ghosting

[susssan]

Hi I had bladeless wavefront lasik 16 days ago. Monovision I realize it's 'early' in healing but I have ghosting and it's hard to deal with.
I would like to know if anyone here had that problem and if it resolved itself.
The monovision is working great but the distance eye seems undercorrected (20/30)and the ghosting is only making it more difficult. If it's improving, it's happening slowly.
One thing -- in surgery, the flap had a slightly ragged edge on one part of the eye. Not a large section, but because of that, I was told to try to keep my eyes closed as much as possible for 24 hours, which I did.
I have been using all kinds of eyedrops plus restasis. Doing the vitamins and fish oil.
it's disappointing to say the least and I am afraid this will be permanent!
I would really like to hear of any experiences with this!
thank you
Susan

[LasikExpert]

I am assumming that the ghosting you describe is in one eye. Test this yourself by covering one eye and then the other and determing if the ghosting appears only in one eye.

The ghosting you describe is commonly caused by astigmatism or astigmatism caused by inflammation. Astigmatism simply means that the cornea is not spherical like the top of a ball, but is elliptical like the back of a spoon. The "tip" of the spoon will focus light off-center and create a second lighter "ghost" image and/or blur. You may have had astigmatism before your Lasik that was not fully resolved with surgery, or surgery may have induced astigmatism.

You are less than three weeks out from surgery. It is very likely that you are experiencing some inflammation of your cornea. Irregular inflammation can induce astigmatism and its symptom of ghosting. Inflammation across the entire cornea can induce myopia (nearsighted, shortsighted) vision. A combination of astigmatism and myopia can cause exactly the symptom you describe of less than excellent distance vision and ghosting with the same eye.

Astigmatism can be resolved with corrective lenses. You may ask your Lasik doctor for your current prescription so you may get a pair of glasses that correct your distance vision and astigmatism, however this may be money poorly spent because if either are due to inflammation they are likely to resolve, or at the very least change, in the coming weeks. If the distance vision and/or ghosting is critical, then get glasses; otherwise you may be best served by saving your money.

Monovision is an excellent way to reduce the need for reading glasses, however it can take some time for the brain to become accustomed to the change.

Report your difficulties to your surgeon. If you have any sudden changes (good or bad), notify your doctor's office straight away. At about three months postop you should discuss with your doctor if enhancement surgery would be appropriate - assumming the problem has not already resolved on its own by then.

[susssan]

Glen Thank you so much for your reply.
As soon as my vision stopped being cloudy, I noticed the ghosting. It is in one eye, and yes I did have astigmatism. Since I had monovision for years with my contacts, I had no qualms having monovision lasik, but I had never heard of ghosting, never met anyone who didn't have successful lasik, and certainly it wasn't mentioned to me prior to surgery. I had never heard of ghosting, and only thought if the surgery wasn't a success that just meant I would still be nearsighted. Having wavefront gave me confidence that this would be successful. So I've been really freaked out about it wondering if this is 'it' for my vision, spending the rest of my life 'ghosting'
It's so obnoxious! And when road signs look clear but blurry at the same time, it's disheartening.
The distance vision is starting to improve, the ghosting remaining, it starts at about 5 to 6 feet away and when driving, signs become clear without the ghosting at about 10 to 15 feet.
My optometrist mentioned astigmatism, and then did an exam being able to clear my vision with his equipment that changes lenses.
I am hoping for no enhancement, because what if it makes it worse?
I was also hoping to hear that there are people that this cleared up in, since on this board I see several are living with ghosting and are frustrated. My optometrist said it gets better but doesn't go away. Is that true?
Do you have any suggestions on how to reduce the inflammation? I'm trying to get this 'right'
Thank you for answering my note! If this clears up, I will certainly post here to help others know it does improve. If it doesn't... then what?
Susan

[LasikExpert]

Glen Thank you so much for your reply.

I'm glad to have been of service. That is why we are here.

I've been really freaked out about it wondering if this is 'it' for my vision, spending the rest of my life 'ghosting'...

If you talk to your friends who have had successful Lasik you will likely find that they had some vision problems during the healing process. The "20-Minute Miracle" often takes a couple of months.

My optometrist mentioned astigmatism, and then did an exam being able to clear my vision with his equipment that changes lenses.

That is exactly what you want to hear. The problem is only refractive (bending light). What you achieve with his equipment is what is possible to achieve with enhancement surgery and you can wear glasses to resolve all problems. You are not "stuck" with ghosting.

I am hoping for no enhancement, because what if it makes it worse?

Evaluate enhancement surgery with the same consideration as intial surgery.

I was also hoping to hear that there are people that this cleared up in, since on this board I see several are living with ghosting and are frustrated. My optometrist said it gets better but doesn't go away. Is that true?

If due to inflammation, it will change. Ghosting due to astigmatism can virtually always be resolved with glasses. The frustration is that people pay to be without glasses of any kind.

Do you have any suggestions on how to reduce the inflammation? I'm trying to get this 'right'

Yes. Use only preservative-free artificial tears. They are easy to find. They come in single use vials and cost more. The preservatives in eye drops are a mild toxin to kill the things that would make it spoil. Once or twice a day is fine, but you are problably putting in drops every hour or so. This can toxify the eye causing irritation and inflammation.

