6 Months post Epi-Lasek. Induced dry eyes

[neil0502]

Ian-

What's the old story about baseball pitchers (or other athletes) and their routines -- lucky underwear, strange rituals, and all that??

If it's working ... I say go with it (always being cautious about side effects and interactions, though).

I'm happy for you. I'm envious of you. I'm smiling vicariously from the relief you're feeling. I hope it only gets better!

Neil

[shells]

Hey Ian!

I second everything that Neil said! I also agree to keep up the routine for a while, just to make sure. So glad that something is helping though! I do have a feeling that maybe this is some of the natural healing going on...maybe your new routine just helped speed the process! Either way, great news, and thanks so much for keeping us updated! It is always so nice when people do that. Someday some lasik newbie is gonna find tons of encouragement from your post, so PLEASE keep the good news coming!!!

-Shells

[Missy]

Hi Ian!

I am so glad to read that you are getting some relief!
Please keep us updated on what you think is helping the most.

Missy

[Guest]

Spoke too soon!!

Well, so much for the improved recovery, it seems that I have hit yet another low spot with my DES. I can't believe how much my life can change from 1 day to the next, obviously I spoke to soon.

Here I was accepting that I wasn't cured but I was at least on the right road, well it seems that I have taken a detour as my symptoms seem to have gotten worse again.

My left eye feels a lot better than my right, but it seems that a lot of you have similar issues.

My bottom right lid margin gets quite red and I get the odd bump on the lid. I think this is a blocked gland but I find a heat pack and some massage usually gets rid of it quite quickly.

Last night was a dreadful night - I tried using just Dwelle alone. I think that it is a little premature of me to think that it is all I need at the moment. I woke several times, reapplied Dwelle but woke around 3:00am with my eyes were on fire - extremely dry and buring. Will go back to the Genteal Gel for now and will try the Dwelle again in a few more weeks. I am not a quitter.

I started on Thera Tears Nutrition today instead of my Omega 3 fish oil capsules. I don't expect any miracles but have read some positive feedback on them.

I am trying to concentrate on using just 1 or 2 products as mixing/chopping and changing can't be good for my eyes (or my bank account).

I have been on Restasis 6 weeks today. My DR said I wouldn't notice any significant change overnight but would notice a gradual improvement over time through the use of less drops.

This seems to be the case except for when I am using my computer I still reach for my drops (Blink and Endura) every couple of hours. I have installed a blinker to remind me to blink and to use my drops. Have quite a routine going now.

I am no longer using Celluvisc as I found that it clouded my vision for about 15 mintues after instilling it and seemed to leave a crusty residue.

My DR was insistent that I stop using Systane (not sure why as I liked it so I will ask again next week when I go back).

When I read back over this it is no wonder that I have good days and bad days with the amount of products that I have put in my eyes over the past couple of months.

I am wearing my glasses again when using the computer as I find that it helps with strain and I don't stare as much. They are Plano but correct my astigmatism (which changes regularly) but is currently:
L - Plano X -0.50 / 180
R - Plano X -0.75 / 30

I see my DR again next week so will keep you posted on my progress and thank you once again for your encouraging words.

Regards

Ian

[SusieD]

Sorry to hear about this blip - might just be a rough patch. I did the same as you at first - used all kinds of drops and kept chopping and changing, your eyes must wonder what the heck is going on!

Now I just stick to two - one for daytime use and other only at night.

I also relate to the one eye feeling worse than the other - this is often the case with me too.

[neil0502]

They are Plano but correct my astigmatism (which changes regularly) but is currently:
L - Plano X -0.50 / 180
R - Plano X -0.75 / 30

Ian,

I'm so sorry you're back. You know what I mean.

This last statement of yours ... "changes regularly."

It does? Why?? Sounds to me like you have astigmatism ... that you're trying a little too hard to "clear" using your accommodative mechanism.

Have you had a recent cycloplegic eye exam, where they dilate your eyes?? They need to get YOUR focusing muscles out of the way, then accurately determine how MUCH astigmatism (and at what axis) you REALLY have, then prescribe that in your glasses.

With cycloplegia, they may also find out that you have a touch of nearsightedness or farsightedness.

