Hyperopic wavefront correction was overcorrected

[croanster]

Hi there. First off, thanks for the great site. It’s helped me greatly through my lasik recovery reading through everyone’s posts!

I had a hyperopic correction performed on 05 July. I had customised wavefront with intralase (which at least for me, was not very comfortable to say the least).

My script before surgery was right eye +4.75, cylinder -1, axis 20 and left eye +3.25 with no astigmatism.

I went in today for another checkup and the optomitrist said my script seemed to have stabilised at: right eye +0.25 with a tiny bit of astigmatism and left eye -0.75 again with a tiny bit of astigmatism.

The trouble is, i have a lazy right eye. I’m very happy with the results for that eye and i see better now through it than before with glasses – but being lazy, i only read 20/40 through it no matter how good it is. I guess i see about 70% of the world through my ‘good’ left eye which now makes everything look blurry.

My left eye which used to be my good eye is blurry at any distance more than about 6 feet and can see 20/30 according to the optomitrist. Before I had the surgery, i could still see 20/20 with my good eye. (just couldn’t read very well any more – i’m 36 starting to get more presbyopic i guess.)

My question is, is it possible to do an enhancement on my overcorrected eye to get rid of the short-sightedness and if it is should i ask for it? Some people have told me -0.75 would be good with less reliance on glasses as i get older. All i know is right now, i can’t see as well as i could before the surgery and i’m regretting it.

Also, my ‘calculated residual stromal thickness' is 321 microns. How much extra do they have to burn off if they can fix it?

Thanks so much for your help in advance. I’m due to go back to see the surgeon in another 3 weeks for my 3 month check-up and am keen to get opinions other than the surgeons at this stage.

[LasikExpert]

Don't be in a rush to have enhancement surgery. The probability of regression of effect after hyperopic (farsighted, longsighted) correction is rather high. It is very likely that some of the -0.75 myopia will regress without surgery.

Before you have enhancement surgery, wear a contact lens for several weeks to simulate vision with full correction. You may find that a small amount of myopia is good to have.

[croanster]

Thanks for the reply Glen. I'm hoping you're right and am not in a rush - quite happy to give it another few months. The optomitrist was pretty sure there wouldn't be much of a change but he's not directly involved with my lasik surgery. He's co-managing due to the 200 kms to my surgeon so i again i'm hoping he's wrong!

I think the main problem is that it's my dominant eye thats shortsighted. Probably if the result was the other way around i'd be quite happy.

So it's quite safe though to do a enhancement in my case if i choose to later? is it pheasable to regress the full amount by itself? I understand its a guessing game just wondering about best and worst scenarios.

This maybe a silly comment, but to me it doesn't feel like a small amount of myopia. everything is.. well, blurry! :(

I will definately try the contact - don't think i'll have any issues at least for a few years. I was still accommodating a +3.25 reasonably eg i could read the newspaper (as long as i was outside in the sunshine) :wink:

[croanster]

I spoke to one of the technicians at my surgery yesterday. She has advised me it would be better have my 3 month follow up at my local optomitrist and delay my visit to them for another month to allow more time for healing.

She gave me this analogy about baking cakes (cant eat your cake straight after it comes out of the oven - it's got to cool and settle or some such thing... would've been better talking to me about repairing a car or something but i got the idea..)

Anyways, she thought they would probably end up having to 'enhance' about 0.5 diopter of shortsightedness but stressed I'd need the eyeball mapping done again to ensure I have enough eyeball left to zap! (they 'calculated' 321 microns in the eye in question)

This scares me a bit. I hope there is enough left because i really didn't expect to fork out all that money to end up with worse (at least for distance) vision than i had before.

Had a lousy vision day yesterday and felt pretty depressed. My sight seems to be twice as bad when it's overcast for some reason. Back to just mediocre today so i'm trying to stay positive.

Anyone else had a longsighted correction done? Seems like i'm one of the few...

