CK distortion

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CK distortion

Postby GeneralPatientInquiry » Wed May 31, 2006 6:17 am

I am a 52 year old female nurse in Toledo, Ohio.I work in a big inner city Labor and Delivery unit, I need good vision. I HAD excellent far vision all my life 20/15.But I have been very much bothered by presbyopia for a long time now. When I learned there was a procedure to help people like me, I couldn't wait to have it done. The doctor placed 16 holes in my left eye five months ago.

I have NEVER been able to read up close, print has always been blurry and ghosty after the procedure. Also my far vision is now distorted, faces began to get distorted at about 10-12 feet away. Dr ays that my brain is not tolerating the monovision and I can now wear "lenses" (GLASSES)!!! That's great, I went to wearing glasses just for reading to now wearing them all the time!!! Needless to say I'm NOT happy, so I had two second opinions. Both ophthalmologist say I have an astigmatism and all the corneal steeping was done inferior to my pupil. Now I'm REALLY NOT happy that Dr. has not been honest with me, I don't know what to do. I really don't want to see him again and I discourage other presbyopic people from seeing him. I have a six month appointment to see his partner. Do you have any suggestions for me? I just want to see better. Thanks for listening, paula
This post is a reprint of a previously requested inquiry received by USAEyes.org via email.
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Postby LasikExpert » Wed May 31, 2006 6:20 am

Paula,

It would appear that you were on the wrong end of your doctor's learning curve with NearVision Conductive Keratoplasty (NearVision CK).

Just to be sure we are on the same page, astigmatism means that your cornea is not spherical like the top of a ball, but elliptical like the back of the spoon. The point of the spoon is the astigmatism. In your case, the spoon is pointing down. The majority of the light going through the bottom of the spoon is focusing fine, but the light passing through the point will be off center and will cause ghosting, blur, and distortion. Things probably get much worse in a low-light environment when your pupils become larger.

I've not seen your eyes and I am not a doctor, but I will probably be able to ascertain what happened from your symptoms. Induction of astigmatism is a limitation of NearVision CK that occurs when the surgeon does not apply the radio-wave energy evenly around the cornea. This can occur when the probe is not inserted at the same angle and depth all the way round the cornea. Consistency is very important in CK.

You have two primary choices. One is do nothing. CK regresses at the rate of about 0.50 diopters a year, so if you do nothing your eyes will eventually regress back to where they were before surgery. Of course, eventually is a pretty long time when the world is distorted in one eye.

The other option is that you may be able to have a CK enhancement surgery. The surgeon would place "bonus spots" to balance the irregular cornea. This takes a knowledge and skill that may or may not be possessed by your existing surgeon. I can give you their contact information if you desire.

A rigid gas permeable (RGP) contact lens will help for sure, but if I am not sure if your astigmatism is too strong. Contacts may not be enough.

One thing that I highly recommend you DO NOT DO is any type of surgery that removes tissue, such as LASIK, LASEK, PRK, or Epi-LASIK. Remember how I said CK will regress? Well, if you have surgery to remove tissue that brings you back to normal today, then tomorrow the CK will regress and you will go from having a bump to having a hole.

So your choices are to do nothing, wear a contact lens, or have CK enhancement. Only you can decide which is best. I suggest that you keep that appointment with the doctor's partner next month, but if you want a referral to one of those specialists I mentioned, just let me know.
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Postby frankkop » Fri Aug 18, 2006 1:55 am

Been there... done that.

I had CK in both eyes done about 3.5 years ago in Dallas, Tx. After the procedure, I ended up with stigmatisms in both eyes. As the prcedure was pretty new then , the Doc didn't know what to do and treated me pretty much like excess baggage.
Vision was fair during the day, but I suffered from severe glare, fuzzy vision, and ghosting at night. Glasses corrected it somewhat, but regression caused the glasses to become ineffective every three month or so as my prescription changed. Before CK I was a volunteer Firefighter/EMT. After CK, I had to resign my position due to the poor night vision.

Interesting, here is a draft copy of the CK information manual I found on the FDA.GOV site. It shows that nearly 60% of all CK patients had some form of night vision problem after 9 month. Check it out at :

http://www.fda.gov/ohrms/dockets/ac/01/ ... _draft.PDF

The good news is that the regression has now reached the point that my eyes are almost as they were before the surgery minus a bit of residual stigmatism. While I am now wearing glasses full time, night vision is getting to be ok again. While the wait was long, the whoe thing now only seems like a bad dream. Time does heal it, and I would wait it out if you can.

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Postby LasikExpert » Fri Aug 18, 2006 2:25 am

I'm sorry to hear of your CK experience, but I'm glad to hear that it seems to be resolving on its own.

Much has changed since your surgery, including a better understanding of the CK effects and a new "LightTouch" method that appears to be less likely to induce astigmatism. Of course, the most important single factor is the surgeon's practical knowledge of CK.

Whenever vision is okay in daytime and poor at night, a tempory solution may be the use of the eye drop Alphagan P. This is actually a glaucoma medication, but a side effect is a slight reduction of the size of the pupil. This reduction may be enough to keep light passing through the outer edges of the cornea from entering the eye and being "seen". A drop of Alphagan P in the evening is often enough relief for the night.
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