LASEK 7 days ago

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LASEK 7 days ago

Postby carmen123 » Wed Jul 26, 2006 8:06 pm

Hello,

First, here is the background:

I am 25 years old. I had pretty significant nearsightedness. Left - -9.25
Right - -9.00. My corneal thickness was 569 microns (i think that is the unit). Right now I am using FML drops, but earlier was using an antibiotic and anti-inflammatory. I also use artifical tears (w/ no preservatives) whenever I need them.

I just had LASEK 7 days ago. I know that LASEK has a longer healing time than LASIK, but after 7 days of healing I thought I would be seeing much better than I currently am.

Right now there is some haziness, but the most annoying part is that one eye is seeing significantly better than the other. My left eye is seeing about 20/40 while my right eye is only seeing about 20/70. My doctor says not to be worried, but I can't help it. The difference in vision makes me dizzy and causes headaches. I also cannot drive which of course doesn't make me happy.

Another worry is that 3 days after surgery my vision was actually better than it is now. My doc said that my right eye might be healing slower because the epithilium (sp?) is a little "heaped up". Will this fix itself or do you think I might need another procedure?

When I borrowed a friend's low prescription glasses and looked through them using my right eye, the image was clearer. Does this mean that maybe the laser didn't "shape" my eye correctly, or is it just too early to tell?

I'm sure that it is a bit early to be so worried, but I can't help it. I chose LASEK after visiting 3 different surgeons. One said LASEK, one said Intralase, and one was in-between. Ultimately I chose LASEK because I didn't want my cornea to end up being too thin.

Any additional information or peace of mind you could give me would be great.

Thank you SO much for reading.
Carmen
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Postby LasikExpert » Wed Jul 26, 2006 8:29 pm

I like to say that for the first three months after LASEK you will wish you had Lasik, and then for every day thereafter you will be delighted you had LASEK.

What you are experiencing is very common. One eye being different than the other, poor vision quality, off-target correction, a dip in vision quality. These are consistent with LASEK recovery.

During LASEK the outermost layer of cells on the cornea (epithelium) is loosened with an alcohol solution, moved aside, the laser reshapes the cornea, and then the epithelium is repositioned over the treatment area. The epithelium acts as a bandage to reduce the probability of corneal haze, reduce discomfort, and improve short-term vision quality. For details, see LASEK Laser Eye Surgery.

During the LASEK process all of the epithelial cells are mortally wounded. All will die and need to be replaced. The corneal epithelial cells are the fastest reproducing cells in the human body, but they do take some time. Also, the process of the damaged cells dying, collapsing, and then being replaced adds to that time. Immediately after surgery the epithelium is relatively thick and healthy and vision quality is not terribly bad. Within a few days it goes downhill rapidly as the cells die and the epithelium thins. The damaged and thinned epithelium will provide poor vision quality and create a pseudo-overcorrection effect. A few days more and new cells are replacing the old cells and vision quality starts to improve. A few weeks later the epithelium will have thickened and will start to become smooth. This is when vision quality is at its best.

In addition to the typical limitations of LASEK recovery, you were very myopic (nearsighted, shortsighted) and regression would be expected. Your surgeon may have deliberately overcorrected you into hyperopia (farsighted, longsighted) vision with the expectation of regression bringing you back to plano (no refractive error). Enhancement surgery is rather common for someone as myopic as you. You may want to read Laser Eye Surgery Overcorrection and Enhancement Surgery.

Expect that in about two more weeks the quality of your vision will be nearly what you expect. A few weeks more and the crispness should return. At that time your doctor can determine if you have residual refractive error and if enhancement surgery is recommended.
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Postby carmen123 » Wed Jul 26, 2006 8:40 pm

Thank you very very much for your quick response. It definitely has helped to answer some of my questions!

Of course now I have some additional quesitons.. :)

With both eyes, I can still see things well close up (from about 6 inches from my face). If the doctor had overcorrected me, would I still be able to see things close up or would things be cleared further away?

