-Dry Eye-

[boston]

Dry eye is the most common reported complication of Lasik and although it commonly resolves during the normal six month healing period, it can last longer.

Lasik Expert, I really hope there are cases where this dryness continues to get better even after the normal 6 month healing period.

I had Lasik done last July '07, about 8 months ago. A month after my surgery my doc told me during at a routine check-up that my eyes were "a little" dry, so I should use eye drops regularly. I didnt really think too much of it because my eyes felt pretty good, and I also had some other personal stuff going on at the time, and they weren't bothering me so I didnt take it too seriously.
Well, it wasnt until I went out to Arizona for a few weeks in November when my eyes bothered me for the first time really for a few days off and on, but even then I just thought I had some new found allergy or something, and hadn't thought about the Lasik at all. I remember driving across the Texas pan handle, the dustbowl I think they call it, and my eyes were killing me, and still I had no idea what it could possibly be. I didnt draw a connection. Then back in Boston starting in about January, when winter really started to set in, is when I realized the cold dry weather was causing it, as my eyes started bothering me again. Also when I was in Mexico City around New Years time, although when I went out to the coast they were fine. But then back to Mexico City, and especially up at Teotihuacan, irritation!!

Its now been about 6 weeks of this intermitent dryness and its really starting to bother me now.

Will this, can this often still improve?
I really hope its not uncommon for this to continue improving, even after the first six months. I work outdoors for a living and yesterday my eyes were irritatiing me in any sort of wind.
I really hope there are many cases out there of people who continue to have dry eye symptoms improve even after the normal first six months, and continue to get better to 12-18 months after.

Can you tell me what you think? I am getting depressed over this. Thanks a lot for your help and advice.
I hope I do not have to live with this nuisance every winter for a few months now for the rest of my life, or everytime I go to out Utah now to visit relatives, or anytime I'm in the arid mountains again or something. I love Colorado and was thinking of moving back one day, I also love trimming trees in the winter, in the brisk cold crisp dry winter air when nobody's out, but not if its gonna be like this!

What a scam this is!! This is something they should let patients know about before they undergo a Lasik procedure, and not just with a quick sign here right 5 minutes before you're about to go in like they did with me, after you've paid, gone through all the prep exams, and asked all the questions about risk, and met with everyone, and everything like that and are just waiting to go in for the procedure. Then they say, "Oh, and sign this form now too Ben. You must copy this short paragraph into this box." "Oh no though, it should be fine.."

What a business scam this is! Its one of the biggest Lasik firms in Boston too!! Advertised in all the local papers for years with the biggest and best ads!
I really hope this improves.
I saw the doctor and he said it is just some "short term nuisance winter dryness." And he's not worried about me having any problems long-term. I hope not.
Otherwise I'm ready to go into their waiting room on a Friday, the one day of the week that they schedule all the Lasik procedures, and expose them to the whole waiting room. This is not fair. How can they do this to people. I hope its not permanent. I'm already making plans to move to Miami.

~B

[LasikExpert]

Will this, can this often still improve?

Yes, Lasik induced dry eye can improve after six months postop. Read the seven month dry eye report of another Boston resident.

I really hope its not uncommon for this to continue improving, even after the first six months.

There are an unfortunate few who have longer-term dry eye problems after Lasik, but they are relatively rare.

I am getting depressed over this.

Chronic pain can get anybody down. Chronic pain from an elective surgery combines the pain with remorse. It would be abnormal for you to not be a bit depressed, angry, frustrated, etc. Expect it, but do seek professional help if it starts to get too much to handle.

You need to revisit your Lasik doctor and seek additional treatment. Restasis is a prescription eye drop that has shown excellent results for many people. Your doctor can determine if your problem is actually dry eye, the qualtity and quantity of your tears, and provide a treatment plan. If your Lasik doctor is without answers, ask for a referral to a dry eye specialist.

See our article about Lasik dry eye treatment.

This is something they should let patients know about before they undergo a Lasik procedure...

We try to do our part to educate.

