Eye strain and headaches after Lasik

Hello,

Sorry for the long post, but I wanted to include all information that might be relevant. I have a lot of questions, so I listed them all at the end.

I had lasik on both eyes 3 months ago and I am experiencing a lot of eye strain and headaches. After lasik, my left eye is a little weaker than my right eye. I think this is one factor causing the eye strain and I am wearing glasses to try to balance my eyes. The glasses help reduce the symptoms, but I still have eye strain and headaches every day.

I get the most eye strain when doing things that involve sustained visual focus (computer, reading, driving), but I can get eye strain doing just about anything. After awhile, my eye muscles start to hurt and I just want to unfocus or close my eyes. It becomes difficult to concentrate. Pain will sometimes develop behind one eye or between my eyes and a headache will often follow. Closing one eye usually feels better. Sometimes I wear an eye patch while reading. I also experience a different type of strain sometimes when moving my head or eyes or changing focus from one place to another. I'll get a brief pulse of pain in my eye, but it is not a sustained feeling of strain like I get when staring at a computer screen. Trips to the store can cause a lot of strain. I think all this strain is cumulative and by late afternoon, I'll usually have sore eye muscles and a headache. I experience these symptoms even on days when I avoid using the computer or reading, but it is not quite as bad. Basically the only way to completely avoid the eye strain is to keep my eyes closed all day.

Some background: I am 33 yrs old. I wore soft contacts for 15 yrs, but discontinued about 2 yrs ago due to discomfort. The Rx I was wearing for the last several years was -3.75 OU (contacts) and -3.75 -.25 OU (glasses). I spend most of my work day in front of a computer, and I did not have eye strain problems before lasik. I usually took my contacts out after work and wore glasses in the evening.

Here are the numbers from my pre-lasik refraction:
Manifest: -3.75 -.50 OD, -4.00 -.25 OS
Cycloplegic: -3.25 -.50 OD, -4.00 -.25 OS
The cycloplegic right eye value is odd to me since my eyes seemed like they were very similar to each other before lasik.

Possible eye strain factors:

Refractive Imbalance - My current refraction is plano or -.25 OD, -.50 OS. No cylinder. The glasses I am wearing are plano OD, -.50 OS. I've tried a few other pairs as well, but these seem to provide the most comfort. Distance vision in my right eye is very good without glasses. I don't really want more correction in that eye since it would just add strain for near vision. If I wear glasses that are plano OD, -.25 OS, my right eye is still stronger. If I wear glasses that are plano OD, -.50 OS, my left eye is a little stronger. So the imbalance between right and left is somewhere between .25 and .50 diopters. Since glasses only come in .25 diopter increments, I still have up to .12 diopter imbalance with glasses. That doesn't sound like much, so it seems like there must be other factors causing eye strain.

Exophoria / Convergence Insufficiency - The ophthalmologist confirmed I have a small amount of exophoria. I don't get double vision so I must be able to compensate easily. I have read that this is common and likely not a problem. The minus lenses in my old glasses were reducing the amount I needed to converge, so perhaps eye muscles are straining due to the extra convergence demand now. This seems unlikely since I wore contacts for so long without strain. Also, before lasik I used to read sometimes without glasses and had to hold the book fairly close due to my nearsightedness, and I didn't get strain. I was told to try pencil push-ups which I've been doing for a few weeks. I can converge up to the tip of my nose, although it hurts within a few inches. I can't focus within about 6 inches anyway so I don't have much need to converge closer than that. I haven't noticed any reduction in strain at reading or computer distances, unfortunately.

Dry Eyes - I have dry eyes, which causes a lot of discomfort at times, but it feels much different than the eye strain described above. The discomfort from the dryness is more of a burning sensation and feeling of air blowing on my eyes. It is usually more of a problem in the late evening, but can occur during the day. Perhaps it is somehow contributing to the eye strain and headaches, but I'm not sure how. I've tried using lots of artificial tears for a day and it didn't seem to have any effect on eye strain. I have lower punctal plugs in both eyes that were inserted about 2 months ago and are supposed to dissolve after 3 months. I use preservative free artificial tears sometimes in the evening and Genteal Gel at night.

Light Sensitivity - I seem to be more sensitive to light after lasik. Maybe this is a factor. I feel better with low ambient light. I see a lot of glare when the sun reflects off cars and things. I also have moderate night halos and starbursts. The glare, halos, and starbursts are annoying, but are much lower concern for me than the eye strain, headaches, and dry eye.


