Can i do another surgery ? or some RGP lens will help me?

Hi everybody,

My name is Rafael Campos and i did PRK one year ago. Now im living with some complications like bad vision at night, halos, starbust and durant the day contrast and reflection.

i would like to know if had some treatment for this problems.

I read a lot on this forum and internet, and i would like to know if some RGP lens could help with this. My vision is 20/20 but i have this aberrations.

I would like to know too if can i do another surgery, this time do with wavefront laser, to correct the aberrations, is this possible ? My cornea is thin, i did pachymetry and my corneas now are 450 micras.

Thanks for reading and sorry my english.
Good luck for us.
Original Post
Hi, Rafael.

Wavefront ablations have not consistently corrected patients' post-refractive surgery visual complications and should not be considered a sure thing. You have enough corneal thickness.

What have your doctors told you lately? Was additional surgery recommended by them? Have you sought other opinions?
When are the aberrations most pronounced? Are the aberrations worse in low light situations?
What was your pre-PRK spectacle prescription?
Are both eyes causing you problems?
Do you have a copy of your latest prescription since surgery?
Can you post your latest corneal topography findings?
What is your pupil size?
RGP contact lenses generally are very effective in these situations but also challenging to fit properly. Did you wear contact lenses before PRK?
Hi Dr. Hartzok I really appreciate your attention !

I have gone to a lot of doctors, some dont know what to do, the last one tried somes RGPs lens but they dont get better my vision, we tried only one day and with those he already have in his room. He told me to wait the aberration laser arrive in our town to study another surgery. He thinks maybe it can help.
We are trying too with some soft contact lens without degrees, I told he i have tried some soft contact lens to correct the aberrations and its works but they had degree, now i bought one without degree and im waiting arrive to test. The name is Biomedics XC of coopervision.
Do you have some cases where its works ?

He told too im with 0,25 astigmatism in right eye now after the surgery.

The aberrations are most pronounced during night, most in low light situations. I see some halos some times, starbusts and reflects. When is rayning it is worse.

Before i did PRK i had only -1,75 of myopia in each eye.

If im right, i think only my right eyes is causing problems, the same one which the doctos told im with 0,25 astigmatism, he told too this eye should be the dominant before the surgery.

I have copy of my lastest prescription (0,0 left eye and 0,25 astigmatism right eye), i have my wavefront exams results too, i will attach on this email.

In my wavefront exame my pupil size is 6.5mm, i dont know if it is right.

I dont have now my latest corneal topography findings, i will try to get it.

Before i did PRK i tried some soft contact lens.

Thanks for the help doctor.

Attachments

Rafael,

Fitting RGP lenses on a cornea that has undergone laser ablation (PRK, LASIK) requires lenses not typically available in the doctor's office. The majority of practitioners do not have the necessary paradigm (fitting strategy) to attain success.

RGP lenses have two functions; therapeutic and diagnostic. Therapeutically, when designed and fitted well, RGPs can correct higher order aberrations emanating from the corneal surface. That can improve vision significantly. Diagnostically, if RGPs that are designed and fitted well DO NOT correct the vision significantly, that tells us the higher order aberrations are emanating from beneath the corneal surface.

The wavefront studies you provided suggest a significant amount of higher order aberrations. What the wavefront studies do not tell is WHERE the higher order aberrations are coming from. This kind of study measures the entire pathway of light from the corneal surface to the retinal surface. It does not differentially diagnose the causes.
Your residual refractive error is not a problem.
Ignore the dominant eye remark. That's not an issue here.
The Biomedics XC soft lenses will not help the higher order aberrations and will probably create even more when worn.

Let's go back to your complaint: You said, "The aberrations are most pronounced during night and low light situations. I see halos some times, starbursts and reflections." This suggest SPHERICAL aberrations. The first consideration here would be that your pupil dilates larger than your ablation diameter. To test this, you can try an eye drop, brimonidine tartrate 0.2%, just as you are about to drive or be outside in the evening and see if your vision improves. If it does, then we can assume part of the problem is the spherical aberrations due to a discrepancy between pupil size and ablation diameter. That can be helped with well-fitted and well-designed RGPs.

1. See if you can get your eye doctor to prescribe brimonidine tartrate 0.2% eye drops to try and let me know how that goes.
2. Also, see if you can get your corneal topographies - before and after the PRK - and post them.
Hi Doctor Hartzok thanks for the answer.

I will get and post here my topographies.

I would like to say just one more thing, during the day i dont like my vision because i see a lot of reflects and contrasts, i feel it only in my right eye, i dont know why. My vision is 20/20, in the left eye i dont have any problems but the right eye is like it is just accompanying the left eye. I feel the right eye is not stronger enough to the lights.

