Hyperopic Lasik Results

[mjs71]

I'm a high hyperope (right eye +3.75, left eye +4.75). I had a consultation with a Doc in the Northern Virginia area who said my script was difficult but that he could perform the surgery. I'm hoping to hear from other hyperopes who have had the procedure. Are you pleased with the results? Would you recommend having the procedure to other hyperopes?

Thanks!

[LasikExpert]

Your hyperopia is indeed high. Hyperopic Lasik is more challenging than Lasik for those who are myopic (nearsighted). High hyperopia is even more challenging, however you are within a treatable range and you do have several options.

Something that is unique about farsighted Lasik is that the older you are the greater the potential benefit. For most patients Lasik is to reduce the need for glasses. This is a matter of convenience or cosmetics. A sub-group of patients who have hyperopic Lasik are actually likely to see better after Lasik than they could see before Lasik with glasses. This is because of something called presbyopia.

The natural crystalline lens within the eye changes shape to focus on near objects. This is called accommodation. Many people who have low to moderate farsighted vision are able to accommodate enough that glasses are not required. Some hyperopes can "focus around" the hyperopia.

As we age the ability of the crystalline lens to accommodate is diminished. This natural process is called presbyopia and for most people does not become a problem until around age 40. Presbyopia is when you need reading glasses to see things close. People who are hyperopic and presbyopic often cannot see well at any distance even with glasses or contact lenses. For these people Lasik may provide better quality vision than glasses or contact lenses. In other words, a hyperope/presbyopia has more to gain from Lasik than a hyperope or myope (nearsighted) person without presbyopia.

It is likely that you will need enhancement surgery to resolve regression of effect common with hyperopic Lasik. You should consider the surface ablation techniques of PRK, LASEK, or Epi-Lasik as an alternative to Lasik. Surface ablation techniques may be more conducive to repeat surgeries.

[croanster]

Hi there mjs71. My script was very similar to yours with the eyes switched around. I'm about 4 months out now and am becomming happier with the results daily. My better eye still doesn't see distance as well as it did before surgery but my doc says this is more to do with accommodation than anything else and with time I'll adapt to the new script.

My worse eye is also slightly amblyopic (lazy) which i believe to be not a bad thing for the first time in my life. Looking through only that eye I see starbursts at night but with both eyes open, my head just blocks the starburst out and i don't see them at all. Doc says this starbursting is due to having 7mm pupils on the 'ol pupilometer or whatever its called. Don't get starbursts from the other eye. I believe the ablation starts at around 7mm and go's out to 9ish so if your pupils are a more normal size than mine, that shouldn't be a problem.

Also, my eyes are still quite dry. I go through 3 - 4 viles of single use gel a day whilst working and 1 - 2 on the weekends.

I agree with Glenn - you should investigate the surface ablation options. I believe these are less likely to cause dry eye as well as the other benefits outlined.

When you have a cycloplegic refraction done as part of your testing, remember how badly you see everything. It's scary! My girlfriend had to lead me around so I wouldn't walk into stuff!! (truely) And thats a fair representation of our vision past 45 - 50 years of age. Makes you feel better during fuzzy days during the recovery period I find.

All in all, I'd recommend hyperopic correction to someone with a similar script to mine. Just don't expect a fast recovery!! I have to stress this - especially if you are less than 40 odd and still accommodating reasonably well. I have days that the world looks brilliantly clear and others where everything is fuzzy and out of focus and looks terrible - they are becomming less frequent though i'm pleased to say.

Good luck - keep us posted! There are a few stories from hyperopes on the forum if you have a bit of a read through.

[mjs71]

Hi croanster, thank you for the reply. You are right there doesn't seem to be many hyperopes here. I have done a lot of research on hyperopic lasik but have never found other hyperopes that underwent the procedure so any info is greatly appreciated. I'm 36 years old and have been debating about getting the procedure done since 2000. I have seen 3 lasik docs in the Northern Virginia area who said they can perform the procedure but stressed that I may need to have an enhancement at some point. Did you have to take a lot of time of from work? I sit in front of the computer all day so I'm concerned that I won't be able to get back to work since hyperopes tend have slower recoveries. Also, what laser did the doc use from your procedure? The doc I saw at [a national chain] said they have both the Allegretto and VISX S4, but said that he would probably use the VISX for my procedure.

