Lasek

[jeannie]

Hello
I had lasek around 3 years ago, and have had severe dry eye since, (although very slowly improving). I do fish/flax combo, compresses, lid hygiene. I don't do any drops night or day as they very definitely make things worse (even preservative free single dose). I had a fairly low schirmers score before my operation but was symptom free, which was why lasek was suggested.

However I would like some advice about my vision. Up to now I have made the assumption that all my visual symptoms were related to dry eye, however as that has improved the vision hasn't.

My preop prescription was Right -3.00S, -1.75Cyl axis 80: Left -3.00S, -1.75 Cyl axis 95.
Corneal thickness in both around 525

Post op:
Right Sphere varies between -0.25 and -0.5 and cyl between -0.5 and -0.75 axis 170-180
Left Sphere varies between 0 and -0.25 and cyl between 0 and -0.5 axis 160-170
the axis on the left is measured at either the same as the right 170 or between 5 degrees less (so 165-175)


The problems I have with my vision are:
I experience double vision (with each eye separately and together), worse with signs, letters etc. the words are doubled and show up as a very distinct 2nd image directly below the right and very slight below and to the left (looking at it) of the left eye. This is worse in shops and the further the distance is. It is correctable with glasses so I presume it is astigmatism, however is it normal for such low levels of astigmatism to cause this amount of visual disturbance.
On a subjective level I see better with the higher values of each prescription, as the lower don't appear to eliminate the astigmatism.

The vision is awful in dusk and low light, but then better in the dark or watching tv at night.
I struggle quite a lot apart from in very good light to see what I would call crisp vision, everything is always blurry, apart from working at a PC.

I am also in my early 50's so presbyopic as well, so the left eye does give me a bit of mid vision, but i need readers for reading.
I wasn't offered monovision as I do a lot of close work, but really do miss my close vision, although it was too close for doing much apart from close reading.

I am right eye dominant.

My question is what should I be discussing with my surgeon.
Thankyou Jeannie.

[LasikExpert]

I experience double vision (with each eye separately and together), worse with signs, letters etc. the words are doubled and show up as a very distinct 2nd image directly below the right and very slight below and to the left (looking at it) of the left eye. This is worse in shops and the further the distance is. It is correctable with glasses so I presume it is astigmatism, however is it normal for such low levels of astigmatism to cause this amount of visual disturbance.

You are undoubtedly correct in your assumption that the doubled vision in each eye is caused by astigmatism. The ghosting is probably worse in low light environments than in bright daylight. Astigmatism means that the cornea is not round like the top of a ball, but is elliptical like the back of a spoon. The "tip" of the spoon focuses light off center, and the result is a ghost image. If a small pupil blocks the light that passes through the tip of the spoon, then the astigmatism is not "seen" and causes no problems. When the pupil dilates in a low light environment the light passing through the tip of the spoon reaches inside the eye and can be problematic.

I am also in my early 50's so presbyopic as well, so the left eye does give me a bit of mid vision, but i need readers for reading. I wasn't offered monovision as I do a lot of close work, but really do miss my close vision, although it was too close for doing much apart from close reading.

The residual myopia is providing you a bit of near vision that works around your presbyopia. It appears to be just the right amount for the distance your computer monitor is from your eyes. After age 50 we need to become accustomed to adequate vision at all distances and excellent vision at only one distance.

You should probably discuss enhancement surgery with your doctor. Your vision is relatively stable. The main problem is the astigmatism. There is a minor coupling effect that will automatically correct the small remaining myopia when the astigmatism is resolved. This will improve your low-light vision and provide the best distance vision. You will need reading glasses for near distances, but that is a normal part of aging. I would not recommend monovision now, because the surgery to get the non-dominant eye myopic is less predictable. Go for full distance correction.

[jeannie]

Thanks Glen.