Induced Astigmatism?

[SilentTears]

Dear fellows, would appreciate some advice/comments on my situation:

I had all-laser wavefront-guided Lasik 13 days ago at a reputable surgeon in my country, on one eye.

Pre-op: myopia of -7.5, astigmatism of -1.00 on 165 axis.
Post op-as measured a few days ago: +0.25, astigmatism of 0.75 on 130 axis (I'm not sure whether the astigmatism is a + or - now). Corneal thickness of about 419 microns (inclusive of flap).

I am still having some Vaseline/hazy vision (looks like soft focus filter has been placed over my eye), and see halos around bright objects during the day and night. This was initially severe and improved during the first few days following my surgery. But the improvement seems to have halted for the last 5 days.

It is difficult to work now as numbers on computers appear blurred and soft. I have had my eye refracted a few times the last week and the astigmatism has been a consistent 0.75 or 1.00.

1) What could have caused the astigmatism? Is this Induced Astigmatism? Would it resolve by itself and if so, when? What is my best-case and worst-case scenario? Will it be enhanceable by further correction?

2) Should I be concerned about the Vaseline vision 13 days on? What could be causing it and will it also eventually resolve by itself? If so, when?

The doctor has told me to wait a month before assessing my eye again, but I am really worried as this vision is affecting my work (my un-operated eye doesn't tolerate contact lenses well).

[LasikExpert]

1) What could have caused the astigmatism? Is this Induced Astigmatism? Would it resolve by itself and if so, when? What is my best-case and worst-case scenario? Will it be enhanceable by further correction?

The astigmatism appears to have been reduced somewhat, but not completely. Astigmatism simply means that the cornea is not spherical like the top of a ball, but is elliptical like the back of a spoon. I suspect that you are suffering from a bit of inflammation. That would be consistent with both the mild hyperopia (farsighted, longsighted) vision and residual astigmatism.

2) Should I be concerned about the Vaseline vision 13 days on? What could be causing it and will it also eventually resolve by itself? If so, when?

You should report anything less than excellent vision to your doctor and follow the surgeon's directions, but it is very early in the healing stage and the vision you describe is consistent with your mild hyperopia and likely inflammation. It is quite possible that the current difficulties will resolve with continued treatment and healing. It is difficult to predict when this may resolve, but it does not sound like you need to be terribly concerned until at least 5-8 weeks postop...longer if you continue to use the medical eye drops.

The doctor has told me to wait a month before assessing my eye again, but I am really worried as this vision is affecting my work (my un-operated eye doesn't tolerate contact lenses well).

If your vision gets worse, then you should insist on seeing the doctor before 4 weeks postop. What you describe is not exactly common, but you had a very high refractive error and it appears your doctor deliberately overcorrected your Lasikto deal with expected progression. Long-term you will likely be happy, but we don't "see" long-term.

[SilentTears]

Thank you Lasik Expert.

It is now 3 weeks post-op.

At my regular optometrist, the autorefractor continues to show a mild hyperopia of +0.25 and astigmatism of -0.75 diopters on the 130 axis. A manifest refraction produces a slightly improved reading of between -0.5 to -0.75 diopters of astigmatism.

There hasn't been any noticeable improvement in the Vaseline vision since my last post. In addition, I'm noticing longer starbursts streaking to the left and right of bright objects at night (these looked mild during the 1st week but seem to have elongated a bit recently). At the local cinema, during dark movie scenes, I see some smearing of the white colored subtitles to the bottom.

I have actually been off all eye drops since the end of the 1st week, under my doctor's instructions. Does this make sense if there is indeed continuing inflammation?

[LasikExpert]

It would appear that your doctor does not believe the residual astigmatism or refractive error are due to inflammation. If he did, you would likely have been instructed to continue with the steroid eye drops.

While your regular eye doctor (optometrist) may be highly qualified, the continued "vasaline vision" should be evaluated by your surgeon (ophthalmologist). It is still early in the healing process, but your surgeon should get a first-hand look at what is going on. I suspect you won't be seen until about four weeks postop, and that is probably just the right time.

[SilentTears]

An update:

It's now 6 weeks post-op. I had a follow-up consultation a couple of days ago with the eye surgeon.

The refraction's been pretty stable over the last 4 weeks. Still 0.25 diopters hyperopic, while astigmatism's reduced slightly to 0.5 diopters.

There appears to be a bit of improvement in the 'Vaseline' vision but it's definitely still there. I think this is the cause of my seeing halos around bright objects during the day and night, and this also makes things look soft and romantic. The glares and slight ghosting in dim light conditions are unchanged. Computer fonts still appear soft but I've noticed a slight improvement over the last few weeks. The eye surgeon said that my cornea looked clear and didn't see any problems. He is therefore unconcerned and said to give it a bit more time. That's exactly what I'll do. For information, I've actually stopped working at the moment because it's too difficult to work with the unbalanced vision.

[LasikExpert]

It appears that you continue to have changes in the right direction, even though it is slow. Please keep us informed of your progress.