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Too Many Surgeries!

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  • Too Many Surgeries!

    I have had 4 eye surgeries--including LASIK twice (12 years apart--see below), Cataract surgery, and Vitrectomy. My many problems started after the Cataract surgery, not after the ORIGINAL LASIK. The history is very lengthy, but I will do my best to summarize:

    I had Bi-lateral LASIK performed in 1996 for severe myopia and astigmatism (-10 diopters of myopia with 3 diopters of astigmatism). I did this because I could not wear contacts due to dry eyes (although I never actually felt any dryness back then) and I did not want to wear "coke bottle" glasses at 26 years old. For 12 years after surgery I was extremely happy with my results (never had any problems with dryness).

    However, for some reason, in 2007 my distance vision started to go practically overnight. I was told that my posterior sub-capsular cataracts (thought to be congenital) had grown and needed to be removed. Now in retrospect I question whether this surgery was truly necessary because I later found out that the cataract surgeon I was referred to has a reputation for being extremely "aggressive".

    At any rate, I had Bi-lateral cataract surgery in 2007 at age 37 with Crystalens accommodating IOLs placed. This is where all the problems started. Another thing I did not know at the time is that it is difficult to calculate the proper lens power for a post-LASIK patient undergoing cataract surgery. So what happened is that I ended up becoming Farsighted in the right eye after the cataract surgery with all sorts of other visual abberations. YAG capsulotumy was performed in both eyes but did not help at all.

    Since my Cataract surgeon is also a LASIK surgeon (but not my original LASIK surgeon), in an effort to try and remedy the refractive error created by the cataract surgery, he suggested re-lifting the LASIK flap in my right eye (that had been created 12 years prior) and performing LASIK. Yet another thing I did not know at the time is that apparently nowadays they do not do LASIK enhancements by lifting the flap; instead I was told that they would now use PRK. So in 2008 I ended up having the flap lifted and LASIK performed again in the right eye.

    With this 2nd LASIK (12 years after my original LASIK), the surgeon's goal was to make the right eye a -1 (slight monovision to help with reading), but I ended up a -3 in the right eye. Since the left eye is about a -0.50 (with 1 diopter of astigmatism), I now have a real big disparity between the two eyes (much more "monovision" than anyone would ever actually intend for--very confusing for the brain).

    In addition to the refractive problems, I also had an intolerable degree of "floaters" I started experiencing after the 2nd and 3rd surgeries. It was said that I had a large vitreal detachment in the right eye that was causing this (no idea how this happened in the course of events). To make a long story short, although it was considered "risky", the only chance I had to rectify the floater situation was to have a "Floater Only" Vitrectomy in the right eye--which I did end up doing in 2009 and it did help with the floaters.

    Since Fall of 2010, I have had intolerable dryness in both eyes and have tried all known dry-eye remedies to no avail. Although I never noticed any dry eye symptoms after the original LASIK in the 12 years before the cataract surgery, who knows if it contributed to a cumulative effect of all the surgeries. All I can say is that ALL of the above problems started only after the Cataract surgery and beyond. In terms of the dry eyes, what I have been told by a doctor who performs both LASIK and Cataract surgeries (yet neither on me) is that the "unspoken risk" of these surgeries is that they desensitize the cornea and destroy the feedback mechanism that sends the message to secrete tears.

    I wish I could somehow "undo" all of the surgeries, but unfortunately I cannot.

  • #2
    Dear Georgiav,

    Welcome to the site. I'm sure you'll find a lot of great info on here, in fact, it can be overwhelming.

    What have you tried so far for the dry eye?

    What is the reason for the dry eye (other than the surgeries)? Do you have a lipid issue (otherwise known as MGD) or do you have an aqueous issue? Finding out what TYPE of dry eye you have can be the key to a successful treatment.

    I struggled for a while wondering what I had, since so many people have LASIK and have no issues, but I found out that I have MGD, aka, a lipid issue. I am now addressing the issue and experiencing relief.

    Let us know some more specifics and perhaps we can provide some good feedback.



    • #3
      Dear Rose,

      Thank you for your kind words of welcome and interest. To answer your questions ....

      I have been given different diagnoses by different doctors--mainly evaporative dry eye and/or aqueous deficient (never MGD or auto-immune; I have had extensive blood work taken). I also know I have a very poor blink rate. Despite all the surgeries, there is surprisingly very little actual surface damage to my eyes. My symptoms are burning, foreign body sensation, blurry vision, and just feeling miserably "bone dry"--the constant pain I experience is excruciating.

      The many treatments I have tried without success include many OTC artificial tears, Oasis Tears Plus, FreshKote, Serum tears, Restasis, Liquid Steroids, Steroid Ointment, Liquid NSAIDs, Fish Oil liquid, compresses, cauterization of lower puncta, plugs in upper puncta, Jupiter scleral lenses, and custom moisture chamber glasses (after trying a few regular "moisture chamber" type glasses and not finding a proper fit for my small face). From all I have heard, I am pretty much out of options I believe.

      Thanks again,
      Last edited by georgiav; 09-Jan-2012, 18:57. Reason: Additional Info. provided


      • #4
        Hi Georgia,

        Evaporative dry eye is also known as MGD so it is possible your oil glands are clogged or just not functioning properly. Typical symptoms of MGD are similar to what you describe but I am not a doctor by any means, just a patient who has dealt with the burning, FB sensation and bone dryness!

        Find out from the doctor that you trust the most what your exact diagnosis is. If they can't tell you, find a doctor who can. From what I've experienced, most doctors don't speak to us in the most understandable terms - they either do not know themselves exactly what the problem is (dry eye is gaining notoriety but it is not the most studied of diseases unfortunately) or they don't think we are going to understand what they are saying.

        Side story: I was told in several different ways that I have MGD (I heard the terms "evaporative," "tear quality issues," and was also told that "plugs won't help you") but never outright told that I had MGD until I said, "What EXACTLY is my diagnosis?" I had to freakin' ask! Once I was armed with my precise diagnosis I could begin the search for answers, but without it I felt like I was in this state of eternally spinning wheels.

        Finally, I have learned that you can't assume you've tried everything. I trust that your diet is extremely clean (no fast foods or sugars and plenty of veggies) and that you exercise and get enough sleep? I don't see that you've tried oral doxycycline or Azasite? Most of what you have tried seems geared towards aqueous deficiency, not lipid or evaporative issues. You are definitely not out of options!

        Let me know,