Silly question time - can you open your eyes under water when your swimming at the beach / pool after lasik? (i'm an aussie living on the coast - live in the water in summer)

Thanks.

[gkrogers]

Howdy. I had Hyperopic LASIK back in April 07. My posting under this heading also. Most of what I have read and heard is that for us it is best to wait up to a year before we have an enhancement done to give our eyes time to heal and stop regressing. I also have a little difficulty in low light situations like overcast days and at night. For the first month or so every thing past 10 feet was fuzzy to me. My distant vision is better now. Just give it more time. The healing process for our eyes is slow.

[LasikExpert]

Enhancing 0.50 diopters of myopia would require removal of about 6 microns of corneal tissue from the center of the cornea. Your hyperopic correction removed tissue from the mid-periphery of the cornea. There is undoubtedly enough tissue to have enhancement surgery if reqired/desired.

Your eyes have been accustomed to a very different range of focusing. I suspect some of your vision problems relate to eye strain. You may want to read our article about Lasik eye strain issues and see if any applies.

[croanster]

Thanks for responding guys.

Glad to hear your eyes are coming good gkrogers. I know what you mean with problems in the first month but thankfully I was expecting that although not quite to the extent that i experienced. I was actually practically blind the day after surgery! Couldn’t read the big ‘A’ on the top of the eye chart. Found that really scary although when the tech tested me out with the glasses I could read 20/20 with my ‘good’ eye again.

Just looking at my day after results, I was approx -4.0 right eye and -3.5 left eye. How’s that for regression – especially in the right eye. +4.75 to -4.0 and settled now at +0.25 at 10 weeks! Pretty good job by the surgeon there if it stays put!

Did you find the improvements were very sudden? I remember coming home from work one day about 3 weeks out and it was like someone flicked a switch – I could suddenly focus with my right eye. Same thing happened with my left at about 5-6 weeks out. Waiting to pick up some takeaway and I looked down the street and realised I could read licence plates on the cars whizzing past.

Glenn, I think some of my issues are certainly eye strain related. You are right it’s very strange indeed changing ‘best’ eyes after 36 years! I think I am actually learning to see more through my lazy eye. I know this is not supposed to be possible but on a nice sunny day, some things look absolutely amazing to me! I sat and watched a bird flying amongst some trees with the hills in the distance for 10 minutes the other day – everything looked so 3-D it was incredible! Felt like a kid watching a 3-D movie for the first time! I never used to get that view of the world even with my glasses on. Everything always looked much ‘flatter’.
So, there are some good points! Hopefully with time some of the bad points (like being frightened driving at night in the rain) will resolve somewhat. –No halo issues or anything, just the myopia in the dominant eye taking over i think. Still keen on the enhancement but will wait and see.

Another quick question: I didn’t pay that much attention at the time and thought I was having a ‘wavefront customised treatment’. Now with more reading it seems like that’s not even available for hyperopic correction? Outside the 6.5 mm maximum ablation zone – is that right? Difficult to dig up info on farsighted stuff everyone’s myopic! ;)

[LasikExpert]

Hyperopic correction will be in conventional ablation, not custom wavefront-guided.

When you pupils become very small in bright light you have an increased depth of focus. This is exactly like the iris on a camera. Most people have significantly improved vision quality in bright light.

[croanster]

Had my 3 month check up today. Some interesting results – I think and hope they’re good..

Cycloplegic Refraction Left eye: +0.75 with a -0.75 astigmatism, Right eye +1 with -0.5 (or a bit less he said) astigmatism.

I’m still showing manifest refraction of around -0.5 to -0.75 in left eye and +0.25 in the right. Very strange. At least I wasn’t overcorrected. I seem to think that’s a good thing with no eye tissue being ‘wasted’. Remarkable amount of regression though.

Couple of questions: how long before this accommodation issue sorts itself out? Should i expect cyclopegic and manifest refraction results to be the same ever?