Whatever they find with cycloplegia SHOULD help lead them to a more accurate and stable glasses prescription that MIGHT help take away SOME of your symptoms.

You could be feeling eyestrain ... in addition to whatever else you have going on.

I'm sorry you're struggling again.

All the best,
Neil

[Guest]

Yes - I am Astigmatic

Neil,

Thanks for the advice, I will ask the DR when I see him next week about the test that you mentioned.

I have no residual prescription in the Sphere it is the Cylinder that keeps changing and one doctor suggested that it can change anything up to 0.5 of a diopter due to dry eye conditions.

I have had 3 different doctors do a refraction and all 3 have come up with 0.50 on the same axis but I find that this varies due to the condition of my eye and the time of day.

I find the astigmatism very frustrating as I had -0.25 Astigmatism in my right eye prior to surgery and none in my left. I had no issue accommodating it with contact lenses.

I find now that I am not only trying to deal with Dry Eye but I am also straining to focus with this Astigmatism. The glasses help but under certain conditions their effectiveness changes.

I find the glasses help as they can allow me to get on with my work and not have to worry too much about the focus issue.

The doctor has suggested that they may be able to correct the residual astigmatism using AK (provided it is more than 0.75) but I am very concerned about having any further "procedures" done, I feel I have done enough damage to my eyes already, however the dangling carrot (AK) held in front of me is very tempting. I am very much on the fence at the moment.

I intend to discuss this with my Dr next week and will let you know how I get on. I certainly won't be having anything else done without lots of questions and reasonable answers from a number of sources. I have already made 1 very big mistake and I am not about to compound it.

Cheers

Ian

[neil0502]

Wow, Ian. That's weird ... at least to me.

I looked for a minute to see if I could understand what would explain that ... that is IF your accommodative mechanism plays NO part (which cycloplegia would determine).

I found a couple of links that helped me understand a bit better:

By the way: all roads lead to Steve Pflugfelder, in Houston, TX....

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

Look, Ian ... I don't know anything about anything about this, but (and I think I'm preaching to the choir) ... be very, very cautious about additional surgery at this point.

Have you ... or your doc's ... ever heard of this???

http://www.firstcolonialeyecenter.com/content.htm

I just heard about it today. Can't recommend it, per se, but you may want to look into it yourself as "among your options."

Best of luck to you. Like many of us: I think I feel your pain (and frustration).

Neil

[Guest]

Neil,

I may have confused the issue, the only time I recall having a cyclopegia test was just prior to my surgery.

Each DR has just done a refraction (better 1 or 2) type test. On my next visit I will ask for this test.

All three DR's said that I had some evidence of dryness during the examination. Two of them explained that dry eyes can contribute to a change in astigmatism as the eye swells (or something like that) and this change is usually limited to -0.25 to -0.50 of a diopter. This seems to support how my vision feels from day to day.

Thanks for the info on Supralase, I am absolutely certain that I am not having any further laser surgery - that goes without saying.

The procedure suggested is AK which I understand is similar to RK but differs in the sense that only 1 meridian is corrected. The Dr said they make two micro incisions in the cornea to flatten it.

As I said, I will be giving this a lot of consideration before I consent this time as I feel that I need to get this dry eye condition under control first before anything else is considered.

What I find so frustrating with my vision is that I just looked outside and everything is crisp and clear yet I struggle to focus on my computer screen and the documents on my desk.

I am certain that I have no residual Sphere as I can see everything, just nothing is sharp at any distance - my glasses fix that (most of the time).

I now have lots of questions for my next Dr's visit.

Again thanks for your time, I will have another read of the links and will keep you posted.

Regards

Ian

[indrep]

Neil,
There are two places astigmatism can occur, the lens or the cornea. Lenticular astigmatism is your lens inside the eye. This tends to be stable. The second and most common astigmatism occurs on or from the irregularities of your cornea. Dry eye causes your cornea to "move" look ing for nourishment. Think of how plants grow toward sunlight. Your cornea will swell in a dry area looking for moisture and nourishment. As long as you have dry eye you will never be able to eliminate the astigmatism. I am familiar with a practice that took ten patients with dry eye and had them come in on the same day of the week and at the same time of day. He performed corneal topography on these patients and their topographies were never the same. The steep axis of astigmatism was different every time. I am sorry that is not better info but it is what it is. You could over several refractions narrow the axis down to a general area and have your glasses made with the astigmatism corrected on the median axis.

