Lasik for Hyperopia +4.25 / +4.75 - 2010 March 11

[Paul]

I am posting this for the benefit of myself to record my progress but as an unbiased guide to anyone considering Lasik.
I had my Lasik treatment carried out at the Natural Vision clinic in Takanawa, Shinagawa-ku, Tokyo. http://natural-vision.jp/index.html

I had spoken to a couple of colleagues who had had surgery in other clinics but they all had myopia whereas I have hyperopia, plus I am 48 so already have well advanced presbyopia. I am far sighted, the test at the initial consultation showed me to be +4.25 on the left and +4.75 with astigmatism in both eyes (don’t have any other figures I’m afraid – I neglected to take a note - but I will do so). As a result, I could not make out faces at virtually any distance.

The cost was typical for what I have seen elsewhere in Japan. For custom lasik it was JPY360,000 for two eyes which includes all consultations and medical supplies for 3 years. Can be cheaper than this depending on the work required - I fall in to the worst (most expensive) case.

My expectations were not unreasonable going into this. My target was to get away from being totally dependent on wearing glasses full time. In my pre-op state I could not function at all without my specs. However, I knew that I would most probably require at least reading glasses. Would be happy even if I have to wear glasses for driving, but can live the rest of the time without them.

I had been considering it for a while – my eyeglass prescription (25+ years wearer) is complicated (and expensive) so when it came round to time to replace them I had a closer look and found the clinic mentioned. I chose it because of its professional website information, as well as the fact that they can cater to English speakers. I’ve lived in Japan a while, but my Japanese is not as good as it should be!! At the initial consultation I was very impressed by all the staff and Doctor Iino, there was never a hint of pushiness.

My reasons for opting for lasik are not related to vanity. I still enjoy skiing and swimming (going to try scuba this year for the first time). Visiting an Onsen (hot spring) is also not enjoyable when you can't see a thing with or without your specs. It’s a pain being hyperopic in these conditions – literally. I have worn glasses so long that I have a dent in my nose bone and got fed up of cleaning them and having chafing behind the ears．In addition my lightweight prescription lenses tended to cause barrel distortion on doorframes and the like. I tried contacts but they were just as troublesome and uncomfortable.

Doctor Iino at the clinic warned me that my prescription was going to be difficult, but in other respects, my eyes were suitable. He also pre-warned me that due to the expected regression from hyperopia, they would first over-correct my eyes to a myopic condition then expect them to settle back. Even so, there would be a fair chance I would require enhancement later on. He also warned me that due to my eye condition, the laser time would be quite long and would have to be done in two or three cycles.

So I went in with both eyes open (excuse the pun) – Here is my personal experience.

Surgery scheduled for 11 March 2010. No mention was made of a tranquilizer, so I asked about it. He asked, “Do you need it?” and I replied no, so went ahead without it. Had a final check then went into the treatment room. Eyes were numbed with eye drops. The right eye flap was cut first – the suction cup went on fine but when my vision went completely blank in the eye with the suction, I had a minor second of panic – even though I had read that it would happen. Getting the suction cup set correctly on the left eye was a bit more troublesome. You are asked to look straight ahead but with the lights blazing in your eyes, it is not so easy. This caused a little discomfort and pinching, but nothing too bad. The actual cutting of the flaps was no problem at all.
Next the right flap was lifted and that was weird – any remaining vision was totally blurred like trying to see underwater.
The right eye went very smoothly, I hardly knew it was being done. Again my left eye wandered a lot which interrupted the process. I also experienced a couple of moments of pain in the left eye similar to pin pricks. I informed him and he paused for a while – may have used something to ease the pain.

Then suddenly it was all over, I was assisted into the recovery room where I sat for 15 minutes. During this time I noted the following. Both eyes gave the impression that I was sitting in a steamy room, or had a veil over my head, the left was worse than the right. The left eye had significant double vision and I could tell it was myopic just as had been predicted. The right eye was sharp (apart from the veiled effect) and almost looked spot on.

A brief check confirmed that the left had shifted to -1.25 and the right was at +0.25. I walked out of the clinic with eye shields (goggle-like plain lens glasses) on about 30 minutes later.

I had booked myself into a nearby hotel – walking in the sunshine was unpleasant but nothing worse than I had expected. Very happy with the right eye vision at the moment.

During the afternoon / evening I rested with the curtains drawn – tried to watch some TV but gave up. The right eye felt fine but I had to use 2 or 3 doses of Benoxil in the left eye that had been given to me to dull the pain. Other eye drop medication was taken precisely at once per hour as prescribed. The double vision in the left eye kept coming and going, the right eye seemed stable.