Do you know what can be it ?
quote:
I would like to say just one more thing, during the day i dont like my vision because i see a lot of reflects and contrasts, i feel it only in my right eye, i dont know why. My vision is 20/20, in the left eye i dont have any problems but the right eye is like it is just accompanying the left eye. I feel the right eye is not stronger enough to the lights.

Do you know what can be it ?


Rafael,

Even though the stated refraction was 0.25 of astigmatism, it's possible you are over-corrected in the right eye. This can make you feel like the right eye is just "along for the ride." In fact, any qualitative difference between the two eyes can create this feeling. At your age, being over-corrected (for nearsightedness) can still give you 20/20.

Some offices rely on automated refraction devices to determine your glasses prescription which can be inaccurate. Then again, not all doctors or technicians perform manual refractions accurately, especially on patients who have had refractive surgery. All too often there is not enough time spent BALANCING the refraction between the two eyes. Your visual system is young enough to try to "right" the imbalance and, if the refraction is monocular (testing only one eye at a time) and hurried, the imbalance goes undetected.

Patients with RSS (Refractive Surgery Syndrome) frequently have multiple issues contributing to their visual frustration. In the previous post I remarked about spherical aberration (based on the worsening of your low light vision) as the culprit. That is still the case. A refractive imbalance causing your daylight visual symptoms cannot be ruled out. If you were to be fitted, even for diagnostic purposes, with RGPs that eliminate the spherical aberrations, then the refractive imbalance could also be discovered and corrected.
O i understand, thanks for the answer Dr.

I will try to fit some RGP lenses and try to discovery my imbalance. I think it can be over-corrected too, because lookink near i fell my right eye is more than i need.
Do you know if with a new surgery this over-corrected can be corrected easily ? Based on my cornea do you think i can do another surgery ?

Thanks for the help !!
Best regards !!
You certainly have enough corneal thickness. However, in the event you are over-corrected for nearsightedness in the right eye, then you would be doing a hyperopic (farsighted) ablation over the previous myopic ablation. In my experience, such adjustments are not always accurate. Until all is known about your situation, I would avoid a second surgery.

You need to find an RGP fitter who has a lot of experience and who has insight into post-ablation RGP fitting.
Hello Barbara and Hartzok

The doctor fitted to me a therapeutic lens and it have corrected a lot of aberrations even at night. The aberrations arent a problem anymore.

But i still have the sensation on my right eye it is "along for the ride".

He told me to wait my tear film stabilize.
I would like to have this problem fixed.

Tomorrow i will go to other 2 doctors to listen what they have to say about it.

Best regards !!!
Sorry i forgeted to say, the lens are like the soft lens but they dont absorb water.

Do you know if some RGP lens can have 0,25 astigmatism degree ? because normal lens start with 0,75.

I forget to ask to the doctor to try some astigmatism degree to find what is my problem. next consult i will say to try this.

Thanks!!!
"The lens is like a soft lens but they don't absorb water."

Rafael,

It sounds like the SynergEyes lens. Are you saying that the sensation of one or the other eye being overcorrected is happening when you wear the therapeutic lenses? If so, have your doctor re-check the balance between the two eyes when wearing the lenses.
Hi Doctor Hartzok

Yes he checked, im wearing lens without degrees, the lens he make to me arent ready yet, it will be done in the next days.

I just would like to understand if the overcorrect is in the RE or LE.
When i receive and use the lens i will post here the results.

Thanks a lot.
Rafael,

If it's not rigid in the center, then it's a soft lens and a soft lens will not eliminate astigmatism or aberrations the way RGPS will, even if it's a silicone hydrogel. I was hoping your doctor used RGPs. By the way, I am not a fan of SynergEyes lenses (yes, rigid center, soft surround) since they are not particularly customizable.
Hi Dr. Davod

In the last days something happened. That problem im my right eye like it was over-corret or something else, almost disappear, i was reading a book and i was forcing to read with the both eyes, not only with the left like normaly occurer, i read for almst 2 hours and i was feeling dolour in the right eye, than i fell something in the right eye and now it is very better, to read, to look etc, i dont feel monovision anymore.

Im thinking about the problem was because the surgery wasnt done in the center of my right eye, one doctor told me once about the results im my right eye was a little moved to left, not in the center of the eye.

Do you already have experienced something like it ? Have some causes when the surgery isnt done in the center ? If you see my wavefront can u tell me if it was done in the center ? the exam is in my post of may 31.

Sorry if im wrong, is just a opinion and im realing feeling better with my right eye.

Oh, i bought a RGP lens and they will be done in the next week. then i will post here the results, my night vision is yet with problems like starbusts etc.

I tried some normals RGP and scleral lens, the both have good results so i choose the normal RGP, if it dont resolve the problem after i will try the semi-scleral lens. what do you think about scleral lens ??

Thanks for the helps Doctor Davod.
Best regards for you.
Rafael,

The higher order aberrations in the right eye are slightly de-centered, like the one doctor mentioned.

