Hyperopia Lasik - 1 Month out

[dstepp]

During my LASIK recovery, I have appreciated reading up on the experiences of others on the site. I thought I would share my own as well.

I had custom cornea LASIK on November 15th. I was hyperopic (about 4D) in each eye with a little astigmatism in the left. I had been wearing glasses since 1967 at the age of 2. I am currently 42 YO WM with no major health problems. My surgery was conducted using the LADARVision 4000 system and my starting read on the Snellen chart was about 20/60-20/70 without glasses.

The surgery went well and the doctors reported no concerns. I was dilated so much that it took 72 hours to regain pupil control, which when combined with the surgical recovery, produced alarming reductions in vision. I was put on Vigamox as an antibiotic and Econopred for a steroid. Initial recovery was pain free and sleep came easy. Pain, grittiness or obvious dry eye was minimal. When I went for the 24 hour follow-up, I was still dilated and the Snellen chart was virtually unreadable. While this was alarming, I was told that it would be better when the dilation wore off. During this period, I had about 3 feet radius of good vision which was clear and sharp.

As the dilation wore off, visual recovery did improve markedly and my working radius increased to about 7 feet of crystal clear vision. Driving became more comfortable and I returned to work (the week following LASIK was thanksgiving week, allowing for lots of sleepy time for recovery). I had some difficult with eye fatigue (my work involves a lot fo computer time) and when I went for my 1 week follow-up, I was told that the antobiotic and the steroid blurred vision and I could expect marked improvement once I stopped taking them. THe Snellen read there was 20/30 with some focal work and 20/25 if I really strained.

True enough, once I stopped the drugs, I obtained additional improvement. I would say I am now crystal clear within 12 feet. When I went for 1 month follow up on the 14th, I was 20/20 minus 1 to 2 characters (I can make out some characters better than others) with both eyes. The left eye, weak for 40 years, still lags.

Ongoing recovery issues are:

Dry eye - This has not been as ferocious as some people make it out to be but it defintely has good days and bad days. A cold blustery day can make vision problematic and uncomfortable. Admittedly, I find the steamy feel of the night goggles to be comfortingeven after a month. I do not feel the need to wake up and put in drops during the night, an issue early on.

Distance vision - far distance vision from 15 to 100 feet remains challenging. The primary way this manifests is ghosting or doubling which robs one of focus. Situations include things like driving where street signs are illegible until you are right up on them, lack of crisp vision when watching a play on a small stage (30-40 feet across) and some lack of clarity when watching TV and there is a crowd scene or a lot of movement. To give a perspective, South Park cartoons are watchable and understandable but the little dots on the boys eyes are two overlapping circles. It's a small thing at close range but when focusing into the distance, is a handicap. Night vision is particularly impaired in this. My optomertrist (I am co-managed with the surgeon) expects this to improve over 3-6 months. I suggesting driving glasses but given that I don't appear to have defects in my eyes, glasses may not help. Recovery will rely on control of driness, improving healing and visual control and probably a little brain re-programming to my new vision paradigm.

D.

[croanster]

Sounds like you're going pretty well!

The distance vision will definately improve with time. Sounds as though your recovery has been very similar to mine as far as what you can see. Biggest improvements came around the 3 month mark.

Keep everyone updated - hyperopic lasik stories are hard to come by!

[dstepp]

Thanks for the encouragement. My managing optometrist says that hyperopes are generally one marker behind myopes and that my vision at 1 month was similar to a myopes at 1 week. My 3 months should be where a myope is a 1 week, which is within 90% of where they end up.

Why is this? I had some presbyopia but now read fine with no glasses (I can read 2 point font, it's like some useless superpower) but was told that I would probably need readers at my age. Do they overcorrect and let you regress back to "normal" (at which point I should have good distance but need the readers)?

Why is the vision distance so blurry? Mine is a ghosting or double image. I know it can be better because with very fresh wet eyes or certain times of day or when I have been good about not overusing the computer ( aserious weakness) I get flashes of excellent vision. What is the healing that is left to occur (my flap is healed seamlessly they claim)?

