4 months after and enhancement yesterday

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4 months after and enhancement yesterday

Postby Mikewas+4 » Sat Jan 19, 2008 7:35 pm

After my initial all laser lasik procedure on Sept 28th 07 my following checkups found that I was at +1 in both eyes after originaly being a +4.25.
I also had an astigmatism in both eyes that after the initial correction was still there but was turned 90 degrees from original astigmatism.

Well; yesterday I had my "enhancment" surgery. I would like to share some VERY IMPORTANT issues.
The most important is the wavefront mapping. After numerous tries (25 to 40) to get a good reading from the VISX wavefront machine they ended up with 2 for the right eye and 1 from the left eye. 3 per eye is what they need.
After that marathon session I was taken into another room with the eyechart in the mirror. I believe this is the refractive test? the machine that optometrist use to find your pescription (You know what looks better 1 or 2, how about 2 or 3 and so on)
The reading from the refractive test was not the same results as the wavefront mapping.
Atttttfter some disscusion with the doctor we agreed to go with the refractive test rather then the wavefront mapping.
I could clearly see better through the doctors refractive test rather then what the wavefront results were showing.
I opted for a traditional treatment rather then the wavefront procedure because of the variences in the testing.
As of this morning after my right eyr is seeing quite a bit clearer then my left eye. Hopefully it will even out in a few days.
Final thoughts. DON"T PUT 100% TRUST IN CUSTONVIEW WAVEFRONT FINDINGS. THE SOFTWARE IS NOT PERFECT>
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Postby croanster » Sun Jan 20, 2008 1:30 am

Interested to hear how things progress for you after the enhancement. My next check is Feb 1st and I’m still keen to zap out the remaining astigmatism. Things just aren’t quite right – it’s close but still getting the ghost / double vision in low light.

I wonder if the differences between the wavefront mapping and your refraction were due to accommodation? Did you have a cycloplegic (drops in) refraction done at any time? Was there a difference with that?

How was the flap lift part? Any more discomfort than the first time?

Sounds good so far for you anyway – Hope the left eye catches up!
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Postby Mikewas+4 » Sun Jan 20, 2008 2:35 am

I don't understand what you mean by accomodation and cycloplegic refraction. Do you mean the drops to dialate your eyes?
If thats what your asking NO he did not use any drops before testing my eye's with the mapping or the optical refraction test. I did have my eyes optically tested 4 times over 15 weeks prior to the attempted wavefront mapping. They tried the wavefront mapping 2 days before my enhancement. It kept getting a missread.

As for the flap lift. That was extremely easy I didn't feel any discomfort in the slighest way.

I really lost confidence in thier wavefront mapping machine after many many tries with bad readings. I sat in that chair for about 90 minutes before they got 2 good readings on my left eye and 1 on the right.

After the wavefront attempt I was put into the other room for the optical refraction test. As I said earlier the readings were not the same as what the wavefront map readings were. This really caught me off guard. I had no idea they could be so different from one another.

Now I was faced with a decision I have never even thought was possible. Do I trust my eyes through the optical refractor. Or do I go for the Wavefront mapping that was not a very coopertive machine?

I opted to trusted what my eyes saw through the refractor rather then trust software.

As of this evening there is a BIG difference between my left and right eye.
Left eye is worse then before right is waaaay better then before.

croanster I hope this information helps you before you get back under the laser.
Thanks for your well wishes and good luck with your "zap"
Mike
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A good smart Doctor???

Postby Mr.UnPerfect » Sun Jan 20, 2008 5:42 am

I am curious, what quality of doctor trained for years in optical equipment, vision exams and eye surgery. Lets an untrained patient tell him what type of treatment to do. Are you an optical expert? If so I am wrong. I apologize for being abrupt but I am learning most of my problems have come from telling the trained professionals what I THINK is best for me, who has no training. I do understand what you are talking about with the equipment confusion. And so many options out there, but trying to decide over correction with wave mapping, refractive exam, should not be the patients place to have to decide. I may be wrong but thats my OPINION. opinion only...
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Postby croanster » Sun Jan 20, 2008 7:55 am

Thanks – it’s definitely helpful for me. And yep, dilating drops in is what I meant. This is a quote from this site about accommodation:

“The ability of the eye to change focus from distant objects to objects closer than optical infinity, approximately 20 feet (6 meters). Like when driving and you switch from looking down the road to reading the speedometer. Accommodation is achieved when the lens shape is changed by small muscles around the lens pushing and pulling.”