Questions...lots of questions:

1. Is it unusual that I am not able to tolerate a refractive imbalance of around .37 diopters without eye strain?
2. Do you think I would eventually adapt without glasses if given enough time (months/years)? I waited 7 weeks after lasik before wearing glasses and did not adapt in that time. It would be nice if I could adapt to this since the weaker eye might help with reading as I get older.
3. Is it possible that my vision system is so sensitive that a refractive imbalance of .12 diopters with glasses on is causing eye strain?
4. Is it possible to buy glasses in .12 diopter increments anywhere? I'd like to try some with -.37 in left eye just to see if it helps.
5. Should I consider a lasik enhancement to my left eye to target .37 diopters more correction to try to match my right eye?
6. What kind of accuracy could I expect if -.37 is targeted for enhancement?
7. Is the accuracy of laser correction generally a percentage of targeted correction? Or is there some additional fixed tolerance just due to lifting and replacing the flap?
8. Would an enhancement increase the risk of developing permanent dry eye? Or would it just set me back to where I was 3 months ago.
9. Do you think exophoria or convergence insufficiency could be causing my symptoms now, even though I didn't have the symptoms with contacts?
10. If so, should I try wearing glasses with base IN prism? I am reluctant to do this since I could become dependent on them.
11. Do pencil push-ups work for adults?
12. Do you think dry eyes could be contributing to the eye strain and headaches I described? How?
13. What else could be causing my eye strain symptoms? Any advice?


Thanks for reading.
Original Post
quote:
Questions...lots of questions:

1. Is it unusual that I am not able to tolerate a refractive imbalance of around .37 diopters without eye strain?

No, it's not unusual. But when you "calculate" your refractive imbalance, you are basing it on your perception of comparing one eye to the other with varying lenses. You can't examine for refractive imbalance that way.

2. Do you think I would eventually adapt without glasses if given enough time (months/years)? I waited 7 weeks after lasik before wearing glasses and did not adapt in that time. It would be nice if I could adapt to this since the weaker eye might help with reading as I get older.

It is doubtful that you will adapt since the imbalance is not great enough to favor suppression of an eye.

3. Is it possible that my vision system is so sensitive that a refractive imbalance of .12 diopters with glasses on is causing eye strain?

No.

4. Is it possible to buy glasses in .12 diopter increments anywhere? I'd like to try some with -.37 in left eye just to see if it helps.

An eighth of a diopter is not going to fix an imbalance.

5. Should I consider a lasik enhancement to my left eye to target .37 diopters more correction to try to match my right eye?

No.

6. What kind of accuracy could I expect if -.37 is targeted for enhancement?

You could end up with anything from being balanced to simply a different imbalance.

7. Is the accuracy of laser correction generally a percentage of targeted correction? Or is there some additional fixed tolerance just due to lifting and replacing the flap?

Flaps create aberrations; the higher the prescription, the greater the potential for flap aberrations. Lifting flaps may alter the aberrations but not guarantee their elimination.

8. Would an enhancement increase the risk of developing permanent dry eye? Or would it just set me back to where I was 3 months ago.

The more you burn off the nerves, the more dryness. But since you wouldn't be cutting another flap, you may recover to present levels.

9. Do you think exophoria or convergence insufficiency could be causing my symptoms now, even though I didn't have the symptoms with contacts?

No.

10. If so, should I try wearing glasses with base IN prism? I am reluctant to do this since I could become dependent on them.

No.

11. Do pencil push-ups work for adults?

Yes.

12. Do you think dry eyes could be contributing to the eye strain and headaches I described? How?

Dryness distorts vision, reduces clarity. Loss of clarity is critical component of eyestrain.

13. What else could be causing my eye strain symptoms? Any advice?

I think you need a long, slow, delayed refraction (lots of fogging) concentrating on getting an accurate measure of any imbalance. Then I think you need a deep, cycloplegic refraction for comparison. Since you have mentioned nothing about loss of corrected acuity, I would definitely concentrate on the refraction.
Thanks for the response Dr. Hartzok. It has been frustrating trying to figure out the cause of the eyestrain and headaches since I seem to have good acuity with the glasses. The dryness does cause some blurriness at times in the evening, but during the day when I have the most strain my vision with glasses is usually sharp. I plan to get a second opinion refraction and cycloplegic refraction as you recommend.

