Experiences with lasik enhancement to fix halos?

[Ida]

Hello All.

I am writing to hear if any of you have experience with undergoing a LASIK enhancement to fix problems with post-LASIK halos?

I had LASIK 4 years ago (I had -3.75 in both eyes and no astigmatism before) and while my vision in daylight is crystal clear (20/20), in low light conditions (like indoors on a cloudy day) I have problems with halos around objects. In pitch darkness (e.g. when driving at night) it doesn't seem to bother me. The problem is mostly there in semi-darkness. I must add here that my pupils are slightly larger than average.

I've been to see the surgeon who originally performed the LASIK procedure and he says they are confident that they can fix my issues by performing a LASIK enhancement (free of charge), however in addition to all the usual risks of LASIK, I run the risk of being over- or undercorrected as a result (10-15% risk). But they could fix this by performing yet another LASIK enhancement afterwards (a 3rd one then).

Now, I am just not sure whether to go ahead with the enhancement or not? I am not sure I really trust the surgeon when he says he is confident he can fix the issues. I mean why did I end up with halos in the first place? Do any of you have experiences with LASIK enhancements to fix the halo issue, that you would like to share with me?

I'm looking very much forward to hearing your opinion/experiences.

Cheers,

Ida

[LasikExpert]

We have a detailed article about Lasik and ghost images that may be helpful. It would appear that there is some residual refractive error that is contributing to the problem. Ask your doctor about trying vision with disposable contact lenses to get a sense of what improvement may bring.

[Ida]

Hello Glenn,

Thanks for the reply.

My doctor gave me Alphagen eyedrops to test and these seem to fix the problem. However I cannot keep using these every day for the rest of my life.

My doctor does not think it is due to residual refractive error and my vision on the chart and in broad daylight is also perfect. He mentioned that they could see a lot of aberrations in the test they took at my last visit (a month ago) and that they would be able to smooth these out to correct my halo problems.

I am personally thinking that the problems are due to the treatment zone being smaller than my maximum dilated pupil.

Do you think I will have a succesful outcome of an enhancement or could the halos likely get worse (or could I incur some other long term complication) from the enhancement?

I'm really worried.

Ida

[Vincent]

Ida,

What exactly is your doctor going to do to fix your halos? It doesn't sound like you have any residual refractive error. Even if you do it's probably very small +-.5 or .25. From what I understand you shouldn't have surgery to correct such a small refractive error because of the risk of over correction. If you or your doctor feel that it's residual refractive error then find out what the prescription is and get a pair of glasses with that prescription. If you see some improvement at night then you'll know what the problem is.

It sounds like you have the standard case of pupils dilating outside the optical zone of the laser (I have it also). Your doctor is not going to be able to fix that by widening the ablation zone etc. Can you just cut your losses and get RGP contacts? Have you looked into those at all?

[Ida]

Hi Vincent,

I have not tried RGP contacts. My eyes do not cope with contacts very well. At the time of my surgery I hadn't been able to wear contacts at all for approximately 1,5 years due to blephataritis and dry eyes due to air con in the office. That's the reason I opted for Lasik in the first place, so not sure it would work with the RGP contacts.

Have you tried RGPs yourself? What are your experiences with these?

My doctor seems very confident he can fix my problems. He said they are going to smooth out some abberations that I have. I picked the most expensive clinique in London to have lasik done in the first place, cause I wanted the best result. Apparently didn't get it, but maybe it's due to the way my eyes healed. That's what the doc tells me. I don't know, I'm not a doctor. My doc says they have experience with fixing halo problems for people who have similar problems to mine and had the original procedure done at other cliniques. Not sure if I can trust my doctor's promises. I had so high hopes the first time round and I ended up disappointed. Not sure I can trust him this time.