As a test, I went out in the evening for a few minutes to check on night vision. Most notable was strong halos and really bad starburst of car headlights. I need to drive home from work in the evenings so hopefully this will clear a little.

Woke up at 4:00am with pain in the left eye, the Benoxil did the trick though. (Note, that was the last time I needed it)

In the morning (Friday), vision was much the same as the night before. I had an appointment at 10:00am. The doctor reported that some inflammation was present and asked me to come back in two days and keep taking the eye drops hourly. Correction was measured at -1.25 and +0.25 so nothing had changed overnight.

The pain in the left eye had subsided to the feeling of a foreign object, the right eye still had nothing.

Saturday 13 March at home, pain and feeling had diminished to virtually zero, during the afternoon I got the impression that the right eye had also shifted a little myopic. Sensitivity to light was virtually back to normal.

Sunday 14 March, morning, 3 days after treatment, the right eye had gone back to its almost perfect condition. Went back to Tokyo for a check at 11:00am. Inflammation is receding nicely but keep taking the drops hourly. Eyes still measure at -1.25 and +0.25. Halos are still present almost as strong as before. In the afternoon I was again aware that the right eye had shifted towards myopic. Small bonus is that currently I have no problems reading fine print, or my watch. Vision up to 3 meters is excellent in left eye, getting progressively blurry beyond that. Left eye is still good up to about 10 meters – progressive blurring beyond that.

Monday 15 March, morning – no apparent changes, first day back at work. Some dryness starting to become apparent, but I had that pre-op anyway. Working at the computer for too long seems to push the myopia on the right eye a little more – left eye has no change. I had to drive home in semi darkness for the first time today. I have starburst and halos but they are not the major issue. Due to tiredness, my eyes are both myopic so I drove with extreme care.

Tuesday 16 March – Woke up with sore eyelids (not eyes). I think it is the eye drops and tears collecting at the outer corner of my eyes while sleeping. It is apparent that the myopia in the right eye increases as the day goes on. In the mornings, it is close to perfect vision, albeit still with halos. The left eye has remained quite stable changed much in terms of focus but the haze is becoming less pronounced.

I tried using an old pair of my wife’s reading glasses while at the computer today that have very a very mild correction – I found that it seems to reduce eye fatigue which lessens the degree of myopia my right eye takes on during the day.

Next appointment is scheduled for Thursday 18 March, one week after the surgery. I am going to ask him about buying a cheap pair of mildly myopic prescription glasses temporarily so that I can drive more safely while waiting for my expected regression to kick in.

My thoughts so far– Even though I had done the due diligence, I am becoming aware that this is going to be a longer process than I first anticipated. However, I am already delighted by the fact that I can walk around and function reasonably well without glasses. I shall have to lay off the radio controlled flying that I do for a hobby for a while but that will be a small sacrifice in the long run.

Would be delighted to hear from any other hyperopics out there

[Paul]

Tuesday 16 March - evening, my right eye had become tired and was getting blurry again, left eye unchanged. Drove home in full darkness - not too bad but needed to keep good concentration. Noted two things;

> Starbursts / halos seem to be slightly reduced from yesterday (or maybe I am getting used to it)
> Starbursts / halos are less severe in the right eye which has less refractive error. So maybe some of it is coming from the overcorrection.

Wednesday 17 March - morning. No dry eye symptoms. Right eye has sharpened up again, left is steady. Drove to work in brilliant sunshine, no major problems with light sensitivity. Did a simple acuity test on myself on the computer monitor corrected for 3 meters. If my test method is correct then Left is about 0.3 (20/63) and Right is about 0.8~1.0 (20/25 to 20/20). Decimal numbers are based on the Japanese notation method. Fair amount of double vision in the left eye in the plane of 9:30 / 3:30 when looking at a clock face.

[Paul]

Thursday 18 March - 7 days after Lasik. Went to the clinic in Tokyo for my 1 week check up. On the journey in, as usual in the morning my right eye felt pretty close, my left eye still has the normal myopia. I have a very slight feeling of what I think might be dry eye in my left eye only. Right eye continues to be comfortable.

My figures from the machines are as follows, Left eye -0.75 with astigmatism, RIght eye -0.25. On the eye chart I have Left - 0.8 (20/25)with double vision, Right 1.2 (20/17) with minimal blurring. The left eye double vision was in the 11:30 / 5:30 plane (looking at a clock face). Seems to be that it is shifting through an arc of 80 to 90 degrees as the eye is recovering.

