22 Days Post Lasik

Research your concerns in this forum or post your questions if you have had Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL within the past three months.

22 Days Post Lasik

Postby Patch » Sat Jul 14, 2007 3:11 am

Hi.

First, let me thank you for this outstanding site and the wonderful folks who are, with their unique knowledge and expertise, helping other people for no monetary return.

I had Lasik 22 days ago and am still experiencing blurred/double vision and overall poor quality vision. That said, my vision is way better than preop w/o glasses.

My 45 year old eyes were -4.00 and I was basically blind w/o glasses - I could see the Big E. Now my doctor (not my surgeon, given I live in a remote area) judges my eyes -.75 with some astigmatism.

My postop eyes have been consistently 20/30 in the left and 20/40 in the right. I have been able to tell since day 1 postop that my left eye is better than my right eye. Bright light on shiny objects gives me problems still. Also, I can see blood spots and "bulges" (albeit outside my cornea area) on my eyes.

I went from 4 drops per day of Pred Forte and Zymar for 11 days postop (until I had my "1 week" postop in remote Montana); to 2 drops per day of each until 14 days postop; and am continuing (on day 22) 1 drop per day until each is done. Each dropper(PF and Zymar) is about done. But I've been saying that for a couple days now. Also, using Refresh Tears since day 1, but don't really need to now except sometimes in the morning. To me, the Zymar and PF (especially PF) seem to adversely affect my vision.

My local Dr., during the day 11 exam, said things are going well. There was a question on the day 1 exam about an epithelial defect, but that had healed by day 11. My local Dr. said he could solve the blurred/double vision immediately with glasses, which I might need long term. He also said my eyes could adjust and clear up the blur/double deal.

I have faith in my local Dr. and surgeon, but everyone keeps saying that my eyes will improve. However, to me they haven't. After 3 weeks and counting, I am again concerned. Also, my reading ability has been adversely affected.

Thank you for your considered response.
Patch
 
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Postby LasikExpert » Sun Jul 15, 2007 10:23 pm

Lasik is often more of a six month process than a 30-Minute Miracle. At less than four weeks postop, you are just in the beginning stages of healing. If you read the postings here you will see many people who had poor vision at one month, but eventually all resolved.

The 0.75 diopter myopia (nearsighted, shortsighted) vision and astigmatism probably account of the majority of your blurred vision. You could have decent near vision with the low myopia, but the astigmatism could easily be causing some blur.

The steroid eye drops help control the healing response and need to be tapered off per your doctor's instructions. The surgery and/or the drops could be causing a bit of corneal edema (inflammation). Corneal edema could cause or exacerbate both the myopia and/or the astigmatism.

The blood spot and bulge on the white part of the eye is undoubtedly a sub-conjunctival hemorrhage, which sounds much worse than it actually is. This kind of bruising can occur when the microkeratome is attached to the eye with suction to be able to make the Lasik flap. It will clear up, but will take some time. There is little you can do to speed the process.

Your local doctor should be able to refract you (which is better, one or two) to give you a current prescription, but that prescription is very likely to change in the next few weeks as you heal.

Ask your doctor to check for dry eye issues. You may feel fine, but the eyes are actually dry. Dry eye can contribute to the symptoms you describe.
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22 Days Post Lasik

Postby Patch » Tue Jul 24, 2007 3:00 am

Had my 1 month checkup today - 33 days post lasik. Finished up the Pred Forte eyedrops on Day 25, and the Zymar eyedrops lasted until Day 30. Vision seemed to improve noticeably the day after I quit using the Pred Forte. This was borne out at the exam today. My left eye is now at plano (20/20), and the right eye is still at -.75 (20/25). Together I am seeing 20/20.

Healing is going well. The astigmatism noticed at the Day 11 exam is now gone. Still some minor ghosting and halo of bright sunlight off shiny objects, but my vision is much better that just a week or so ago. Dr. says my vision may take up to 6 months to reach final stabilization. Still a chance that my right eye may come around. I believe it is coming around , as sometimes when looking at an object or a face across the room, my vision seems to snap into focus and become amazingly clear for a bit.