Regarding the first question, I assume the reason you say comparing eyes is not a good way to measure an imbalance is because I could be over-corrected and accomodating? I'm pretty sure I'm not over-corrected since a -.25 lens over my stronger right eye does make things a little sharper and a +.25 lens makes things worse, but I haven't had a cycloplegic refraction since the lasik so perhaps that will show something.

Regarding an enhancement, I suppose I knew the response would be no, but I figured I shoud at least think about all my options. I would really like to get rid of (or at least reduce) my "headache vision", but I realize an enhancement may not be worth the risks.

I also want to ask you about peripheral vision after lasik and whether it could be a factor somehow? I understand that peripheral acuity is decreased after lasik since the laser primarily corrects the central vision. Sometimes it seems like my peripheral vision is not quite as good, but its hard to remember how it used to be. I seem to feel more strain when there is a lot of stuff in my peripheral vision and I am scanning around a lot.

Do you think RGP contacts may do anything for me? I assume they would help with the glare and halos, but I don't know if they would help reduce strain any more than glasses for me. Do RGP contacts restore peripheral acuity? I'm not sure if that's even my problem, but I'm curious.

Thanks.
The post-LASIK refraction can be difficult to ascertain. Since you are young enough to accommodate, pupil size can play into the quality of your corrected vision. Let's say you are over-corrected and actually +0.50 in the right eye; this can certainly cause discomfort. When +0.50 is placed into your glasses, the need to accommodate (focus) is relieved and so too the discomfort. But something else happens when the full correction of +0.50 is placed into your glasses: The pupil size increases a bit, allowing uncorrected mid-periphery light (-4.00) to spill into the centrally-ablated and clearer (+0.50) cornea. The resultant mix reduces the quality of your vision. Now, during refraction, when -0.25 is placed in front of the eye, accommodation kicks in, the pupil constricts, the out of focus mid-periphery (-4.00) light is subtracted and your subjective response is "That's the clear one, Doc." So, the doctor writes -0.25 into his or her chart. This "clearer" lens is put into your glasses but you are over-corrected and your eye strain is not relieved.

Besides the natural connection between pupil size and accommodation, there is the relationship between accommodation and convergence. The excess accommodation that goes along with an over-corretion creates a shift in convergence to a slightly more esophoric (or less exophoric) posture. This can add to the eye strain because it isn't your natural postural state. Your ophthalmologist may have measured a bit of exophoria but you may have been "comfortably" more exophoric before LASIK, so treating this finding of mild exophoria may have no impact on relieving your eyestrain.

Practitioners with great skills fitting RGPs are in decline because fewer patients are wearing them. Fitting an RGP on a "virginal" cornea versus a post-LASIK cornea is analogous to playing checkers versus chess. Most fitters believe, and rightly so in some cases, that the RGP lenses are correcting surface aberrations within the ablation zone. Secondarily, they believe that the RGP is also fixing the pupil size problem by offering an oversized optic zone on the RGP lens. Consequently, they attempt to use massive optic zones when designing RGPs. This latter point represents a huge misunderstanding of how RGP lenses benefit the post-ablation patient. The benefit of a well-fitted RGP lens on the post-ablation cornea is because the RGP lens is correcting the mid-peripheral vision (in the case example, 4.00 diopters of nearsightedness). So, no matter what size the pupil is, the previously uncorrected 4.00 diopters of light no longer spills into the laser-corrected ablation area. In fact, even a poorly fitted RGP will correct this problem. The effect is independent of the RGP's optic zone. The secondary and even tertiary curves on a post-LASIK RGP lens are STILL optically correcting the mid-peripheral vision.

If this is difficult to follow or understand, don't be dismayed. I estimate that 95% of ODs would not understand this phenomenon. They mostly think a big central optic zone is the way to go. But a big central optic zone precludes a comfortable fit on the post-ablation cornea. The misunderstanding about larger optic zones stems from the validity of their use on NON-ABLATED corneas. The benefit of SMALLER optic zones on ABLATED corneas requires a true paradigm shift in how to approach RGP design.

So, in spite of some arguments to the contrary, pupil size does matter in patients' LASIK outcomes. And, in spite of spurious arguments for the need of excessively large RGP optic zones, the true benefit of RGP lenses can be appreciated in cases possibly like yours, where you can attain relatively clear vision after LASIK that is, never the less, stressful.
Hello KS9,

My name is John and went through issues very similar to what you are going through. I had lasik and had terrible headaches while concentrating my vision while reading, on the computer and in general. I almost went back for a "touch up" which could have been devastating to my life. I did months of vision rehab and it did not work. Through a friend on here I came across Dr. Ken Maller in Fort Lauderdale and he was a life saver. Please please please give yourself the gift of going to see him. He is the best in his field and specializes in post lasik complications. His website is www.noblur.com and you can read his testimonials here http://noblur.com/patie.html. I am happy to call/speak to you and give you my perspective. My number is six zero two five two four four one four zero.