My friend is also near-sighted, so when I used her lense over my right eye and it made things clearer wouldn't this mean that I am still myoptic?

I have another appt with my doc tomorrow, so maybe I will know if there has been any improvement (although it doesn't seem like it).

Also, what is your advice on going into the water after LASEK. My doc said wait 2 weeks, but since the healing time is so much longer do you think 2 weeks is enough time?

Again, thank you!! It is so nice to be able to ask questions on this forum!!
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Postby LasikExpert » Wed Jul 26, 2006 9:19 pm

Being able to see objects close and not objects at a distance would indicate that you are myopic, however at age 25 you would have significant accommodation. Accommodation is the ability of the eye to change focus from an object distant to an object near. Accommodation will “focus around” myopia and hyperopia. How much of your refractive error is due to actual refractive error, or pseudo error from a distressed epithelium would be difficult to say without a cycloplegic examination that stops the natural lens from changing focus.

It is reasonable to expect regression over the next several weeks with things settling down around 3-6 months postop.

If all healing is going well, two weeks may be fine. Be sure that your doctor has examined you to verify that your eyes are ready for swimming.
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Postby carmen123 » Thu Jul 27, 2006 7:55 pm

Just thought I would post an update.

I saw my doc today and my eyes have slightly improved since Monday(although in my right eye it is difficult to tell any difference).

My left eye is now 20/30 and my right is about 20/50! :)

Even though I could read the letters on the chart, they still appeared blurry, not crisp. Almost had a shadowy effect.

One thing that scared me a bit was when my doc looked at my right eye and said "whoa! it looks like there is a a tornado in your eye!" When I asked him what he meant, he said that the way my epithilium was healing was very "interesting". Again, he didn't seem worried at all, but it still made me a bit nervous.

So, overall I'm optimistic that things will continue to improve..and maybe I will even feel comfortable to drive by Monday. I'm crossing my fingers!

Thanks again!!
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Postby LasikExpert » Thu Jul 27, 2006 8:06 pm

I think I may know what your doctor meant by "tornado". When the epithelium heals it tends to come in from the outside to the center at three angles. The front edge of this healing epithelium can be a bit cloudy. The shape of the cloudy front edge can look like a Mercedes Benz logo - the three pronged star. If the epithelium is healing from outer edge to the center plus rotating slightly, it could give the appearance of a twiter or tornado.

This would be consistent with what your doctor said and your vision recovery symptoms.
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Postby ericliutexas » Fri Jul 28, 2006 1:22 am

Carmen, thanks for your interesting post.

First, i wanna say that we had almost identical refractive errors.

Second, we had different degrees of cornear thickness. Mine was 550.

third, we also had different surgeries. I had a intralasik surgery three weeks ago.

It would be interesting to do some comparisons. Currently, my left eye is almost 20/20, while right eye 20/40. In the past 3 weeks, no significant improvements in either eye.

other problems: it is hard to see indoor objects clearly, and hard to see outdoor objects clearly at night either. Have you had the same experience?
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Postby carmen123 » Fri Jul 28, 2006 1:57 am

That is a good idea.

Well, right now the vision in my right eye still seems pretty bad. I can see slightly better outside, inside objects appear more blurry.

I still have some haze as well, but it has been getting better.

How long did your doc say until you should see "close-to" final results? My doc estimated at least another 2 weeks for me.

Does the difference in vision between eyes irritate you? I find it incredibly annoying. I'm really hoping that things will get better.

I hope your sight continues to improve as well!
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Postby ericliutexas » Fri Jul 28, 2006 2:09 am

Hi Carmen,

We has similar experiences in terms of hazeness and blurry problems.

My doc told me the recovery time would take 4 months or so.

My vision stays stable after the surgery, with haziness diminishing overtime.

I was very concerned about the difference in vision between my two eyes. And I dont understand why my right eye vision has been so poor. Did the doc do right to it? At least I know my right eye vision 20/40 is not due to regression.