Still using Refresh Tears and Equate Gentle Lubricant Eye Drops. Don't really feel the need to other than upon awakening in the morning, but I have heard from everyone that they help the healing process so I continue to use them throughout the day.

Dr. showed me that being slightly nearsighted in one eye may actually be an advantage to help me read, while my distant vision is acceptable. However, I am hoping to get to 20/20 in my right eye as well as my left. I'll wear reading glasses if need be, but I want to see! 8)

Next exam in 2 months (3 months post op).
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Postby LasikExpert » Tue Jul 24, 2007 8:57 pm

Your doctor is correct that being slightly myopic (nearsighted, shortsighted) in one eye can reduce your need for reading glasses. Visit our article about monovision for details.

Be sure to report back.
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Postby Patch » Sun Aug 12, 2007 6:06 am

Vision is getting better. Still a bit of halo/ghosting, but it is minor. Can drive at night w/o problem, except some of the extremely bright white/blue headlights give me a bit of a pause. Haven't been to Dr. since the last post, so I don't have numbers, but feel strongly that vision is clearer and crisper. This is partially offset with my loss of reading ability. I am a voracious reader and my reading ability has definitely declined since my Lasik surgery 51 days ago. I am going to talk to my Dr. about reading glasses when I have my 3 month checkup.

Still very pleased overall. Due to an extremely hot summer, the fans, dry air, dust, forest fire smoke and A/C of summer have not helped one bit for dry eyes conditions. I believe the cooler fall weather will help. Also boating has a wind blast situation. Refresh Tears help.

Went for a drive late today. The crispness of my driving/living vision is a true joy to me that most can not relate to. I am a avid outdoorsman and work outside for a living. Being able to function w/o glasses is magic.

Also, bought a pair of outstanding sunglasses for a ridiculously large sum ($200). I have always envied those who could wear sunglasses. I promised myself I would buy a quality pair of sunglasses for myself if I could. While I can and did. Love them and can't compare them at all to the Rx sunglasses over the years.

So far, so good.
Patch
 
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Postby Patch » Fri Sep 28, 2007 6:03 pm

Had my 3 month checkup earlier this week. Eyes are healing nicely. Vision has been very stabil since last checkup: -.25 in left eye; -.75 in right eye. Left eye has consistently been better than the right eye since day 1 postop. Discussed enhancement with Dr. and will wait until 6 month checkup to decide.

No astigatism in either eye. Minor ghosting/blur due to more myopia in right eye. Still using Refresh Tears, mostly in the morning. Seldom do I need to use Refresh Tears during the day. Dr. gave me a sample of Optive, a new eye lubricant that helps corneal healing as well. Didn't really care for Optive, as it seems to make my eyes drier, rather than lubricated.

Dr. did show me what my reading ability would be if I had an enhancement to plano - basically I would not be able to read without reading glasses. He had a page with sample text on it in 6 different sizes from small (classified ad in newspaper-size font) to large (newspaper headline-size font). Currently I can read the smallest (#1) with minor difficulty. With the enhancement, I would be able to read only #5 or larger. Smaller type than a #5 would require that I use reading glasses.

Not sure if an enhancement would be worth it to see clearer at mid and long range, but much worse at close range. Will wait and see what happens over the next 3 months.
Patch
 
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Postby yawny » Mon Oct 01, 2007 4:12 am

You might want to consider that it is not just reading etc . that might bother you. You might lose the ability to read your watch, your dashboard in the car your cell phone etc. if you lose that close up vision. It would be a pain to have to put on glasses to see these things.
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Postby LasikExpert » Mon Oct 01, 2007 4:53 pm

I very, very highly recommend that you wear fully correcting contact lenses for at least two weeks before you decide to have enhancement surgery to remove the small remaining myopia. The real world is a very different experience from that which is provided in an examination room.
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Postby Patch » Sat Dec 22, 2007 4:41 am

Had my 6 month checkup earlier this week. Left eye is still -.25 (20/20 minus) and right is now -1.00 (20/50). Vision quality has declined noticeably in my right eye, and perhaps in my left as well, since my 3 month checkup.

