Decenterd ablation

[tasha946]

I had lasik at Johns Hopkins in Sept. 2012. I was very nearsighted, about -9 in both eyes with astigmatism. I wore hard contacts then RGPs for about 45 years. Prior to surgery, I had not worn anything but glasses for a year or more. I have been told at every visit back to MD that I am/have healed fine. He is a very important doctor in the eye world and is a man of very few words and I have been told nothing in any detail there at all. At first I had 20/15 in my right eye and 20/40 in the left. It has continued to change on a daily basis--mainly tho I am usually 20/25 in the right and 20/30 or so in the left. In MD he says "way better than before" and I must agree with that. Last time he asked me if I was glad I had it done? Of course I said yes.
My optometrist here( I do not live in MD) has seen me for about 20 years and seen me since the lasik every couple of months. My vision seems to be "multifocal" says the optician---??? I asked for distance correction, not monovision and anyway multifocal is not FDA approved here???? I see very well usually until later in the day. I had my optician make me glasses to drive with in the evenings or to see long distances when I need to read signs, etc.
The other thing is I have been fighting dry eyes ever since the surgery. I have tried plugs, a huge array of drops, gels, lotemax for the irritation, flaxseed oil, fish oil, restasis and I thought it was better until a couple weeks ago and my eyes started burning and even drops burned. I went to a local opthamologist last week to see what was going on. I was seeing 20/30 right and 20/60 left that day! Burning aside, to my surprise I found out that I have decentered ablation. VERY DECENTERED! He just couldn't understand how that happened at Hopkins and neither do I. Except now I read that a doctor might do planned decentered ablation for nearsightedness in older patients?? I am 58. My new doctor here is very knowledgeable and I think I am at the right place now to proceed but where exactly, I don't know. He did not see any infection or anything, I guess the burning, redness is from the dryness or allergies or both. This week I am to start the autologous serum eye drops. I am so tired of this roller coaster ride!
Anyone have anything to share??
Thanks bunches--sometimes I feel so alone :( Tasha

[LasikExpert]

The theory behind deliberate decentered ablation is that the cornea can be made like bifocal glasses with an area for near vision and an area for distance vision. Multifocal Lasik has been in the development stage for years, with limited success. Rather than providing two separate vision corrections, a multifocal cornea simply mixes light focused for near and light focused for distance at the same time. If 1/3rd of your vision is for near, 1/3rd is for mid-distance, and 1/3rd is for distant/infinity, then that means that no matter what you look at, 2/3rds of your vision is out of focus. This leads to loss of contrast and the presence of halos around light sources, especially in low light environments.

Low light will be troubling because your pupils will dilate. This increases the area through which light passes and will likely include more of the multiple focused surfaces, thus mixing focused light with unfocused light. You may want to read our article about pupil size and Lasik.

A workaround for a decentered ablation would be to reduce your pupil size. Pilocarpine is for the task of reducing pupil size, but is awfully hard on the eyes and snaps those pupils down tight for a long time. An alternative would be Alphagan P. Alphagan P is a glaucoma medication that has the side effect of reducing pupil size. One drop of Alphagan P in the evening is usually enough to resolve minor night vision problems. Talk to your doctor about whether or not Alphagan P would be appropriate.

Dry eyes is a known issue with Lasik, but usually resolves quickly. It sounds like you are having quite an issue. Please read our article about Lasik and dry eye treatment.

[tasha946]

Thanks for your response. I start the autologous serum eyes drops tomorrow in hopes that this will get my dry eye under control. At that point I will be able to see exactly what I "see!" Then I can decide what to do about the decentered ablation.

It does appear that it was done on purpose without mentioning it to me, much less having my consent. Both eyes are almost identically decentered. This is a world renowned doctor.

Today is another day and I will see how it goes.

Thanks again and I will be back in touch---
Tasha