[boston]

Its been 9 months now, and dry eyes still a bit of a problem. I get frustrated sometimes. Oh lord, I hope this can still improve. I hope the healing isn't through. For some reason, I was just down in Miami over the weekend where it is very humid, so I expected things to be much better, actually things were still irritating me, almost more. Why is that. This is messing with my eyes, the skin surrounding my eyes, getting dry and wrinkly, its hard for me to have bright eyes now because they feel irrated and I feel stickiness/dryness a lot. Its pretty much a disappointment, and a real bumb deal. Why does it feel better, and then worse sometimes.
I hope this will get better.
Can this last forever, or will it improve?
Has the final healing happened, and now I am stuck like this forever? It just didn't heal right??

Shyssen!

[DryEye]

Boston
Things should get better with more time
I am 22 months out and remember that it was the 12 and 18 month mark where things really got better
The first 6 months for me were very hard and one of the reasons I have been slow in going back for an enhancement, but will probably have to do it at some point
If your surgeon got you to plano without any aberrations then you should be fine with more time
Time does heal all wounds
I hear you on the some of your comments, but hang in there and keep using preservative free tears - try Thera Tears, Systane or even try the Restasis - I didn't want to use it.
Not sure how bad yours are, but I was using about 25 to 30 vials a day (close to a full box) easily the first 3 months
It is worse in the desert states.

[boston]

Hi Dry Eye,
How is your dryness treating you?
Are you dry free now?

I would like to know.
My eyes feel dry, and it bothers me when it is cold out.

Thanks,
Boston

ps. did you ever use any sort of sleeping mask, and where did you get it?

[lboogie]

www.dryeyezone.com has a wealth of knowledge -- there are some post-lasik folks on forum there. Like me.......

I'm 5 months post lasik and have bad dry eyes -- but they are feeling less parched these days. I am restasis, have lower plugs, and just finished a round of doxycycline for clogged oil glands.

[Saleh Ridha]

Hi! I went to an eye doctor at a hospital here in Riyadh, Saudi Arabia (Riyadh Care Hospial) to complain about my dry eyes. I had done my Lasik surgery about nine months ago in Damascus, Syria. The Lasik doc, a consultant opthalmologist here, told me not to worry. I told him that studies in U.S. universities have shown that cut corneal nerves (the cause of dry eye) heal only 20%. He said these are lies. He said the nerves do heal. He said he can show me studies at U.S. universities that show that smoking a few cigarettes a day is good for your health. He said all these new Lasik machines are gimmicks-like the Lasik flap cutter which he said is not safe because now your eyes are lasered twice with longer suction pressure.
I don't think you should worry. Think of all the positives. I don't think you should do any enhancement or have plugs put in etc. Use preservative free tears and see the good in your results and thank God.

[boston]

... I don't think you should worry. Think of all the positives. I don't think you should do any enhancement or have plugs put in etc. Use preservative free tears and see the good in your results and thank God.

Why, Saleh, are you saying that your dry eyes don't bother you that much? Are you feeling they will eventually get MUCH better? IS this what this doctor has told you,
or are your eyes simply not bad?

~B, in Boston

[Saleh Ridha]

Well sometimes they burn and sting and I won't say my eyes are normal-for sure. But I don't freak out as I used to. When I just ignore it-the pain seems to go away. Certainly my dry eye has improved since the first few months of surgery. The doctor told me to use a gel at night for my eyes. But I don't because it's too artificial. I just use preservative free eye drops and have tried to increase consumption of Omega 3 oils-tuna, mangos etc.
The doc had told me to stop worrying and that the nerves will grow back. That has made me relax a lot and seemed to alleviate the burning feeeling. I wish someone could show me some data/studies on nerves growing back-that would help me even more. The solution to this problem is psychological for me.

[boston]

Boston
Things should get better with more time
I am 22 months out and remember that it was the 12 and 18 month mark where things really got better
The first 6 months for me were very hard and one of the reasons I have been slow in going back for an enhancement, but will probably have to do it at some point
If your surgeon got you to plano without any aberrations then you should be fine with more time
Time does heal all wounds
I hear you on the some of your comments, but hang in there and keep using preservative free tears - try Thera Tears, Systane or even try the Restasis - I didn't want to use it.
Not sure how bad yours are, but I was using about 25 to 30 vials a day (close to a full box) easily the first 3 months
It is worse in the desert states.