D.

[croanster]

This is all just from personal experiences http://www.usaeyes.org/ask-lasik-expert/viewtopic.php?t=1189 and what I’ve picked up mostly from this site so don’t take it as gospel, but, there’s a few different things at work for hyperopes as I understand it.

Firstly, the actual surgery is trickier. With myopes, they just blast away in a nice 6 or 7 mm circle in the middle of the eye and away you go. Done. Hyperopic correction is trickier because they have to make the cornea rounder / steeper or ‘bulge’ in the middle by blasting away around the outside of the cornea without getting anything off centre etc. This link explains it a bit better: http://www.usaeyes.org/faq/subjects/hyperopia.htm

There’s more regression with hyperopic correction usually as well and the regression can be a bit unpredictable which can induce a bit of astigmatism. So yes, they do overcorrect you into short-sightedness to allow for this regression. The first week is a bit like having some sort of super macro lens on your eye!

The third thing and this is what’s been slowest for me, is your brain adjusting to your new eyes. Hyperopes usually are very good at accommodating for their refractive error. I had glasses since I was 4 but never had to wear them until I hit 28 or 29 even for the closest work. This was the start of presbyopia for me. When I had surgery, there was still around 1 dioptre difference between manifest and cycloplegic (dilated) refractions. Unfortunately, after surgery that difference is still there for a while. Your eyes might be corrected after surgery to, say, +0.5 but you may manifest at, say, -0.75 in an eye test. Takes a while to stop accommodating for your old error that no longer exists and you see the world as if you are myopic even though you’re not!

The good thing is, we should have good strong eye muscles which might hold the need for reading glasses at bay for a bit longer!

As far as the glasses go, if you are like me and wanting a minus lens to see clearly but are actually still a tad on the plus side, it’s a bad idea. Will just delay you getting used to your new eyes. (my interpretation only and may not apply in your case...) Of course this has to be weighed up against the potential for walking into a bus on your way home from work... :wink:

Night vision is difficult for me as well nearly 6 months out. Seems hard to get a focus on anything. Bit of starbursting to content with as well although not too bad. Hoping I can get rid of that down the track.

It’s definitely a long process but hang in there! Some days will be good, some will be awful but should all be good days in the end!

[Mack]

>>>>Do they overcorrect and let you regress back to "normal" (at which point I should have good distance but need the readers)?
Why is the vision distance so blurry? Mine is a ghosting or double image.

Exactly correct. You really should ask the OD for an accurate refraction now to see what your error measurements actually are. You are no doubt around -1 myopic with some induced astigmatism right now that is causing the distance double vision and ghosting. Correcting +4 to stable eventual plano will entail over-correcting by about -1.25 D, i.e., ablating the optical zone from +4 to -1.25, allowing the natural healing regression process to take you back to plano. That number will vary a llittle depending on age and eyeball metrics. It usually takes about 4 to 6 months minimum. It took me about a full year from +5.25 to hit plano sphere, but with an induced +1.25 cylinder (astigmatism). Subsequent enhancements cleaned that up to about +0.5 astig and 20/20 un-aided with both eyes. Patience is the key in early h-lasik recovery. Enjoy your close-up unaided vision while you have it. That will slowly regress and your distance will start to sharpen. I actually think using temporary -1 or whatever myopic correction you need to sharpen distance vision during the recovery period is a good idea, especially for driving and at night. It helped me for about 3 months, but then as the astig increased, I needed exact prescription multi-vision correction for optimal visual clarity in all conditions and distances until the later enhancements stabilized. Now I only need +1.25 readers for close up work. My only regret is losing a razor sharp 20/15 pre-lasik with correction, to only 20/20 now with or without any degree of light correction, plus minor degraded clarity in low light situations. Good luck.

