POst Surgery almost 3 weeks

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POst Surgery almost 3 weeks

Postby Jim » Mon Aug 28, 2006 4:24 am

I had lasik surgery 3 weeks ago and last week at my 2 week visit I was told my dizziness and headaches were probably because of my sight being different in my eyes. One eye was 20/30 and the other 20/40 +. They gave me prescription lenes to help w/ this problem. The Dr said I would probably need enchancement surgery in 6 months. The glasses Im wearing now are progressive, the bottom for some upclose/reading correction. I have been wearing the glasses for 3 1/2 days and I am still experiencing headaches and dizziness. The whole situation has been very trying and upsetting. Your thoughts Please!
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Postby LasikExpert » Mon Aug 28, 2006 5:07 am

A difference in refractive error between the eyes can be very disconcerting. Dizzyness, nausea, poor depth perception, and headaches can be some of the symptoms. My bet is that one eye is hyperopic (farsighted, longsighted) and the other eye is myopic (nearsighted, shortsighted).

Glasses can help, but contact lenses are often the way to go when the imbalance is great and glasses don’t do the job. With contact lenses you will probably need to use reading glasses for close vision, but you probably will no longer feel ill and be bumping into things.

If contact lenses provide the relief you need, then that correction would be an appropriate target if you decide to have enhancement surgery. Be sure to discuss all potential risks and benefits of enhancement surgery with your doctor.

Were you attempting to achieve monovision?

Glenn Hagele
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Postby Jim » Mon Aug 28, 2006 12:24 pm

Thank you for your reply. The surgery was to correct long distant sight in both eyes. Monovision was not recommended because of some of my activities (Golf). There was a very slight need before surgery for upclose work although most of the time it was not needed. Now, after surgery, there is a great need for reading glasses. I knew this might be the case after the surgery, but these headaches and dizziness are very hard to deal with.

Could the headaches etc be because of the difference in the two eyes? 20/30, 20/40 +? Would contacts be better correction until enchancements?
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Postby LasikExpert » Mon Aug 28, 2006 5:08 pm

The Snellen 20/whatever numbers do not really provide the information that would be helpful to research your concerns. If you have your current prescription, that would be much more helpful. If you have your eyeglass prescription, please post the information.

An imbalance in the prescription from eye to eye most certainly could cause headaches. It may also be that your eyes are working so hard trying to focus on near objects that this is contributing to your headaches.
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Appears We have the Same Problem - Dizziness Post Lasik!

Postby Gerry » Tue Sep 26, 2006 4:23 am

I have not seen our mutual complaints of dizziness on the net. It is horrible! After several laisk consults, brain MRI, etc, no one has really told me the cause of the dizziness until the other day when I went to get my 5th pair of progessive glasses. I have been to multiple doctors with the last one giving me her opinion:

I was corrected for too powerful distance that my eye muscles for up close vision is having a difficult time to compensate for up close vision.

At 41 years old with -6 both eyes, I had lasik early 2001. Post lasik was about 20/30 or so later regressed to about 20/50 or 20/60. How I wish I left it at that! I went in for a "re-touch" 8 months later and that is when problems started. It was tolerable the next 2 years but as of last year, dizziness intensified. I was hoping my brain would get used to it. Now, I am no longer a candidate for lasik as I do not have much tissue left. I am now 47 is presbyopic with 20/30 or so.

My guess is I was corrected for excellent distance vision, which I don't really need, with no myopic left. I have never had 20/20 vision in my life. I find my distance vision is excellent, able to see far away objects I have never seen before, and again don't really need to see, however mid and up close vision are the problems.

Do you find any similarties? If so, I could be able to chat on the phone (I can call you as I am in Northern California). I would appreciate comparing our complaints.

You are early in the post laisk stage and after some healing, you vision most likely regress. I did regress but the diziness remains. Let me know if you feel comfortable in chatting over the phone.

Look luck.
Gerry
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Postby LasikExpert » Tue Sep 26, 2006 7:11 pm

Gerry, Your statement that you were corrected for "too powerful" distance vision may be confusing to some. A person can be myopic (nearsighted, shortsighted) with near objects focused and distant objects out of focus, hyperopic (farsighted, longsighted) with distant objects focused and near objects out of focus, or plano (no refractive error, neither hyperopic or myopic). Contacts, glasses, and surgery can adjust a person between these three states of optics, but cannot change the "power" of those optics per se. If you were myopic before surgery and were overcorrected past plano, you would be hyperopic. If you were hyperopic before surgery and were overcorrected past plano, you would be myopic. "Overcorrection" is not necessarily a good thing.

When the eye is in a relaxed state, it is myopic, hyperopic, or plano. When plano, the optimum depth of focus is about 20 feet and beyond.

A complicating factor to these optic states is astigmatism. Astigmatism most often refers to the cornea not being spherical like the top of a ball, but being elliptical like the back of a spoon. Astigmatism would cause some - but not all - light passing through the cornea to be focused off-center. For purposes of discussion I’ll assume there is no astigmatism.

Accommodation is when the natural lens in the eye changes shape to manipulate the focus of light entering the eye. Accommodation dynamically changes the optic state of the eye. As an example, if the patient was plano wanted to see an object within about 20 feet of him, the natural lens would change shape to make the patient myopic, thus allowing clear focus on a near object. If a person was myopic and wanted to see an object more than about 20 feet away, the natural lens would change shape to make the patient plano. Up to about age 40 we have a significant amount of accommodation.

