Need Enhancement Advice Please!

Post your questions and start your research in this forum if more than three months ago you had any type of surgery to reduce the need for glasses and contacts.

Need Enhancement Advice Please!

Postby sunshellsea » Wed Sep 06, 2006 1:17 am

Hi,
I had Traditional Lasik done about 5.5 years ago. My original prescription was R -1.75, -1.00 X 95 and L -2.00, -1.00 X 60
One year after surgery, I was at -0.25, -0.25 X180 for both eyes. Now 5.5 years later, I am at R -1.25, -0.25 X180 and L -1.25, -0.75 X180

My right eye isn't so bad, but my left seems pretty blurry. I definitely have more glare and halo problems with my left eye at night. I had several appointments trying to decide between Custom and Traditional Lasik for the Enhancement. I went ahead with choosing Traditional, but now I think I will call the doctor to discuss further.

Can you ever have Custom on the Left eye and Regular on the Right? The halos are worse in the left and overall the vision seems worse. The Prevue lenses seemed to have helped the left, but not the right.

And, should I really only correct the Left eye at this point? I am currently 28 so I know monovision is in my future. Am I getting too greedy to enhance both eyes? My Left is about 20/60 and my right is 20/30-40.

Any help would be greatly appreciated!!
sunshellsea
 
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Postby LasikExpert » Wed Sep 06, 2006 4:16 am

Monovision does not make any sense at all at age 28. You should have 10-20 years before presbyopia would become problematic.

You could have conventional ablation on one eye and wavefront-guided on the other. Which is best would depend upon the results of your evaluation. You may want to read our article about wavefront Lasik.

Lasik does not normally fully regress like it did for you. I recommend that you be evaluated by a corneal specialist for underlying problems before having additional surgery.
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Postby sunshellsea » Wed Sep 06, 2006 12:51 pm

I had a full evaluation both at my regular eye doctor and at TLC. My regular eye doctor even did a more detailed exam for glaucoma because he thought I had some thin fibers. A more detailed look said everything was normal.

I was told that regression can be normal after Lasik, but I hear such differing opinions. I just do not know what to do! I am scheduled for surgery next week, but am getting really nervous. I had no problems with the 1st surgery and never thought I would have to do it again, but I really want to be able to see better without glasses.

Would it be better to just do one eye now and see how I do? However, my measurements of -1.25 in each eye are the same? Why is one eye much worse than the other if the measurements are similar? That is why I was considering Custom in one eye and Traditional in the other.

Thanks!
sunshellsea
 
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Postby LasikExpert » Wed Sep 06, 2006 5:50 pm

Regression is common after Lasik, but normally regression affects people who have about 6.00 diopters or more of refractive error. Your very low original refractive error would not be expected to regress.

It is possible that you do not have actual Lasik regression at all, but that this is what your eyes would have done with or without Lasik.

Has anyone in your family, including uncles and aunts, had a cornea transplant or a cornea disease called keratoconus? Are you regularly taking any medications of any kind, including over-the-counter meds? Are you pregnant or nursing?
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Postby sunshellsea » Wed Sep 06, 2006 6:03 pm

I do think the regression is just the change in my eyes. Looking back, I think my prescription was barely stable a year before my first Lasik.

I had a baby 19 months ago and stopped nursing 5 months ago. I know hormone changes can affect vision and probably did for awhile during the pregnancy and after. However, my vision now seems to be the same as it was before the pregnancy. Poor vision runs in my family, but no major eye diseases or problems that I know of. My grandmother does have glaucoma, but she is 85.

I did not have complications with my first Lasik surgery. I think I could probably just have my left eye done at this point. If I just look out of my left, things are blurry and I have a lot of halos around lights. However, my measurements seem similar for both eyes, so is the problem in the left halos or just weaker vision?

As for Custom vs. Lasik, if I did not have problems with standard Lasik the first time, should I just stick with it? Would doing Custom on the Left eye help or hurt at this point as compared to Standard?

Should I just go ahead and treat both eyes? I am waiting a call back from the eye doctor today.

Thank you so much for your help! It is greatly greatly appreciated!!!!
sunshellsea
 
Posts: 13
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Postby LasikExpert » Wed Sep 06, 2006 11:26 pm

It sounds more like your preoperative unstable refractive error is the cause of your current situation, rather than actual Lasik regression. That is important to know.

Halos, starbursts, etc., all indicate elevated higher order aberrations (HOA) that may be best handled with wavefront-guided ablation if surgery is considered appropriate. If you have read our article on wavefront Lasik you will know that as a general rule people do better with wavefront-guided than conventional. This is really something that you will need to discuss with your doctor after s/he has completed wavefront analysis.

You can always have one eye done at a time and decide if you need to do the other eye. This may be the wise method even if you are sure you want the other eye enhanced.
Glenn Hagele
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Postby sunshellsea » Thu Sep 07, 2006 1:23 pm

Another question--can you start birth control pills shortly after having the lasik? I have been reading various opinions. I am not currently on the pill but would like to start it within the next month or two. My surgery is currently scheduled for next week. Thanks!
sunshellsea
 
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Postby LasikExpert » Thu Sep 07, 2006 5:13 pm

The problem with starting any medication regime around the time of surgery is if something goes awry with the surgery outcome. If you have just started new medication, it would be impossible to know if the unexpected Lasik outcome is due to Lasik or due to the meds.