I will certainly post here to help others know it does improve. If it doesn't... then what?

Post either way. Since it appears that your problem is due to regular astigmatism you will have several options if it does not resolve by the three month mark.

[susssan]

thank you so much! Your reply has helped me lose some of the anxiety attached to this issue. It's easier to 'live with' after this discussion and I am hoping time will make a difference. I see my eye Dr later this week and hope there is an improvement over the last exam. We certainly will discuss the ghosting more this time. I will let you know what is said.
Susan

[LasikExpert]

I'm glad your concerns are more focused on the probable result. When you meet with your doctor you may want to take this thread with you. Your doctor can verify with an exam those issues we could only discuss in hypothetically.

[susssan]

so I had my optometrist appointment this morning. My prescription is -1 My vision isn't as good as it was two weeks ago, and there is a small spot of opacity under the flap.
I am waiting for a call from the surgeon's office.
do you have any input on this? I'm rather unhappy at the moment!
thank you!!

[susssan]

pred forte for about three weeks at an aggressive dose at first.. see the optometrist/opthomologist on Tuesday
opinions?

[LasikExpert]

The opacity at the flap and the prescription for a steroid indicates your surgeon is agressively treating for Diffuse Lamellar Keratitis (DLK). Your optometrist's quick diagnosis and surgeon's agressive treament is exactly what you need. Use the eye drops exactly as prescribed and do not under any circumstance stop using them until instructed by your surgeon. If you actually have DLK, this is the treatment most likely to resolve it fully. Permanent problems from DLK is very, very rare when timely diagnosed and agressively treated.

In a somewhat backhanded way this can be good news. DLK is an inflamation at the location of the Lasik flap. That inflammation can induce astigmatism, which can present as ghosting and myopia. The "20-Minute Miracle" is becoming quite a journey for you, but know that DLK commonly resolves with the steriod treatment. Report any sudden changes to your doctor without delay, but it is reasonable to expect only gradual clearing and possibly reduction of the ghosting.

You may want to know the results of our organization's vision correction patient survey. These are all patients who are at least six months postop.

99% report quality of life as expected, better, or much better
98% day vision as expected, better, or much better
98% no complications or issues are seldom problematic
98% would recommend surgery to family and friends.
97% would have surgery again, knowing what they know now
96% wear corrective lenses as often as expected, less, or much less than expected
96% report postop vision without lenses as expected, better, or much better than expected when compared to preop vision with lenses
96% report overall quality of vision as expected, better, or much better than expected
91% no complications at any time
91% night vision as expected, better, or much better
7% complications seldom problematic
– yet 91% of these same patients would have surgery again
2% complications frequent or always problematic
– yet 22% of f these same patients would have surgery again

Even with all your are going through immediately postop, at six months postop the odds are still on your side that you will have an acceptable result. See Lasik Results for more detailed information.

[susssan]

Well thank you. I hope you are right and it's a bit of 'good news' Today is the best I have seen since surgery! I have used the pred forte every two hours since yesterday afternoon. Just in the one eye. crossing my fingers and toes and eyes ;-)
I see the surgeon next week. will keep you posted and appreciate your help and support!

[LasikExpert]

Sounds like the Pred Forte is doing its job of fighting inflammation. Keep us informed.

[susssan]

Wow I wish they'd caught this sooner. Amazingly enough, the ghosting is clearing up, as is my vision.. I am getting glimpses of success. :-)
I am wondering if the inflammation is from all the dry wall dust we had in our house the past 3 weeks. About 4 days after my lasik we had drywalling done in the garage, and they sanded. I've dusted and dusted and finally am ahead of it, but it just crawled into the house. I was sneezing for weeks.
Whatever it was/is the pred forte is making a big difference. When I put drops in my eyes my vision momentarily becomes crisp and clear. Hoping this is a good sign!!
I will keep you posted.

[LasikExpert]

I'm glad to year you are on the mend. Keep us informed. We always appreciate hearing about how things turn out.

Please be certain to notify your doctor of the drywall dust issues. This fact may help with diagnosis and treatment.

[susssan]

The Dr did say it is probably DLK although it's in an odd place. Not on the edge of the flap but a spot less than a mm that is in the lower center. Not real sure how that happened but not from dry wall dust.
so since my vision is clearing slightly from the predforte we are following that course for 4 weeks tapering off slowly. She says the spot will take time to go away but if it doesn't get larger that is a good sign.
Check it again in a few weeks. And yes this could for sure cause ghosting and some loss of clarity.
hoping this works well!
if it continues... then we'll 'lift the flap'
I'll keep you posted.

In the meantime. Why would my vision become really crisp for a moment after I put in eye drops?
any clue?
thanks!!

[LasikExpert]

The tear film acts like wax on your car; it fills in all the tiny rough spots and gives a smooth surface. Also, the film will increase the thickness of the cornea just a bit, but a whole diopter of refractive change requires only 12 microns of thickness change. A human hair is about 60 microns thick. It is likely that the combination of thickness change and smoot surface work to your advantage.

It sounds like you are on the mend. Do keep us informed.