I don't know what would have happened to the right eye for your apparent vision to have improved. I would not suggest that it is something to do with the ablation. It is possible that your visual system is making some kind of adjustment but time will tell whether this improvement is permanent. Did this sense of improved vision happen at any point after wearing the contact lenses?

Scleral lenses can relieve a lot of the aberrations, depending on how well they are fitted. One difficulty is avoiding pressure on the limbal-conjunctival area.

Again, I don't know what changed in your right eye. Keep me up to date on this.
Rafael,

The fact that your vision has suddenly changed needs to be understood. Did your prescription change?

Yes, a well-designed RGP can override the slightly de-centered ablation. And, unfortunately, in our (VSRN's) experience, additional surgery does not guarantee relief from the aberrations.
Hi Doctor

My prescription is a mistery, each doctor say one thing but the last 4 told it was between -0,5 , -0,25 of myop and one says it is -0,25 of astigmatism.

Im yet fighting against the problems, and today i read about the IVIS tech. do you know some cases of good results for paticients who have pre surgery problems ? i have found on the web some succes cases and would like to know more.

Im trying to use the RGP lens, but i need to go again to the doctor to re-fit the rgp o my left eye because is a lot hard to use and the focus isnt good, by the way the rgp of my right eye is very good.

Thanks for the help !!!
good night !!
Rafael,

You need to know that RGP fitting to our damaged corneas is no easy task. It is a process that can take numerous fittings to get it just right. There is nothing simple about fixing us, so follow through and be patient with your doctor as he works through all the issues.
Artistwoman,

I would like to know if the rgp lens can help me, cause my case is a litle diferent, my vision is ok, when i do the eye exame the results in my left eye are 20/20 and in my right eye i have only -0,25 of myopi. With this results the doctos says my vision is ok, and yes if i had only this problem it should be ok.
But the problem is i dont feel good with my right eye vision, i feel like im forcing my right eye to see togheter with my left, i dont know why, im thinking it is descentralized.
When i look to someone who is near me my right vision is like im scared, my right eye is doing a lot of strong. I tried to use lens with -0,25, i tried to +0,25, and tried too -0,75 of astigmatism, until lens without dregree and none have resolved the problem.
When i use some lens in my left eye, doing this vision worse, i feel my right vision better, i dont know why, maybe because it dont is doing strong too see togheter with the left anymore.

So i dont even know what is the problem, i think this sensation is because it is descentralized.

Could you plz see my eye exame of my right eye and tell me if have anything wrong ?

Im posting it attached.

I will try the rgp lens the problem is because the doctor dont live in my city and i dont have time to go there a lot of times because i work traveling a lot =(.

Thanks for the help, sorry i insist in surgerys to resolve, but im thinking its the only way.

Attachments

another idea is maybe before my surgery my dominant eye was the right eye, and now after the surgery my left eye have a better vision but my brain didnt understand it and force my right eye to look better, doing this pain.

I dont know why but when i use a lens without the degree in my right eye, this pain caused of just look near or use computer disapear. but the vision is worse. Without this lens the pain appear again.
Rafael, there is no surgery that can fix what's wrong. It sounds as though you may have a muscle imbalance. I'll let Dr. Hartzok address the clinical issues. If you do have an imbalance, there are vision therapy exercises that can help.

Unless you are willing to work with the expert RGP fitter, there is really nothing much that I can recommend. Maybe Dr. Hartzok will have a suggestion.
Hello Hartzok and Artistwoman i have one question...

I heard about silicon lens must worse the HOA, but i tried to use a acuvue2 lens -0,5 who have UV protection and the HOAs have disapeared.

I would like to know if someone knows some lens of this same material with this protection UV but whithout degrees.
I would like to try it to see if the HOAs goes away.

And what kind of exercises can i do to make strong my right eye ??

CYA !!!
Rafael,

If the soft contact lens you are using is a bit too strong it could cause your pupils to decrease in size just enough to reduce the HOA. As long as you can tolerate the overcorrection and, as you say, the HOAs are gone, then what problem are you trying to solve?

Don't get hung up on materials and UV protection. The fit is the critical element. There is a lot of misinformation around about contact lenses. It comes down to (1) the fit and (2) the prescription.
O i urderstand so why the hoas go away was because my pupil stays little.

The problem is cause when i use the lens with this -0,5 or -0,25 it causes a litle headache, the hoas go away but i cant use it for a long time. Normaly i use when i go to night clubs.

I thought was the UV protection or the material. So the only way to corrige this HOAs and didnt using the wrong fit is the RGP lens i think or a miracle surgery :P

Another problem i have is my right eye, i think it was the dominate eye before the surgery, but now it isnt anymore and im not accustoming with it, until during the day when the HOAs dont appears. Do u know if with some exercises i can make he the dominate back again ?
I dont know why i feel it, maybe im with some umbalance in the eyes.
If the contact lens is too strong (too much minus), it can reduce the HOAs, making the vision clearer BUT it can give you a headache. The overcorrection can cause eye strain and alter the muscle balance.

