Being sure its dry eyes and not something else

[Jeannie]

I'm almost 5 weeks post lasik surgery. Since day 1, I've had problems with blurryness in my left eye. The doctors have all said that its dry eye patches, and that in that eye, its right in the center of my vision.

I've had times where it gets better, and then regresses only a couple of days later. Right now, its bad, but we've started another protocol and I go in again on friday to see if there is improvement.

I worry, though, that maybe its something more than just dry eye. However, the one thing that makes me think it really is a dry eye patch that is just in the center of my vision is that when I put drops in that eye, for the couple of seconds after putting the drops in, I can see great, and then it goes away. I've had two days, for most of the morning on those two days, where my vision was very good out of that eye. Certainly, that must be due to the dryness getting better, right? Would there be something else that would cause that reaction when I put the drops in?

I'm also curious to know if there is anyone that had this problem at this point where it was eventually cleared up. I'm okay, as long I know there will be a point at which this blurriness will end!

Thanks,
jeannie

[Rebecca Petris]

However, the one thing that makes me think it really is a dry eye patch that is just in the center of my vision is that when I put drops in that eye, for the couple of seconds after putting the drops in, I can see great, and then it goes away. .... Would there be something else that would cause that reaction when I put the drops in?

This is a very frequently asked question amongst people with imperfect vision after laser surgery (whether temporary or long-term - and the former is more common than the latter, so please don't worry too soon!!).

Corneal surface irregularity will cause exactly the reaction you have to the drops. The reason is that the irregular surface 'bends' the light entering the eye so that it does not all focus nice & neat on the retina. This results in blurred vision. When you apply eyedrops, they temporarily smooth over the microscopic hills & valleys on the eye surface, creating a smooth refractive surface and immediately sharpening the focus. As the tears drain off, vision returns to what it was. Surface irregularity has a variety of potential explanations after laser surgery. It may just be a matter of time and healing. If you want to pursue this in more detail I would suggest visiting D'Eyealogues.

Note - I'M NOT SAYING that I think you don't have dry eye or that it isn't the explanation. I'm just saying that to the best of my belief as a layperson who's heard a lot of these stories over the years, the symptoms you describe are also perfectly consistent with other relatively common explanations.

[Jeannie]

Thanks Rebecca. I have visited the site you recommended, although I'm not sure what i"m looking for there. What I see is a lot of people with PRK post op isssues, and althought they might be similar, I just don't know. I also don't know what I"m looking for! I guess I'm looking to find out if what I'm experiencing is somewhat normal. And thank you for the explanation of what the drops are doing to allow me that wonderful spark of vision for those few seconds after I put them in! That makes complete sense to me.

I'm trying not to lose hope. At almost 5 weeks post op I just thought I'd be in a better place. And it may be that i'm a slow healer. I don't know. I think I'm just looking for some hope. I suppose I'm lucky in that I can't actually "feel" the dry eye right now. At least, not much. I'm afraid of what I'll feel when the nerves finally heal! The doctors keep assuring me that this is dry eye. They said that I'm measuring an astigmatism, but that its due to the dry spots causing the irregularity on the surface. When we can get the spots to clear up, the astigmatism will (or theoretically should) go away. What I don't get is why its not clearing up. I'm back on freshkote, and I'm hoping it will help clear this up. We'll see I guess. I had some improvement using freshkote a few weeks ago, but then took a turn for the worse so they took me off it.

I guess I'm just looking for some hope that there is someone out there that had this blurriness this early on, and that it eventually cleared up. I don't know if I have room for an enhancement later on down the road. I don't even care if I have to wear glasses for driving or watching tv or anything. But I'm afraid it is too early for that. I just wonder how much longer I need to wait until I will know whether things are going to get better or worse.

[Guest]

Jeannie

It may be really early days to even suggest this but I found that at 3 months I couldn't deal with the fuzzy vision anymore so I invested in a set of replacement lenses for my previous glasses frame, this was the cheapest option but it gamve me my pre laser vision back (pretty much, except for the new starbursts and halos).

My dr seems to think it is totally acceptable to have some residual or induced astigmatism/sphere up to -1.0. I ended up with -0.50 so I guess I am in their threshold but the difficult thing with astigmatism is that if you didn't have one before hand, it can take some getting used to.

I just hate my fuzzy vision and due to an abrasion on 15 October, my vision now is nowhere near as good as it was before the abrasion ocurred. I started with an astigmatism at 3 months of -0.75 that reduced to -0.25 at about 9 months post op. I am hoping that I will get back to my -0.25 or better in the next few months as my right eye (worst eye and recurrent corneal erosions) heals.

I fully understand your frustration with this blurry vision, but my best advice is to discuss the results of your research with your DR, go armed with some of Rebecca's suggestions and some of the reading you have done. They can only palm you off for so long, and sooner rather than later, you will get the answers you seek.

It is my opinion also that you need to play an active role in the treatment plan. I have no issues discussing options and treatments with my DR. Sometimes he dismisses me with "where did you hear that" but sometimes he responds with "we have nothing to lose, lets try it". He is extremely open and very inclusive, I am very thankful for the relationship I have managed to establish with this DR.

It is a tough place to be but I am sure time will be the healer for all of us. It is just a frustrating journey that we have embarked upon.

Take care and I wish you well
Ian

[kaypeeoh]

How about a no-prescription soft lens? Focus Night and Day makes a plano soft lens that I used after PRK. Being a soft lens it kept the cornea lubricated as it healed.

