Double/Triple Vision

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Double/Triple Vision

Postby nedzie » Wed May 21, 2008 8:58 pm

I had Custom LASIK 22 days ago. Prior to the surgery, I was -9.00 in both eyes. Since the day after the surgery, I have double vision in one eye, and triple vision out of the other. My Dr. is claiming that my retinas are swollen and causing the problem. He prescribed Xibrom drops for me. He said it can take months to heal.

I asked him to explain the corneal topography printout to me. He said the different colors show different elevations of my cornea. I noticed on my "better" eye, there was 1 spot just off center that showed a little elevation, and on the other eye, there were 3 or 4 random spots that were elevated. Most of the printout of the topography was a blue color, but these elevated spots were showing as yellow colors.

If I am putting 2 and 2 together, wouldn't what I'm seeing (double in one eye and triple in the other) be as a result of these elevated spots on my cornea?? If so, what does this have to do with him telling me my retinas are swollen? Will these elevated spots eventually go away or can they be corrected somehow?

I am worried that maybe something didn't go right and the surgeon is using an excuse that he knows may take some time to heal to delay telling me what is actually wrong.
nedzie
 
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Postby BAM17 » Thu May 22, 2008 12:14 am

Nedzie,
Where are you located....geographically? I would find a major city nearby....and seek out a second opinion as soon as possible. What I often read, is to seek an opinion from a university-teaching facility....often these opthamologists/surgeons are professors or assistant professors. Or ask Glenn from this web site for a referral to a doctor in your area. So sorry to hear of your troubles. You're in my thoughts and prayers. Please keep us posted.
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Postby nedzie » Thu May 22, 2008 2:38 am

I am just outside of Chicago. I've called around some LASIK centers, and it's tough to find anyone willing to give a 2nd opinion without having to pay a ton of money just to see them.

Glenn, if you have any input on my questions, that would be appreciated. Also, if you have any suggestion on who I can get a 2nd opinion from, I would appreciate that as well...
nedzie
 
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Postby LasikExpert » Thu May 22, 2008 5:48 pm

Your retinas may be swollen, but the multiple images you describe are more likey because of irregularities of your cornea.

High spots in a topographical map of your cornea (darker and red in color on the graph) can focus light off center, causing a second "ghost" image. I suspect that your vision in your better eye, the one with only one ghost, is fine in bright daylight. The vision in the eye with multiple ghosts may get better in bright daylight, but probably does not resolve completely.

It is very likely that all of this problem is due to corneal edema (inflammation) that will resolve with treatment and time. Three weeks postop is still relatively early in the healing stage.

You may want to see our list of Chicago Lasik doctors for a second opinion.
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Postby nedzie » Thu May 22, 2008 6:02 pm

Thanks for the reply Glenn.

There is no difference in vision in daylight versus night time. The one thing I can tell you is that when is the surgeon's office and he's checking my vision on the chart, he had me block one eye completely and he had me block the other eye with a device that had pinholes in it. Looking through it, I was reading 20/15 in both eyes.

I guess I hope that this is due to swelling, whether it's on my cornea or retina, because I assume that should eventually heal?
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Postby LasikExpert » Thu May 22, 2008 6:39 pm

Having good pinhole vision is a very good sign.

Yes, the inflammation needs to resolve, wherever it may be. Keep your doctor informed of any major changes and see him/her regularly even if things seem to be stable.

Let us know how things progress.
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Postby nedzie » Fri May 23, 2008 4:03 pm

I went to an Optometrist who is a friend of mine to get some input and to confirm whether my retinas are swollen or not.

He said my retinas are definitely NOT swollen, so either this swelling has gone down or my surgeon sees something he that the Optometrist is missing. I am a little concerned why my surgeon would tell me this unless he is just trying to make me really wait things out.

My optometrist buddy did very detailed tests and somehow came to the conclusion that my issue is corneal and not retinal. I am taking what he is telling me somewhat lightly simply because he is not an MD, but he also is very honest and not giving me what I feel is "Dr. Talk".