Most importantly, if in a few months I go ahead with the enhancement to get rid of the fuzziness out of my left (dominant) eye, will I manifest as being shortsighted if I am corrected to 0 with cyclopegic refraction? This is what the local optometrist suggested. He was concerned that if I’m manifesting now at -.75 after enhancement the effect would be around -1.25. Doesn’t make sense to me – why would they bother with a cycloplegic refraction at all if you didn’t adapt to it eventually?

It was remarkable the difference in my vision after the drops today compared with ‘dilated vision’ before surgery. Before, I couldn’t see a darn thing properly where as today my distance and mid vision was actually quite good apart from everything being too bright. I was encouraged by this as well.

The starbursts tonight through huge dilated pupils were astonishing. Glad I didn’t have to drive anywhere! Nice to look at for a night (like a Christmas scene) but I’m glad I don’t have to live with it all the time.

The optometrist also noted haze hasn’t really improved since the first month. He said it was mainly around the periphery and attributed it to healing (wound response) which I’ve read about – sounds right since the laser zapped my corneas at the periphery for the hyperopic correction. He wasn’t concerned about it anyway so I’m not either. Should I be? Hope not.

Overall I think my vision has improved to the point where I’m happy I had the surgery. Just this lingering fuzziness in my dominant eye that I guess must be due to the astigmatism? Anyway, back down to Sydney on the 29th for the ‘proper’ tests with the wavefront mapping etc and to discuss enhancements.

[LasikExpert]

...how long before this accommodation issue sorts itself out? Should i expect cyclopegic and manifest refraction results to be the same ever?

Past age 40 the ability of the natural crystalline lens within the eye to change focus (accommodate) becomes limited to the point that reading glasses or bifocals become necessary. Eventually, accommodation will stop completely and cycloplegic and manifest refractions will be the same.

...Most importantly, if in a few months I go ahead with the enhancement to get rid of the fuzziness out of my left (dominant) eye, will I manifest as being shortsighted if I am corrected to 0 with cyclopegic refraction?

The most common cause of myopia and hyperopia is that the length of the eye is too long or too short. The eye "focuses around" this length disparity. Cycloplegic refraction is based totally upon length of eye optics. Manifest is based upon length of eye plus accommodation focusing around the myopia or hyperopia. If refractive surgery based on cycloplegic measurements makes the refractive error plano (zero refractive error), then there is no reason for the eye to focus around an axial length refractive error. It may take a little while for your eyes to adjust to the new range of focus and lack of need to focus around everything, but it should settledown to plano manifest as well as plano cycloplegic.

The optometrist also noted haze hasn’t really improved since the first month. He said it was mainly around the periphery and attributed it to healing (wound response) which I’ve read about – sounds right since the laser zapped my corneas at the periphery for the hyperopic correction. He wasn’t concerned about it anyway so I’m not either. Should I be? Hope not.

If the corneal haze is not within the visual axis and is not "seen", then it is only a curiousity that needs to be monitored on ocassion. If it interferes with normal vision, an application of Mitomycin C may be suggested.

Overall I think my vision has improved to the point where I’m happy I had the surgery.

That is a good place to start!

[croanster]

Well, I had my 4 month check up yesterday and all seems good.

Medically speaking, the surgeon said the flaps looked great – healing nicely, the bit of corneal haze is nothing to worry about – just a ‘normal’ level and should resolve by itself with continued healing.