Best Regards,

John
While I have the greatest respect for Dr. Maller, whom I, myself, have been to see twice, I would strongly suggest perhaps seeing an expert fitter someone a bit closer to home who can give you an honest second opinion, refract you properly and perhaps give you some idea of whether RGP lenses might help you. If you are interested in a referral to someone one your area, please send me an email or private message.
KS9,

Dr. Hartzok has posted some excellent information for you. His comments regarding RGP use, as complicated as it might seem, is actually just the tip of the iceberg. And sadly, although he said that ~95% of ODs wouldn't understand the concepts that he commented on, in my experience (I teach fitters as well as consult with them to help them on cases), I believe the 95% is optimistic and unfortunately it is probably closer to 99%.

With regard to your eyestrain issue, I believe that this problem is quite a bit more common post-Lasik than is generally recognized as well as ignored and under-reported by post-surgical patients because they don't make the connection between this strain and their surgery. Often, I believe the patients that have vision that is "acceptable enough" for them i.e. the halos, glare, etc. aren't bothersome enough to complain about or pursue any remediation, the "eye strain" problem intuitively in the minds of these people isn't related to their surgical procedure because they feel very satisfied about the fact that their vision is quite good. Their thought process is "I see well so how could this possibly be contributing to my eyestrain?"

The reality here is that the same aberrations that contribute to the symptoms of glare, halos, spikes, sparkles, loss of contrast, etc., can also contribute to both accommodative dysfunction and throw a "monkey wrench" into the properly functioning binocular vision system. I have seen my share of post-surgical patients complain of this strain, diagnosed "correctly" elsewhere (and possibly by multiple physicians) with binocular vision dysfunction to then pursue various forms of therapy that ultimately all fail to provide relief. Although these therapies are excellent at addressing "normally occurring" binocular dysfunction, the reason they fail in these instances is that none of these therapies are aimed at (or capable of) fixing the underlying reason, which are the aberrations introduced into the visual system by the surgical intervention.

Obviously, without examining you, I do not know that these are your problems and it makes good sense as Dr. Hartzok recommended, to begin your road to remediation of the strain with proper assessment by another physician that will ferret out hidden refractive error through extensive fogging, cycloplegic exam, and then do comprehensive binocular and accommodative assessment. With this information you will be in a better position to pursue proper remediation of your strain.


Best of luck.
Sincerely,
Dr. Maller
Thanks for the response Dr. Maller. After describing my symptoms to others offline, I have been told that maybe I'm just thinking about my vision too much since lasik, implying I should just relax and stop overthinking it and it will go away. Of course, I know that doesn't work. The strain develops every day, no matter how much I'm focused on other things. So it is good to hear from people who understand that lasik can cause this even though my vision seems to be good.

There is no doubt for me that the strain is a result of lasik, since it started right after the procedure and the type of strain is not something I ever had before lasik. The reason I tried to describe the strain in detail in my original post is that "eye strain" is a general term that gets invoked to describe various types of eye discomfort with various causes. Saying I have "eye strain" is a little like telling a mechanic my car is making a "noise". Before lasik, my only idea of eye strain was having tired eyes from staring at a screen or road for too long and just need a short break. So I wanted to provide some detail in hopes that anyone reading this can understand that the eye strain I am experiencing is not just garden variety strain from staring at a screen too long or whatever...I also get eye pain sensations that often occur at times when you would not expect to be getting typical eye strain.

If the same aberrations that cause GASH also cause strain, it seems odd to me that more people would not be making similar complaints since GASH seems to be so common. It could be true as you point out that lasik related strain is more common than is realized and people aren't making the connection, but for me the connection seems obvious.
It has been 5 months since Lasik and I am still experiencing eye strain and headaches every day. The short bursts of eye pain I was getting has mostly gone away. I think that was probably just the flap healing or nerves reconnecting or something. I was associating it with the strain, but now I think it was just a separate thing since the strain has not really decreased. I have noticed that I am much more comfortable after dark, especially when on the computer. I don't know if this is an improvement or if I'm just noticing it more since its getting dark sooner now. Dry eye is slowly improving...I usually only notice it at night now.

