Vision post-laser vision correction...does this mean what I think it does?

To make a long story short, my vision in my right eye (done with LASIK
18 months ago) is 20/25, uncorrectable to the vision in my left eye
(done with PRK 18 months ago), which is 20/15. The difference bothers
me. I have tried rigid gas permeable contact lenses, but don't
tolerate them due to dryness. I have no tear drainage due to punctal
cautery lower + silicone plugs upper. I have tried Restasis,
artificial tears, flaxseed oil and HydroEye and none of them make rgp
lenses tolerable. I have a wavefront error (coma 0.3) in the right
eye and I've been advised that a wavefront enhancement might correct
the right eye. However, the right eye has both myopic and hyperopic
components, so the surgery is not yet available (to my knowledge).

Now, I went to the optometrist today in hopes that maybe I could get a
very light prescription soft lens to at least make my vision more
tolerable. I'm not saying my vision is BAD. It is just annoying.
None of the lenses did anything for the blur near or far in the right
eye. This exam was done with dialation, so that means that I could
not accomodate in any way (right?). He said that I had no
prescription and therefore he couldn't do anything for me.

Since I still have this blur regardless of the lens, does this mean
the blur is entirely wavefront related? Or does it mean that I just
like annoying my doctors? I have ruled out dryness causing the vision
issues since both eyes are equally dry, yet I see great with one of my
eyes.

 

(Kathy) wrote in

Dear Katherine,

You say you have tried an RGP lens, but cannot tolerate it. However, does
it correct the vision problem? If so, then there are certain steps to be
taken to increase the tolerance.

Chances are that you have LASIK-induced higher order aberrations, for which
RGP lenses are the most reliable fix.

We can continue this discussion here, or you may email me privately.

DrG

 

Glenn -

Thank you. I did ask my optometrist to make my vision worse in the
left eye because (and I stressed this) the difference in vision is
what bothers me. He said that if he made my vision worse in the good
eye, I wouldn't have good vision in either eye. He wants me to have
good vision in at least one eye. I honestly don't know what to do...if
there is anything else that can be done.

Regarding the dryness...I don't know what else there is to try. I
have tried: lower punctal cautery, upper punctal plugs (still in
place), flaxseed oil, artificial tears, TheraTears Nutrition,
HydroEye, and Restasis. Supposedly the last two brought my Schirmer's
up from 3 in both eyes to a normal value in both eyes (10-13).
However, this regimen was costly at $90 per month, not giving me
enough tears to support the rgp lenses, not improving my vision, and
not making my eyes feel any different.

I tend to think that the HOA are the problem. My Schirmer's scores
were 3 in both eyes before the surgery and I never had any near vision
issues then. The fact that my surgical procedure was changed due to
suspected EBMD and I've read that this can cause people with this
condition who get LASIK to complain about vision quality problems.

I will welcome any suggestions you may have.

-Kathy

 

Kathy,

First, I feel for you. Sincerely...

I haven't followed this entire thread, but are you saying that you had
Schirmer's scores of 3 in each eye and that a doctor performed LASIK
despite this? Wow!! Glenn, I know we may not have all the facts, but
doesn't that surprise you?

Did you wind up getting the punctal cautery and plugs post-operatively, as
a reaction to further dryness induced by the LASIK??

I've got a bunch of eye issues myself that I wrestle with (high hyperopia,
astigmatism, accommodative spasm, alignment issues, _and_ severe dry eye
(also a 3 in both eyes with lower cautery and uppers plugged)). I've
looked into LASIK (for part of the refractive error), clear lens extraction
+ intraocular lens, and implantable contact lens, but I won't proceed with
any of them based on the information that I've seen: that all of them more
often than not result in decreased TBUT and Schirmer's.

Have you tried Lacri-serts? http://snipurl.com/8u04

I wish you all the best on this. In my case, I usually can't tell which
particular issue causes my eyes to hurt, but . . . on a windy day, or in an
air conditioned/heated building, I know how painful the dry eye component
can be.

 

(Kathy) wrote in

HOA's are indeed a problem. Most patients who consult me have zero or
little refractive error, and can be corrected to 20/25- with spectacles.
And yet, they fly or drive hundreds or thousands of miles to be rid of
higher order aberrations. The adverse effects of this are nearly always
underestimated.

I think that Restasis can help, or at least the vehicle can help. But, it
needs to be used for a minimum of 6 months. EBMD is almost always
accompanied by dry eye symptoms, probably due to the irregular surface and
poor TBUT.

DrG

 

I will welcome any suggestions you may have.


Try the only thing that truly works, and depends on your intelligence,
not on the stupidity of any doctors.
http://TheCentralFixation.com

 

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I had three consults before the surgery. One did not do tear testing,
one did the tear testing and I got 3 and 5. He wanted to do punctal
cautery about a week prior to surgery. The third did testing and I
got 3 and 2. He would have plugged the lower puncta on the day of
surgery. I told all three that I didn't have much problems with the
dryness, that I rarely use artificial tears, that I first recieved a
dry eye diagnosis at age 17 (I'm 35 now), and that I was intolerant of
contact lenses due to the dryness. I chose the second and had the
cautery. A few days later I wasn't noticing any change in the way my
eyes felt, so my doc told me to come on in. He looked with a slitlamp
and said that my tear film looked fine. I figured that I was a very
poor judge of how wet my eyes were. I believed him and went ahead
with the surgery.

The surgery went fine except that the dye marks sunk in too far on the
right (LASIK) eye and my cornea was fragile, so he switched to PRK for
the left.

I got a second opinion about the blur issue a couple of months after
surgery and I scored 3 on the tear test in both eyes with this doctor.

I have not tried Lacri-serts. Do they work for you?

 

Again, wow! I certainly am not a doctor, but from the research I've done,
a few things stick out:

1) 3-5mm on a Schirmer's test is pretty darned low. That's about where I
am, fully plugged (I'm 40. I think it also generally worsens with age)

2) as you know, Schirmer's is quantitative, not qualitative. The T-BUT
(Tear BreakUp Time) is a bit more qualitative. You can have a lot of
tears, but if you're not making the proper mix of aqueous, mucin, and
lipid, you can still have dry eyes. It may be that if your 'mix' is wrong,
plugs can simply dilute the mix further. This is what my corneal guy told
me.

3) PRK and LASIK are known to decrease TBUT and Schirmer's
(cause/exacerbate dry eye syndrome) in many cases

That's why I'm so surprised they would think you a good candidate for laser
refractive surgery.

Regarding the Lacri-serts: yes and no. They probably did more to thicken
and stabilize my tear film than anything else I've tried (drops, gels,
lubes, Restasis, etc.), *but* they did/do/will cause transient blurring.
With my accommodative spasm, that blurring just kept tweaking my focusing
mechanism so I stopped using them. You may want to ask your
ophthalmologist about them, though. They're very cool, reasonably priced,
and seem to take a great approach (also saving you from repeatedly using
drops during the day) toward managing dry eye.

Again, best of luck, Kathy.