As far as the snellan chart is concerned, I should be over the moon. My right eye (amblyopic) can see 6/10 (about 20/35) which is much the same as before surgery with my glasses on. My left eye can read around 6/5 (about 20/15) with difficulty – I missed a couple of letters. The 20 / 20 line was do-able only with hesitation and it looked fuzzy to me. I guess most people would be very happy with that but it’s just a bit fuzzy still which is really frustrating! (not quite as good now as uncorrected before surgery)

The technician did a refraction and with a -0.5 lens (don’t know what the angle or level of astigmatism is – why is it so hard to get actual numbers they guard them with their life??) the bottom line of the eye chat snapped into perfect focus! It was magnificent! (20/12.5 I think it is) and I rekon I could read the tiny print below the bottom line that said ‘made in china’!! ;)

The surgeon said that my sphere is around +0.4 which is very close to spot on although I see so much better with a -0.5 lens. He assured me this is normal and I’m still adjusting to the new range of focus – still accommodating for an error that no longer exists. I have great faith in my surgeon – he came highly recommended and hasn’t been wrong yet so it’s back to the waiting game for me at this stage. I would love to be able to see that way I could with that lens. Have to find out what the full script actually is for my own interest.

I also mentioned that I can focus really well on red light but not green – for example stopped at traffic lights I can see the red fairly crisply but when the lights turn green, they blur and elongate like a football. He said that is apparently a ‘real world example’ of a common eye test to indicate if people are have focusing issues which clearly I am!

I was wondering if there is any way I can speed up my adaptation to my new eyes? (had a crazy idea about getting some glasses at -1.0. I seemed to adapt quicker the further my manifest was away from cycloplegic.)

Anyway, the outcome was to come back in 6 months time to see how things are going. My doc seemed confident that an enhancement won’t be necessary – I trust what he says, but am not quite so confident. Hard to believe my acuity issues are all related to accommodation errors.

I’m trying to remember, the way I could see 10 years ago is very different from the way I would have been able to see in 5 years time had I not had Lasik and from that point of view the change is remarkable already – I’m just being greedy and want it all! :)

Also like to recommend flaxseed oil to anyone with dry eyes. It has made a huge difference for me over the last month since I’ve been taking it.

And also – I asked my doc “Can I open my eyes underwater at the beach / in the pool?” He said “yes of course and when you do, it’ll look remarkable!” so I’m looking forward to that!! :)

Thanks to this forum and especially Glenn – its a great place for reassurance, advise, information and just to talk (obsess?;)) about our recoveries!! Cheers everyone!

[croanster]

I just realised that I haven't ever mentioned anything about my close vision which was one of the main reasons I had the surgery in the first place!

Menu's in dark restaurants are a snack! I soldered a circuit board on a remote control the other day and did a beautiful job if i do say so myself and i can read the newspaper by candlelight without a seconds thought so that side of things are brilliant.

Before lasik, I was starting to struggle to see the time on the clock in the morning and i had to close my really bad eye to focus on people in a club / restaurant (everyone thought i was winking at them - good in some instances, not so good in others! ;)

[LasikExpert]

I was wondering if there is any way I can speed up my adaptation to my new eyes? (had a crazy idea about getting some glasses at -1.0. I seemed to adapt quicker the further my manifest was away from cycloplegic.)

Your eyes need to learn the new range of correction and that really will be learned best by just using them in every day situations.

Thanks to this forum and especially Glenn – its a great place for reassurance, advise, information and just to talk (obsess?;)) about our recoveries!!

Thank you for the kind words. I'm glad our information has been helpful. Thanks to "obsessing", many people will be able to read about your recovery and recognize their own situation. This forum is valuable because of people like you.

[isa]

hi croanster
I m 36 years old and also hyperopic i can see well through +4.00 glasses and no astigmatism
my cycloplegic prescription is +6 in my right eye and +5.5 in my left and 0.5 astigmatism
I have been using +4 glasses for the past 11 years and +4.75 contact lenses so I figure my eyes are stablized at this prescription
how is your vision right now?
and do you recomend lasik for me?
I have a postion under hyperopic lasik
thanx

[batista]

Hi,
The surgical reduction of hyperopia is an evasive but worthy pursuit since hyperopia affects both distance vision and near vision and is compounded by presbyopia at a time when patients are in the prime of their vocational and personal life. A wide spectrum of refractive surgeries has been applied over the years in the relentless pursuit of hyperopia correction.