Best regards,

Ida

[Vincent]

Hi Ida,

I have tried RGP contacts and I have had moderate success with them. They reduce a significant amount of some of my aberrations - specifically starbursts, but they don't reduce the halos very much. I understand your concern with dry eye. Although I did not have dry eye before LASIK, I did develop it afterward. I could not tolerate soft contacts or regular RGP lenses resting on my corneas. I am able to tolerate scleral lenses which rest on the white part of the eye (sclera) and "vault" the cornea. You fill the lenses with a small amount of saline solution and put them on your eyes. This way no part of the contact in touching your cornea. From what I understand this doesn't guarantee you'll be able to wear them, but since the sclera is less sensitive than the cornea you may be able to.

I'm not a doctor so please keep that in mind - I'm just going to give you my opinion. An opinion based off my own problems and reading problems of other LASIK/PRK patients. I think you need to get a better understanding of what your problem is before you go ahead with any more surgery. It seems like your main problem is mismatch between the optical zone of your 1st surgery and your dilated pupil. Is that what your doctor is telling you? "Smoothing out abberations" means nothing. If the problem is mostly due to your pupil dilated outside the optical zone it seems doubtful that this can be corrected with more surgery. I haven't read a single anecdotal story or seen any published study where there has been consistent success. The technology just doesn't seem to be there yet.

Like Glenn said you should get a pair of prescription glasses and see if they help your problems. If they do then you'll be able to confirm that your issues are mainly related to residual refractive error - you still have some form of myopia/astigmatism. IF they don't help at all then the problem could be related to flat corneas, pupil size etc - things that cannot easily be corrected with more surgery.

I also thought I picked a great clinic, very experienced doctor, best technology etc. The fact remains that some people are not good candidates for surgery and should be warned of the risks. No surgeon can overcome all the risks associated with LASIK/PRK. The fact that your doctor is promising you a good outcome is very disconcerting. At this point he already screwed up your eyes the first time - why is he so confident that he can fix the problem this time? Most LASIK/PRK doctors give free consultations to prospective patients. Why don't you try going to few other clinics and getting other opinions?

[Ida]

Hi Vincent,

Thanks for your thoughts. I did actually see another doctor yesterday. He confirmed that my optical zone seems quite small 4-5 mm and that I have a high order of spherical abberations. He said they would most likely be able to correct the issue at their clinic, but since the other clinic (where I had the procedure done initially) is offering to re-operate free of charge, he recommended that I have the re-operation done there.

I am still contemplating what to do. I appreciate your input very much :)

I would still like to hear if anyone actually had experiences with and enhancement to enlarge their optical zone?

Best regards,

Ida

[Vincent]

Hi Ida,

You may want to check out this article: http://www.revophth.com/content/c/35282/

Topography-guided Ablation may offer hope to those of us with problems. Aleksandar Stojanovic in Norway seems to have had varying levels of success with this type of surgery. You can read some first hand accounts of people's experiences with Dr. Stojanovic at lasermyeye.org/forums/. You can also post your story there for more advice as the message board there is a bit more active than this one.

Good luck.

[lex]

Ida,

I had my hyperopic-astigmatism surgery with this platform and with the technique described by Dr. K in this article (unfortunately not with him..).
Hyperopic surgery is significantly different from myopic surgery and far more complex. I have been left with mild halos and startburst at night and day.
While night vision is quite good (i got used to the starburst), in doors ambient like shoppings/market (semi-dark) is terribly annoying.
This technique should be better for treating astigmatism, and for my surprise, all the astigmatism are back as pre-lasik, in fact day 1 after my procedure showed this. This technique should create a smoother transition zone, but i suspect not in my case, and i bet this is the cause of my starbursts and aberrations i still have.
My case has been considered a good outcome for statistics (it is plain wrong!), i can see 20/20 blurry overall, it is considered a success and we know the real world outside there is not about reading a still snellen chart.
If you see 20/20 crystal clear i would try to find and talk to someone who is really happy with this technique.
Unfortunately not many lasik patients want to talk about their outcome.
I am not a doctor, but i am the one who had my eyes done and no doctors can tell you what is like!

Good luck