Hello,

I'm 7 months post op and had a wavefront scan done earlier today. I'm quite worried as the RMS err for my left eye is 3.62 and right is 1.04. I was holding out hope that RGPs might be effective but from what I've read 0.2 is an average RMS error. Has anyone had similarly high RMS an had success with RGPs? My problems are mostly coma and spherical abberation, which are .7 and .3 respectively in my left eye and .5 and .6 in my right eye. I am very worried, any feedback would really be appreciated, even if it is bad news, at least I could try to start coping with it instead of having false hope.

- Chris

Chris,

Really, the only way to know whether an expertly fitted RGP will clear up your vision is to get an evaluation by an expert fitter. Some of us have extremely aberrated vision with very high RMS error, and have had great success, while others with only minor aberrations are still unhappy with their vision with RGP lenses.

Most of those who are unsuccessful with RGP lenses attribute the problems to dry eye and its accompanying discomfort, as well as a poor fit by a fitter who means well, but has no clue how to approach the issues of a surgically altered cornea. Your chances may be much better than you think.

Visual resolution of aberrations with RGPs is not based strictly on the RMS findings. Aberrations are due to optical irregularities at the level of the corneal surface, aberrations within the flap, within the interface (potential space between the flap and residual stromal bed) and due to the contours of the residual bed. The overall diameter of the ablation relative to your pupil size can be a very significant factor as well.

RGPs, as they presently exist, benefit RS casualties mostly by addressing irregularities at the corneal surface, which are manifestations of the shape of the deeper structures. Properly fitted RGPs work primarily by providing an optically regular surface and by mitigating the pupil size/ablation diameter differences. MOST of the aberrations can be addressed in this way. RGPS can create their own aberrations as well, which is why the fitting is so critical.

A lot of emphasis (way too much) is placed on what is called the "optic zone" (the center curve) diameter of the contact lens. This is true in traditional RGP designs, where optic zones that exceed the pupil diameter in low light situations, like driving at night, give better optics. In non-lasered, healthy eyes, the transition of the corneal curvature from the center to the periphery is one flowing curve and a large optic zone can be made to align fairly well with that natural contour. On ablated corneas (LASIK, PRK, LASEK, epi-LASIK), an overly large "optic zone" does not align particularly well. This can cause problems with the lens centering properly, reduce the physical comfort and reduce the quality of the vision. What is misunderstood is that the entire RGP lens is "optical" and that the anterior (front) surface of the RGP is almost always the entire diameter of the lens. This means that not only the central curve (traditional lens "optic zone") but secondary and even tertiary curves can help correct the underlying aberrations. When the secondary and tertiary curves are properly aligned (fitted), the overall optical quality is improved and comfort enhanced.

The higher your pre-op prescription, the greater the difference between the central (ablation zone) curvature and the natural, non-ablated curvature. Patients with low level prescriptions can get by with simpler RGPs (or even soft lenses in some cases). Patients who were quite nearsighted or farsighted prior to surgery are more challenging to fit; one size definitely does not fit all. This is why one patient will swear by a particular RGP design or brand while others find no help. Since nearsightedness and farsightedness do NOT correlate with the pre-surgical corneal curvature, a patient who is -6.00 could have a pre-op corneal curvature less than 41 diopters to over 47. Successful fitting, IME, must address the pre-op peripheral curvature as precisely as the ablation zone itself. The higher the pre-op Rx, the greater the difference between the RGP's central and peripheral curves. The more an RGP specifically accommodates those differences, the better the outcome and the better the vision.

That said, we really can't know in advance what percentage of your aberrations can be corrected with RGPs, especially since the fit is so critical. The odds are in your favor that RGPs will help. Higher RMS findings, if anything, indicate a greater need for RGPs.

Thank you for clearing things up a bit for me. From what I'm hearing it's just really not about the RMS and I'm really misleading myself, diagnosimg myself without any expertise on the subject.

I've contacted DrG and am going to schedule an appointment as I live in Texas. I'm hopeful things may work out and I will hopefully post my experience here to maybe help others that might be having similar troubles with HOAs. Thanks again! You eased alot of my worries when it was much needed.

