I hit the send button too soon. I wanted to finish by saying that in the exam room objective data is collected which can be reviewed by peers. Night vision problems are mostly subjective and can't be quantified easily. So it becomes a Catch 22. If it can't be measured by the doctor, how is he supposed to know whether the treament will help?

RGPs work for me. But I can't tolerate them long enough to use daily. I've tried everything except testosterone eyedrops, because a blood test says my hormone level is normal. Maybe that's the next thing to try.

like i said in the other thread i did get a copy of my medical records which include a wavescan. i can provide the information from them. thanks.


helmit

Helmit,

A wavescan cannot tell ou how much of your cornea is flap and how much is residual stroma. According to all the topographies, interwave and wavelight scans, etc., I had 400 microns+, The reality, as the Artemis scan showed, is that my flap is 200 microns, and the remaining stroma is only 200 microns. Please don't make the mistake of thinking that a wavescan can provide you with all of the information you need to make a good decision.

oh no i would never make that mistake. i was drawing information from the "orbscan," which said 450-460 microns thick for each eye i think if i am reading it correctly. see the thread "eye clinic worker's attitudes".

because i am 20/20, i have been told there is an increased chance that i could lose BCVA(about 10%). if this happens, is there any way to deal with it? or does it mean what it says?

How many opinions have you gathered regarding your situation? Re-treatment should only be considered, IMO, after you have gotten several opinions and, hopefully, from a doctor who has done quite a few. Wavescan technology promises a lot but some patients with the latest wavescan procedures end up here with the same complaints as patients who were lasered five years ago.

I know you are tired of your visual condition but all this very impressive technology is not a quarantee. I think you need a serious second and third surgical opinion.

Your doctor also said he didn't think contact lenses would help you. Chances are great that he has little or no experience with RGPs. Fitting the lasered eye is a kicker but, while you are at it, get an opinion on RGPs. I think Artistwoman gave you some names of fitters in your area. You mentioned the expense of RGPs. How much did you pay for LASIK and how much will an irreversible and unguaranteed second surgery cost? If the second surgery leaves you with unsatisfactory vision, you could still end up needing RGPs.

quote:

How many opinions have you gathered regarding your situation? Re-treatment should only be considered, IMO, after you have gotten several opinions and, hopefully, from a doctor who has done quite a few. Wavescan technology promises a lot but some patients with the latest wavescan procedures end up here with the same complaints as patients who were lasered five years ago.

I have only had one opinion from a surgeon on a custom enhancement and he seems confident that he can help me. He has done 40-50 such procedures. I have an appointment with another surgeon for a 2nd opinion which hopefully my insurance will cover but if not, no big deal.

quote:

Your doctor also said he didn't think contact lenses would help you. Chances are great that he has little or no experience with RGPs. Fitting the lasered eye is a kicker but, while you are at it, get an opinion on RGPs. I think Artistwoman gave you some names of fitters in your area. You mentioned the expense of RGPs. How much did you pay for LASIK and how much will an irreversible and unguaranteed second surgery cost? If the second surgery leaves you with unsatisfactory vision, you could still end up needing RGPs.

I did mention the expense of RGPs but just as kind of an off-hand comment. Money is not that big of an issue- after all this is my VISION, which to a large extent is my LIFE.

I still strongly doubt that I could tolerate RGPs from a comfort perspective, as I cannot even tolerate soft contacts. And I do not think it is an oxygen permeability issue. But I guess I might as well hear the optometrist out, so I will probably make an appointment next week.

I will repeat my question from above- does loss of Best Correctable Visual Acuity mean you cannot correct it by any means? Or is there still some way to correct it? With hard contacts?

Thank you very much.

Loss of BCVA means that you cannot be corrected by any means, RGP or otherwise. For many of us, it means that even at 20/20, we still can't see clearly because of all the aberrations that contribute to what I now call "dirty vision."

Loss of BCVA usually is reserved to imply loss with spectacle correction. Loss of BCVA with rigid contact lenses implies the aberrations are beneath the corneal surface where RGPs have a limited capacity to correct.

got my 2nd opinion yesterday.

the surgeon gave me the green light so to speak.
he was not affiliated with the company that performed my surgeries, but had heard of the surgeon that may perform my "enhancement"(God).

they performed another wavescan which again produced images that are striklingly similar to the awful aberrations i experience.

i dunno though- my vision has been so awful for so long it's almost like being abused by someone and then going back to that same person for help. almost.

he assured me i have plenty of corneal thickness even for another surgery after this one should better technology become available(which it undoubtably will) and said the worst case scenario would be to fit me with a pair of RGP's if the surgery didn't work or made things even worse(but it shouldn't). i do have large eyeballs- big corneas- which is an advantage.

that brings me to another question, maybe for doctors. well, first of all they will not do an optical zone larger than 6 or 6.5 mm, correct? how can that be constant for everyone? say someone(like myself) has eyes that are 25% bigger than the average eye- couldn't the zone then be 25% bigger? proportionate? that seems logical though i do not know much about optics.

he said ablating farter out than 6 or 6.5 mm would remove more tissue with an uncertain benefit to vision. he also said that people have come in with night vision like me BEFORE any lasik and have ended up better AFTER "custom" lasik- - no way IN HELL can i believe that. ah well, just take it with a grain of salt i guess. thanks.

helmit

I do know one person, whoes night vision was improved after usual LASIK (even not wavefront). But she had really bad night vision, multiple images, starbursts all her life, and she had very specific cornea defect which was improved by refractive surgery. So, this is very rare, I suppose but happens sometime...

