1 1/2 months post Lasik Unhappy with Results

[ZDK109]

I had Custom wavefront Lasik about 1 1/2 months ago on both eyes. My prescription was -5.00 in each eye with some astigmatism in my left eye. The day after having the surgery I was pretty impressed with my eyesight. Although at my 1 day post-op, the doctor noticed some inflammation in my right eye and told me to keep putting the in the Pred forte drops hourly until my next appointment in 1 week. Only at my 1 week post-op did I realize that my vision was not all that good. The inflammation was gone according to the doctor, but I struggled reading the lines they showed me and guessed at many of the letters, but apparently I got every letter right on the 20/20 line with my left eye and only missed one letter with my right eye.

I wasn't too worried about this at the time because I knew it was only 1 week and that my vision should improve over time. Over the next few weeks I was doing the hand over each eye technique quite a lot and I realized my right eye was definitely off compared to my left eye. I was not comfortable with my distance vision and things like road signs and clocks from far away were a challenge to read. I was also getting headaches and eye strain due to the difference in each eye. Fast forward to to my next appointment which was last week and I am not still not comfortable with my vision. I went into the appointment expecting to get some answers and maybe find out that I was just undercorrected. I was shown a line and I guessed and struggled to lead every letter, but apparently I got most of them right. I told the doctor that everything was blurry, but he informed me that what I read was the 20/15 line so that was good. I persisted saying that my right eye was definitely off, but he didn't seem to have an answer for me. I told him it seemed like some kind of astigmatism and he didn't rule it out, but said that I was still in the healing process and he had me make another appointment for two months. I've been in kind of a depressed mood now because my vision sucks and I didn't get any clear answers. Any thoughts or advice would be greatly appreciated. Thanks.

[LasikExpert]

Unfortunately your doctor is not providing much information for us to go on, so I'll need to guess and read between the lines.

Having "inflammation" that required steroids every hour for a week sounds like Diffuse Lamellar Keratitis, or DLK. DLK can present with exactly the symptoms you describe. If you have had DLK the prognosis is actually good, but it takes a while for the inflammation to subside and the cornea to again clear.

It is not surprising that your doctor is taking a wait-and-see (pun intended) attitude. DLK causes the cornea to inflame. An inflamed cornea will often cause refractive error along with the haze of the keratitis at the Lasik interface. The only real treatment is steroids, and you have been using them. The rest is up to the cornea's healing ability.

Whenever a patient can read the black known letters on a white background with sharp edges and in a controlled lighting environment of the Snellen 20/whatever test, but complains of continued vision difficulties, as contrast sensitivity test may be in order. This can help define the nature of your vision limitations.

That "Lasik Salute" of covering one eye, then the other, then back again, will drive you nuts. For now just accept that your vision in the affected eye is going to be worse. You need to report your problems to your Lasik doctor, and you may even consider getting a second opinion from a corneal specialist, but what will be needed is healing time. At three to six months postop you will have a much better evaluation of what your final outcome will be.

[ZDK109]

Thanks for the great response. That is exactly what I had (DLK). I have been off the steroid drops for over a month now, and the doctor didn't say anything about still seeing any inflammation though. My right eye was actually my better eye before surgery, so I am definitely not used to this.

What is concerning to me, is it doesn't seem like the eye hasn't improved much over this last month.

[LasikExpert]

The healing response of the DLK eye was aberrant. It would have been altered by both the DLK and the steroids used to control the DLK. After 3-6 months you will want to talk to your doctor about Lasik enhancement surgery.

[ZDK109]

I was fearing that I would need an enhancement. Did a little research on DLK and saw that only between 2-4 percent of people who have had Lasik develop it. Lucky me.

[ZDK109]

Today my eye has developed a red spot near the bottom left part of my iris. This morning I thought I noticed it, but it has expanded since then. I've also had a headache all day today, but don't know if that is related. Should this be a cause for concern?

[LasikExpert]

This is cause to immediately see your eye doctor. If the office is closed, there should be an on-call doctor who can see you. If not, go to an emergency room or urgent care center. Don't panic; the problem may be benign, but you want to be certain.