My eye problem is by far the most difficult thing that has ever happened to me. I went from being nearsighted and able to wear contacts, to perfect vision for two year, to the last five having an astigmatism, being nearsighted and far sighted, having no contacts fit my eyes,having severe dry eyes that have been treated with plugs, restasis, steroids, over the counter drops and having glasses, which I hate that never really work since my eyes change constantly. My eyes will not stablizie so they can supposedly try wavefront, two doctors have now said I should have never had the surgery to begin with. I am unable to pass a job physical since I cannot read the eye chart. Does anyone have any suggestions? The doctors tell me time. It's been seven years. Someone please help me!!!!

Hello Pinkey,
I'm sorry to hear you're having such a difficult time. Your situation sounds all too familiar and similar. Can you provide further details about your symptoms, your surgery and complications? It's hard to tell much without any further information.

Perhaps if you could answer a few questions, we may be able to help.
First, when did you have surgery, and what kind?
What was your pre-op prescription, and did you have any other contraindications for surgery?
Aside from the constant vision fluctuations, what other complications are you experiencing?
What various treatments have you tried?

I don't mean to pry, but without some further info to go on, it's tough to know how to help.

I had surgery on May 4, 2000. I had just regular lasik. On March 17th 2002 is when I noticed that i was having a hard time seeing. I believe my eyesight prior to surgery was 20/750. The day before my surgery when they were taking pictures, the lab tech commented about the size of my pupils but only said since my pupils were so large and my eyes so light my eyes would say dilated longer.

They had to do an enhancement on the right eye in August of 2000. At first it was fine but then it got worse, the doctor said it was due to the refresh drops I bought being in a bottle and not the vials. Since then, I have severe dry eyes, horrible night visions, halos, double vision and eyes that no longer can wear contacts since my eyes are "too steep".

Since this time, I have had numerous glasses presciptions, steroids, too many over the counter drops to name, restasis. And one time they were going to do RK on my right eye and when they read my vision with the machine and then refracted me my astigmastism axis was off from each reading my 180 degrees, so needless to say that did not happen.

So any advice you have wou;d be great!!! :-)

One thing is certain, and that is that more surgery is likely to result only in more problems.

I suspect that you have been unable to wear contact lenses because you have not been properly fitted. It takes an expert fitter to know how to evaluate and design an RGP (rigid gas permeable) prosthetic lens for a highly irregular cornea, and because your dry eye has not been properly treated.

You need a second opinion from someone who is familiar with Lasik disasters, and who knows not only what he/she is looking at, but what kind of treatment is necessary. Your dry eye needs to be evaluated and treated before you begin the process of getting fitted for lenses. I highly recommend a new book by dry eye specialist Steven Maskin, OD, Reversing Dry Eye Syndrome: Practical Ways to Improve Your Comfort, Vision, and Appearance, which gives a thorough examination of ways to combat dry eye, along with simple, easy to understand explanations of the multiple factors that can cause dry eye. The book also provides lots of information for working with your doctor to combat your dry eye. I think it's available from Amazon.com.

Once you are able to get control over the dry eye issues, you may be able to be fitted for RGP lenses that will minimize the aberrations/irregular astigmatism and provide decent night vision.

It may also be possible to work with a competent OD who will experiment with glasses to tweak them for you. You may not be able to get rid of the higher order aberrations and all of the symptoms, but you may be able to get a pair of glasses that will make it possible for you to see well enough to function more or less normally.

You might also want to try some eye drops available only via the Internet that many of us have used to find dry eye relief. Dwelle, Dakrina and NutraTear are specially formulated and samples may be ordered from dryeyezone.com. If you do a search on this bulletin board for "Dr. Holly's drops" or Dwelle, Dakrina or NutraTear, you will find a wealth of information.

"...no longer can wear contacts since my eyes are "too steep"."

Evidently you were farsighted prior to LASIK. Farsighted (hyperopic) LASIK can be more problematic than myopic LASIK in regard to higher order aberrations. The effective optical zone is usually smaller and more irregular.

The dry eye issue following LASIK is, in some respects, a greater problem for people since an uncomfortable eye is less likely to tolerate contact lenses. However, RGPs are probably the only way you will overcome the HOAs.

A lot of things can be happening with the fluctuating vision and hyperopic LASIK. Since the visual system is not getting a proper focus, the accommodation (focussing) aspects fail to achieve a proper "lock" on what you are seeing, making an exact and stable refraction (glasses prescription) impossible. I have had several patients whose actual prescription was quite different than initially determined once RGPs are fitted.

RGPs for patients who are post-hyperopic LASIK are definitely different than what is needed for post-myopic LASIK patients, the former being the greater challenge. There is a shortage of docs who have the experience and the opportunity to work with these cases unless they have committed themselves to post-ablation rehab. The patient must be committed to the process as well. The doctor must recognize that very fine adjustments to the fitting are indicated. To that patience and perseverance must be added an insightful understanding as to the unique design required. The reason I am editorializing is that most patients registering at VSRN have had negative post-surgical experiences with RGP contact lenses and, understandably, are quick to state that they have "been there, done that." IME, most RGP work on post-ablation patients shows too little effort and too little creativity to presume an inability to wear RGPs. They are and will continue to be the best bet we have to rehab vision for post-corneal surgery.

It is an axiom of post-surgery complications that patients will persist in the thinking that additional surgery will restore their vision. While some patients experience some benefit to second surgeries, others are not helped or even worse for the effort. For those whose second or even third surgeries are unsuccessful, the option reverts to RGP lenses.

I was actually nearsighted, contacts were usually about -5.75. Now i am nearsighted, farsighted and have a constantly changing astigmatism.

Pinkey,

In your post you mentioned having difficulty wearing contact lenses because your eyes are "too steep". If you were -5.75 pre-LASIK, then your eyes are not too steep in regards to the increased difficulty of fitting the hyperopic LASIK patient. Evidently someone gave you some conflicting information. As much as your dry eyes are a major concern at this time, the RGP fitting aspect of your rehab should be easier. If you can get any specific data on your attempted RGPs, please post them.

according to all the doctors after lasik they are too steep. before I only wore soft lenses.

Pinkey,

Your central cornea would be flatter now than before LASIK. If the doctors feel your corneas are too steep, they must be referring to the non-ablated, peripheral cornea. That does not prevent the fitting of an RGP; it does mean that the lens must be sufficiently customized to fit the peripheral cornea relative to the central cornea. That difference, the difference between the central and peripheral cornea, must be accounted for in the lens design. "Off the shelf" lens designs are limited in this regard.

For now, the key thing will be to work on getting more comfortable; the lens work will have to wait. Please do not conclude you are not able to be fitted based on your experience to date.

What do I do about the dry eyes?

This is a good starting point.

http://www.visionsurgeryrehab.org/dryeye.html