[dstepp]

Thanks for the feedback. I am 6 weeks out and vision is about the same. I have some days where, with work, I get improvement but it comes at a cost: worser dry eye, fatigue, blood shot eyes from working too hard. Worst example: Xmas eve I drove home ( 3 hour drive) and went Xmas shopping for ~2 hours. 5 hours in a car with the vents going on a cold day and by the end of the evening, I had aching bloodshot eyes. They cleared up some but I have noticed that I am at some sort of tipping point. Before I could not see well beyond 12 feet or so (ghosting) no matter what I did. Now I can see further but with strain and fatigue on my eyes. Hopefully this means that I will soon transition to a point where I can see furtehr without the fatigue and blood shot eyes.

I share the other posters experience (which can be frustrating) that a few drops of Systane or Optive and for a moment, with film on my eye, my vision is perfect. Then I blink and it's gone. It drives you nuts!

D.

[LasikExpert]

If your vision at distance is poor, but your mid-distance vision and near vision are good, that indicates that you are still a bit myopic (nearsighted, shortsighted) and have not fully regressed.

The ghosting indicates the cornea is a bit irregular. This could be normal astigmatism, but is more than likely the common irregularity of healing after hyperopic correction. It is reasonable to expect improvement, but be sure to report your problems to your doctor.

[croanster]

A few ideas for you when your eyes are tired sore and dry.

Plenty of lubricating drops (which you’d already know about)

Try some flax seed oil. It’s cheap and does a god job of helping to restore your tear film stability by replenishing lipids (or something like that – whatever it does it definitely helped me)
I’ve got the liquid flax in the fridge. Tastes terrible but you can also get capsules from the health food places. More convenient but you need to take 3 – 6 a day to be effective.

Try a heat pack (or wheat pack?) they are absolutely brilliant! 5 minutes under one of those is like a full nights sleep for your eyes! They only cost around $10. The next best thing is to get a face washer, run it under the hottest water your hands can stand then ring it out, fold it into 3 and drape it over your eyes. Doesn’t hold the heat as long as one of the heat packs but still gives you some effect. In the 2 – 3 months straight after lasik i’d be sitting watching tele with ghosts and blurred picture. Put the heat pack on for a couple of minutes and everything looked so clear. Worth a go.

At work they call it my “eye pillow” and get a bit of a chuckle... oh well. :)

The other thing which sounds a bit silly but really works well is a pair of ski or motorbike goggles. If you're driving for example - keeps the dry air out and makes like a mini - climate for your eyes. Nice and moist. Stumbled across that one looking for something to protect my eyes mowing the grass one day.

Let us know if any of that works!

[dstepp]

I tried the hot towel several times today. I may have seen some effect but mainly it just felt real good. :D

I have been doing Flax Seed but based on your stats, I have been def low balling it (1 capsule/day). What is the recommended doasge for supplementation?

I also got collagen punctal plugs about 2 months ago (1-2 weeks prior to the actual surgery). They dissolve completely at 3 months and it occurs to me that they may be dissolving already, hence the appearance of some dry eye issues that were lacking until now.

One of the issues I wrestle with is how hard to try. The doc sez there are two schools of thought during the recovery period. "train your eyes" by working them hard or "baby your eyes" by keeping things like driving and comp work to a minimum (hard with my job). I also note that if I shift over to the left eye, my historically very weak eye, it seems to give better vision but tire easily (hence the red eye). What is your take on the best path to recovery?

D.

[LasikExpert]

Use your eyes normally. If your uncorrected vision means you don't have functional vision, then use glasses (like for driving). Be agressive on dry eye treatment, including new punctal plugs if deemed appropriate. You may want to read about Lasik eye strain.

[croanster]

Should say on the bottle the recommended dose for flax capsules. Most I’ve seen recommend 3 – 6 daily. The liquid oil I’ve got says 15 – 30mls daily. I usually just throw a shot of that down with breakfast.