Helmit, the size of your eyes is not important. What is important is your residual sickness under the flap, and the thickness of the flap if surface treatment is considered. Please do not make any decision about further surgery without Artemis scan which is able to measure the thickness of each layer in your cornea.

Hey all,

I'm new here so I thought I'd say hi, first post ever. I'm also very tired so I am going to keep this short.

I have been experiencing night vision problems like many of you and will only undergo another surgery as a last resort. Currently I am most interested in RGP lenses. I was wondering if any of you know a good doctor in my area (Champaign, IL) that may be able to help fit me. Thanks a lot.

Hello McKraken,

If you are interested in topography-driven custom lens designs, check out:
http://www.wavecontactlenses.com/ or
www.visionrestored.com

Both have doctor locater links. I have been wearing WAVE lenses since 2002, and they correct over 95% of my post-LASIK visual aberrations and allow me to drive at night again.

Good luck,

Lynne

McKraken,

I'll have more info for you shortly.

b

well i had it done- the "enhancement"(God) with the wavefront technology of course. about 4 months ago now- my how time flies.

so far my total HOAs have been reduced only 25-30%, not the 95-100% i and my doctor had hoped for. the number has been slowly creeping down about .01 per month since one month out so it is possible it could keep going down- seems unlikely it could get over 40-50% but i have to think positively and hope for the best.

i had it done in one eye. the vision seems better in that eye in medium to well lit environments and after the use of alphagan than it was before the procedure. the blob of aberrations is only slightly smaller in the treated eye than in the untreated eye in dim environments without the use of alphagan.

i can say that if my pupils become small enough my vision is perfect in the wavefront "enhanced" eye whereas in the other eye no matter how small the pupil gets there are still some aberrations.

it didn't make my acuity any worse- in fact made it slightly better- even though i was already "20/15" on old snellan.

so i am very disappointed, let down, etc.- something new and different. this summer will mark the 7 year anniversary of my visual hell. but hey it might keep improving. still kickin'. still have all four limbs.

i will try a hard lense in the other eye- really doubt i can tolerate it, though.

i am being put on a waiting list for a new computer algorithm for removing tissue which will probably take years and even then i will not just jump into it.

was it worth 30 microns and $500? i don't think so.

Last week I had my 5th or 6th second opinion. This place has a glitzy website with a lot of testimonials from newcasters and athletes that I've seen on TV. The doctor says I have about 650 microns in each eye. He was surprised considering I've had two procedures on one eye. "Awesome corneas" was the term he used.

Then he said visx was the only laser that he would use on me but they were just getting it. In fact my wife saw it being delivered. So he said I could wait 6 months to give him time to see what the visx can do or he could send me to another place that has been using the visx laser for about a year. And he said that pupil size is not a factor for starbursts and halos.

So now I have an appointment for this other place, which has a much smaller website and no athlete testimonials.

Helmit,

I'm sorry your most recent experiment produced unsatisfactory results for you. There are extremely few reports of further surgery fixing anyone satisfactorily. Surgeons who boast of great retreatment results in those with GASH tend not to be particularly interested in what the patient has to say about it...

Kevin,

Before you trust the numbers pulled off a topography, or arrived at through simple calculations, GET AN ARTEMIS SCAN. According to my topographies, my corneas were fine, too, until the Artemis showed that I had a 200 micron flap and only 200 microns of stroma beneath it.

Any surgeon who tells you that pupil size doesn't affect starbursts and halos is either woefully ignorant or lying. If pupil size were not a factor, that pilo you've been using would have been of no consequence. True, for some of us, the issues are in the tissue, and not related to pupil size. (Neither pilo nor alphagan reduced my massive glare, starbursts and haloes.) But for those who DO *see* benefit from constricting their pupils, their experience negates your most recent op's opinion.

quote:

There are extremely few reports of further surgery fixing anyone satisfactorily.

That may be true now but wavefront is very new- it's only been in use for 2 years now. 2 or 3 years from now it may be a different story. just trying to be hopeful.

Kevin- if I were you I would wait, depending on how much HOA's you have. You saw what happened with me and my surgeon was tops.

...

Any good RGP fitters in the DC area, preferably northern VA? I will be there on an extended stay. Thanks!

I have no issue with being hopeful, but from the number of people who email me with poor results from Wavefront retreatments, it's tough to be optimistic. Not only have many of them seen no improvement, their complications are worse now than they were before retreatment.

Retreating an unpredictable surgery with another round of unpredictable surgery doesn't strike me as a sound approach to the issues.

*****************

Within two hours of DC, in Chambersburg, PA, is Dr Hartzok, VSRN's executive director, who has worked with quite a few patients in that area. Email him for information at dhartzok@visionsurgeryrehab.org.