Thanks!

Note: Post edited to remove name of clinic.

[LasikExpert]

There is little doubt that this particular facility would select Visx for hyperopic correction. The WaveLight Allegretto is not FDA approved for wavefront-custom Lasik to correct hyperopia.

BTW, a laser approved for one laser vision correction proceedure can be used for another proceedure. The laser may be approved for Lasik, but can be used for PRK.

A concern with hyperopic correction is that it tends to reduce the size of the functional optical zone (FOZ). Without getting too technical, this is the area of your eye that is used for forward and sharpest vision. A little reduction in FOZ is not likely to be a problem, but a larger reduction of the FOZ can cause a reduction in vision quality. You may want to discuss your preoperative FOZ and the postoperative FOZ with surgeons who use different lasers.

[croanster]

I actually didn't do a great deal of research before I went ahead although I had been considering it for a long time as well. I chose my surgeon, rather than looking into the technology too much. (which is very much out of character for me!)

I actually lived next door to an industry rep when I was a kid (he markets the various lasers etc) and I was in a position to seek his recommendation on surgeons – he has seen quite a few in action.

To answer your question though, I had wavefront guided (but not customised because it’s not possible for hyperopes) intralase lasik and I’m pretty sure the laser was the Technolas 217z. If you end up getting Lasik and not a surface ablation, my personal belief is that intralase is the better way to go – it’s supposed to give the surgeons alot better control and predictability with flap size and thickness and it’s a fairly big flap needed to do a hyperopic correction. (I think thats why hyperopes ‘generally’ have more trouble with dry eyes??) Can’t really help you with which is best of the different lasers though.

As far as being able to resume work, about the only thing I could see in the first week was the computer screen – as long as I was 6 – 8 inchs away from it! Your (very close) close up vision is usually really good straight after surgery is the distance that takes a while to come in. I had surgery on a Monday afternoon, had the rest of the week off and back the following Monday. Again, working on the computer didn’t pose any problem but getting to work did. In hindsight it was foolish even to attempt riding a motorbike – there were times I could not read the number plate on the car in front of me! It took around a month for me to be able to see things in the distance consistently and 3 months until I was confident the outcome was a success.

Catch the bus / train for the first 3 – 4 weeks. ;)

Personally, I think the recovery time differences between lasik and PRK / Epilasik should be less of a consideration for hyperopic corrections – you can’t see very well for the first month anyway! The recovery for ‘younger’ hyperopes seems to be as much about the head / brain learning to relax the accommodating muscles as it is about the eyes themselves recovering medically.

I had a thought that if I had the option to wear a pair of glasses based on my cycloplegic refraction for a month or so before surgery to try and get used to it a bit more it would have saved a lot of worry and stress whilst i got more used to my new eyes! (Glenn – do you think this would be worthwile?)

Another negative – as well as the starbursting, I get a fairly hefty shadow at night time from my worse eye which is noticeable driving looking at reflective road signs and even watching the tv. Only through my worse eye though and the effect is diminished when both eyes are open.

Another positive – today my vision was fantastic just about all day both near and far. Great being able to read txt’s on the mobile phone without reaching for the specs and you can decide what you want for tea without pestering people about what’s on the menu!

[LasikExpert]

I actually lived next door to an industry rep when I was a kid (he markets the various lasers etc) and I was in a position to seek his recommendation on surgeons – he has seen quite a few in action.

That is probably a great source for referral.

I had a thought that if I had the option to wear a pair of glasses based on my cycloplegic refraction for a month or so before surgery to try and get used to it a bit more it would have saved a lot of worry and stress whilst i got more used to my new eyes! (Glenn – do you think this would be worthwile?)

Yes, this seems wise. You will get through some of the accommodation stresses before surgery so you will have a more rapid recovery. Going into surgery with your eyes in as natural of a state as possible is an excellent idea.