[Rebecca Petris]

They said that I'm measuring an astigmatism, but that its due to the dry spots causing the irregularity on the surface. When we can get the spots to clear up, the astigmatism will (or theoretically should) go away. What I don't get is why its not clearing up.

Y'know, I'm realizing I've been very stupid not to ask a more basic question first:

Do corrective lenses correct the vision in that eye? I mean when they are refracting you (the "Better 1, or better 2?" test) is there ever a lens that completely clears up the vision in that eye? - I'm guessing no based on everything else you've shared but it would help to make sure. If no, then the astigmatism they're talking about is probably irregular astigmatism (which is another way of saying what I've been saying, surface irregularity).

[Jeannie]

Ian,

Thank you. I have thought about the corrective lenses to help me, but I worry about when I should invest in that. Should I do that now, or wait? Things seem to change so much from day to to day. For example, yesterday was a particularly bad day. My vision in the left eye was awful, and I had a headache most of the day. Today, its MUCH better. Would I still like corrective lenses? Yes, but today its manageable and I could certainly do without.

I actually really like the doctor I'm seeing. I'm seeing the doctor (not the surgeon) from the place that did my procedure. I know that the surgeon and doctor are highly regarded. The doctors that put in my plugs said that if they were going to have lasik done, there would be no question that they would go to the doctors I have gone to. So that makes me feel good. My doctor, like yours, is very open to questions, open to the things I've brought up to her, and I certainly will talk to her about the things that Rebecca has mentioned.

Rebecca, as for the refractive tests, and whether or not i see better when they do them. Actually, there is some improvement. I'd say by 50% or so. Its still not as "crisp" as the other eye, but its definitely better than what it currently is. I would not be surprised to have a residual astigmatism in that eye from the surgery. And actually that wouldn't bother me. I think its the "degree" to which I have which will bother me. I had very realistic expectations going into this surgery, I believe. I wanted to eliminate my dependency on glasses/contacts. However, one of the things I had said (to the doctors and myself) was that I would be happy if I even got to where I only needed glasses to drive and watch tv. That's not a big deal to me at all. So if there is a bit of astigmatism in that eye, I can deal with that. However, if I were live day to day like it was yesterday, I honestly don't know how I could cope! LOL! If glasses wouldn't help that, I would be in a bit of a bind!

I guess that's why I'm so focused on trying to figure out whether things will get better. I can live with how I'm seeing today, but can't live with how I was seeing things yesterday.

You both, Ian and Rebecca, have been a tremendous help to me. Thank you for bringing all this information and your thoughts on my sitatuion to me. I appreciate it more than you'll ever know.

[Guest]

Jeannie

Both Rebecca and I have had laser surgery (different versions Lasik (Rebecca) vs Lasek (me)) so it is my opinion that by discussing my own experience with others may be able to help you and others work through their challenges. Rebecca has a wealth of knowledge and I also appreciate the information she has shared with me.

It is my understanding that if your post operative vision is corrected through a standard refraction, then your astigmatism may be regarded as regular and therefore can be corrected with standard glasses, if not, then you may have an irregular astigmatism and this is a whole different ball game.

The induced astigmatism in my left eye is considered as regular (ie, it is on one axis) and therefore, my specs fix this really crisp and clearly, however, my right eye (due to the recurrent erosions) has resulted in an irregular astigmatism (on two different axis) so therefore, specs correction doesn't sharpen this eye as good as the left but it is still within tolerable limits.

It is again my opinion that you are over one of the major hurdles when you have a doctor you are comfortable with and can discuss different treatment options - this certainly wasn't the case for me in the first 6 months - one DR told me that if I was an NHS patient he would have shown me the door (the same DR said you can't have DES you are crying and have loads of tears), even when I presented 3 times in 2 weeks with recurrent corneal erosions.

At three months my vision was pretty stable (although it did sharpen up even more (except for the abrasion incident)).

My Dr simply looked at my history of refractions and we agreed on one (he put it into a temporary frame) that was the most consistent. Not exactly rocket science, probably not the best way to conduct an eye test but it gave me acceptable vision that allowed me to continue a relatively normal life - sure it wasn't as good as it was before the surgery but it was a heck of a lot more manageable than my fuzzy vision.

I get through most days now without glasses at all, I just find that in flourescent lighting and low lilghting that things go a bit fuzzy but this could be normal - I don't know what is normal anymore.

Again, I wish you well. I wouldn't be rushing into the glasses (afterall the surgery was designed to reduce your dependence), but I think there are a number of people that go through quite a few sets of glasses in the first year post op - afterall, you have a life you need to get on with, and you may just need a temp pair of glasses to help you achieve that.

Take care

Ian

PS. Another one of those horrific advertisments on TV promoting laser surgery and "perfect vision" as I signed off on this post. Makes my blood boil everytime I see them.

[Lucy]

Funny thing, Ian. Prior to lasik, I only needed one pair of glasses which were progressive bifocals. After lasik 7 years ago, I've probably had a dozen pair of RX glasses, a dozen pair of OTC reading glasses, two pair RGP's. One $800 and one $8,000. Plus Panoptx goggles with RX=$500 and various other sundry eye stuff. Tranquileyes, drops by the barrel, trips all over the US.

This is not meaning that Jeannie will have anything remotely like this. Jeannie will probably heal and do just fine within the next few weeks and/or months. Or possibly with a pair of glasses.

It is a reality, however, that with one time lasik, I've gotten into a whole plethora of eyewear. Something I never dreamed possible. Now-if I can find that magic spaceship and transport back to January 2000, whoosh, I'm normal again.