An often overlooked part of seeing objects near is convergence. When looking at a distant object, the dominant eye looks directly at the object and the nondominant eye looks at the object from a slight angle. This difference between straight on and slight angle helps provide depth perception. When looking at an object near, the eyes converge toward each other to keep the relative angles of the dominant and nondominant eye the same as with distance and provide good depth perception. This convergence, which can look like a person is cross-eyed, is performed with the muscles outside the eye that control eye direction.

Presbyopia is when the natural lens of the eye becomes less able to change focus. Presbyopia is a natural part of the aging process that actually starts at around age 8-10, but is not very noticeable until around age 40 when it becomes difficult to read a newspaper and otherwise see objects close. This is when we need reading glasses.

It is important to remember that there are two ways to describe myopia. One is that you cannot see things far away very well, the other is that you can see things close very well. Reading glasses are actually regular spectacles designed to make the wearer more myopic. If you are naturally myopic and presbyopic, it is probably possible to just remove your glasses to see objects near. Even with glasses on, myopia provides a mechanical advantage and can “mask” the effects of presbyopia. If you have Lasik or similar refractive surgery and remove your myopia, you remove any advantage that myopia provided for near vision and are suddenly hit with the full effects of presbyopia. I call this “sudden presbyopia” and it catches Lasik patients in their early 40’s off guard all too often. Before surgery seeing things close was not much of a problem, not they need reading glasses to see objects near.

In addition to removing any advantage myopia may have provided, refractive surgery changes the range of accommodation and convergence necessary to see objects near. For the sake of demonstration (and these numbers are only for demonstration) let's say that the range of focus of your eyes is 1-10. 1-3 is for near focus, like your computer. 4-7 is for mid-range, like your TV, and 8-10 is for distance vision. In the 8-10 range your eyes are almost or totally relaxed with no accommodation and no convergence. To achieve clear vision in the 4-7 range, you must accommodate. To achieve clear vision in the 1-3 range, you must accommodate and converge.

Before surgery, your myopia provided a mechanical advantage (gross over-simplification but you get the idea) for the 1-3 range. You actually had to accommodate and converge less before surgery than after. Before surgery your myopia would have provided a slight advantage in the 4-7 range. Not much, but a little. Now that you don't have myopia, your accommodation and convergence must work full time, not part time.

If you have been overcorrected into hyperopia, your range is -3 to 10 and your eyes must first accommodate an additional 3 steps to get back up to where you want to go down to.

All this attempted accommodation and convergence can cause more than just poor vision. Accommodation and convergence deficiency can cause headaches, nausea, vertigo, and the dizziness you describe.

Since we are going into great detail, let’s throw in anther complicating matter. If one eye does not have the same refractive error, - especially if one eye is hyperopic and the other is myopic – then the accommodation and convergence is imbalanced and one eye is always working harder than the other. Also, the size of the images hitting the retinas may be different, causing the eyes to be constantly trying to focus away the blur.

Even at age 47 you probably have some accommodation. Whatever amount you may have, it is probably working overtime. All of these issues may combine into the “perfect storm” to cause dizziness and poor vision. There are some options you may consider.

Obviously contact lenses are an option. They can correct residual refractive error and bring balance between the eyes (no pun intended). You could opt to have that balance a little more myopic to give you better near vision a the cost of distance vision. Glasses help quite a bit, but they do not have some of the advantages of contact lenses.

An option that you believe is not available may actually be available: enhancement surgery. PRK on the Lasik flap has been developed since you had your original Lasik. The tissue removal would occur on top of the Lasik flap, not deeper in the cornea. The thickness of the untouched corneal bed would remain the same. PRK on Lasik flap is not appropriate in all circumstances, but it is most certainly something for you to have evaluated.
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Postby Gerry » Wed Sep 27, 2006 4:43 am

Glenn:
Thanks for the response. You articulated my dizzines problem better than I could have expressed. Specifically the depth perception issue. I didn't realize this is one of my issues until the explained it.

I am so miserable and the dizziness has been affecting my work since Nov 2005 and at my wits end. While I would have to think long and hard about another surgical procedure, would you be able to recommend a PRK surgeon in Northern California for a consult?

During the last 8 months, I have been to 4 lasik surgeons, each consult at a cost of $300 - $500 each. (The $500 lasik surgeon who shall be nameless was at Stanford, really rude and arrogant and I got the impression he was not listening.) I have also tried 4 pairs of glasses and soft lenses between -1.0 and .5 which has relieved the dizziness but later in the end continues but with somewhat less intensity. Does this make any sense? One indicated he could do another procedure but did not recommend it and told me to come back in 6 months and the rest outright told he "I didn't have enough tissue left for further surgery." However, no one provided me the explanation you outlined.

Thanks again and really hope you could recommend PRK surgeons in my area.

Gerry
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Postby LasikExpert » Wed Sep 27, 2006 6:35 am

Sometimes too much information is just the right amount.

I've emailed you directly to discuss your location and more details about what your previous examinations revealed. Hopefully we will find something to help.
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