Hi, I just wanted to update anyone reading this thread on my visit to Dr. G.

The contacts are pretty amazing, I would say they solve about 70% of my issues. There are still some things to tweak, as for some reason bright sunlight vision is not as good with the contacts in, and the right one isn't fitting as well as I would like, some blurriness after removal that goes away after 30 min, but Dr. G is pretty sure these can be fixed with minor tweaks. I am going to visit him again this saturday.

Both he and Kim, his assistant are excellent people as well as excellent practitioners and I felt at the start til the end that they were a very patient and caring staff. I would bug Kim almost every day about some issue I was worried about and she would calm my unwarranted fears. It's pretty silly to self-diagnose but it was just hard to help and I think Kim understood this well as she is a post refractive sufferer as well (really helps psychologically to have someone who understands what you are going through)

In any case, if you suffer from HOAs, definitely a visit to Dr.G might most definitely help you. My dim light vision is excellent now, and I can watch movies in a movie theater etc. Again, about 70% fixed (this is not only subjective, quanitatively you can see your wavefront with the lenses in). This is definitely into the liveable range again. Once I get these last pair I should be able continue on with my life in terms of physiological issues, cause my eyes are pretty darn functional (can see the monitor at work at super high-res). Then it is just getting over the emotional stuff, which may be harder.

Anyway, looking at my wavefronts with the contacts on its pretty amazing, they are really close to pre-lasik, the bars are all pretty far down on the wavefront scan, its really amazing. The other thing that impresses me is that Dr.G is constantly in the learning process to, looking for ways to help patients each day, sharpening his skills even more.

All in all, COMPLETELY worth the visit, again if you suffer from HOAs, custom fitted RGPs seem to BE the solution as of now. Will post more after my next set of lenses that I should get pretty soon. I am really really glad I went to Dr.G. If I even meet another lasik sufferer (I haven't except for Kim) I would tell them it is probably best not to mess around with these things and go to someone very experienced with post-rs fitting, a specialist like Dr.G, who you can get excellent and very reliable results from.

Cayeung,

I'm glad you've found some relief for your visual issues. For those in Texas, Dr G may be a good option. VSRN has, for the past two years since its inception, been assembling a network of skilled, caring RGP fitters all over the country.

There is no longer any need to travel excessive distances to see any one practitioner. VSRN makes referrals to very successful expert fitters in all parts of the country and in some foreign countries, as well.

On the east coast, Dr. Hartzok is probably the most experienced, skilled RGP designer and fitter available. In Florida, Drs. Ken Maller and Ed Boshnick are excellent. In northern Illinois, there's Dr. Cary Herzberg, one of the inventors of the Macrolens, in the Colorado Springs area, Dr. James VanCamp, and in Sacramento, CA, Dr. Bob Buffington. These are just a few members of our RS clean-up crew.

If anyone is looking for a referral to a skilled, caring RGP fitter, please, e-mail info@visionsurgeryrehab.org and ASK FOR A REFERRAL. If we don't know of anyone in your geographic area, we will try to find someone for you. Rehab is our primary focus, and we are always looking for new doctors to add to our network of providers.

This message has been edited. Last edited by: artistwoman,

Yes, the vision I have right now I think is certainly liveable, where I think I will get used to it and just stop noticing it pretty soon. Then I can just enjoy life and not ever get elective eye surgery again. I do hope in the future they make wavefront designed custom contacts and I get 100% visual abberations gone, but then that is being excessively greedy. 70% is quite good for a mistake I thought had no solution.

It has been quite a journey, it was almost like going on a mystical journey to the emerald towers of dallas to get these magical eye lenses. It does seem like a bit of an art when Dr. G is fitting you.

Anyway, I think in the end I'll make it through it, so anyone else having similar issues, I think there is a way with getting custom contacts as artistwoman pointed out, in many different areas, and maybe even better in the future, and to not give up hope. Forums like these helped me, and I think can help you too if you are having these dibilitating issues.