Dry EYe, how are things with your eyes?? Has the dryness really gone away?
We would appreciate an update.

~B

[Mr.UnPerfect]

You can skip all the technical stuff and go to Conclusion... this give me hope also..as my eyes are a little dry still at 14 months

Original article
Recovery of Corneal Subbasal Nerve Density After PRK and LASIK

Presented in part at the European Society of Cataract and Refractive Surgery, Paris, France, September 18–22, 2004, and at the Association for Research in Vision and Ophthalmology, Ft Lauderdale, Florida, May 1–5, 2005.

Jay C. Erie MDa, , , Jay W. McLaren PhDa, David O. Hodge MSb and William M. Bourne MDa
aDepartment of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
bDivision of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
Accepted 7 July 2005. Available online 21 December 2005.



Purpose
To measure and compare the return of corneal innervation up to 5 years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

Design
Prospective, nonrandomized clinical trial.

Methods
Eighteen eyes of 12 patients received PRK to correct a mean refractive error of –3.73 ± 1.30 diopters, and 16 eyes of 11 patients received LASIK to correct a mean refractive error of –6.56 ± 2.44 diopters. Corneas were examined by confocal microscopy before and at 1, 2, 3, and 5 years after the procedures. Subbasal nerve fiber bundles were measured to determine density (visible length of nerve/frame area) and expressed as micrometers per square millimeters. Differences were compared by Friedman’s test and adjusted for multiple comparisons by the Student-Newman-Keuls procedure.

Results
After PRK, mean subbasal nerve density was reduced by 59% at 1 year (2764 ± 1321 μm/mm2 [±SD]) when compared with preoperative (6786 ± 1948 μm/mm2; P < .001). By 2 years, subbasal nerve density (6242 ± 1763 μm/mm2) was not significantly different from density before PRK and remained unchanged to 5 years (5903 ± 3086 μm/mm2). After LASIK, subbasal nerve density was reduced ine density (visible length of nerve/frame area) and expressed as micrometers per square millimeters. Differences were compared by Friedman’s test and adjusted for multiple comparisons by the Student-Newman-Keuls procedure.

Results
After PRK, mean subbasal nerve density was reduced by 59% at 1 year (2764 ± 1321 μm/mm2 [±SD]) when compared with preoperative (6786 ± 1948 μm/mm2; P < .001). By 2 years, subbasal nerve density (6242 ± 1763 μm/mm2) was not significantly different from density before PRK and remained unchanged to 5 years (5903 ± 3086 μm/mm2). After LASIK, subbasal nerve density was reduced by 51%, 35%, and 34% at 1, 2, and 3 years, respectively (P < .001). By 5 years, subbasal nerves had returned to densities (4441 ± 2819 μm/mm2) that were not significantly different from densities before LASIK (5589 ± 2436 μm/mm2).

Conclusion
Corneal subbasal nerve density does not recover to near preoperative densities until 5 years after LASIK, as compared with 2 years after PRK.



Supported in part by National Institutes of Health grant EY 02037; by Research to Prevent Blindness, Inc, New York, NY; and by the Mayo Foundation, Rochester, Minnesota.
Inquiries to Jay C. Erie, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905; fax: 507-284-4612

[boston]

Very encouraging,
you are right!

Have you talked to other doctors who support this claim, as well?

Also, are your eyes improving as months upon months go by, how would you describe?

Thanks for the encouraging words.

~B

[Mr.UnPerfect]

Ophthalmology Times

[LasikExpert]

I told him that studies in U.S. universities have shown that cut corneal nerves (the cause of dry eye) heal only 20%. He said these are lies. He said the nerves do heal.

Several studies have shown that corneal nerve cell density returns to preoperative levels at about five years after surgery for Lasik and about three years for PRK, however what is much more important is of nerve function, which commonly returns within the normal six month healing process.

[boston]

Mr UnPerfect, are you just advocating the use of drops for treating the eyes, with that link?

It would have been a good report to give to my doctor BEFORE I had the lasik, I agree, but what does it tell us now?