Enhancement next week; 3.5 months post-Lasik

[Remander]

I am “fairly” satisfied with my first Custom Vue Lasik procedure, but I am scheduled to receive the euphemistically named “enhancement” procedure next week (April 19).

I offer my (abbreviated) story (thus far) for the benefit of others weighing the risks and rewards. I also welcome any comments, suggestions, etc.

I was just past my 41st birthday when I had Custom Vue Lasik January 8, 2007 by a surgeon approved by this site and one of the most experienced in my region. I still like him.

My eyeglasses Rx was OD -3.75 +0.75 x 107
OS -4.00 +1.75 x 060


It took a couple of weeks to get decent vision for much distance. Be patient. It can be a little scary at first. I saw much improvement after the first week and after getting off of some of the medicated drops.

Post-op, I used Flax Seed Oil,“TheraTears Nutrition For Dry Eyes” (which makes me burp fish taste), and Restasis. Doc now puts patients on Restasis drops and TheraTears capsules pre-op, which makes sense because inserts say they can take several weeks to have an effect.

I had no major dry eye problems, but I do still experience a little dryness 3 months out. I use a drop in the a.m. when I get up, one in the afternoon, and usually at least one in the evening. I use gel drops at bedtime too. (Plus Restasis drops twice daily).

At the several post-op checkups, some including scans, Doc said healing issues looked good. He said I am “a little under-corrected.”

After several weeks, close vision was pretty good; medium to distant was still fuzzy.

Exam March 2007 (3 months out): I could read most of the 20/20 line, but it was fuzzy. They said I was 20/20 (minus a few letters) in right, 20/25 in left. Opposite of how the eyes read (L/R) in the last test, they said. In layman’s terms, I have fair vision (not as good as with glasses before), decent in a room setting, but lacking crispness at much distance.

Also, I still see “ghosts” on digital clocks (and digital eye charts) in the dark, which clear up when I turn on background light like opening a refrigerator door (which makes the pupils shrink). Is this correctable on enhancement?? I plan to ask during pre-op for the enhancement. I forgot to ask today.

My vision is good enough to drive, work, etc. But it is certainly not as good as it was with glasses before. I would have difficulty driving in a strange town and trying to read road signs at high speed. Hazy or cloudy days are the worst.

Today, April 13, 2007: Vison was exactly the same as when last checked a month ago. Everything has stabilized, but it is not where we want it.

The computer/wave-front pics in March indicated astigmatism in the right eye is gone, but there is a tiny bit in the left eye.

I am still -.75 in both eyes (nearsighted). That is the primary reason for the enhancement.

Doc suggested we do the enhancement (as he predicted at the last visit), and we scheduled it for next week. I want to go ahead and knock it out, and try to get better results.

I have a vacation planned for early June, and Doc was very optimistic that I would be well recovered for it. He said recovery for the enhancement should be shorter than for the original operation.

I have my (second) pre-op Monday, April 16, and “enhancement” April 19.

That’s the story thus far. I hope it helps you in your journey or decision. I plan to add updates after the enhancement.

If you have advice for me, please offer it. Thanks.

Light Sensitivity Note: I wore photogray and then transition lenses for 25 years, so I am used to having sun protection. I no longer need corrective lenses (even pre-enhancement), but I still must wear sunglasses almost anytime I am outdoors, even on cloudy days. I am very sensitive to light. Is this simply a function of my years of tinted lenses, or is it a Lasik side-effect (or both)? And might it go away with time? I talked to a lady who had a serious but temporary light sensitivity problem a few weeks post-Lasik that kept her indoors for several days. Mine is not that bad, but it is a bother.

I am going to write a list of these questions for my pre-op. I think of them walking in and then get side-tracked and forget, even though Doc and staff take plenty of time with me during visits. But I’d also appreciate hearing from others about their experiences with these issues.

[Betty39]

I burped fish taste too on those capsules! Yuck I couldn't take it. I switched to BioTears but it is way more expensive. Like 35 bucks a bottle that lasts only a month. I got it off the internet. I don't know if it's really helping or if it's the Restasis, plugs, additional healing etc.
When they lift the flap it's my understanding that it starts the healing all over. So you can probably expect the dry eyes to get worse. I am certainly no expert, just relaying what I have read from Glen.
Good luck with your enhancement!

[JPD]

I only have one suggestion and I think it's something you should seriously consider. I'm fortunate enough not to need an enhancement, but If I was, this is the ONLY way I would even consider doing it. Because of the risk of side effects involved I think you should strongly consider having your enhancements done only on one eye at a time. Have your doctor perform on your non-dominant eye, and take as long as you need(weeks/months) to determine if the results are positive or negative before you go back and have the second eye done. Discuss it with your doctor, and there's no reason he should object to doing it this way. In reality more doctors should be performing the first lasik procedure this way as well.

[Remander]

Thursday, April 19, 2007: Had the enhancement

10:00 a.m. appt.; out by about 12:30.

Doc rechecked me on the charts to make sure vision was same as pre-op on Monday. He deadened my eyes with drops and used a little needle/blade to trace the cut/seam of the flap while I sat in a chair in an exam room. No discomfort at all. Once on the Laser table, he used a little device to flip the flap open.

