation zone smaller than their naturally dilated pupil has this problem. Our article about Lasik night vision problems provides details.
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Postby JPD » Wed May 16, 2007 4:07 am

peakaboo wrote:Well, I tried Alphagan P tonight for the first time...took about 30 minutes to start to kick in, but boy, what a difference with night vision! I guess this proves that the starbursts and halos at night are due to pupil size for me, which is no surprise since the ablation zone (6.5mm) and blend zone (out to 8mm) are quite a bit smaller than my dilated pupil sizes (8.3 - 8.8mm).


So is your night vision now equal to or better then pre-Lasik?
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Postby peakaboo » Thu May 17, 2007 1:47 am

I've only tried the drops one night so far. I intend to use the drops only when I feel I really need them, like on a long night drive in unfamiliar territory or on occasions when I absolutely need good vision in dim lighting.

I absolutely believe the only reason for the halos and starbursts at this point is the fact that my pupils in dim light are larger than the fully corrected ablation zone of 6.5mm. If the drops shrink my pupils and the starbursts go away, and the lighting doesn't change...it's a no brainer. Another way of putting it is if I had abnormally thick corneas (say 700um), and they used a laser that could ablate a full 9mm diameter optical zone , i would have no night vision problems.
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Postby LasikExpert » Thu May 17, 2007 8:24 pm

The cause and effect is absolute. Those who have night vision problems that are resolved with the use of Alphagan P or pilocarpine clearly have problems because of the difference between the size of the optical ablation zone and the size of the naturally dilated pupils.

The other, but related, issue is predictability. Not everyone who has an ablation smaller than pupils develops night vision problems, so pupil size alone is not a reliable predictor of night vision problems. It may initially sound counterintuitive, but there is a huge difference between predicting the occurrence of a problem and treating a problem when it has actually occurred.
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