I am in the process of scheduling an enhancement of at least my right eye. My local doctor is consulting with the surgeon who performed the original Lasik procedure. My local doctor stated that with the stable refraction over the 6 month period, there would be no reason to wait further for an enhancement. I am definitely wanting to improve my vision quality and want to do this soon.

Dry eye is mainly an issue upon awakening in the morning. Otherwise, I rarely use eye drops, although I do carry them with me still.

Do you think the small refractive error in my left eye should be enhanced? If not, will that remaining small refractive error, assuming plano in the right eye, cause a noticeable blur?
Patch
 
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Re: 22 Days Post Lasik

Postby LasikExpert » Sat Dec 22, 2007 6:54 am

Patch wrote:First, let me thank you for this outstanding site and the wonderful folks who are, with their unique knowledge and expertise, helping other people for no monetary return.


Thanks for the kind words, but I do get paid to research answers for you. Eveyone else, however, is helping while at the same time being helped.

Patch wrote:I had Lasik 22 days ago and am still experiencing blurred/double vision and overall poor quality vision.


That is way early in the healing stage. There is nothing wrong with being concerned and you want to report all problems to your doctor, but it is much too early to come to any conclusions yet.

Patch wrote:Now my doctor (not my surgeon, given I live in a remote area) judges my eyes -.75 with some astigmatism.


The 0.75 diopter myopia (nearsighted, shortsighted) vision is probably a good thing for someone who is 45. A little bit of myopia can greatly reduce the need for reading glasses. You may also want to read about sudden presbyopia.

The astigmatism is another matter, but being so early it's difficult to know how much a problem it will be. Astigmatism means that your cornea is not spherical like the top of a ball, but is elliptical like the back of a spoon. The "tip of the spoon" will cause some of the light entering your eye to be off center and off focus, often resulting in poor vision quality. Vision is likely of better quality in brightly lighted environments.

Patch wrote:Bright light on shiny objects gives me problems still.


Photophobia is often a symptom of corneal edema (inflammation). Edema can cause or exacerbate astigmatism. It sounds like your corneas are a bit angry after your surgery.

Patch wrote:Also, I can see blood spots and "bulges" (albeit outside my cornea area) on my eyes.


This is likely what is called subconjunctival hematoma. It's a blood blister in the white part of the eye. This can be caused by the microkeratome that is used to create the Lasik flap. I'll bet they are crecent shaped.

The microkeratome is applied to the eye with suction. This can bruise the eye. It can look terrible, but this is normally benign and resolves with healing. If it is subconjunctival hematoma, don't be surprised if it takes a long time before it is gone completely. Discuss this with your doctor.

Patch wrote:I went from 4 drops per day of Pred Forte and Zymar...


The steroids are used to control healing and reduce edema. It is very likely that some of your photophobia is related to the steroids. Some people react differently than most.

Patch wrote:Also, using Refresh Tears since day 1, but don't really need to now except sometimes in the morning.


Dry eyes is the number one complaint after Lasik, so a good dry eye treatment routine is important and will help promote healing.

Patch wrote:To me, the Zymar and PF (especially PF) seem to adversely affect my vision.


It may, but continue using them until your doctor advises otherwise. These are very important to your long-term recovery.

Patch wrote:My local Dr., during the day 11 exam, said things are going well. There was a question on the day 1 exam about an epithelial defect, but that had healed by day 11.


Your experience provides hints as to why you may have edema. Those eyes are probably are angry.

Patch wrote:My local Dr. said he could solve the blurred/double vision immediately with glasses, which I might need long term. He also said my eyes could adjust and clear up the blur/double deal.


Glasses will not hurt your recovery and you may find them necessary. Your doctor is probably correct that this can resolve completely with healing.

Patch wrote:After 3 weeks and counting, I am again concerned.


From the symptoms you describe, you need to not consider your final outcome until about 3-6 months. The improvement will likely be very gradual, but it would also be reasonable to expect a quick improvement after you taper off the steroids. That does happen sometimes.