He used conventional Lasik this time to focus on the tiny bit that he thought was causing the ghosts and -.75 nearsightedness after the first Custom Lasik.

My total time on the Laser table was about 20 or 25 minutes, but the laser ran only about 5 seconds on each eye. The staff (who are absolutely terrific!) got a chuckle at how short it was, but it was well worth doing. (I had over 1 1/2 minutes of laser for each eye the first time.)

My epithelium was loose (Doc said it was a 1 on a ten scale of slipperiness, with 10 being best). Doc had trouble getting it where it needed to be on the right eye (zapped first), and I reminded him that he had trouble with it on the left last time. Left epithelium was equally slippery this time too.

I was comfortable and conversant during the procedure, but I must admit that (as the first time) I stayed pretty tense and had my hands and jaws clenched (except when speaking).

Rode home with a dark towel over my head that I thought to bring. I suggest you take one because sunglasses don't always do the job on a bright day to block the light. Napped for a couple of hours after I got home.

I had more discomfort (stinging) this time post-op. The informed-consent form said that discomfort in the hours after an enhancement is generally worse than after the first go-round, although overall recovery is faster. That seems to be my experience.

The mild stinging lasted until about 6:00 p.m. Watched TV that night. Saw pretty decent. Very mild halos compared to after the first procedure.

Friday, April 20, 2007: Did not notice ghosts last night on clocks. (Hooray!) All ok at follow-up, but Doc wants to leave the protective contacts in another day to make sure that danged epithelium gets a solid hold. Boy, I hate the feel of those contacts.

Saturday, April 21, 2007 : Doc saw me on a Saturday a.m. Contacts come out. Epithelium looks good. I can read 20/20. I notice that my left eye is sharper than the right. Doc says I actually test the same in each eye when reading the chart, but I can definitely tell that the left is better than the right. There is reading a fuzzy Z and seeing a crisp Z, if you know what I mean.

I am also light sensitive. Doc predicted that the light sensitivity should pass in a week or so.

Doc sees a few white blood cells gathering on the left eye, so he says to use Econopred drops every two hours to address that. I also continue to use other drops and meds. Will return Monday.

I am VERY light sensitive this bright Saturday afternoon after the contacts are removed. Had to ride in the car with my eyes closed most of the time, and I left my sunglasses on in a restaurant at lunch. At times Saturday afternoon, I can’t even watch TV with the shades drawn and sunglasses on, but it gets better as the day passes. By 5:00 p.m. or so, that issue seems to have resolved a great deal.

My neighbor had PRK, and he said he basically sat in the dark for a week with sunglasses on. Ouch!

I have a little foreign-body sensation in the left eye Saturday afternoon, but the right eye is great, and the left FBS goes away in the evening. No extraordinary dryness.

Saturday night: I watched the Phoenix Nascar race (Jeff Burton fan) and noticed that my vision got better and better (!!) during the night. The fonts on the TV got more and more crisp. I think I could read Doc's eye charts much better at midnight than I did at noon today.

At this early point, I think the enhancement was well worth the discomfort and time.

My right eye already seems to be catching up with the left, and I hope it does, because I am a right-eyed pistol and rifle target shooter.

So far, so good!

P.S. I don't know if it helps, but I am have been using Restasis , liquid Flax Seed Oil, and TheraTears Nutrition For Dry Eyes. I figure it's worth the few $$ to maybe avoid dry eyes, even if you sometimes burp fish taste.

[mowchowch]

Remander
Thanks for the informative post.
I was wondering how much of the liquid flax seed oil you are using?

[Remander]

I was wondering how much of the liquid flax seed oil you are using?

The directions on the bottle I bought suggest 1 teaspoon twice a day.

I have not been religious about it, and have used one or two teaspoons a day. And I get additional flax seed oil from the Theratears pills (about three a day).

I also try to stay well hydrated by drinking lots of water.

I don't know if any of this does a darned bit of good, but I figure it's worth a try.

[Remander]

April 23, 2007: All healing looks good. Doc pops up the 20/20 line and says I know you can read this. I can’t. He puts drops in, and it is crystal clear until I blink and blur it up again. Chalk it up to dryness. I always see better outside than in the A/C hospital building.

In the week that follows, vision outdoors is pretty good, worse indoors in A/C and in the car with A/C.

April 30, 2007: Checkup. White blood cells issue is gone. Thanks, Prednisone. All healing looks good. Read about ½ of 20/20 line, but, again, I feel I read worse in the clinic building than outdoors. Vision seemed great Sunday, but a little worse this Monday. Come back in 2.5 weeks.

Vison seems fair in the several days afterward. Still see some ghosts/tails in low light. Close and medium vision is pretty good, but distance could be better (probably was a little better with glasses).

The light sensitivity issue is much reduced, with improvement seeming to coincide with getting off the medicated drops about one-week post-op. No more discomfort, but I do need tears drops a few times a day.

So far, I feel the enhancement is well worth it. We'll see how it all shakes out in the long run.