Doctor's visual inspection showed that I still have very slight inflammation in the left eye but this is receding. He was happy with my progress. I still have two types of eye drops, D.E.X 0.1% which is for the inflammation and Hiaronsan for dryness. (These names are from Japanese katakana so may sound strange) He said I can reduce the D.E.X to 5 times a day and Hiaronsan only when I feel dry.

Next appointment is 2 weeks from now - 1st April

I asked him for a temporary eye glass prescription to help with my driving which he was happy to give (they don't sell glasses, except readers). On the way home I stopped in an optician near my home and got a cheap pair of frames with economy lenses at L -0.75, Right -0.25 and no astigmatism correction. Since the lenses were off the shelf, I walked out 45 minutes later with my specs. In the car at night they made a HUGE difference. I can now drive safely during the transition time to my expected regression. Halos and starburst are of course still there but with less refractive error, the starbursts are much reduced especially for the left eye. The lenses are cheap enough that if my eyes shift a bit next month, I can buy a set of replacement lenses just for a month or two.

If everything goes as I hope and my eyes settle down to good distance vision, I shall simply junk the cheap lenses for a set of reading lenses (I mentioned I was 48 years old already) which I don't need yet due to the current myopia.

Current Feelings - Can't help but continue to feel optimistic. Everything seems to be going as expected. The myopia takes some getting used to but the results seems to be showing that things are shifting slightly in the right direction.

Recommendation - I don't yet know how well my eyes will finally turn out. I have lived in Japan for a number of years and I am used to the excellent service here but I would just like to add how wonderful the staff and Dr. Iino have been at the Takanawa Natural Vision clinic. Despite the odd communication difficulty they have been brilliant. For any ex-pats living in and around Tokyo who are considering Lasik, I thoroughly recommend this clinic.

[browneyedgirl70]

Thank you for your detailed account of your surgery! I just wanted to let you know that I am following with interest, and hope you will continue to update. I just had Lasik myself March 16, 2010 at the Duke Center for Vision Correction in North Carolina, and am getting ready to post my experience also!

[Paul]

Thanks for the kind words browneyedgirl - I wish you success.

Saturday 20 March - I've had a chance to experiment with the cheap long distance specs now and they have helped enormously. Night driving is now safe. I am limiting myself to using them just for driving.
Despite the reduction in eye drop frequency, I still have not identified any major dry eye symptoms. I have only use the lubricant drops now 2 or 3 times in a day. Anti inflammatory still at the prescribed 5 times per day
My major "concern" at the moment is the amount of halo. I have been told that this will subside so it is just a matter of being patient.

Tuesday 23 March - I had a really lazy long weekend. My wife and daughter are on a short break to the UK and Monday was a holiday. The weather was rotten so I spent most of the time vegging around the house on my own so I was not really aware of any long distance issues or halos etc. By being so relaxed I found that I almost forgot that my eyes had been treated. No dry eye despite the fact that the heating was on all weekend.

The one thing I really miss right now is the luxury of a nice refreshing eye rub!!

I will keep reporting in, but I will only update if anything significant happens.

[Paul]

2010 April 1 - Went for my check at 3 weeks post op. Doc could see some dryness in both eyes so advised stepping up the drops to 1 hour or as and when required.
Right eye is fairly stable at 1.2 (approx 20/17) and left eye reading has improved to 0.9 (approx 20/25). I had astigmatism pre-op, now my right eye has had variable astigmatism from day one. The left eye actually has less astigmatism now but in practise is a little more blurry

He was happy with the progress, no abnormalities as far as he is concerned. Next check is scheduled for May 7 which will be eight weeks post op.

He advised me that he would like me to consider an enhancement at around 3~4 months post op. This is in line with what I was told at my initial consultation.

As for daily life, I have a mix of good and bad days. The bad days normally come from too much time at the computer - it tires my eyes. However, on a good day I can drive home quite comfortably without the temporary distance glasses I bought.
It seems that the ratio of good days to bad is moving in the right direction.

Halos and some starburst continue but I have advice from a 4 year post-op colleague and my doctor that he expects this might continue up to 6 months post op. I have become accustomed to it now so driving at night is not an issue from this point.

Overall happiness is still high.