Although birth control pills seldom cause problems with vision or with Lasik surgery, it is always most wise to refrain from changes in environment, diet, or medications until after the healing period.
Glenn Hagele
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Postby sunshellsea » Fri Sep 08, 2006 7:56 pm

How long is the main healing period? I know healing takes awhile, but is there a specific number of weeks that are the most crucial?

I am now leaning toward waiting for an enhancement. I spoke with the doctor and she was very helpful in explaining that pregnancy as well as just time can cause changes in your vision. She says I can certainly have the enhancement now or I can wait until I am finished having kids or wait until my eyes are worse. It has been helpful to read through this website. I really appreciate your help!!!

She said you have to weigh the risks vs. the benefits. I guess it is harder to decide this time because I can pretty much see without glasses just not as clear as before. I need to have glasses for driving. However, before my first surgery, I couldn't really see at all without glasses. I didn't think twice about having the first surgery. However, my prescription seems to be heading back toward what it was the 1st surgery, but I do not seem to see nearly as poorly.

Is there a huge difference between -1.25 and -1.75/-2.00? Maybe it was the astigmatism? And she said my prescriptions are similar in both eyes, but I see much better with my right. Why is that?

Thanks!
sunshellsea
 
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Postby LasikExpert » Fri Sep 08, 2006 8:33 pm

We have a detailed article on Lasik Flap Healing that will help you, but as far as functionality is concerned the most important period is the first 3-6 weeks - if everything goes as planned. If there are complications, obviously the critical period will be longer.

I like that your doctor does not seem to be pushing you and is discussing what is best for your lifestyle.

The difference between -1.25 and -1.75/-2.00 is certainly noticeable. Put another way, if someone was -0.75, there would likely be a noticeable degradation in distance vision (but possibly an increase in near vision).

Your prescription is a measurement of refractive error...essentially vision quantity. Vision quality, which is often measured with contrast sensitivity testing, can be poor even with good corrected vision.
Glenn Hagele
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Postby sunshellsea » Tue Nov 07, 2006 4:37 am

Well I cancelled my enhancement surgery in September, but now I am back to wanting to get it again. I am just not happy with the -1.25 vision in both eyes. I am thinking about rescheduling the enhancement. Do you think -1.25 is significiant enough to do the surgery again? I do not want to get too greedy, but I just do not feel that I can see very well anymore. I know I could get glasses to wear sometimes, but I know if I wear them, I will want the good vision all of the time. I was going to wait a few more years, but now I am not so sure. I know there are risks, but looking at my prescription, do you think I have a good chance?
Thanks!
sunshellsea
 
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Postby LasikExpert » Tue Nov 07, 2006 5:25 am

"Better" is the enemy of "good enough", but better may be what you want. If you have been reading this forum and our website you will have a pretty good idea of your risks. Only you can decide if the potential benefit is worth the potential risks.

I recommend you get a pair disposable contacts and wear them for a few weeks. This will give you a better idea if the difference with and without correction is really that important to you.
Glenn Hagele
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I am not a doctor.
LasikExpert
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Postby sunshellsea » Tue Nov 07, 2006 2:29 pm

I am still confused about CustomVue vs. Traditonal for Enhancement. I do have some halos and starbursts at night so I thought the CustomVue would be better. The practice (TLC) says that they prefer Traditional for Enhancement because it removes less tissue and they can therefore preserve more tissue. However, I also read that there are some problems with overcorrection with CustomVue with low prescriptions
(-1.25) like mine. If I go ahead with the enhancement, I obviously want the best outcome possible. It just seems like CustomVue is the newer, better technology so why wouldn't doctors want to use it for patients who originally had conventional? Does Pupil size play a role? I think I may have larger dilated pupils, but I need to check. I feel like the doctor based a lot of the decision on traditional on the "prevue lenses." I felt the lenses were pretty pointless though b/c everything was fuzzy. I am just afraid of having more problems with night driving if I have the conventional. I am so confused!
sunshellsea
 
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Postby LasikExpert » Tue Nov 07, 2006 6:07 pm

It appears that your doctors are concerned that additional tissue removal may make your cornea too thin and unstable. This would cause a forward bulging of the cornea that would present as agressive regression and astigmatisim.

Pupil size does play a role for two reasons. One is if your halo problems go away when your pupil size is smaller. This indicates that the periphery of your cornea has a different refractive error than the center. The other is that the larger the laser ablation area, the more tissue removal required per diopter of change. For conventional ablation, a 6.0mm ablation zone requires about 12 microns of tissue for each diopter of refractive change. Enlarge that zone to 7.0mm and the ration is closer to 18 microns per diopter.

Wavefront-guided ablation commonly removes more tissue than conventional ablation.

The fact that the prevue wavefront lenses provided fuzzy vision is a very strong indicator that you should not have wavefront-guided ablation. Those lenses are what you could expect for your wavefront-guided outcome, and that does not sound so good. It appears from what you and your doctor's say that a topographical and/or prescription based ablation would be best...if anything at all is appropriate.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California

Postby sunshellsea » Thu Nov 09, 2006 5:15 am

Well, I think I am going to go ahead with the enhancement. I think I will do one eye at at time. Do people sometimes do one eye at a time? My measurements are -1.25 in both eyes, but my left seems much worse. I think I will have my left done first and see how I do. Maybe correcting just the left will be enough for now.
sunshellsea
 
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Joined: Wed Sep 06, 2006 1:06 am

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