Total Blurred Vision in One Eye

[gluonspin]

Hi Glen,
My recent doctor visit this past week showed that my refractive error is +1.50 in my dominant eye, the eye I am struggling with. I know that is not a major error but I can't pass the 20/20 Snellen test with that eye and need to for work or else in a few months, I'll quite literally be looking for a new line of work. My doctor gave me a contact lens for that eye at the +1.50 but I still can't pass the 20/20 test with that eye with the contact. He thinks its b/c my eye needs to "get used to" the contact and that my lens and eye need to relax from the strain of the last few months.
So two questions for you:
a) Does that sound right or am I just being appeased?
b)Why do I still have contrast problems with the contact, for instance my right eye seems to be extra sensitive to poor or artificial lighting but performs better outdoors?

I am still convinced there is something else going on with my eye. I may be wrong and hopefully are, but objects at intermediate and near distances have blurry haze around them all the time which is why I am wondering if the contact can actually help me to pass the test and whether or not I am fully healed. At the 6th month mark, my doctor is considering enhancement BUT what if the contact hasn't helped me by that point? Enhancement can't be an option if you don't know the parameters right?

thanks

[LasikExpert]

a) Does that sound right or am I just being appeased?

Probably a bit of each. It is reasonable to expect your eye will need to readjust, but this should be rather quick.

Forgive my forgetting, but you are presbyopic if I recall. The combination of hyperopia (your +1.50) plus presbyopia can provide poor vision quality at all distances even with a contact lens. Also, if you have any accommodation remaining, the contact may not be enough because the measurements were taken while you were trying to "focus around" the hyperopia.

b)Why do I still have contrast problems with the contact, for instance my right eye seems to be extra sensitive to poor or artificial lighting but performs better outdoors?

That is quite common in the early months after Lasik or flap lift. Artificial light, especially fluorescent light that is not color corrected, can make vision seem hazy or even blurry. Incandescent light and natural light don't have the same problem. It is an issue of the wavelength of the light reflecting off of the objects that you see. This normally passes with healing.

At the 6th month mark, my doctor is considering enhancement BUT what if the contact hasn't helped me by that point? Enhancement can't be an option if you don't know the parameters right?

For the most part this is correct, however hyperopia is an odd duck. It is not unusual for someone who is corrected with laser to claim superior vision compared to before surgery. If the vision is very close with contacts, then enhancement surgery may be appropriate.

[gluonspin]

Thanks Glenn.
You mentioned about being presbyopic, isn't this an age related issue? I am in my twenties, so would that be an issue?

What I am still confused about though is if I am past three months now, when should the healing process be done? Can my eye get better over time and if so why isn't a contact lens able to help me now?

thanks

[gluonspin]

Glenn-
Just had my doctor's visit. He said that although the contact lens could not achieve 20/20 correction (which includes hazziness/blurriness), the spectal exam did. I confirm this b/c when the doctor was testing my refractive error with various lenses, I reached a point where the right eye saw considerablly better at 20/20. So I presume then that if I wore glasses with a corrective lens for that one eye, I would see 20/20?

I am scheduled to wait another 3 months before considering enhancement. I REALLY DO NOT WANT AN ENHANCEMENT after the doctor described the many number of things that can and do go wrong with that process and the healing process thereafter. He mentioned that the surgeon has to disconnect the original flap which produces tears and uneven edges and the flap seal may be compromised. Epithelial cells may grow creating further disparities in vision requiring another surgery to remove them. And the list goes on...

Any thoughts? Would you get it done??? I don't trust the process right now....

[LasikExpert]

You may want to read our article about epthelial ingrowth. You should also read about presbyopia and hyperopic correction.

Before you make a decision, you need to try contact lenses. If these seem adequate, then there is not so much need for corrective surgery. If inadequate, you may want to explore enhancement surgery.

You can always have an enhancement later. There is no rush. You may also want to discuss with your doctor if PRK on the Lasik flap would be appropriate. That would nullify the epithelial ingrowth problem.

[gluonspin]

Hi Glenn--
To follow up on my thread, after over a year of having blurred vision in one eye with no improvement (i.e. stability confirmed), my doctor recommended the enhancement surgery. I explained to him going into the procedure that regardless of what my correction was, everything always has this blurry haze or fog to it. For instance, even if I am looking at something where I should be able to make out the letters like say 20/40 or even 20/200, everything has a fog over it. Needless to say, he believed the surgery would help, so I went through with it. Now 4 days later, I am still dealing with the haze/fog only now it seems more pronounced. I know I need to wait, again, to see how things change, but I am so perplexed and bothered by this process, I don't know what to think of what is going on with my eye. Do I have some other condition that went undetected? My career plans seem shot at this point. I wish I had not had lasik.

[LasikExpert]

It is really difficult to comment so early after having your surgery. Please keep us updated.

