lens accommodation

[jz5168]

My original op was 7/17 and up to 2 weeks ago my right eye has been pretty clear (20/25) until started 2 weeks ago I noticed my eye started towards blur side. Then since my doc visit 1 week ago, my left also started towards blur side. The past 2 - 3 days this process gets accelerated, now I'm very blur.

I'm concerned, so I called my doc this morning and they wanted me in this afternoon. I just come back from this visit.

During this visit, I told the doc all my experiences including the fact that my eyes are clear after waking up but quickly become blur after 1 hour.
The doc did some eye exam like last time (the regular one, not the dilated one, which will be done some time later). Surprisingly, the doc told me what I've experienceing is caused by the lens accommodation, in my case, over focus. My reading one week ago: 20/40 and -0.75, 20/60 and -1.00. This time (only 1 week later): 20/60 and -1.00, 20/200 and -1.75. After the eye exame and the corneal curlvage reading, she said my corneal hasn't changed much operation, and the eye exam confirmed this is due to lens accommodation and being over focus.

I do comupter work and did read a bit more during the past 2 weeks, and that might tirggered it. The doc said I need to take lots of breaks and look at far distance frequently.

When I asked whether this is tempory, the answer I got is yes. Also I was told I'm not typical (I'm 39).

My next appt is now 2 weeks from now instead of 4.

So Glenn, do you have any comments?

[jz5168]

btw, this also explains my eye strain for the past 2 weeks, which I had not experienced in the first month.

Now I wonder how long this would last. But my action after this visit is I need to cut donw computer use as much as possible and look far as much as possible.

[LasikExpert]

To see objects within about 20 feet, the natural crystalline lens within the eye changes shape and thereby changes focus. This is called accommodation. After around age 40 accommodation is reduced to the point that reading glasses are needed to see near objects. This is presbyopia.

Your crystalline lenses have become acusstomed to a range of change based upon your old myopia (nearsighted, shortsighted) vision. Lasik has changed that range and your lenses are trying to catch up. Even a small amount of presbyopia can make this change more difficult.

A cycloplegic refraction (which is better, one or two?) with the crystalline lens paralyzed may determine that you are now a little hyperopic (farsighted, longsighted). If you are, then you require even more accommodation.

We have an article about eye strain after Lasik that you may find helpful. You may also want to read about presbyopia after Lasik.

It is reasonable to expect this to improve, but at some point in your life presbyopia will limit your ability to focus on objects near.

[jz5168]

Hi Glenn,

Thanks for your feedback, but I'm afraid you completely misunderstood my situation. My problem is mainly with my left eye. (My right eye has been up and down but I will say it regressed a little, but not much, like this morning I see far instance well again with right eye). Pls bear w/ me and allow me to describe the history again.

On 7/17, I had wavefront lasik. My left eye before op was -6.0 for many years (10+ years), very stable prescription, with no astigmatism. Right after the op, I noticed my left eye was undercorrected. That's the case 1 day, 1 week, 1 month after the op, my right eye has always seen better than left one. This is the reading after op:

First week: Left 20/50, right 20/25
Second week: Left 20/50, right 20/25
5th week: Left 20/60, right 20/40
6th week: Left 20/200, right 20/60

I know my right eye has been up and down, and at this point I'm guessing 20/40 because it's a lot better than 6th week visit which was 2 days ago. But I have major concern towards my left eye. It's becoming blurer and blurer within the past 2 weeks. I used to be able to see computer crystal clear with left eye from maybe 2 feet away, now I have to pull my fact so close to the monitor (about 6 inch) in order to see text well and my mid range and long range vision with left eye has been worsened a lot. This is the opposite of what you described as "sudden presbyobia" or lens cannot accomodate to close range, because my left eye can read close-up perfectly, the problem is it can't see far.

The doc said the flap heals very well and it's not caused by dry eyes. So why lens accommodation? Can accommodation cause such problem? What I'm thinking is left was undercorrected from the very beginning and never got any better, but within the past 2 weeks, it started regresssion so now it's worse.

Glenn, so what is your take on this? Is my doc telling the truth?

[LasikExpert]

Sorry about misunderstanding your situation.

What is needed is a prescription, not just the Snellen/whatever test. A cycloplegic refraction would be able to determine the true refractive error and a manifest refraction would indicate if accommodation is an issue.

A pair of glasses that correct the current refractive error seem to be needed for you to be able to function well.

Your symptoms sound like significant myopic regression. Normal regression would be a bit odd because your starting refractive error was not very high. Edema (inflammation) could be causing an increase in myopia, but your doctor has not diagnosed this as the problem. Edema can be caused by the wound response, dry eyes, or allergic reaction (including to your postop eye drops).

The other possibility is ectasia or keratoconus exacerbated by Lasik. Keratoconus normally presents before the fourth decade of life and seems unlikely in your situation. Ectasia is possible, but is normally related to thin corneas and/or a large amount of refractive error. It is a bit early in the healing process to consider ectasia as the culprit. This could all be regression and/or edema. If this is normal regression, your doctor will probably recommend enhancement surgery at around 3-6 months postop.

You may want to seek a second opinion. You may not learn anything new, but it can give a tremendous amount of peace of mind. You need to be assured that you are on the right treatment path.

[jz5168]

Thanks Glenn for your quick response. I have thick corneal to begin with, 624 left and 629 right. My doc only cut 90 micron flap, if traditional laser takes away 12 per -1.0, and wavefront takes 30-40% more and lets say take away 18 micron per -1.0, then I should have 624-(5.25*18) = 440 untouched tissue left. Here I need to tell you even if my prescription was -6.0, the wavefront mapping at the surgery day revealed the need for correction of 5.25. In my last visit, my doc and I did the calculation and I was assured corneal thickness shouldn't be an issue. So this should pretty much rule out ectasia.

At this point I think I do need second opinion. I'll let you know once I find out more. I'm hoping this is just tempory or regular regression.

Thanks.