Patch wrote:Also, my reading ability has been adversely affected.


This must be from the astigmatism. Your -0.75 should give you a bit of a reading advantage, but the astigmatism can make things blur.

Please keep us informed of your progress over the coming weeks.
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Lets get with it.........just kiddin

Postby Mr.UnPerfect » Sat Dec 22, 2007 10:42 pm

Patch was asking for a reply on his current post December 07....your reply was from his post on July 07 .... The reason I am buttin in is because it may apply to me also.... Thanks PAL......
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Postby LasikExpert » Sat Dec 22, 2007 11:24 pm

Mr. UnPerfect,

Thanks! I don't know what happened but when I responded I only had the original message.

Patch,

The most that you can expect from orginal Lasik or enhancement surgery is what you can achieve with corrective lenses. You say that the quality of your vision is relatively poor. If your quality is poor with glasses or contacts, then it seems unreasonable to expect that surgery is going to vastly improve the quality of your vision. There are some exceptions.

If your cornea is irregular then a customized laser ablation may be helpful. If the problem is due to some higher order aberrations (HOA) being very elevated, then a wavefront-custom ablation may improve your vision quality.

It is my personal opinion that attempting to correct refractive error within 0.25 diopter of target is not worth the risk. There are those who would disagree, and if the purpose of the enhancement surgery is to resolve irregularities or HOA, then there may be benefit beyond regular refractive error.

The problem with the very small corrections is the possibility of overcorrection into hyperopia (farsighted, longsighted) vision - which you absolutely do not want - and that you have all the same risk with much less to gain.

It is highly unlikely that your local optometrist has all the equipment to check your eyes to give you all the information you really need about the probability of vision improvement beyond simple refractive error.

If what you get now with glasses is acceptable, then you at least have an acceptable target. 1.00 diopters of myopia is certainly enough to reduce distance vision quality, but should actually improve near and mid distance.
Glenn Hagele
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Postby Patch » Sun Feb 17, 2008 10:55 pm

I had the enhancement performed on my right eye 3 days ago. Everything seemed to go well. The Dr. lifted the existing flap, the laser did its thing, and the flap was replaced. There was some minor discomfort and scratchyness the first evening, but not as bad as I thought it might be. I really poured the lubricant to my eye that night and continue to.

The next morning, my right eye vision was measured at 20/20 using a Snellen chart. I could also read some of 20/15 line. Distance vision is noticeably better, although there is some blur in the right eye. Reading vision has degenerated significantly in the right eye, but I can still read newspaper-size font. A small amount of debris, outside my vision area, was noticed on the edge of the flap. Also, a small epithelial defect which should smooth itself out.

I have an exam scheduled on the 25th which will include a manifest refraction.

I am currently taking 4 drops/day each of Pred Forte and Zymar. I started the Zymar the day before the surgery. The Pred Forte I started the day of the surgery. I also have been using Refresh Tears since the original surgery 6/21/07.

So far, so good.
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Question for Patch

Postby Mr.UnPerfect » Mon Feb 18, 2008 2:48 am

Glad the right eye redo went well. What did the Doc say about the -.25 in the left. Is that to small to safely correct? as Glen suggested. Now that the right eye will be picking up the slack it may not be an issue. good luck
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Re: Question for Patch

Postby Walt » Mon Feb 18, 2008 3:58 am

Mr.UnPerfect wrote:Glad the right eye redo went well. What did the Doc say about the -.25 in the left. Is that to small to safely correct? as Glen suggested. Now that the right eye will be picking up the slack it may not be an issue. good luck
At 45 yrs old -.25 is perfect. I am 49 and went from -2.5 in both eyes to +1 and +1.25. Over shooting the mark like that at my age leaves you with bad vision all around. I will be going in for a retreatment within the next 3 to 6 weeks and I would love for both eyes to end up at -.25. If needed I'll gladly leave a set of glasses in the car for driving.

That's my opinion for my age. As always your mileage might vary.

Hope things work out for you Patch. Keep us updated.
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