Post Hyperopic LASIK

[gkrogers]

I just had Hyperopic or farsighted LASIK yesterday afternoon. My pre-LASIK RX was OD +5.25 - 1.25 X 031; OS +5.25 - 1.75 X 145 (Bifocals +2.00). I have worn glasses since I was 7 yrs old. With-out my glasses everything was just a blur. The Dr. used the Alcon LADAR system. My treatment was standard and not custom due to my RX being outside the FDA approved range for custom treatment.
My procedure was pretty much normal like what most people have written here. The suction ring used while cutting the flap (laser) was uncomfortable in my right eye and slightly (minimally) painfull in my left. I did not feel the flap being cut. The worst part of the entire process was when the Dr. turned on the extra bright lights while he was moving the flap prior to the actual ablation. The lights were extremely intense and made it VERY VERY uncomfortable. The bright lights went away once he had the flap moved and was ready to begin. There was that funky burning smell while the laser did its job but again I did not feel that.
Once it was over they led me out to the examining room where I waited about 10 minutes for the Dr. The first thing I noticed after a few minutes was that I could see and read the "ALCON" logo on the side of one of the pieces of equipment about 3 feet away. It was a little hazy but clear other than that (it would have been a blur before). The Dr. came in, checked my eyes again with a bright light and gave me my marching orders of what to and not to do for the weekend until I go back in on Monday for my first post-LASIK follow-up exam.
So this is the night of the second day. I've been using all the various drops as directed and the Systaine lubricants about every two hours. My eyes haven't felt abnormally dry but from everything I've read, the more the better on the eye lubricant drops. I can see extremely clear from about a foot to about 10 feet. My distance past that is a little fuzzy to blurry the further you get. I can drive with no problems. Large objects like vehicles, motorcycles are still pretty clear, just not their liscense plates. My night driving is ok too. The headlights have a little glare but then they did with my glasses too. No halos or starbursts yet. I know I have possibly 6 months or longer of healing where my eyes will fluctuate to some degree. So I know it is too soon to say I'm totally satisfied but the beginning is quite amazing to me. If I had to guess where I'm at right now, I'd say 20/40 with just a slight bit of astigmatism left. I'll post again after my check up on Monday. :D

[LasikExpert]

You had very, very high hyperopia (farsighted, longsighted) vison. Regression of effect is almost guaranteed. Many doctors will deliberately overcorrect a hyperopic patient into myopia (nearsighted, shortsighted) vision so regression takes you back to plano (no refractive error).

What you describe sounds like moderate myopia. As the regression lowers the myopia during the coming weeks you will probably find that items at distance will become more and more clear.

Do not be surprised if an a few months your surgeon suggest enhancement surgery. It is very difficult to get that much hyperopia corrected. It's possible, but difficult.

You had previously mentioned that you are almost age 50. Being a little myopic will allow you to see objects close much better, but at the cost of excellent distance vision. Even if you do not fully regress to plano, you may be very satisfied with your results.

That Lasik burning smellwas not actually the cornea burning. The cornea's temperature is only raised about 11 degrees F during surgery. It is actually a chemical reaction. Read the link for details.

[gkrogers]

I had my first check up today. It's been three days. The doctor explained that my great close vision will slightly subside and that my distant vision will improve in the near future. I am 50 yrs old and was pretty much fully presbiopic. I have worn bi-focals since I was 32.
My current Rx is blurry 20/20 in the right eye and a blurry 20/30 in the left eye. They have said my astigmatism is aproximately nill. I have no night time driving problem, low light problems, or excessive light sensitivity. The sun does seem a little brighter with out sun glasses though. I'm still using the antibiotic and steroid drops 4 times a day till both run out. I use systaine drops every 2 hours whether I feel dry or not and most of the time they don't.
I have read the study results that showed a higher regression for hyperopic patients and it was more pronounced in those with higher prescriptions. Glenn, you also know that the astigamatism like mine some how subtracted from the hyperopia which in turm moved my level of hyperopia closer to the +4 range so I will think positive but understand the possibilities.
Glenn, you are right about my feeling that the results are great. I do feel that way. I also know I probably will have fluctuations and changes in my eye sight for the next several months, possibly longer. So with that in mind my "GREAT" description is a little reserved. But it sure is nice to be able to see my tooth brush in the morning when I put tooth paste on it instead of just feeling it and groping around.
Next post in a week after my next appointment.

[gkrogers]

I mis-used the term Rx to provide my Snellen chart measurement. They did not actually perform a refractive measurement to see what my exact prescription is now. My apologies for the mis-statement.

[Mack]

>I have read the study results that showed a higher regression for hyperopic patients and it was more pronounced in those with higher prescriptions...... the astigamatism like mine some how subtracted from the hyperopia which in turm moved my level of hyperopia closer to the +4 range so I will think positive.

Galen..from another hyperopic lasik survivor, congrats on your successful outcome! The best news is that you did not suffer any serious complications from the flap lift and initial procedure, and that you are nearsighted right now. The worst of the complications would have included decentered ablation, a damaged or button-hole flap, DLK, very dry eye etc. It is very early and there will definitely be regression. Just how much regression and how much of it will be astigmatic is the hard question to answer. As Glynn says, you are moderatly nearsighted right now, probably around -1.0 to -1.5 and that's good. I know too many h-lasik survivvors who started out closer to plano right away and were thrilled but then healed back into hyperopia again after regression fully stopped. For your script, regression will probably go on for qute a while, up to a year or longer like it did for me. At +5, I was deliberately over-corrected by +1.375 diopters to allow for spherical regression, but no overcorrection for the double carded -1.25 cylinder. It turned out that I needed more astigmatic over-correction. I recall getting refracted at
-1.5sph, +0.5 cyl at one week. Even after 6 month enhancements to clean up the residual astig, after about another year, my Rx settled out at pl, +1.25 cyl. The amount of astigmatism correction/regression with h-lasik is always the wildcard. The older laser models induced 1/4D of extra astigmatism for every 1D of hyperopia ablated. The new breed lasers that do everything in one pass are probably better doing astigmatism than they were in 1999. Maybe Glenn could comment on that. But as he indicates, you will likely need enhancements to get a final BUCVA of 20/20. Based on my experience, I would advise waiting at least one year to get those. Keep us posted.

