2 month update

[Judy]

Hi all, I went in to see my Doc, my visit seemed strained. I was asking her questions about plano, hyperopia etc and she seemed put off. I think she might be worried I was planning on a lawsuit or something. I truly am not, just wanted information to help me understand where I am and how far I am from where I should be.

When I asked for my numbers she rattled them off fast. Sorta annoyed. Anyway My overall vision has not improved much.......still 20/30.....but she says I am improved since last visit. Dryness is better. Lets face it, if I improve slightly at each visit till 6 months I should be doing pretty good.

my hyperopia number is +.50 and my astigmatism number i either -.1 or -.100 as she rattled it so fast I did not write it down well. Glen, I hope you can understand and make sense out of it.

I asked her about enhancement and she says she can give me a chance to see how it would be to enhance to 20/20 both eyes, or to do one eye...... I do not know if Glen thinks getting only one eye done is best but would be curious to know.

I also explained to her I am not wild to do any enhancement if we can get a little better.....she agreed. Maybe get to 20/25 if things can keep improving which she and I both hope will happen.

I am noticing my far vision is decent but frankly losing my near vision is not worth having only fair far vision. While driving, signs are not clear until I get close up. Also I feel my eyes straining to see.

I wish the docs were not so afraid to talk to us. I guess they have forgotten how frightening it is to have your vision change so radically. I know my doc seems like a very nice woman, I know she is doing the best she can. I just wish she didn't seem so annoyed at my questions and my concerns and my worries. This has been very scary at times and I question my sanity daily about ever doing it in the first place.

I realized with glasses I can probably do okay....but hey.....I just spent a horse load of money to shed my glasses.......Now I need several pairs of glasses. My old near-sighted glasses worked just fine plus I could read up close without them and not feel like Mrs. Magoo when shopping or trying to read a menu.....

I know I got a few months of healing left, and I am hoping against hope as the dryness subsides a bit more that my vision will settle further and I will get close to that 20/25 that will be good enough!

[rosecmd]

I with you, Judy! The overcorrection into hyperopia layered onto presbyopia is not a great situation. I know I have about .5 - .9 dioptors of overcorrection and also some astigmatism left. Maybe we have the same surgeon! Mine also seems reluctant and slightly impatient with more than 2-3 minutes of questions. Too bad. I am going to see another doctor on Monday just to get the chance to ask some questions. I belong to Kaiser and their opthalmologists used to do refractory surgery but they stopped a few years ago. So I'm going to see one of their docs for an exam and to bounce some thoughts off of him about an enhancement and the expected results. My three month visit with my surgeon is on October 8th, and I have a consultation with another very experience laser surgeon on the 12th. By then, I figure I can put all my info together and decide on a course. At my current almost 12 weeks post original Lasik, I find my distance vision outside is great. My eyes are less sore and dry. My biggest concern is my blurry indoor near and mid-range vision. I really need to wear preseciption glasses indoors to see well.

[Mr.UnPerfect]

I am curious if you gals know what type of procedure you had. Was the flap made with a laser or blade, and what type of Laser machine was used. I am having similiar issues and may need enhancement. I had the blade with Allegretto Eye Q laser. I am just now 6 months post op. I was outside in the sun and could see the smallest print I could find. And the distance vision was great. I had blended vision.. But when the sun starts to set.. and inside without good light.. not so good. Last week was 6 months and just about that time poof...hardly any dry eyes..during the day even before it wasn't to bad but when I woke up they were dry, now that is gone now , I hope for good. Vision is still gradually changing, so I don't want to do something and regret it again. Alot of the people who were posting problems are now gone, i just wonder if they all got better and that means PATIENCE, PATIENCE, not one of my virtues, but this is a good lesson. Ha Ha. Bob K

[Judy]

Good to hear you are both still posting and moving forward somewhat in recovery. Sounds like you guys are a bit better than I am in distance vision. I am at 8 weeks and at 20/30 although it seems as good as I had with glasses.

The dryness is definitely better. Worst is morning and end of day. During day I have to remind myself to drop some in as the tears seem to have come back enough to keep me in good shape, unless I am in a drying out zone, like air conditioning etc.

I would much rather be undercorrected at 20/30 rather than overcorrected at 20/30.....although I still don't understand how I can be overcorrected and yet have undercorrected vision......

Dim light definitely is a struggle. I have to light all the lights in my kitchen to work effectively in there. My kitchen does not have windows. In rooms with windows my midrange seems fine. Rose, I am sorry you are still struggling with midrange. Is it primarily in dim light or all the time? My midrange was terrible for about 4 weeks and has slowly gotten clearer over the last 4 weeks. Now I think its fine.