I went to the optometrist that Barbara recommended and had the following refraction:
Manifest: R: Plano L: -.50
Cycloplegic: R: +.25 L: -.25

So it turns out I am a little over-corrected in my right eye but not much. I've tried several different pairs of glasses with slightly different strengths. They all help, but I still get a lot of strain. I've tried reading glasses but they don't seem to help. I even tried glasses with .37 diopter difference between right and left to see if it helped. They do actually feel a little more comfortable than the others, particularly during the day, but I still get headaches. I don't notice any imbalance at all with them. With the other pairs, I usually end up with a dull pain behind one eye or the other and something just feels a little off. After dark, it doesn't seem to matter as much. Maybe the light sensitivity is making me extra sensitive to any imbalance. The glasses I'm wearing currently are R: +.37, L: plano. I'm probably not quite 20/20 with these but distance vision is good enough to get by.

The optometrist did not detect any binocular issues or other abnormalities. He did a wavefront topography which showed low aberrations. Total high-order aberrations are 0.15D for right eye and 0.14D for left eye according to the Ophthonix printout. There are pictures on this printout showing cars with headlights on that is supposed to simulate what I see, but I think it is underestimating my aberrations since I see starbursts from headlights and the images had none. I also noticed it lists my pupil diameter as 6.7mm and measurement diameter as 4.5mm so there could be aberrations outside the measurement diameter that affect my vision. I guess all this tells me is I have low aberrations in my central vision. Oh yeah, it also tells me I am a "good candidate for iZON lenses". Super!...I googled them and found they are out of business. I also got some other Medmont Studio printouts showing a more detailed corneal topography for tangential and axial power along with a bunch of numbers, but I'm not sure how to interpret it all. I asked if RGP contacts might help me and he suggested trying soft contacts first and if I am still having problems then try a hard contact. So I will probably try a soft contact next.

I am still considering an enhancement to try to reduce the imbalance but not sure which eye to enhance. I'd prefer to only do one eye and I am thinking I would have less strain being slightly near-sighted rather than slightly far-sighted so I would probably change my right eye to match my left. If my strain is due to aberrations as Dr. Maller suggested, then I am a little concerned that the enhancement could increase the aberrations and my symptoms. I'm not sure exactly what happens at the outer edge of the ablation zone when the laser makes the cornea steeper as it would in my case, but it seems like there would have to be a little dip that would create a less smooth surface than the original procedure. But for only .37 diopters the amount of material removed by the laser would be quite small so maybe it wouldn't matter. I feel like I need to make a decision on this relatively soon if I want to still be able to lift the flap for the enhancement. I do not want to cut another flap or do a surface procedure. I plan do discuss options with the Lasik surgeon tomorrow.
Your outcome represents, more-or-less, a classic post-LASIK patient frustration VSRN regularly attempts to address.

Your O.D. failed to detect any binocular issues, which is good. The short bursts of pain have decreased which suggests your corneal surface is healthier.

You are left with: Persistent headaches and eyestrain not relieved satisfactorily by correcting the imbalance with glasses. Simple logic argues that additional surgery to correct the imbalance will likewise fail to relieve your residual symptoms.

You are more comfortable now after dark and on the computer. A point could be made that you are adapting to whatever it is that has caused your frustrations. Would additional surgery to correct the imbalance leave the other factors frustrating you better or worse? No one can provide that kind of assurance since no one can, with certainty, tell you what underlies your continuing symptoms. If your symptoms are related to central corneal aberrations, only well-fitted RGP lenses can make that determination. Soft lenses offer no magic in that regard.

LASIK is PLASTIC SURGERY for corneas. Patients (i.e., CUSTOMERS) do not always get what was featured in the ads.

BTW… some time ago I suggested on this forum a change in terminology. An RGP lens following post-refractive surgery should be referred to as a CORNEAL PROSTHESIS. A prosthesis is a device to replace a missing, injured or non-functioning body part. In this case it is the cornea that has lost tissue and/or become less functional. Restoring corneal function with a device would qualify that said device be referred to as a prosthesis. This would differentiate post-RS RGPs from "contact lenses" and elevate their role in the process of vision rehabilitation.
I am 6 months post-Lasik and I think light sensitivity is probably the primary cause of my eye strain and headaches. I remember reading about Transient Light Sensitivity (TLS) shortly after the Lasik procedure, but for some reason didn't think that was my problem. I don't know if I have TLS or just some other type of Lasik-induced photophobia. I did have intralase which seems to be associated with TLS. I don't exactly feel blinded by light when going outdoors, but if I am outside for awhile I generally get a headache even though I don't notice as much eye strain as I do when focusing my vision indoors in a room with windows or overhead lighting. I usually feel better just by cupping my hands around the sides of my face to block out some of the ambient light. My eye muscles feel sore almost all the time and don't relax until after dark.

