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Third PRK Surgery


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#1 mwhdev

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Posted 30 June 2010 - 01:03 AM

I have been a lurker in these forums since I was educating myself on the pros and cons of laser eye surgery. I am posting this because I have not seen many cases like mine. My initial prescription was: OD -3.75 -0.75 OS -3.50 -1.50 In January of this year I had PRK (ASA) in both eyes. My right eye ended up at +0.50 -0.50 but my left eye was overcorrected to +1.25 -0.25. After my vision stabilized (about 3 months) I had a PRK enhancement of my left eye. My left eye is now -1.25 -0.37 with some star bursting at night. I have gone to my regular surgery follow-up exams and my vision has been “co-managed” by my O.D of many years. Both doctors say my eyes are healing well and there is no scarring or haze. My corrected visual acuity is 20/15 in both eyes. I am currently using a contact lens and Xibrom in my left eye to encourage some regression. I am contemplating having a second enhancement (third surgery) to address the myopia in my left eye. I went to a well known and respected M.D. for my surgery. My O.D. is confident in the MD’s skills and opinion and has done many laser eye surgery evaluations / referrals so I trust his opinion. In discussions with my M.D. I have plenty of cornea left (over 400) for the second enhancement and the biggest risk is infection. (I understand that “enhancements” have the same risks as the initial surgery.) I was told the reason for the overcorrection and subsequent undercorrection was due to my healing response. From what I understand I under-respond in my corneal healing. The M.D. is confident after the two previous surgeries they can predict my healing response and get to plano or very close and also address the HOA causing the star bursting. Questions / Opinions: :confused: Should I leave my left eye as is and just continue to use a contact lens or should I see this through and have the third surgery? Are there other alternative procedures I should discuss with my M.D.? Thanks for your responses!

#2 amsco15

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Posted 30 June 2010 - 08:28 AM

Just my opinion based upon my experience: DO NOT HAVE ANY MORE SURGERY. The surgeon cannot predict healing and surgey does not reduce HOAs. If you are correctable to 20/20 or better with standard glasses and contacts, you have won the lottery. Also, your -1.25 will come in handy for reading in your late 40s.... If you ask me, that is a nearly perfect result. Dale

#3 Rebecca Petris

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Posted 30 June 2010 - 10:03 AM

How old are you?

Which is your dominant eye?

My overall opinion without knowing the answer to those is, Leave it alone. Re-doing it once, I can sort of understand, but re-doing it twice when you had such a low prescription to start with does not make sense when you're so obviously having an unpredictable healing response. Overcorrection into plus, overcorrection into minus (or regression?) and starbursting. What is next for your left eye? Do you really want to find out? Chasing perfect vision in refractive surgery is a serious mistake.

Every additional time you go in with a laser you are jeopardizing that beautiful 20/15 corrected vision. It is not fun (take it from one who knows) to lose the ability to get clear, crisp vision even with glasses.

I also think you should read the stories of people here whose vision changed at a point much later than 3 months. It is not frequent but it does happen a lot. It is entirely within the realm of possibility that if you had left it alone at 3 months, it would have changed further afterwards. That may happen now in the aftermath of the second surgery. You are chasing a moving target. And even with the very best possible outcome, where you get yourself to 20/20 without glasses with a third surgery, it's not permanent anyway. It may change one, three, five or more years down the line - and your left eye will have had three surgeries already. What will you do then? More surgery?


I am contemplating having a second enhancement (third surgery) to address the myopia in my left eye. I went to a well known and respected M.D. for my surgery. My O.D. is confident in the MD’s skills and opinion and has done many laser eye surgery evaluations / referrals so I trust his opinion.


I trusted the opinion of my excellent optometrist and well respected corneal specialist laser surgeon. But if trust were enough, you wouldn't be here asking questions :)

...the biggest risk is infection.


That's not true. Sorry, but medical literature does NOT bear that out. Statistically, well, I can't give them in the correct order without going and digging up the studies, but undercorrection, overcorrection, poor vision quality (ghosting, starbursts, poor contrast, etc)... THESE are top risks of retreatments - plus the NOT negligible risk of haze that accompanies all surface ablation procedures. Don't forget - what surgeons call a "complication" or risk is NOT what you or I call it. To them things like poor vision quality are side effects, not complications. It's an important distinction.

From what I understand I under-respond in my corneal healing. The M.D. is confident after the two previous surgeries they can predict my healing response and get to plano or very close and also address the HOA causing the star bursting.


And... did your surgeon not feel that way when performing the second surgery? If he didn't feel that way, why did he perform it? Is your third surgery going to be just another step in the learning curve of how your unique corneas respond?

