Hyperopic Lasik 9 wks & distance is blurry evn w/ correction

[tanis2116]

Hi! First--this site is awesome for Q&A! I use this site along with another (asklasikdocs.com) to get the majority of my information.

Second--I am 9 wks out w/ hyperopic Lasik w/ a great deal of astigmatism. Specifically:
OD +5.25 -2.25 x 175
OS +6.00 -4.00 x 175
The same doctor actually refused me 2.5 years ago and wanted me to come back about now for them to re-run the tests. I think the most important thing for them was to see stability in my vision, etc. Actually, they remarked more than 1x about how stable my eyes have been along with how regular the astigmatism is (or should I say 'was').

At last visit (about 3 weeks ago) the autorefractor read:
OD -0.25
OS -0.25 -1.00 (I don't know the rest...)

This seems awesome from a numerical perspective--especially since I know that there is a high likelihood of at least some regression during the healing process! Even so, my vision seems pretty crisp (not as good as with glasses prior, but I didn't expect it to be) up close to say--about 3-4 ft. out. after that, things begin to get blurry. Something else is that even big banners and ads that are at a distance that I can still read easily due to its size is not crisp--I recently told someone that I can read them easily, but it looks like that it was written with a highlighter instead of a fine tip pen. (to illustrate it's slight blurriness and lack of crispness.)

When my VA was tested, the Doc said that I was reading 20/30 well, most of the 20/25 line and picking out a letter or two of 20/20. But honestly, except for 20/30 (which still wasn't perfect) it was all somewhat blurry. When I unofficially test myself at home, I can read 20/25 in the morning (pretty blurry and barely) and 20/30 is okay (but again not crisp) and by the end of the day I can read 20/30 but it is really blurry and 20/40 is okay.

Lastly, the Doc put me on Muro128, which I believe is for reducing corneal swelling. He asked me to continue it until finished--which I still have probably about a week's worth left. He put me on this somewhere around week 2.

My questions are:
1). Does my (in my opinion) pretty severe myopic shift make sense with the autorefractor's readings?
2). If so, I believe that a little bit of expected regression will help care for it, but I kinda expected to see some improvement by now. Does regression happen this slowly or delayed, or could something be a little off?
3). Could corneal swelling still be going on this far into the healing process? If so, could that be causing my vision issues?

Ultimately, I expect distance to be a little blurry--the numbers say as much. I just think that something else is keeping it from being as crisp as it should be--even at closer distances where I can see/read it relatively clearly. Any insight on this would be GREATLY APPRECIATED!

[LasikExpert]

Hi! First--this site is awesome for Q&A! I use this site along with another (asklasikdocs.com) to get the majority of my information.

Thanks for the kind words. I didn't know that AskLasikDocs was still around. It was quite active several years ago, but when we launched this forum all my time is spent here.

At last visit (about 3 weeks ago) the autorefractor read:
OD -0.25
OS -0.25 -1.00 (I don't know the rest...)

That is an amazingly good result considering that you started at such a high hyperopic (farsighted, longsighted) refractive error and so much astigmatism.

Even so, my vision seems pretty crisp (not as good as with glasses prior, but I didn't expect it to be) up close to say--about 3-4 ft. out. after that, things begin to get blurry.

The process of hyperopic Lasik correction is to steepen the cornea. To achieve that goal the cornea is not actually steepened, but the periphery is lowered. This is like lowering the water instead of raising the bridge. A "doughnut" of tissue is removed.

This has an effect of reducing the functional optical zone. That is the area of the optics where real and clear vision is present. A reduced functional optical zone can lead to blurred vision that often improves in very brightly lit environments as the pupils constrict and only light through the functional optical zone enters the eye and is "seen".

1). Does my (in my opinion) pretty severe myopic shift make sense with the autorefractor's readings?

That is a very large myopic shift, but it may not be the autorefractor that is causing an odd reading. If you are under age 40, you probably have the ability to accommodate. Accommodation is the process of the natural lens within the eye being manipulated to change shape and allow focus on near objects. You may have more hyperopia than the autorefractor shows because you are "focusing around" the hyperopia. An autorefractor would not catch this. A cycloplegic refraction (which is better, one or two, with your natural lens paralyzed) would reveal your true refractive state.

2). If so, I believe that a little bit of expected regression will help care for it, but I kinda expected to see some improvement by now. Does regression happen this slowly or delayed, or could something be a little off?