The dilating (cycloplegic) drops take this ability away by temporarily paralysing the muscles that change the shape your eye’s lens. Depending on your age, it’s possible to have quite a substantial difference between the two especially for longsighted people and depending on your age. (mine was 1 dioptre different at 36 years of age) May explain the discrepancies between your refraction and wavefront mapping.

Still, it doesn’t explain why they needed so many trys to get decent readings... Anyway, for an enhancement I kind of think a refraction based zap might not be a bad way to go especially if what you’re seeing in the exam is nice and clear. Do you know what your script was they used for the enhancement?
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Postby rosecmd » Sun Jan 20, 2008 6:56 pm

I appreciate your comments because I, too, am also about +.75-1 diopter overcorrected from my 7/9/07 lasik surgery to correct my -3.5 nearsightedness. I'm 48, so I am a bit presbyopic on top of the now somewhat farsightedness. Distance vision is good. Recovery from initial surgery was slow and hard due to dry eye and lingering corneal edema issues. Now, my eyes are quite comfortable, my near and mid-range vision is not what it should be so I have a hyperopic enhancement surgery scheduled for 2/8.

For my initial surgery, my wavefront and the manual refraction also differed and I had two wavefronts and about 5 manual refraction checks and the surgeon decided to go with her own calculations and I ended up overcorrected. However, she said if she went with the wavefront machine, I would have been even more overcorrected. For the enhancement, although she wants me to have another wavefront, I know she knows how much to manually set the machine at. I did not have a refraction using drops, but she did say that her numbers correlated with some machine's numbers in the office. I have another pre-op visit scheduled with her and will ask more questions.

Glenn, for enhancements, do surgeons generally do traditional lasik for correction? Surely by the time someone has a second surgery, there is a lot of information the surgeon has about someone's eyes and how they respond and how stable they've been over several months and what the last several manual refractions have been to have the confidence to know how much to correct.

Glenn, how much does pre-existing, untreated dry eye effect both the wavefront and the manual refractions? With treated dry eye, would you expect better results with both methods?

Mikewas+4, what does the surgeon say about your left eye? Why is it worse? I'm glad it wasn't hard to lift the flap, how was the first 12 hours or so? Tha's kind of creepy, though, how easy it is to lift. I actually watched a hyperopic lasik enhancement surgery on the web the other day and basically, the flap came right up with a little knife/spatula-like gizmo --it was so thin and looked like a little piece of saran wrap!

What kind of discomfort did you have and how does it compare to the intial surgery. Did you have a bandage contact lense and if so, how did that feel? Was it irritating? I'm pretty anxious about having a second surgery, however, I want to get rid of my bit of hyperopia. It's a different part of the eye that is lasered, around the outer edge of the cornea instead of in the center, so it takes more time for the laser to make the trip around, my surgeon explained to me. How long did the laser last to correct your +1 hyperopia?

Thx & keep us posted on your progress.
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Postby LasikExpert » Mon Jan 21, 2008 8:23 pm

rosecmd wrote:Glenn, for enhancements, do surgeons generally do traditional lasik for correction?


If by traditional you mean conventional laser ablation instead of wavefront-guided laser ablation, the answer is that the surgeon will do what has the geatest probability of providing a good outcome. If good wavefront data is captured, then wavefront-guided would probably be the procedure recommend by the surgeon.

rosecmd wrote:Glenn, how much does pre-existing, untreated dry eye effect both the wavefront and the manual refractions?


A very large amount, especially the wavefront data. Wavefront is objectively measuring the full optics of the eye. If a dry surface - especially an irregular dry surface - is involved the data will be wrong.

rosecmd wrote:With treated dry eye, would you expect better results with both methods?


You would expect more stable results with the best possible data. Dry eye should be treated and managed before an analysis of whether or not Lasik is appropriate can be performed with any sense of accuracy.
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Postby rosecmd » Mon Jan 21, 2008 9:16 pm

Thanks, Glenn, for your speedy responses. Another dry eye question, as mine is "treated", however, I still wake up in the morning with a bit of dry eye and if I wake up during the night, I still reach for the Refresh drops. My morning vision is still a tiny bit blurry, but some of this may be due to the fact that it's dark. They clear up fast with a drop or two, and I seldom have dry eye during the day, although I do use drops here & there (Refresh & Endura). Sometimes, I still feel like my overall vision is still improving at 7 months, even just a bit, mostly in terms of it getting sharper and clearer.