[LasikExpert]

The older laser models induced 1/4D of extra astigmatism for every 1D of hyperopia ablated.

I think you may have crossed information. To my knowledge there was never a coupling effect for hyperopic correction that would automatically induce astigmatism. Yes, it certainly occurred, but was not a limitation of the physics of laser correction of hyperopia.

Where there is a coupling effect s in the correction of astigmatism. About 0.25 to 0.40 diopter of myopic correction automatically occurs with each 1.00 diopter of astigmatism correction.

[gkrogers]

Went to my 2nd check-up yesterday. All has been going well. My distance vision has gotten a little more crisp and my fine print reading is a lttle worse. Reading glasses (1.25) help with the fine print. Mid-range reading still good. I'm only using the Systaine drops every 2 hours whether needed or not and allergy drops (for the pollen) once a day. My surgeon examined me, stated my eyes were healing exceptionally well and that he did not need to see me again until 4 months from now. If anything starts to bother me or not seem right, I am to go in immediately. They measured me at a clear 20/20 in my right eye and about 20/25 (clear) in the left. So far so good. Eyes still get tired by the end of the day but I know thgat will improve with time. Now it is a wait and see on how much I regress over the next 4 months. I still definitely feel it was worth it but 1.5 weeks out from surgery is still very early in the game for a final opinion. :D

[LasikExpert]

Your results thus far are superb, especially considering the very high hyperopia (farsighted, longsighted) vision you had before surgery.

It is reasonable to expect continued regresstion. That will present as improved distance vision at the cost of near vision. Reading glasses can make up the difference.

[gkrogers]

Well it has been a month since I had LASIK. I've been pretty lucky so far. My right is still at a clear 20/20 and my left is a clear 20/30. It has pretty much been that way for the last 3 weeks. I still use systaine drops 4 o 5 times a day. I am having a little night time dry eyes problems. So I use the Genteel Liqui-gel at night. It helps a little. My distant vision is better but not crisp yet. My mid-distance is still great and my close-up vision is good. 1.00 reading glasses help with the smaller print. My next post-op exam is at the 4 month mark unless I have any problems. One thing to recommend: Wear eye protection when doing yard work. That dust and minute particulate matter from the grass can really dry your eyes out severly. I'll post again next month and hopefully will only have minimal or no regression to comment on. Still amazed. :D

[LasikExpert]

It sounds like you are just a little myopic (nearsighted, shortsighted) after your hyperopic (farsighted, longsighted) Lasik. That is a very good thing at this point because it is common to have regression. Regression would take you back toward plano. Hopefully your eye that is 20/20 does not change.

Keep us informed. Thus far you have given hope to high hyperopes who often have great difficulty with vision correction.

[gkrogers]

Well it's been a little over two months now. So far everything is pretty much the same as my last post. I still have minimal dry eye at night mainly because I also use a fan that blows on me at night. I am using the allergy eye drops daily. I've always had allergies and itchy eyes. The drops help immensely. I'm still at about 20/20 right eye and 20/30 left eye. My eyes still feel tired at the end of long days but that is decreasing. So basically no change and still happy with results. :D

[LasikExpert]

I bet you are looking forward to cooler and more moist weather.

[gkrogers]

It's a catch 22. I love warm climates but they tend to agrivate my allergies. Before I would just rub or itch my eyes and get over it. Now I have to be a little more carefull. Still it's is better than when I wore glasses. :D

[gkrogers]

Just had my 4 month check-up. I'm holding at 20/20 right eye and 20/25 left eye and 20/20 overall. Distant and mid range vision good. I do need 1.0 reading glasses for close up. I have an occasional vision fluctuation where my mid range is slightly fuzzy but it usually clears up in an hour or two. I still use Systane drops two to three times a day mostly due to A/C and fans at night. Overall I'm very pleased. It has met and exceeded my expectations at this point. I know I'm still healing and my eye sight can and may still change. Time will tell.

[Mack]

Galen,
Congrats on the stable recovery and minimal regression. You have indicated you have remained 20/20 right and 20/25 left but use +1 readers for close up work for about the past 3 months. That would suggest your regression has mostly subsided. Coming from +5, I would say that is quite remarkable. I would have thought you would still be a little bit myopic. I presume those numbers are for BUCVA (no correction)? Would you say your uncorrected distance vision now is as good overall in all lighting conditions, day and night as it was before lasik with your +5 correction? If not, what would you say is different? I'm wondering if the doc can refract you to any sharper acuity, especially in your 20/25 eye and if so, what is the Rx? Many of the H-lasik survivors I know end up with a little residual astigmatism, around +0.5D or so. I did and even with slight correction, I still do not see the 20/15 line as clear and sharp as I did pre-lasik with correction. Am wondering what your BCVA was before lasik and what it is now? BTW, I also experience occasional minor "blurry periods" of up to an hour that come and go, maybe every few weeks. During the first year or 2, they occured more often. It seemed the residual hyperopic astigmatism would increase during those episodes and then relax to "normal". In good light, I sense my overall vision is virtually as good as it was pre-lasik with correction and I almost forget I ever wore glasses or had the procedure.