The Astigmatism is back.

Post your questions and start your research in this forum if more than three months ago you had any type of surgery to reduce the need for glasses and contacts.

The Astigmatism is back.

Postby Tsume » Tue Jul 18, 2006 4:58 am

I had Lasik in 1999 and all has been wonderful up until 3 months ago. I began not really being able to see as well as I knew that I had been(close or far away). I scheduled an appointment with my eye doc and it turns out the astigmatism that was present in both eyes has returned to pre-Lasik numbers(-075, -100). The reason I had done Lasik is because I had so much trouble with the contact lens for astigmatism. I play sports and have an active job which makes wearing glasses very inconvienient. I was told that it is was a permenant procedure, but I might need reading glasses as I age. I contacted my Lasik provider and they said that a retouch would be risky because I had done the original procedure so long ago. Is this true? I am 32, on no medications and have had no diet, exercise or hormonal changes. I also have no health problems. Please help! I am actually quite depressed that I payed so much for the procedure and the benefits have suddenly vanished. I do not have vision insurance so I have already spent money on a few pairs of glasses. To me that seems wrong.
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Postby LasikExpert » Tue Jul 18, 2006 5:53 pm

The relative permanence of Lasik is often misunderstood. What is permanent is the removal of the tissue of the cornea. This tissue does not "grow back", however the eye will continue to change after Lasik just as it would have changed before Lasik. Undoubtedly the increase of astigmatism that you have encountered would have occurred whether or not you had had Lasik in 1999.

There is nothing about the fact that you had surgery 7 years ago that directly contraindicates having enhancement surgery, but the fact that you have progressive astigmatism does raise some yellow flags. Depending upon the exact nature of the astigmatism, it could be an early sign of keratoconus.

Keratoconus is a naturally occurring disease of the eye the can cause irregular forward movement of the cornea due to weakness. The first noticeable signs of keratoconus are often progressive astigmatism in the lower portion (inferior) portion of the cornea. The information you provide does not give enough details to indicate if keratoconus is actually a problem, but a somewhat rapid development of astigmatism would indicate it should be checked. You may want to read about Lasik and Keratoconus.

Another limitation of correcting only astigmatism is that the laser systems do not actually correct only astigmatism. The physics of the correction requires an automatic correction of myopia (nearsighted, shortsighted) vision at the same time as astigmatism correction even if you don’t want myopic correction. This is called coupling and the ratio is about 0.25 – 0.33 diopter of myopic correction for every 1.00 diopter of astigmatism correction.

The coupling effect would automatically overcorrect you into hyperopia (farsighted, longsighted) vision. To achieve the desired outcome, the doctor would need to effectively override the system and provide both astigmatic correction for the astigmatism you already have, plus hyperopic correction for the hyperopia that will be induced by the astigmatism correction. This can sometimes be accomplished all in the one surgery, but you may require two separate surgeries; one for astigmatism and one for the hyperopia induced by the astigmatism correction.

Concern of overcorrection into hyperopia is real and significant. With such a small amount of error to be corrected and the coupling effect, the doctor is undoubtedly wary of leaving you unhappy as a hyperope. You need to discuss all these details with your surgeon.

I recommend that you seek a second opinion from a refractive surgery specialist and/or cornea specialist who is affiliated with a teaching hospital. It is necessary to rule out keratoconus as a possible cause of your problem, and you need to discuss all the potential advantages and disadvantages of attempting to correct your astigmatism only.

Whether or not your previous doctor is able or willing to correct the problem is unknown, but you should make this determination before proceeding with any doctor.
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