ASA and ghosting

Research your concerns in this forum or post your questions if you have had Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL within the past three months.

ASA and ghosting

Postby kslone » Wed Aug 27, 2008 3:33 pm

Had ghosting problems for years and went to several different specialist over the years till things worked out to get surgery done. Finally 6 weeks ago I get ASA done do to slight chance of dry eye. After the surgery, I could see that most of the ghosting had gone away in the right eye and about 3/4 of it in the left (but not clear vision).
A day and a half later the ghosting came back and got worse and worse in both eyes. I can count about 6 different ghosting shadows with each eye. Before the surgery I had a lot of ghosting, but this was more and worse. Can drive in the day and see up close well, (think God for that cause I work in IT with computers).
I am now on week six and no change, blurry, massive ghosting, with no improvement to be seen. My doctor says everything is healing ok and this can happen and tells me it will go away, it takes time.
At this point I feel I have made a BIG mistake. :(
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Postby LasikExpert » Wed Aug 27, 2008 5:45 pm

Did you have LASEK or Epi-Lasik?
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Postby kslone » Wed Aug 27, 2008 6:15 pm

ASA is what I know it by.
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Postby LasikExpert » Wed Aug 27, 2008 7:05 pm

ASA means Advanced Surface Ablation. This includes PRK, LASEK, and Epi-Lasik. The difference is how the epithelium is handled. The epithelium is the outermost layer of corneal cells. The epithelium is soft and pliable. It smooths the surface by filling in dips in the underlying corneal layer. They are also the fastest reproducing cells in the human body.

In PRK the epithelium is disrupted with an alcohol solution and removed. The cells regenerate over the treatment area. In LASEK the epithelium is disrupted with an alcohol solution, moved aside, and then repositioned over the treatment area. Epi-Lasik uses a device that slides a blunt blade over the cornea, lifting the epithelium in a sheet, which is then moved aside and repositioned over the treatment area.

In all ASA techniques the epithelium is mortally wounded and must regenerate. In LASEK and Epi-Lasik, the old cells must die, be sloughed off, and then new cells take their place.

I suspect you had LASEK or Epi-Lasik. This process of cells dying and being replaced is not exactly smooth. Some areas will regerate faster than others. This causes temporary bumps on the cornea that often present as multiple images of ghosting.

The entire process should take between four and eight weeks, some longer and some shorter. I suspect that what you are experiencing is this process.

Another issue is inflammation. Your eye has just had surgery and it's probably pretty angry about that. A normal wound response is inflammation. Irregular inflammation on the cornea will create bumps that can create multiple images.

And if these two were not enough, dry eye can exacerbate both issues.

Fortunately, this commonly resolves with normal healing and treatment. It may be frustrating for a while - and downright scary - but don't panic just yet.
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Postby kslone » Wed Aug 27, 2008 7:44 pm

I had (PRK the epithelium is disrupted with an alcohol solution and removed). Just hoping the ghosting will go away. Had it for several years and now worse. Should I start seeing some improvement soon?
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Postby LasikExpert » Wed Aug 27, 2008 8:59 pm

When you see improvement depends on the exact cause. Your doctor tells you that you are healing well, but does not seem to provide an explanation for the situation.

If it is due to inflammation, then you should be getting near the time that this will resolve. As a general rule, you can expect resolution within a couple of weeks of being off all medicated drops.

If it is due to dry eye, you may need agressive dry eye treatment to get things under control and then normal dry eye management.

You may even be suffering from a minor reaction to the medication. It's hard to tell. You really are going to need to get this information from a physician.

A second opinion from a corneal specialist may be appropriate in a few weeks. Either you will learn that your problems are beyond the ability of your current doctor, or you will learn that your current doctor is doing all that should be done.

Do not be surprised if you get frustrated at what may appear as your doctor's lack of concern. Most Lasik doctors have seen dozens of cases like this that resolve on their own. They are not concerned because they have seen the probable outcome many times. This is the first time for you. Excuse the pun, but doctors tend to have a different perspective than patients.
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Postby kslone » Fri Sep 26, 2008 4:20 pm

2 1/2 month check up still healing in right eye, no changes in ghosting. Now back to contacts just to see better.
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Postby LasikExpert » Sat Sep 27, 2008 1:48 am

It looks like you have astigmatism that will need to be corrected. The contacts will do that, but you should probably consider too if an enhancment would be an appropriate choice.
Glenn Hagele
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I am not a doctor.
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