Sorry to be so negative, but your post really touched a nerve. If you're feeling very strongly about going through with this, then my best advice is this:

1) WAIT ANOTHER THREE MONTHS. Your vision may change more, I don't care what the doc says - this community is ample proof of slow changes after PRK. Also, a cooling-off period wouldn't hurt. A lot of people get caught up in this thing in the first six months after surgery - gotta get it just right. You lose NOTHING BY WAITING.

2) While you're waiting - or if you're not willing to wait - Go find a couple of refractive surgeons who are corneal specialists, make it clear that if you have more surgery it will not be with them so they have no financial incentive beyond the consultation fee. Give them your records, have them examine you, and ask them simply to give their opinion about whether more laser surgery is a good idea for that eye.
Rebecca Petris

#4 mwhdev

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Posted 30 June 2010 - 10:39 AM

I am 44, left eye dominant. If this was not my dominant eye I would not be considering the third surgery but without the contact lens I really feel unbalanced and I get headaches. The M.D. is not pressing me to have the surgery but he wants me to be satisfied. He has even mentioned that at -1.25 I am in a great position with Presbyopia coming down the road. I just rely on my left eye for distance. I would prefer needing glasses for reading over needing glasses for distance. I plan on getting a second opinion or two and I am not in a big rush to have the surgery. Thanks!

#5 Rebecca Petris

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Posted 30 June 2010 - 12:32 PM

Totally understand. What a shame, if only it had been the right eye that was minus, you'd have a near perfect monovision situation for approaching presbyopia. Sorry this happened to you. Anyway, best of luck with your quest & decision. Just to toss out another option, have you considered wearing a single contact lens? It might be worth just trying this for a few months to give yourself some time to consider all options.
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#6 mwhdev

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Posted 30 June 2010 - 12:38 PM

Thanks. I have been wearing a single contact for about a month. I will update this thread as things progress.

#7 Rebecca Petris

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Posted 01 July 2010 - 09:32 AM

Oopsie... you already mentioned and I completely overlooked it :o Do let us know how you progress. Wishing you good continued healing.
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#8 msto

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Posted 05 July 2010 - 10:54 AM

I would say to anyone considering laser surgery for anything other than medical necessity, don't do it! In 1989 I wanted RK and my doctor at the time wouldn't do it; he said "why would you cut into a perfectly healthy cornea?" I was bound a determined to shed the contacts and glasses & found a doctor who did the procedure. I was nearsighted; 20/400 before, and 20/20 after. For about 15 years my vision was perfect. Then it started fluctuating and I couldn't get one prescription that I could wear throughout the day. I became hyperoptic and had to carry about 3-4 different strengths of readers to accomodate the vision ride of the day; needed them for distance and reading. After a few years of frustration a doctor told me he could reel in the fluxuation and vision to a more normal bracket with PRK. I thought about it for a long time and finally went for it. Before doing the procedure he checked my vision a couple of times a day; three or four different days so he could see the range of fluxuation before the surgery.....which I had 5 1/2 weeks ago. I'm MISERABLE! I went from hyperoptic to myopic; now wearing a -2.75 in each eye while they completely heal. My right eye hasn't changed at all, and my left has changed slightly. It's insane. For now I'm so sorry I went through with it. And even MORE sorry that I had the RK years ago because they've found that many years later RK becomes unstable. There hasn't been enough years with all this laser surgery to really know any long term issues. If it weren't for the contact lenses I'd be totally screwed right now. After 5 1/2 weeks I feel I should be seeing some improvement. Now I'm just nearsighted and still dependent on contacts & glasses. The doctor tells me they won't really know where it's going to be until three full months have passed. Then, if necessary, he can do a "touch up". Honestly, I don't think I'll do anything more to these corneas. Common sense tells me it just can't be good. I wish I wasn't so "trusting" years ago, and had exercised a bit more "common sense" then. With everything, right now the only vision that is 20/20....is my "hindsight" :(

#9 Rebecca Petris

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Posted 05 July 2010 - 09:24 PM

msto,

Welcome. I'm sorry to hear your story.

Much as I tend to question things refractive surgeons say ;) your doctor is right and if anything 3 months is conservative. PRK even on a virgin cornea can take many weeks, and even many months, to stabilize. This bulletin board is full of people who didn't get their "final result" until months after surgery and while that's not "normal", it's not extremely rare either. When you add RK to the mix... it exponentially complicates things including the remodeling process of the cornea after surgery. If I were getting PRK over RK I'd be expecting a good six months before I started judging the result, just based on the people I've known and people who have posted here about these complex multiple-type surgery cases.

There hasn't been enough years with all this laser surgery to really know any long term issues.