Rafael... I think you may be visiting other forums where people give poor advice. Don't worry about UV protection (it's invisible), don't worry about materials (it's the fit that matters) and don't worry about which eye is dominant.

The number one factor in all of this is clarity. If you can clear the vision WITHOUT having to overcorrect, which I believe is your case, then you will see better without the headaches.

Doctors and techs who do refractions don't always do a good job of determining the prescription of patients who have had refractive surgery. The visual system is DYNAMIC.. it adjusts to changing visual needs. Most important, it adjusts WHILE THE REFRACTION IS BEING PERFORMED. I have examined patients with PLANO/PLANO results (no prescription) only to find them to be farsighted when doing the contact lens work. A well-fitted RGP, because it removes the HOAs, can allow the eyes to relax. So, while wearing the RGPs, I can determine the amount of overcorrection and adjust the power of the lenses.

Something is not being done in your case. Something is not being done in a lot of cases for people with RS complaints. Too often a well-intentioned doctor uses a soft lens in situations like this and finds that by pushing some (-) power, the patient says, "That's better." So, that's what you get. But they don't understand the reason you are responding and the underlying problem.

One reason VSRN exists is because these situations happen to some people following refractive surgery. The biggest problem VSRN has is finding doctors with INSIGHT, doctors who are able to shift their paradigm away from the simple SPHERE, CYLINDER and AXIS mentality and recognize that refractive surgery does more than alter the prescription. IT ALTERS EVERYTHING.
Thanks Hartzok this your answer is really really making sense. I used a lot of time a lens with (-) power, overcorrect, and maybe im with some muscle balance, i dont know.

Bu i really feel this clarity is all what metters. When i found this rgp who can make it clarity, and dont make headaches it will be perfect.

My case i think is the same of these patients u mentioned, PLANO/PLANO, cause when i use any power (-) or (+) i feel this headdaches and without i dont feel, only some times using the computer, i think it because the umbalance muscle.

So u have sucess doing RGPs for this cases of patients ? they told u after some days of the consult it was good yet? because sometimes i leaved the consult thinking the soft have resolved but it was for a short time.

Do you have some advices for materials or something in fitting RGPs ? i will try a doctor here in my city. Thanks a lot for your help, at least, i am understading what is happening.
If the doctor here dont fix it i will need to go do a visit to you =).

Thanks !!!
A curious thing is my own eye can clarity the vision, i thought it will be done for some material in front of my eye. Because this my idea, i thought was the UV protection :P.

So the RGP lens will correct the clarity with my pupills getting bigger ?

And thats personalized surgery, who correct more spaces of the pupil, if beeing with sucess can clarity the vision too?
Dr. Hartzok

I would like too know if the materials makes diference in RGP lens, i will fit one here in with a doctor of my city and would like too know if it will resolve.

And is normal in the first days the lens make a litle nuisance or if it been good fitted should be like a soft lens sensation in the eyes ??

Best Regards
Im asking about the materials because i received this answer from the doctor K. Maller:

"Rafael,

I of course understand your desire to seek a solution locally, but honestly and as I said previously, your chance of achieving success (good vision, good comfort, and good corneal health) with a "standard" rgp contact lens is virtually zero. Still, I wish you the best of luck with this endeavor. Of course should this not work out well, I am ready when you are to address your post-surgical problems.

Sincerely,
Dr. Maller"
after i received thins e-mail, im very sad because i thought i could resolve it here in my country, with RGPs, but now im thinking the only way will be travelling to florida to fit this lens there.

I just would like to know your opinion Dr. Hartzok because i believe in you.

What u think i suposed to do ? try a normal RGP here or go to florida try with Dr. Ken Maller lens ?

And i would like to know, with what kind of RGP lens do u work, because u told u helped peoples with this problems, so u fitted this z-wave lens too or another one ??

sorry for a lot of questions but i would like to know what i need to do ..
Rafael,

Responding to your questions about Dr. Maller, he is one of the most talented contact lens fitters in the world today. He fits many different kinds of lenses, including Z-waves, which have the capability of correcting aberrations caused by refractive surgery to a greater extent than many other lenses.

He fits lenses individually to the unique cornea of the patient. When properly fitted, you won't feel them in your eyes! He has helped many patients here in the US and people from all over the world come to him for help.

Dr. Hartzok does not fit Z-wave lenses. He uses a different method for custom fitting, and has also been successful in helping many patients to recover their clear vision.

Being fitted for RGPs is a process that can take several tries to get a good fit and good vision. You have to stick with the process until it's right.

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