Is it possible for vision to keep improving after 6 months? At what point are eyes considered stable enough for an enhancement?
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Postby LasikExpert » Mon Jan 21, 2008 10:20 pm

rosecmd wrote:Is it possible for vision to keep improving after 6 months? At what point are eyes considered stable enough for an enhancement?


Yes, and it happens all the time.

We use six months as the "cut-off point" because most resolution will occur within this period. That does not mean, however, that additional healing does not occur. It does. Some effects are not fully resolved until five years after surgery, although these are sub-clinical changes that do not directly affect the quality of vision.
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Postby Mikewas+4 » Fri Jan 25, 2008 7:30 pm

I've been gone for a week, so I just saw this discussion/rant.

croanster;

That definition of "accomadation" sounds like the excuse they gave me for the errors in the wavefront mapping. Or if I can remember right they said something like, "your eye's keep making small movements or adjustments during the scanning process so the machine keeps getting a bad read". It could have been a scanner that needs a software tweek or just my eyes, it could be a number of things. But remember they did get enough readings. It just took a long time.
After evaluating the results of the wavefront scan VS the traditional refraction test I would 10 out of 10 times choose what my eye's are telling over that of a wavefront scan.
No, I do not know the script used for the enhancement.
The doctor dialed in my eyes with the traditional refraction test to the point that I could see perfect, then he would change it to what the wavefront scan results were. It was clear that the manual refraction findings were better. That makes for an easy choice.
Oh yeah, they did put some drops in my eye's while they were trying to get a good reading using the wavefront scanner. I don't know what type of drops were used.
I am 45 years old and had somewhere around +1 in both eye's( over +4 before first correction) with astigmatism that was turned around 90 degrees from it's original point (before first correction). So as you point out my age maybe the reason for the discrepancies between the two findings.
First correction was done with the all laser custom wavefront mapping.

rosecmd;

I see my doctor next week ( one week check-up). It's been 8 days since my enhancement and things are good. No discomfort at all. My right eye is still seeing better then my left at near distances but my left eye seems to be seeing better at farther distances. Vision varies alot with the amount of avalible light. I guess I ended up with monovision. An unintended consequence.

Your doctor decided to go with traditional over wavefront correction and things did not go perfect. Sorry to hear that, I know how you feel.
There comes a point where you have to trust your doctors experience and unfortunatley her choice did not produce acceptable results. Would have the wavefront results been better? We'll never know.
My suggestion would be to have a series of manual and a wavefront refraction exams. Get to the point with the manual refractor where you see perfect. Then take the wavefront results and have her set the refractor to those settings. Then your eyes can be the decider. Of course discuss the differences if any with your doctor and find out why there is differences ( you did say the results correlated ).
If you post-op is anything like mine you will be very happy with the recovery. The second time around is not nearly as tough as the first time. Just be carefull with those flaps.
Good luck with your enhancement.

And now Mr.UnPerfect.

My doctor is board certified with over 20,000 surgeries performed. And me an optical expert? I am a dedicated photographer with a pretty good understanding of how cameras and lenses work, but no, I'm am not a vision expert.
Let me make this very clear, my doctor did not let me tell him what type of enhancement to perform! After a series of test both wavefront scanning and multiple refractive exams over a period of 3 months the results did not correlate.
When he dialed in the refractor so I could see the best and then moved the lenses to show me what the wavefront scanning results were, it was easy for him and I to agree that the difference between the two varied quite a bit with manual refraction looking better.
With such a varience between the two findings we had to discuss which one of the two would be used. I feel it was very proffesional of him to let me be the decider since it was my choices looking through the refractor
(does 1 look better then 2 and so on), and my eye's. I told him the manual refractor results look a lot better then what the wavefront results are showing and I'de rather go with the manual refractors results (remember you can only choose one). He gave me a nod of confidence and agreed that, that would also be the logical choice for him.

Fortunatley you've never been in my position. May I ask you how would want your doctor to handle this?
Please answer this, it just may help someone else out who's in this same dilema.

Will post after one week exam.
Mike
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Postby LasikExpert » Fri Jan 25, 2008 8:39 pm

Mikewas+4 wrote:May I ask you how would want your doctor to handle this?


If the wavefront does not agree with the patient's subjective opinion of best corrected vision during a refraction, then it is the refraction that should be used for treatment. Technology does not know what is best. The patient's subjective results should always have the priority.
Glenn Hagele
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