I agree. - Although actually even with LASIK there's been enough to know a fair amount BUT that amount does not get publicized or communicated properly to new customers (I mean candidates).
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#10 mwhdev

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Posted 04 September 2010 - 07:24 PM

I went to and got a second opinion and it was in-step with what my surgeon had recommended. My eyes are healthy and plenty of cornea (485 at center). I had my surgery on my left eye yesterday. I did have some pain it has been the best post-op for me yet. Very little light sensitivity or tearing. I read 20/30 in the eye this morning with some effort at my follow up appointment. I have the expected day 1+ blurriness but the HOAs really seem to be reduced. I know it is early but I am encouraged! Now I have to wait 3 or 4 days to get the bandage contact removed. I will keep this thread updated as I move along. Let me know if you have any questions.

#11 Perception

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Posted 05 September 2010 - 04:34 PM

Good luck with your recovery

#12 prkgirl

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Posted 16 September 2010 - 09:10 PM

Looks like my two cents is too late, but maybe it will help someone else. It sounds to me like perfect vision is difficult to obtain from surgery. In your situation you said that you could be corrected with contacts after your surgery. For me, my post-surgery prescription is too low- I can not be fitted with contacts to get my best vision. I can only wear glasses to correct the little bit of astigmatism and overcorrection that remains. Also because of the new shape of my eye, I can no longer wear a toric lens. It just won't sit right. My recommendation on enhancements to get you closer is don't do it. If you enjoy having the very best vision you can, you may always want a prescription of some sort- and getting too close to plano can give you vision that is not quite perfect, whereas glasses usually can correct.

#13 mwhdev

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Posted 22 September 2010 - 06:34 PM

I have experienced more "variable vision" this time around. In the mornings my vision is best and it degrades throughout the day. I also have noticed if I blink my vision blurs and then well get sharper then blurs again. I also have a definite ghost image. The HOAs I had before surgery number three seem to be reduced. I had a checkup today (19 days) and I am at 20/40 (20/15 through the pinholes). During the vision exam there was not a setting (prescription) that made any big difference in my vision. The doc said that is a good sign and that the blurring is coming from the healing / irregular epithelium. The slit lamp exam revealed that there is some dryness and the "variable vision" issues I described were consistent with mild dry eyes. They inserted a temporary punctal plug that will dissolve in about a month. It still is early but I am seeing progress!

#14 mwhdev

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Posted 22 February 2011 - 07:14 PM

Time for a follow-up! Today after six months I am -1.00 with .75 astigmatism and I see 20/25 (really 20/20 -1) in my left eye. Since I last posted decided to go "reverse" mono-vision (I am left eye dominant) and six weeks ago I had "standard" PRK on my right eye to tune it for distance and today I am 20/20 PLANO! So hang in there people... I can read 20/15 -1 with both eyes. To sum it up: Left eye: PRK - 01/10, 04/10, 09/10 (today 20/25 @ -1.00) Right eye:PRK - 01/10, 01/11 (today 20/20 PLANO) I hope this offers some support with those doing PRK it is a long haul! Drew

#15 sam01

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Posted 22 February 2011 - 11:52 PM

Hi Drew...I'm a little confused... from what you said you were left eye dominant. You went from being originally nearsighted to +.50 -.50 astig in the right and overcorrected to +1.25 -0.25 left eye. if your desire was to use your dominant left eye for distance and maybe wear glasses for reading why did you have the second surgery? After the second surgery your left eye ended up at -1.25 -0.37. That took you back to nearsighted. You were unbalanced and had headaches so you had the 3rd surgery which didn't really help you that much as you ended up still -1.00 nearsighted but with more astigmatism. It's great that your plano in the right eye but it's your dominant eye that needs to be + if you want your distance...right?. Question: Im 48 and 6 months post bilateral lasek sept 2010... had bilateral lasik 2001. We're kind of in the same boat in that I prefer to be farsighted and wear readers for near. I'm pretty much now plano with .50 astig both eyes. Because I still have dry eye my vision still fluctuates but my doc said I'm at 20/25. I would really like my left eye (dominant) to go back to + just a bit to give me better distance. Do you feel that you're seeing 20/20 distance... really? Did wearing the contact lens help you to regress? Are you happy with the -1.00. Thanks for sharing your update Drew... :)

#16 mwhdev

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Posted 04 March 2011 - 11:23 AM

Sam01, Sorry for the late reply. Yes, if I wanted traditional mono-vision I would want my left eye for distance but after three surgeries I was still nearsighted in my left eye and my right eye was good for distance but not quite where I would want it. I have had some form of what I call "reverse" mono-vision since my second surgery on my left eye and I have adjusted to it. I do see very well now both distance and close-up. I do have more astigmatism in my left eye than I want but it is not enough to make a major impact to my vision and I do not want to consider a fourth surgery in that eye. I am happy with my vision and my right eye will continue regression toward farsightedness. The way I think about it is that you see with your brain and the eyes provide the "data". I don't think the contact really helped all that much but one thing I did use this last time was Muro128 at night and I believe it made a difference in the healing speed. Any more questions?

