What is the Cause of a Lack of Sense of Kinesthetic Awareness Following LASIK? This Problem With My Left Eye Started Several Days After Undergoing an Enhancement That Has Somewhat Regressed. Rigid Gas Permeable Contact Lenses Exasperate the Problem.

Your corneal nerves have been severed. This is why there is no kinaesthetic response. This should resolve somewhat over time, but will never recover to pre-Lasik sensation.

grant
grantm@connexus.net.au

I experience the Lack of Sense of Kinesthetic Awareness in the visual sense not the physical when viewing the world from my left eye. The above is accompanies by a feeling of being Spaced-Out, Confused and Disorientation. I would appreciate any input about what might cause these symptoms before undergoing more surgery.

The world is the sum of your sensory awareness plus any cognitive interpretation your mind adds. Feeling "spaced-out, confused and disorientated" is the product of altered sensory awareness. Vision is a powerful sense. It cannot be dumbed down to physical measurements, no matter how complicated the technology may seem.

Simple refractive errors can be corrected with lenses. New glasses, even with little or no change in prescription, will make people feel "spaced-out, confused and disoriented" for awhile until the brain adapts. A change in contact lens prescription generally is easier to accept because the peripheral vision is not altered as it is with glasses. Why we adapt to new glasses eventually is because the changes are consistent over a variety of visual experiences - daylight, night light, reading, etc. AND because the retinal images of both eyes generally can be made similar to each other. I believe the reason people continue to have the feelings you describe after refractive surgery is because the visual experience is not consistent over a variety of conditions and because the two eyes suffer dissimilar retinal images.

Patients with significant vision loss - corneal, lenticular or retinal - seem to adapt to the alterations. One reason is because the brain learns to suppress the image in the "bad" eye. I think the retinal images produced by LASIK are unique and, even if both eyes are measurably equal in refractive error, peculiar since the peripheral vision remains uncorrected while the central vision is "corrected". Of all the conditions we encounter in patients, nothing is like ablation surgery. I believe the more patients are able to adapt to the central vision/peripheral vision difference, the less they will suffer the "spaced out" vision.

In your original post you said RGP lenses exacerbate the problem. This is contrary to my experience. A properly fitted RGP can restore the central vision/peripheral vision discrepancy, provided the lenses center well and align well. I also have seen a number of cases where RGPs are improperly powered, mostly under-correction, causing some accommodative/convergence problems.

To steal and adapt a line, "Everything I needed to know about vision I learned in optometry school." Vision is not the act of seeing but rather a complex of many factors coming together in such a way that we are unaware of the process. Chronic awareness of the alteration in one's vision following LASIK suggests a complexity that needs to be better understood. Some patients undergo second surgeries and are relieved while others recognize a difference but no improvement. Clearly, there is more to post-refractice surgery syndrome than, excuse the pun, meets the eye.