[PRKorIntacs]

reposted here:

Your high hyperopia makes you a difficult case. Most lasik centers I read of can only treat up to +3 or +4. Regression is common and you may end slightly hyperopic. Do you plan to get an enhancement if you are still hyperopic? Have you gotten to 20/40 yet? I am aiming for a -1d or 20/40 distance in order to preserve most of my near vision and see without reading glasses.

[Paul]

I have been hyperopic all my life and now I am temporarily slightly myopic. It is a very interesting experience that I am still getting used to.

I am already at 20/40 or better - and if my eyes regress as expected, that will improve closer to 20/20. The only thing that will need sorting then (hopefully) is a little tuning for astigmatism.

I have a current temporary pair of glasses that correct for -0.75 and -0.25 (without any astigmatism correction). Based on this experience, I would not like to be myopic to -1.0. Around -0.5 would be the most I would be able to accept - and that would most likely need glasses for driving or other long distance use.

As a result, if I cannot get to plano then I would be happier to be slightly on the hyperopic side and use reading glasses.

[PRKorIntacs]

I have been hyperopic all my life and now I am temporarily slightly myopic. It is a very interesting experience that I am still getting used to.

If I were hyperopic, an overcorrection would be a good thing. Me being myopic, an overcorrection is bad news!

I am already at 20/40 or better - and if my eyes regress as expected, that will improve closer to 20/20. The only thing that will need sorting then (hopefully) is a little tuning for astigmatism.

How much astigmatism do you have in each eye?

I have a current temporary pair of glasses that correct for -0.75 and -0.25 (without any astigmatism correction).

Im guessing your astigmatism is still fluctuating. How does it affect your vision in each eye?

Based on this experience, I would not like to be myopic to -1.0. Around -0.5 would be the most I would be able to accept - and that would most likely need glasses for driving or other long distance use.

I never heard of any -0.5 needing distance glasses since youd be 20/25. A -1 would be 20/40 to 20/50 so glasses would be needed for driving. I don't drive anyway so there would be no legal requirement to wear glasses. I was a -1 at 12 and did get glasses but rarely wore them. My brother is -1.25 and 20/60 and rarely wears glasses for reasons other than driving.

As a result, if I cannot get to plano then I would be happier to be slightly on the hyperopic side and use reading glasses.

Youll need bifocals or progressive glasses since you can't accomodate around your hyperopia. This is why I am aiming for at least -1 so I don't need reading glasses 6-8 hours a day(take it from my presbyopic friends) and very rarely need distance glasses. Also it would greatly reduce the chance of an overcorrection which would equal bifocals or progressive glasses full time.

[Paul]

PRKorIntacs,
From your text, it appears that you have not had surgery. Please don't tell me what I should or should not be doing - you are not a doctor - correct?

I am merely reporting what I have experienced, I do not wish to discuss anything else.

[PRKorIntacs]

PRKorIntacs,
From your text, it appears that you have not had surgery. Please don't tell me what I should or should not be doing - you are not a doctor - correct?

I am merely reporting what I have experienced, I do not wish to discuss anything else.

Just offering advice, but you are free to do as you wish, they are your eyes, not mine. You can discuss all this with your doctor, he will tell you about presbyopia, hyperopia and bifocals. This is what I discussed at my PRK evaluation. Thanks for sharing your story. Ill check for your updates.

[mjs71]

Paul, Thanks for your posting. I'm also hypeopic with a similar prescription. I've been thinking about getting the procedure done for years. Are you pleased with the results so far? What laser did your doctor use for the procedure?

[Mack]

Interesting discussion about hyperopic lasik and recovery.Those who have posted that most lasik centers will not do over +3 or +4 and advise doing IOL's for higher scripts have just not done enough research. Hi hyperopic lasik is getting better and there are specialists who know how to calculate the amount of expected regression and better handle astigmatism, which is always the wildcard. I was +3.75 and +5.25 iwth -1.5 astig in both eyes and had the procedure in 1999 by a hyperopic lasik specialist in VA. Like Paul, I was myopic for the first few months. After regression stabilized, I got enhancements at 6 months. After another 6 months, vision stabilized around plano but with +1.0 to +1.25 astig in both eyes. 4 years ago, I got CK (conductive keretoplasty) to correct that and it worked quite well. Vision has remained stable with perhaps +0.25 to +0.5 remaining astig, depending on lighting. In good light, vision is a solid 20/20. Many docs advised that CK would only be temporary and last about a year or so, but it has not changed at all in over 4 years. I did have a sharp 20/15 with correction pre-lasik, so I did lose one line of BCVA, but overall, I have been satisfied with the results.