Close up, need glasses......but I am adjusting to this new concept. I figure I am like most folks my age now and will learn to throw a pair on when I need to see closeup. Having the midrange clear has at least made it possible for me to go without glasses most of the time now. I only need glasses for reading, computer or anything that requires close up vision....like cell phone, or reading instructions or filling out paperwork. Of course the trick is having a pair handy when one needs to do one of those things.

I read back in the archives that older people take longer to heal and should not consider enhancement before six months. Being older, I pretty much agree that I will not entertain the idea until I have made it that far. I think its interesting that the vision keeps fluctuating that far out. I intellectually tell myself this is it, but obviously this is not IT.

Rose, good luck at your checkup and please let us know how it goes. Mr. Unperfect.....hang in there buddy you are doing great. By the way, I do not know the exact machine but I had custom wavefront lasik and my doc used a blade to make my flap.

[rosecmd]

My flap was created by a blade also... I will let you both know what the doctor on Monday says...I do not think my eyes have fully healed yet and would likely not consider an enhancement until at least 6-9 months. I need the dry eye to resolve first, and my eyes to fully settle out. Although, my sister-in-law had very dry eyes after her lasik for a year, her visual results were fine. She also was just about unable to drive and had a huge halo/starburst thing going on -- she was about 33 when she had it done and it was about 8 years ago. She had an enhancement at one year and still has punctal plugs in and her vision has been perfect, despite her issues.

[Betty39]

I am like your sister-in-law. I have had VERY dry eyes since my surgery almost a year ago. Well they have improved now to mild dry eye and sometimes they don't bug me at all. However, since day 1 my vision has been perfect. Even when my eyes were so dry they were killing me I could see great. This puzzles me still. I wonder how come some people have little dry eye and vision problems and some have severe dry eyes and see perfect. Anybody got an answer for that one?

[rosecmd]

Betty, I'm not sure about your question. I have dry eye and am told it affects my vision quality. But my sister-in-law had dry eye and it did not affect her daytime vision at all - that was perfect.

Judy, I had my second opionion consultation yesterday with a Kaiser opthalmologist who used to do refractive surgery at the TLC where I had mine done by another surgeon. First of all, he took the time to talk to me and answer most of my questions. Bottom line is that just about all of my blurry near and mid-range vision issues are caused my the .5-1 dioptor of overcorrection. Overcorrection is a bad thing for us middle aged presbyopics. He said my surgeon was a good surgeon, he knew her and he said I should go back to her for an enhancement, if that was necessary. He said I needed to see where I was at 6 months.

It's somewhat possible that I will regress to plano and be left needing reading glasses for all near vision. If I have no change, he suggested one of two options, assuming I have enough corneal thickness left. Have her correct the hyperopia in both eyes to plano (he kept calling it being fully corrected for distance). Then, I would be fully presbyopic for near distance, but should have better mid-range. Or, have her fully correct one eye for distance (take away the hyperopia) and make one eye mildly myopic, maybe .5-.75 to assist with near vision (still need reading glasses but better near vision). He suggested she do one eye at a time. I liked him - he seemed to know exactly what my issues were. He said he saw no dry spots on my eyes but my tear film was decreased.

My right eye is progressing faster than my left. It feels normal and is not that dry. My mid-range vision is improving in that eye. My left eye is slower and about half the time, that eye still feels tender and throbs a bit and is more blurry. He said this was due to the dry eye issue and that it should resolve by 6 months. It's also a lot of work for my eyes to accomadate and focus. He mentioned that one reason for morning bluriness was that overnight they eyes relax and then since I had sucha shift in vision/focus, have to work hard to warm up and function properly. He said he understood that most of my issues with my surgeon were likely due to her not communicating as much as she should have because she is so busy but now that she was more than likely aware that I am not happy with the outcome, that I will likely be able to discuss the situation with her and in the end, get the results I want from her. I asked him how she could possibly think that I would want to go from having good near vision to having totally crappy near vision and poor mid-range vision and excellent distance vision. What good is that for a middle-aged mom who spends most of her life in the house or the office engaged in near and mid-range vision tasks? Actually, those words describe my surgeon also. I also said I was appalled that she never told me I would lose the good near vision I had if she were to fully correct me for distance. I have more pairs of glasses now than before surgery! You know the story - it's the same as yours.

So, I continue with my Restasis, Refresh Plus, Endura, and Celluvisic drops and my flax oil capsules. I wait patiently for both eyes to heal. I see my surgeon at 3 months to see where I am and if my refraction has changed and to make a plan for six months. At six months, I can make a decision about an enhancement and really plan for the results. I will ask for contact lenses to simulate whatever the final result is. If I'm not happy with my surgeon and the communication issues, I will decide whether or not to go to a different surgeon. I dread having to think about an enhancement as I predict I will go through the same discomfort and dry eye that I am now working through.