As Glenn says – use your eyes normally. My doctor told me to “go and look at the hills” as much as I could but that was mainly due to my ‘pseudo myopia’ – ie my eyes had physically regressed to plano but I was still accommodating into short-sightedness. I still notice the more close work I do the more my distance vision suffers but the effect is much less than early on. I tried a pair of +1 readers for the computer which didn’t really help on the computer (not needed), but my distance vision was better at the end of the day for it when I took them off. They are still handy at times if my eyes get focus locked. Seems to shake things up a bit – brain starts hunting around for a better focus. This might be totally pointless for you though it just depends on what your eyes / brain are doing. The optomitrist actually said when i was complaining of not being able to see very well - "what do you expect?? You've just had the front half of your eyeball ripped off then been blasted at by a ray gun!" :)

As far as either working or babying your eyes, I don't know what would be best. I know what worked for me and that’s to look out into the distance as much as I could and giving them plenty of rest when i could. Either way, you have to look after your eyes by keeping them moist as much as you can. It really is just a waiting game though as frustrating as it is sometimes. Took 4 – 5 months before I could see properly in shopping malls through the flouro lights. Much better now.

Have you had refraction done recently?

[dstepp]

So I am 7 weeks as of tomorrow and the itch, scratchy bloodshot eyes are worse. I have the advantage of being on the faculty of the med school that did my LASIK so I droppped by for a quick check.

About two weeks before the actual surgery, I had collagen punctal plugs to offset any dry eye. They appear to have dissolved a little sooner than I had hoped so I am now getting the full brunt of the dry eye. It's a drag but I will have the permanent plugs this week and go on Restasis. The doc figures I can be weened off restasis eventually as I heal and maybe even pull the punctal plugs.

The real drag is taht eysterday was my best day yet for vision. Street signs as 50 feet, license plates three cars ahead, the wind sock a quarter mile away looked like w indsock insteads of two tailed pennant.

Back to lots of drops. More as I go on...

D.

[dstepp]

New info - So I went on Restasis. I am two doses in (last night and this AM) and see some improvement but not 100%. How long does it take the body to adapt to the drug and produce tears reliably? I will get my plugs Monday and hoping for a good effect as I had on the temp plugs as the Restasis is 1) expensive, 2) a milky emulsion that feels disgusting and 3) burns my eyeballs. How long should I wait to expect results?

D.

[floatanddry]

Restasis is a multi-month process. From what I understand a minimum of one month is necessary to see results from it, with improvements up to three month.

I am on it as well. Basically, the formula almost uses a soap like substance to deliver the medicine - thus the stinging. After a few weeks this normally goes away. My eyes are always a little red afterwards.

Just to give you my dry eye experience:
- OK for the first 1 month. Just used drops for healing process.
- bad from 1-3 month. I was using drops a lot because my eyes basically stung all day
- much better after month 4

My doctor stills sees some dryness in the eye so he wants to keep me on it till the end of winter. I am not sure how much it helps, versus the natural healing process, but it is not that expensive from my insurance policy IF you use the mail order option, and I have not read about any potential bad side-effects.

FD

[h3lder]

I was operated (LASIK) on my left eye on November 8, and a week later on my right eye (November 15). I was myope.
On the first 2 weeks I had a sharp and clear vision, near and far, now, almost two months later and I have the same simptoms you describe. I have dry eye and my eyes itch a lot. I'm using Systane eye drops for that (my doctor prescribed me those). Far vision is not as bad as when I whore glasses but it's defenetly worse than those two first weeks. Distance readind is hard, sometimes I have to close me eyes a bit and concentrate real hard to read a car plate 15m away. Close range is allright, I use my computer with no problems, I read perfectly. TV subtitles are a bit blurry but good enough to watch a movie with no major issues.

I read on-line this is normal, and with time (6 months recovery) it will be better. I hope so. My doctor says my operation went perfecly well and he espects me to be fully recovered by May.

I had my operation for free in an Hospital in Portugal, and since I'm a blood donner I didn't even had to pay Hospital taxes :-) so for 0€ it can't get any better and I'm not really unhappy with the final result (not exactly "final", as I hope to be better 4 months from now).
If anything changes in my situation I'll report it back here.