#17 Indept

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Posted 04 March 2011 - 07:39 PM

Sam01,
I am happy with my vision and my right eye will continue regression toward farsightedness.


mwhdev,
I am glad to hear that you are happy with your vision & wish you the best of luck with healing. Just wondering, why do you expect your right eye to regress toward farsightedness? I too have had 3 prk's on my right eye with similar results as you, Initially nearsighted, about 20/50, then VERY farsighted after PRK 1, then about - 0.5 after PRK 2, now after 1 month after PRK 3 (and all done with steroid drops) I have excellent vision 20/13. I too am very happy with my results & hope my eye doesn't change from this point on.

#18 mwhdev

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Posted 07 March 2011 - 12:01 PM

mwhdev,
I am glad to hear that you are happy with your vision & wish you the best of luck with healing. Just wondering, why do you expect your right eye to regress toward farsightedness? I too have had 3 prk's on my right eye with similar results as you, Initially nearsighted, about 20/50, then VERY farsighted after PRK 1, then about - 0.5 after PRK 2, now after 1 month after PRK 3 (and all done with steroid drops) I have excellent vision 20/13. I too am very happy with my results & hope my eye doesn't change from this point on.


Just my history, I tend to 'float' back to my pre-surgery numbers. I am still at plano and I may stay there ... no complaints!

#19 Blended_Vision

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Posted 03 May 2012 - 12:03 AM

Hello, I am very intrigued by this post because I also have what you are calling "reverse mono-vision." I had PRK (ASA) about 13 months ago, followed by an enhancement a month ago. In the first surgery, the surgeon did what he calls a "blend." The intent was to fully correct my dominant (left) eye, and undercorrect the non-dominant (right) eye by about -1.00 or -1.25, to lessen the effects of presbyopia. However, the left eye didn't heal as planned, and I wound up with two undercorrected eyes. A full year after surgery, the left eye was between -.75 and -1.00. Since my resulting vision wasn't adequate for distance, I went back for an enhancement. Before having the first surgery, I was not very familiar with the whole concept of the dominant vs. non-dominant eye. I'd thought it very strange when told that my left eye was dominant, because that was actually the weaker eye, prescription-wise. The idea of having a stronger left eye felt "wrong" somehow, and post-surgery, took some getting used to. When I went back for the enhancement, I had them fully correct my right eye -- thinking, good, this is what I've been used to my whole life -- my right eye will be stronger again. So they did. I have "HDTV" vision now in the right eye - ridiculously clear. And...I hate it!! Now that I'm actually experiencing a "blend," I understand what the surgeon was trying to do the first time, and I feel like I made a mistake in having them fix the right eye instead of the left. It's very uncomfortable, my right eye feels tired most of the time, and I often have eyestrain, or an eyeache, or a mild headache....It's as if the right eye had previously been the go-to eye for close-up work (unbeknownst to me), and it's still trying so hard to focus, but it can't very well. And the left eye, being the dominant "distance" eye, isn't taking over for the near vision very well. I *can* read, and work at the computer, but it can get pretty uncomfortable. And reading/computer work takes up most of my day. (whereas, before I had the enhancement, I had perfect computer vision, sigh.) Sometimes I wear reading glasses (with only the right lens), which seems to help a little, for awhile, but even that gives me a headache if I wear them for a full workday. So, long story short, what I want to know is...how long did it take you to get used to the "reverse" vision? I've been kind of depressed, thinking, this is the most uncomfortable vision I've had in my life, and why didn't I do more than wear a contact in the right eye for 3 days, before going ahead with this? (I don't tolerate contacts well, so that was a pretty poor test in terms of discomfort) Why didn't I fork over some $ for pairs of glasses to simulate the blended vision, before deciding which eye to enhance? etc. Your story at least gives me encouragement that maybe I also will get used to this, and won't notice discomfort down the road. I really didn't experience vision discomfort after my first surgery, but I do remember that I was somewhat sub-consciously trying too hard to see better with my left eye (thnking it should have corrected better than it did), and it was almost a full year before I kind of relaxed and settled into the vision that I had.

#20 charles1965

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Posted 04 May 2012 - 12:30 AM

Blended Vision. From your story is seems you have been misinformed. What you think is a 'perfectly corrected right eye' is a slightly hyperopic one. In a refractive test the human eye will function extreemly well at slighly hyperopic (+.5 to +0.75) because the muscles will accommodate to sharpen up 100% I would bet you a dollar that a wavescan shows you as being around half a dipoter long sighted. Thats why you get the uncomfortable eye ache.




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