[music]

It is reassuring to read some of the same types of stories here that have been part of my experience since my Lasik on July 20th. I go in for a follow-up appointment this week, and I am hoping that the surgeon says that my dry-eye is improving a little bit. It feels to me as if it's doing better, at least in my right eye. There were a few weeks where I had to take prescription painpills that I had been given after my abdominal surgery in June. I actually felt more pain from my eye situation than I had after major surgery the preceding month! Crazy, huh?
My vision is still not good, but I will cross the enhancement bridge later. It is good to hear that others of you are also being advised to wait for enhancement surgery until after 6 months have passed. I am hoping that within a year this will all be taken care of and that I can go back to work full-time again and get my life back!

[Judy]

Hi ROse, great post on your followup checkup. I have a few questions since we are so much on the same game. I have the same amount of overcorrection....plus a bit of astigmatism. My main concern is with the enhancement, if we are corrected to plano, will we have worse upclose vision.......... my next question is, if they correct you to plano in one eye and slightly myopic, will our near vision get a bit better? What is the best option, and how do we determine this before we go under the laser again. I have noticed this month that now that my eyes are not quite so dry that my far vision is not as great as I thought it was. When driving, the signs are really not a good read. So as Glen once said......my vision is not really good in any of the three arenas.

Now the decision must be made, which enhancement method is going to let us end up with the best of all possible worlds. I know I do not want the near vision to deteriorate any further as I feel very clumsy and awkward with this sudden presbyopia. The glasses help but I never feel like my near vision is adequate since surgery. The mid vision is clearer but things like small print on TV is still blurry. Now I notice the far vision is semi-good but still at 20/30 is not really great.

I guess our next decision is which surgery to opt for. 20/20 plano or the one eye plano and one eye slightly mypopic. Gosh, I wish I had my old eyes back......I am so tired of this mess. I am tired of thinking about my vision so much. I am tired of eye strain. I am tired of having 6 pairs of glasses to use for different functions. I am tired of buying eyedrops. I hope this long journey will eventually finish with decent results. I am now at 9 weeks. I look forward to the 3 month checkup to see if I have made any change since the 2 month checkup. I don't feel any change lately. Still hoping they will regress some, but nothing seems to be moving.

Thanks for your good post Rose, and hope Music, Betty and Mr. Unperfect are doing better. Keep posting guys and we will get this thing licked because we have enough information to ask the right questions.

[rosecmd]

Judy,

Thanks for your reply! As I understand it, because we are now somewhat farsighted in additon to presbyopic, full correction for distance to plano will improve our near vision to "normal 47 year old" (in my case) vision. So, our near vision would improve, but we would still need readinfg or other glasses to see things up close. The second opthalmologist I saw said that if I was just presbyopic and not farsignted, I should be able to hold something I'm reading out farther and see it, but I can't now.

I have my three month visit with my original surgeon on Monday October 8th. I'll let you know what she says. I do think that at our age, we will always need glasses for something. I am also tired of the eye strain and discomfort, although I mainly have that in my left eye still - a weird kind of pain I think is either nerves regenerating or tired eye muscles, who knows. I think that being farsighted with a slight astigmatism and presbyopia is a poor combination. Essentially, we were probably poor candidates for this surgery, based even on optimal expected outcomes, in the first place. However, the only choice is forward. I am looking forward to a time when I have stable, comfortable vision with some sort of glasses I use indoors mostly. Luckily for me, I do not have much of an issue with starbursts and halos or poor night vision anymore. Keep in touch!

[rosecmd]

Well, I had my three month post custom Lasik visit today and my eyes continue to improve. While I have no dry spots or what the doctor called corneal scratching, they are still subjectively dry, especially in the morning. My flaps look good, no problems. I also have a reduced tear film, but I had mild dry eye prior to surgery so I don't know how much better that will get. I am to continue to use the Restasis. My doctor also gave me a weak steroid drop, Alrex, to use for one month.

My right eye has returned to 20/20 for distance (from 20/30 at the one month check up) and I now have no astigmatism in that eye. I'm at +.75, so I am still overcorrected but that seems to have regressed from +1.00. I do have slightly better near and midrange vision than I did 2 months ago. My overall vision is better as my eyes heal and the dryness improves.

My left eye is a little behind, probably due to the dryness and my somewhat lengthy normal healing process, I have 20/30 distance (from 20/40 at the one month check up) and +.50 cylindrical and 143 axis in that eye, same as at one month. Do the cylindrical and axis numbers reflect astigmatism? I no longer have mild eye pain and soreness in either eye.

My reading glasses have decreased to 1.75 from 2.00/2.25.

I asked about punctal plugs and she said to wait a full three months on Restasis as the plugs will keep white blood cells and debris in my eye longer as the normal cleansing/drainage would be "plugged up", so wait on that.