[LasikExpert]

Keep up the excellent and informative journal. I'm sure many who are considering travelling your path will find your experience valuable.

[Remander]

May 31: Light Sensitivity continues

More than one month post-enhancement, dryness is steadily going away, but I still must wear sunglasses almost anytime I am outdoors, even on very cloudy days.

I am unable to keep my eyes open to drive or walk in almost any daylight w/o sunglasses.

Has anyone else had this side-effect, and did it go away with time? How long did it take to resolve?

P.S. I did read 20/20 at last visit, and outdoors vision is great (with sunglasses). Indoors in large buildings with massive A/C, I still get dry and have some "glaze" effect. In my central A/C home, vision is fine. Just the big buildings get me.

[LasikExpert]

Light sensitivity (pain) is a known problem with All-Laser Lasik, when the flap is created with a femtosecond laser instead of a metal blade. Common treatment is long-term use of steroids until sensitivity resolves.

If instead of pain you feel a bit overwhelmed by light and squint, then the issue may relate to years of photogray glasses use.

Be sure to keep the surgeon informed of your sensitivity issues.

[Remander]

June 29: About 2 months post-enhancement. VERY happy I did the enhancement back in April.

Have really turned the corner in the last couple of weeks. All dryness is almost gone.

My vision is clear and crisp. Those darned LED lights (alarm clock, coffee pot, etc.) are the only thing that look funny. Still a little ghosty.

I still take a hit of drops in the morning and sometimes in the evening, but could live w/o them if I had to. Am not drying out in big A/C buildings nearly as bad as a few weeks back. I continue to use gel drops at bedtime, just because.

I stopped using Restasis about 3 weeks ago. Did not notice any difference when I quit.

Light sensitivity continues and is my only lasting issue. It is not painful, just a sensation of too darned bright, but it is seeming to reduce with time.

I still need sunglasses to drive or be outside on all but the cloudiest days. Perhaps it is just me getting weaned from my 25 yrs of photogray/transition lenses, as Glenn's post would suggest. Doc says it should go away. My informed consent sheet indicates that light sensitivity is a common post-Lasik complaint even months out.

I can read as fine as ever, despite the warning that I would immediately need reading glasses post-Lasik if I was over 40.

I am closing on the 6 month mark since my original Lasik, and things are looking good. I just need to shake the light-sensitivity issue.

Recovery post-enhancement: Many ask about this. Mine was MUCH quicker than after the original operation, though my enhancement was just a 5 second blast on each eye (but did involve a flap lift). It was as if the enhancement, after about a week or two, left me on the track where I was before as far as dryness. It was not like starting over, as I feared. Very glad I had the enhancement.

Who does the follow-up exam?: Some friends who have used other docs say their follow-ups are with optometrists or staff. All of my follow-ups have started with exams by staff but always include an exam and talk-time with my M.D. surgeon, which I appreciate. That may be an issue to ask about if that is important to you.

Good luck to all. I'll update with any developments, pro or con.

[LasikExpert]

Thanks for telling us about your journey!

[JPD]

Thanks for telling us about your journey!

Glenn, a somewhat related question to this thread. How can doctors do enhancements at 3 months, when it takes 6 months for the eyes to heal? At three months you don't know what your final vision would be like, so how can they do an enhancement? At three months, honestly I thought it was strong possibility I might need one. But now at almost 4.5, I know for sure I won't.

I just don't understand how they can do additional surgeries when the eye isn't fully healed yet.

[LasikExpert]

The doctor's judgment of the patient's condition will best determine when enhancement surgery may be appropriate. As an example, if there is a significant amount of refractive error, then enhancement surgery may be considered appropriate, whereas if the error is small, waiting may be more appropriate.

Yet another example why a good doctor is so important.

[Remander]

August 17, 2007: First visit since June 29. Read the 20/20 line with no hesitation. Read 20/15 with some difficulty, but got all letters correct. Managed a couple of letters on 20/12.5.

All is well.

Light sensitivity has much reduced and continues to improve. I think I am almost "normal" on this issue now. It's nice to wear "cool" sunglasses this summer.

Still have moments of "not quite as clear as usual" when in big buildings with lots of AC and refrigeration (like the hospital building where I read the chart), but that is also reducing and going away with time. I'd like to read the chart in the parking lot. I think I would do much better.

LED lights (alarm clock, coffee pot, etc.) still look ghosty. May have to live with that; worth it!

Outdoor vision is excellent!

I still use Systane drops in the morning, as I sometimes feel some dryness when I awake. I also hit gel drops at bedtime, just because I have some packets of gel left.

Quit the Restasis some time ago and noticed no change.

I do think, however, that the fish-oil/flaxseed-oil capsules help. I have been off and on them, and I think on is better, though it could be my imagination. If I were doing it again, I'd start taking them with each meal weeks ahead of time.

Reading vision (age 41) is still fine, and I read all day long on computer and paper at work. I did try a friend's 1.0 readers, and they were nice, but I don't need them and do not intend to use them until I have to.

Next follow-up is Feb. 2008.

Best of luck to others who decide to take the plunge!