Another negative – as well as the starbursting, I get a fairly hefty shadow at night time from my worse eye which is noticeable driving looking at reflective road signs and even watching the tv. Only through my worse eye though and the effect is diminished when both eyes are open.

Hyperopic correction tends to reduce the size of the functional optic zone - the portion of the optic that provides the best forward vision. Another issue is pupil size. A large pupil and small functional optic zone (not treatment zone or even optical treatment zone) can cause poor vision quality often presented as starbursting, ghosting, and halos. Discuss these issues with your surgeon and ask if Alphagan P would be appropriate for you. This eye drop can reduce the size of your pupils and possibly reduce your night vision problems.

[mjs71]

Glenn and croanster thanks for all your valuable advice. Croanster thanks for telling me about your experience with hyperopic lasik. Knowing now that hyperopes have a much longer recovery time will be very helpful if I decide to undergo the procedure especially when it comes to deciding how much time to take off of work after the procedure. I was thinking to just take a few days off but I think taking at least one week as you did is a better idea.

Please keep us posted on your recovery and if there are any other hyperopes out there I would love to hear your from you.

Thanks!

ps. I came across an article comparing 2 lasers for hyperopic lasik that might be of interest. Looks like today’s laser technology is producing encouraging results for hyperopes interested in having lasik.

http://www.eyeworld.org/ewweeksupplemen ... php?id=118

[Mack]

As an 8 year h-lasik survivor starting at +5 with -1.5 astig and presbyopic, let me add a few more thoughts on the procedure and concerns. There is no question that the newer lasers with larger ablation zones, improving nomograms and most importantly improving acquired expertise by the docs doing the procedure in allowing for the correct amount of regression, h-lasik results have gotten much better than when I did it in 1999. Everything was "off-label" then, so I was a bit of a guinea pig.

I went right back to work 2 days after the initial procedure and like Croanster was able to do everything within about 2 feet very well. I was ecstatic about my close vision. But distance was certainly blurry. I actually borrowed my brother's -1.5 spare glasses that worked pretty well for driving. As time went on, the regression brought the early -1.5 all the way down to near plano but with about +1.25 of residual astigmatism. Enhancements at 6 months helped bring that down to about +0.75 or so and I could read most all of the 20/20 line with either eye unaided. But regression wasnt finished and after another year or so, the +1.25 astig was back. Acuity was decent in good light but degraded in low light conditions. I had to get corrective lenses with trifocals to feel really comfortable doing all activities at all distances and in any lighting condition.

It wasnt until almost 2 years ago when I got CK enhancements for both eyes (6 months apart) that I returned to plano sphere with about +0.5 astig and 20/20 unaided. I use +1.25 readers. It's remained stable and I can finally say I'm quite happy I did all of this. I had only a minor dry eye issue the first year or so but that improved slowly and after about 2 years, tearing seemed completely normal. I also noticed that contrast sensitivity was degraded in the beginning but that has also improved. Acuity is still degraded in low light for me and I attribute that to the astigmatic error increasing as my 6 mm pupils open wider. The Visx S2 laser only had a 6 mm AZ and with the 1.5 cylinder correction, my FOZ was actually reduced to about 4.5 mm. At night, I see small little "flares" coming off light sources to one side, mostly only in one eye now. The CK corrected all but a small portion of that. I also was "double-carded", meaning 2 passes of the laser were originally required, one for sphere (100 seconds) and the other for cylinder (12 seconds). The new lasers go out farther and do everything in one pass if you have any cylinder error, so pupil size and corneal depth are very important.

I always wondered if I should have done PRK or epi-lasek. The initial recovery is longer but since you are near-sighted then anyway, that seems more prudent. I had a flap complication with one eye that was resolved. With the surface techniques, that issue goes away. If I had it to do again, I'd do surface and forgo the flap. I also think that if I had waited about 5 more years for h-lasik to improve, my outcome would likely have been a little better.

If you are in Northern Viginia, look up Dr. Robert Johnston in Leesburg. He did my initial procedure and enhancements. He's a hyperopia expert and has been doing h-lasik probably longer than any other doc out there since the early FDA trials began in the late 1990's. Good luck!