At my six month visit in January we will talk about a re-treatment to get rid of the induced farsightedness/overcorrection. She said I need less than a 10 second zap in each eye. I would go back to having the increased dryness for several months while my eyes heal all over again. Sigh.

My plan is to wait, use the Alrex for one month, use the Restasis, take my flax capsules, use my Refresh Plus during the day and Refresh Celuvisic at night, update the lenses in my new "indoor & nightime" prescription glasses to reflect the new changes - my current two month old glasses are too strong. I hope I continue to regress, but my gut tells me that if I will need a re-treatment to maximize my near and mid-range vision.

My doctor was very nice, helpful, and communicative today, and I was very grateful for that.

[Judy]

Rose, I am so glad for you. It's good to hear things have improved so much for you. I hope my 3 month will be as good. My appointment is on 30 October so I will let you know. Perhaps things are going to improve to the point you will not need enhancement.

This week my eyes seem dryer than normal. I am now at 10 weeks and I feel no improvement in the last 3 weeks. In fact, this dryer eye sensation is very annoying. I wish I had asked for Restastis last time.

I suspect I will need a zap in each eye to get things where I want them to be. I still cannot sit and read a book and feel like I have the proper glasses to read in comfort. My eyes begin to feel weak and overstressed after a short time.

These are the things that I am wondering if they will improve if I get my eyes back to plano. I am willing to go through another 3-4 months of dry eye if I can get my vision adjusted to good. I figure the dry eye, even though it is annoying and irritating will improve with time. I can be patient. I just want good vision......

I am so delighted to hear your journey is going along in a good manner and that things are improving and hopefully, soon, you will be where you want to be. I am also glad your Doc was kind and positive this go round and I can only hope mine will be to me next visit. She is always kind, but seems annoyed by my questions and does not seem forthcoming with answers to what I need to do to get improvement. I hope my 3-month will be a little better as yours was Rose. Gives me hope. Keep posting and hopefully we both will soon have a day when we can say. We have got the results we wanted at the beginning of this journey.

[rosecmd]

So Judy...I went back to my optometrist yesterday to have my lenses in my glasses updated as they now seem to strong. Anyway, for fun, he put some glasses contraption on me to show me what we would aim for with an enhancement. One eye was corrected by +.75 and the other by +1.00. I was so excited!!!! I could see so much better. I did have some presbyopia...when I held something within 10 inches or one foot of my face, maybe even out to 18 inches or so, it was fuzzy. BUT, everything else near and mid-range were great, I could see so much better. And of course, by distance vision was the same, which is 20/20, 20/30 which is fine. Bascially, by simulating full distance correction (plano) - the results I should have had had I not been overcorrected into hyperopia, my results were just great. The presbyopia was there, but not that bad. And, I could extend my arm out and read at arm's length what I could not see at a normal or closer reading length. This is how my original surgery should have turned out.

So, it looks like another surgery may be in my future. He works doing the follow-up and pre-surgery counseling for the TLC where I had my original surgery... he suggested I consider having the all-laser lasik to do the correction instead of lifting the flap again. He seemed to think that the issue of epithelial ingrowth was quite prevalent in flap lift enhancements. I'll have to do my research.

My dry eye is much better...I'm now almost 14 weeks out. Plan is to wait for 6 months to do an enhancement.

[Judy]

Rose, your news is so hopeful and exciting. I feel hopeful hearing yur results that both of us might end up pretty good by the time we get through this. My next visit is at the end of this month. My surgeon said she would show me possible results with lenses so I hope she will do for me what your optician did for you so I can judge results. I would love love love to have back some of my near vision. I hate this presbyopia. I realize I wont get everything back but anything will be great. I am older than you so expect less dramatic end product. I also would like the mid and far vision to be better. I am definitely noticing that my far vision is not great. Street signs etc, a tad unreadable until close. My near vision seems better, but sometimes watching TV hurts my eyes.

Still have dry eyes, but not as severe. In the morning I notice it most. I also notice it if I go out and spend 4-5 hours out....eyes dry when I return.

I am at least coping well now, and your news gives me such a lift, thinking that the hyperobia has been the culprit all along.

I am going to copy your post and take it to my Doc and ask her to show me the same possibilities. Also I will talk about the flap. I will let you know the answers. I am so pleased things are moving forward for you Rose. When did you get your surgery exactly..... I got mine on July 27th. Thanks for your encouragement and your persistant search for answers.

[rosecmd]

Judy, I had my initial surgery July 9th. I really think that almost all my issues are due to the induced hyperopia. It really does screw up the final results and affect near, mid-range, and distance vision in dim light. The amount of natural presbyopia I had when the hyperopia was removed was something I could deal with. I needed 2.0 reading glasses to correct it, but otherwise, everything about 18 inches and furthur out was pretty darn clear. Are you using Restasis and taking the Thera Tears flax oil capsules? They really help with dry eye.