Thank you for the wish. I hope the same for you. As Glenn suggested, you need to be more patient because the recovery time is relatively long for LASEK.
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Postby carmen123 » Fri Jul 28, 2006 2:16 am

Yea, my doc also said that final results wouldn't occur until around the 6 month mark.

I will just be happy when I feel comfortable enough to drive!! :)

Just curious, but how old are you?

Right now my doc seems to think that my right eye is seeing poorly because the epithilium is healing slowly. Right now I am taking his word for it, although I know I won't feel very happy until I can actually notice some improvement.

As far as I know, the actual procedure went very smoothly.

I'm a bit worried about regression. I'm not sure if my doc over-corrected me or not..so I'm nervous that it might get worse later on. All I can do is wait and see I guess..
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Postby ericliutexas » Fri Jul 28, 2006 4:17 am

Good to hear that you are on the track. I am older than you, 28.

See? We have different concerns.

First, you at least know why your right eye vision is so poor, but i dont. I was wondering if my poor right eye vision can also be affected by the slowing healing epithilium, though the surgery was Introlasik not LASEK.

The second concern is, you are worried about regression, i am worried about thin cornea. My vision has been stable.

I will greatly appreciate Glenn's any words.
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Postby LasikExpert » Fri Jul 28, 2006 5:15 am

There is really nothing you can do about regression. If it is going to happen it is going to happen and you really won’t know until about 3-6 months postop where your vision will land. Then the surgeon can determine of enhancement surgery is appropriate.

LASEK takes much longer to resolve than Lasik or IntraLasik. Several weeks to a couple of months before crisp vision returns is not really surprising. If the epithelium is having problems with healing it can take longer. Much longer.

I personally had PRK and (stupidly) did not follow my surgeon’s postop instructions appropriately, causing epithelium damage. Yes, I should have known better. I mean, really. It took a long time for things to settle down. I know first-hand how hard it is to not be able to fully function and to worry about healing issues. Long term you may be fine, but we don’t “see” long-term.

IntraLasik commonly has a quick recovery, however everyone heals differently. This time can easily be scary and there are several websites out there that seem designed to make your anxiety even worse, but anxiety will not help your healing. It is easier said than done, but try to be patient.
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Postby carmen123 » Fri Jul 28, 2006 2:11 pm

Just a quick question about enhacements..

If I were to get an enhancement, would it pretty much just be the same LASEK procedure that I originally had, except a smaller correction?

Also, is there more risk of corneal haze if you get an enhacement?

I feel very lukcy that at least for now there isn't too much haze..but I'm a little worried that I could develope some haze the second go round..

I think you mentioned that haze with correction over 6 is more likely..

Thanks so much LasikExpert! You are great!
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Postby carmen123 » Fri Jul 28, 2006 2:16 pm

Eric,

One more thing I wanted to tell you!

One of my mother's friends had reg LASIK, but had a very similar experience as you in terms of the healing. One eye was faster than the other, and even after 1 month she wasn't seeing as clear as she wanted..

Also, she could see pretty well outside, but her vision inside was pretty poor (even though her eye doc said that "wasn't possible")

After about 2 months though, her vision improved, and now, 2 years later, she is super happy with the results. It just took longer than what she thought it would.

So..maybe that will make you feel better :) Sometimes, even with LASIK, it seems as though healing takes a while.

We both just need to be patient.
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Postby ericliutexas » Fri Jul 28, 2006 5:23 pm

Hi Carmen,

Thanks for your kind words. I am happy. I think that you are right about our benefitting from patience, not worriness. My experience tells me that you will soon find that worriness is disappearing as time passes by.

What is important for you now is to follow post-op instructions. As long as doc says O.K., your should have no problem with your eyes which heal on their own. Nothing else is important.

An enhancement is normal for large refractive errors due to regression. My doc suggested it to me as early as I saw him first time. But my current situation seems different. I suspect that my eyes were undercorrected because my doc wanted it that way for safety.

Anyway, please dont worry, we will get there soon.
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