At nine weeks you sould have seen some regression. It would be astounding if you do not regress.

3). Could corneal swelling still be going on this far into the healing process? If so, could that be causing my vision issues?

Edema could still be present and it could contribute to your vision issues.

[tanis2116]

"Thanks for the kind words. I didn't know that AskLasikDocs was still around. It was quite active several years ago, but when we launched this forum all my time is spent here."
---You're welcome! they still respond, although it is not always and sometimes a decent amount of time can pass before they do, it seems.

"This has an effect of reducing the functional optical zone. That is the area of the optics where real and clear vision is present. A reduced functional optical zone can lead to blurred vision that often improves in very brightly lit environments as the pupils constrict and only light through the functional optical zone enters the eye and is "seen".
---To me, this sounds like you're describing issues regarding night vision, etc., of which I have very little. Other than halos and small starbursts, everything w/ night vision is suprisingly okay. Interestingly enough, if I look at the object for a second or two, I can actually *want* the starbursts "retreat!" It's kinda funny, actually. As I re-read this, are you suggesting that a little blur at distance is due to my refractive error and the "extra" that doesn't seem to go away until very near could be from 'reduced functional optical zone?'"

"A cycloplegic refraction (which is better, one or two, with your natural lens paralyzed) would reveal your true refractive state."
---Is this normal to do at some point throughout the 'check-up' process? At this point, they've mostly relied on looking at my eye (slit-lamp, I believe) and VA tests. I have another follow-up scheduled in about 1.5 months, should I wait until then, or do you think I should try to get in sooner to learn more?

"At nine weeks you should have seen some regression. It would be astounding if you do not regress."
---Are you suggesting that I have regressed to some point by now and that I'm accommodating for it, then? Quite honestly, if my vision has changed
since the surgery, it's not too noticeable. The main thing is that my vision w/ computer usage and haloes have 'tightened up' some. (although I'm still hoping for more since it's not exactly where I want it to be)

"Edema could still be present"
---How long until I should expect it to be fully resolved, typically?

[LasikExpert]

A cycloplegic refraction (which is better, one or two, with your natural lens paralyzed) would reveal your true refractive state."

---Is this normal to do at some point throughout the 'check-up' process? At this point, they've mostly relied on looking at my eye (slit-lamp, I believe) and VA tests. I have another follow-up scheduled in about 1.5 months, should I wait until then, or do you think I should try to get in sooner to learn more?

Unless you experience Lasik eye strain related problems, waiting would probably be fine. Of course, this is something to ask your doctor.

At nine weeks you should have seen some regression. It would be astounding if you do not regress."

---Are you suggesting that I have regressed to some point by now and that I'm accommodating for it, then?

I'm suggesting that this is a possibility and should eventually be evaluated.

"Edema could still be present"

---How long until I should expect it to be fully resolved, typically?

Considering the unique nature of your circumstances, I really hesitate to give even a guess. This is something your doctor - who has actually examined your eyes - can estimate much better than I.

[tanis2116]

Thank you--I will talk to my doctor more about what you suggest. One other thought I've had...

Do you think that it's possible that I was purposely overcorrected with the assumption that I would regress some but perhaps haven't yet...or maybe on did so mildly so far? I've read about situations where the doctor would purposely overcorrect some to account for regression....

Would an overcorrection and some residual edema cause my situation? I know that ultimately I"ll have to have my doctor involved, but I'd like to be armed with as much info as possible. :-) (My family has suggested that perhaps I'm borderline OCD--haha!)

[LasikExpert]

Deliberate Lasik overcorrection is highly likely considering your starting degree of hyperopia.

Edema induces myopia. Edema could be at play, but how it is affecting you would depend upon where the edema is located and the amount.

[mjs71]

What laser did your doc use?

[tanis2116]

I know I should--but unfortunately I don't know for sure. I know it was a custom correction and my surgeon is certified on the following lasers, so I'm guessing it was one of them.

# Bausch and Lomb Technolas 217
# VISX excimer laser certification
# Alcon (LADAR) excimer certification
# Chiron C-Lasik certified

[lex]

Hello tanis2116,
If your are still active user and receive a notification from this post, would you please, login and update or comment my lasik?
I wonder how you resolved the edema and how long was your healing process?
if you are kind enough to take some time to respond i would really appreciate any comments.
best wishes,
lex