As far as AK surgery goes there is a system available that makes the procedure very safe and predictable on normal corneas.

[neil0502]

Thanks, indrep. Good explanation.

Only issue with the plant analogy, though, is that plants--even succulents--need at least a little moisture

I've got nearly 2d of astigmatism in each eye, so ... even if it's variable as all get-out ... it's sort of buried in the rest of the "optometric noise."

Whaddyagonnado.....

EDIT: It *does* make me wonder, though, whether an RGP (for any who could wear it) might help with these (rather KC-sounding effects) of the dry eye....

[Guest]

Been to the Dr - Good news I think???????

I have just returned from my Dr appointment and feel encouraged by the outcome.

Today just happens to be the 8 month anniversary of my original Lasek procedure, pitty it wasn't tomorrow, I would call the surgery and cancel but we all have perfect hindsight vision.

I put in Restasis at 7:30 this morning and saw the Dr at 11:30 with no drops in between (4 hours must be a new records for me), whilst my eyes felt a little dry and irritated, he did comment that my corneas looked healthy with no dry spots.

We have both noticed a minor increase in tear film since starting Restasis 6 weeks ago but it is not quite enough to get me out of the woods just yet, so he decided that I would benefit from another set of temporary punctul plugs (Oasis Medical - Extended Duration, last approx 90 days, absorbable)

I must admit that after the plugs were put in my eyes felt quite good for about 3 hours (could have something to do with the local anaesthetic), however I have just put in my first drops for the day at 3:00 after fairly hefty computer use.

I decided that there wasn't much point addressing the prescription issues just yet as my priority is to get this DES manageable.

I am absolutely certain that I am seeing the right Dr for me. I left with the confidence that he is doing everything he can to find a workable solution fo me.

I will continue to be positive and I just hope that I will be jumping for joy when I leave his office after my next follow up visit.

Again, thanks everyone, I will keep you updated.

Regards

Ian

[Lucy]

My 2 cents here--since I haven't posted on this thread.

I've been saying for years "it's the color of socks you're wearing on any given day that influences whether your eyes feel good or not." It makes as much sense as all the stuff we do to try and feel better. Ian, go out and buy some new socks.

[Guest]

Matched or unmatched??

Lucy,

Off to the shop to buy new socks then. I am going to insist on an unmatched pair becuase it seems that what I do for 1 eye just doesn't work with the other.

I might have better luck with your suggestion.

Have a great day
Ian

[Guest]

Update

Hi folks

Thought I would post an update on my progress.

I have been putting off posting as everytime I post an update, I seem to have a flareup fairly soon after.

Since my last post, the only major change is that I have been on a course of steroids (10 days). This really helped to clear things up, although since stopping them, I think that I am reverting back to where I was.

When using the steroids, my eyes felt quite good, although they usually went quite red (particularly near my nose) for about an hour after putting them in then they cleared to nice and white.

I was also quadraplugged, I only had bottom plugs previously. They are the Oasis 90 day dissolvable ones.

I am still taking lots of time off work - but when I do work, I manage to spend more time in front of the computer now than I have for a long time. I am still using AMO-Blink and Systane but have noticed that I am using them less often.

On my last visit (a week after steroids and being quadraplugged), my DR told me that my TBUT was quite good and that I had a very small tear meniscus. I was so excited about this as it was such an improvement on previous visits.

One thing that I have noticed is that every now and again, I am conscious of the moisture in my eyes, I can feel them being moist. I have also noticed that the constant burning sensation has largely gone.

I still have my good and bad moments, I find that I have to be really careful when showering that I don't get water in my eyes otherwise everything goes horribly wrong for about 1 - 2 hours.

When having a bad time now, I remind myself of what I was going through a few months ago and it soon puts everything into perspective.

My routine is as follows:
- Restasis morning & night
- Systane/AMO-Blink as needed during the day
- Genteal Gel and Tranquil Eyes of a night
- Theratears Nutrition

So thanks to everyone for your continued support.

I am sure that I can attribute at least some of this improvement to the new pair of socks (unmatched) that Lucy suggested I buy.

Have a great day

Ian