[gluonspin]

Will do, however, I have another question. Could my symptoms of blurry vision in one eye be the result of my pupils being too large for the procedure in the first place? I don't know if they were too large b/c I was approved for surgery, but if they were too large and this issue was overlooked, could this be the issue? Is it possible for this to occur in only one eye? Do the eyes dilate at significantly different sizes?

[LasikExpert]

Pupils do dilate differently in each eye. It is possible that blurred vision can be exacerbated by overly large pupils. It is not likely that this is your case. You seem to be having vision troubles in normal light as well as dim light. Learn about pupil size issues with Lasik.

[gluonspin]

Thanks Glenn for the article - it was helpful. Let me explain my ongoing symptoms. Since learning that pupil dilation can be an issue (and I am not sure it is my issue), I have paid much more attention as to when the hazy effect occurs. When I am outside under natural light in the open, I can see everything perfect, I can read everything, see everything without a cloudy effect. As soon as I walk into the shade or a building or a room that has poorer light quality, the hazy effect returns and everything has this blur to it that I have to work really hard to "push" through (sometimes I can, sometimes I can't). My left eye sees perfect regardless of the lighting conditions. These are the same things I experienced before the enhancement surgery - only now I think the enhancement did improve some of the focusing issues I was having. But what is creating the foggy, hazy-like effect in poor light conditions? Is there anything that can be done about it?

thanks

[LasikExpert]

Is there anything that can be done about it?

Yes there is, but it is quite possibly the most difficult task for a Lasik patient to undertake. You need to be patient. Yea, I know it can be tough. Doing nothing is a lot more difficult than doing something...anything...but that is what you need at this point. It is so very soon after your surgery that all your reported effects can be attributed to incomplete healing.

What I recommend is that you pick a specific date and ignore your eyes until a that date. Maybe it should be Thanksgiving. Maybe Christmas. Maybe a birthday or other such event, but whatever it is you simply ignore any problems you are having. Follow your doctor's instructions, but decide that you will not decide about the results of your enhancement surgery until after that date. You don't need the stress of questioning everything at this moment.

[gluonspin]

I am still having the same symptoms: blurry vision in my right eye at any distance (near and far) in less than direct light. Please tell me what my options are if my condition stays the same after another year. If I don't have any options and this is the best that can be done, please let me know. My doctor can't seem to beleive the second surgery was not a success and wont discuss other options at this point. For the sake of my sanity I just need someone to tell me whether or not anything else can be done - my job depends on my being able to SEE!!!

[LasikExpert]

Let's look at the absolute worse case scenario. This is not going to happen. You don't need it and it is not necessary, but the worst case scenario is a corneal transplant. Everything with Lasik, PRK, Epi-Lasik, and LASEK is done on the cornea. If everything goes wrong, then a corneal transplant is the worst case scenario. Nobody should take a corneal transplant lightly, but tens of thousands are performed successfully every year. Of course, there is no way you are going to need a corneal transplant, but you want to know what could be the worst, and that is it.

Now, let's venture back toward reality.

What you need is a second opinion. Not because I think your doctor has done anything wrong, but because that needs to be ruled out. You need either the peace of mind that your doctor is on the right path and you are on the mend, or that you need to take another path with another doctor. I recommend you contact the ophthalmology department of a university affiliated teaching hospital for a second opinion.

[mrav]

Thanks for all the good info. folks. It's nice hearing feedback from others.

Gluonspin, I was curious how your progress is going since your last “enhancement”? It appears I might possibly be having a similar problem in my left eye (vision slightly blurry at any distance, very slight haze/glare, little speckles when moving eyes). I’m scheduled to see my doctor at the end of May for my 1 year checkup. Both eyes seemed “perfect” at my first checkup the day following my Lasik. I began complaining about the Left eye one week later. He had my eye scanned again using the VISX mapping computer and he said the results looked good (He did the same at my two month checkup). After the three month checkup my Doctor finally spoke up and mentioned it looked like I had SPK in both eyes and the Left eye had little “sand blast” looking particles in the center of the pupil/eye which would be the reason for the blur. Apparently the SPK in the Right eye was lower and not in the center. He mentioned this was probably causing the blur. He put me on Restasis and told me to come back in a month. (I only tried Restasis for about one month. Is that not long enough?) At six months we tried a punctual plug but no improvement. Still having the same problem at my nine month checkup. He basically told me the problem is probably related to my sleeping with my eye slightly open based upon the line of SPK in the Left eye???

I’ve spent HUNDREDS of dollars on all different types of Eye drops and feel I’ve done a good job of keeping them hydrated day and night (Refresh PM). I’m just not sure what options I have next. It seems as if my doctor is “trying” to help me but it’s just not happening. I’m not sure if I’m to the point where I should be asking my doctor for a possible enhancement? Of course I’m concerned. Does any one have any suggestions? Thanks in advance.

Art