He did the pinhole test again and I am able to read 20/15 with both lines. He indicated this would confirm that my issue is corneal and not retinal. He did try to correct my vision with the device where they ask what looks better, 1 or 2, 3 or 4, etc... and he's not able to get rid of the ghosting.

He recommended I do wait some time, because he looked at the topography and did notice the high spots, he thought these spots are either swelling that would go away, or if it doesn't go away then it will just need to be enhanced by LASIK.

Again, I take what he is telling me with a grain of salt, but he was very thorough, and explained in detail how the eye works and what can result in my current vision.
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Postby nedzie » Fri May 23, 2008 4:39 pm

I forgot to mention one other thing....

I brought my records from my surgeon pre and post surgery to my Optometrist friend. He noticed I had astigmatism prior to surgery, but didn't need any special contact lenses to correct the astigmatism. I saw 20/20 with the contacts with no double vision problems at all. He then viewed the post surgery topography and saw the astigmatism was gone, but then mentioned it is possible that I have lenticular astigmatism that was countering the corneal astigmatism, which is why I was able to see perfectly without anything other than a standard contact prescription. Now he said if this is the case and my corneas are now smooth, the lenticular astigmatism can be causing the problem.

Does this sound feasable?
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Postby LasikExpert » Sat May 24, 2008 6:24 am

Everything your optometrist has said sounds absolutely on target. The inflammation is at the cornea, not the retina. That makes sense. You cannot get rid of the ghosting with a manifest refraction (which is better, one or two?) because the astigmatism is irregular - several bumps. This is also consistent with corneal edema.

Your astigmatism may have been so slight that the contact lenses reshaped the cornea enough to resolve it. It may be lenticular, but it is now resolved through surgery. Wavefront-guided custom Lasik does this semi-automatically.

I think your MD either misspoke or you missheard about the retina inflammation. That happens all the time.
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Postby nedzie » Sat May 24, 2008 2:54 pm

On my last visit's record, my MD did write Macular Edema with a question mark so I'm pretty sure that's what he meant when he said retinal swelling. I just think he really is trying to preach patience to me, which is fine.

I was reading more about my vision, and I read something about Central Islands. These high spots on my topos sound very similar to this...?

Either way, I'm just hoping that I can see normal again. I don't like when I read about what is considered 20/20 vision. I hope that I don't just get to point where I can read 20/20, but still have these ghosting/double vision. I didn't have this prior to the surgery with contacts, and I sure hope I don't have it now.
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Postby LasikExpert » Sat May 24, 2008 7:13 pm

Central islands are when the laser does not remove tissue in spots on the cornea. At the very first they would appear the same as edema, however edema resolves with time and treatment. Central islands do not change. Even the slightest change in the topography map of your cornea would indicate that the issue is edema, not islands.

Central islands were a serious concern, however the new generation of lasers have all but eliminated this problem. It is very unlikely that you have central islands.
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Postby nedzie » Sun May 25, 2008 1:23 am

I definitely hope it's just edema, but I would think there would be some sort of change by now, it's been almost 4 weeks since the surgery.

I read Central Islands are still possible, due to "clouds" of smoke coming off the lasered material. If it is central islands, is this something can can simply enhanced with another procedure?
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Postby LasikExpert » Sun May 25, 2008 6:57 pm

Central islands are a challenge to resolve, but the body does a good job by itself. The outermost soft pliable layer of corneal cells will actually thin over a central island to make it less pronounced.

You will probably continue to have these difficulties until you have completed your medication regimine, then have rapid vision recover. It's a process that has worked well for others.
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Postby nedzie » Thu May 29, 2008 8:16 pm

So do you have any idea how long it may take for my body to correct this if it is central islands? I do notice that when I put drops in my eyes, that I can see almost perfect for a very brief amount of time, maybe 10 seconds.
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Postby LasikExpert » Fri May 30, 2008 1:22 am

The brief vision clarity probably has more to do with dry eyes than central islands. When you see your surgeon next, ask if the high spots have changed and if they may be central islands.
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