I have been trying to find information about Lasik-induced photophobia and what, if any, treatment options are available. I have read that in the case of TLS, prednisolone steroid drops can help if it is caught in the first few weeks, but is difficult to treat later on. I did take prednisoline drops 4x a day for the first week after Lasik.
http://www.healio.com/ophthalm...ion-of-intralase-use

Do you think more steroid drops could help me, even though it has now been 6 months? I took Lotemax for a couple weeks back in August and didn't notice much difference, but those are not as strong as the prednisolone drops that may be prescribed for TLS. I have read that steroid drops can cause early development of cataracts so I am hesitant to take more unless there is a good chance it will help.

Do you think Restasis is likely to help me? I don't feel bothered by dry eye most of the day, but my eyes do feel dry occasionally and at night. The optometrist I saw in August did some fancy Tearlab osmolarity analysis and it was just inside the normal range, but I haven't had a Schirmer test since the pre-Lasik exam so I'm not sure how dry they really are. The Lasik doctor gave me a prescription for Restasis, but I am hesitant to take them because of the expense (~$300/month) and I am skeptical that they will help. I have read that they only increase tear production for 10-15% of people. Even if i am one of them, I don't know if it will reduce my main problems since they have not really imrpoved over the last 6 months even though the dry eye has improved noticably.

I tried soft contacts, but found them uncomfortable and my vision was blurry much of the time. I have not tried RGP contacts yet, but will probably try them at some point. I suspect I will have trouble wearing any type of contact due to how sensitive my eyes are now. The Lasik doctor recommended against trying RGP lenses since you have to be out of them awhile before doing an enhancement. I am leaning away from doing an enhancement anyway, since I assume it would not help with the photosensitivity and could make it worse. I am still wearing glasses full-time due to the imbalance. The Lasik doctor thought it would be difficult to get a good result if he tried to enhance my stronger R eye back to match my L eye and thought it would be better do the L eye, but I'm not sure its worth the risk and don't want my L eye to end up overcorrected.

How likely is it that the photophobia will resolve on its own, especially if it is still present after 6 months? I haven't found much about the chances for improvement other than a few anecdotal stories, some that improved and some that didn't. I'd be interested to hear from anyone who has had long-term photophobia after Lasik and what treatments worked or didn't work and if it ever resolved.

Thank you.
I've been to see my Lasik doctor several times and each time I report my symptoms (eye strain, headache, light sensitivity) and he tells me to wait and it will get better. He says everything looks fine and that he has never seen someone not get better with time. He tells me I must be extremely sensitive and that I am thinking about it too much. I ask him what other patients do in my situation and he says they would probably be happy with the result. But it is obvious to me that something is very wrong and it is not getting better, so I turn to the internet to try to find solutions or at least understand it better. I haven't specifically told him that I think I might have TLS but I always mention that I am more comfortable after dark so it seems he would have diagnosed TLS by now if that is my problem. I will probably go see him again and specifically bring up TLS to see what he thinks. I am also thinking about going to see a different Lasik doctor to get another opinion.
If your surgeon is not taking your complaints seriously, it might be in your best interest to request your records and find another doctor for a second opinion, preferably someone who has no connection with your LASIK surgeon, and who will actually listen to you before making a judgment.
I am amazed that you havn't gone for a second and third lasik doctor opinion so far. Never trust one doctor, and especially when his results are bad.
Have you tried different eye relaxation exercises? I have no experience with this but since you haven't mentioned any, I thought it might be good to check. Bates method have such exercises.
Plus I didn't understand if the strain is only when you use both eyes or also when using one? Not that I can provide more insight, but maybe noting that may give you a better understanding.
If you say light sensitivity, what about sunglasses? any improvement?
night bursts - any improvement with Alphagan?

Keep positive thinking, and best of luck!
Thanks for the reponse prk. Yeah, I should have gone to another Lasik doctor much sooner. If I was smarter, I would have done a lot of things differently. I spent a lot of time driving myself crazy with all these different pairs of glasses and thinking maybe I had some convergence problem or other random stuff, but I think I'm just very sensitive to light and is causing me all these problems even indoors.

I did go see an optometrist a few months ago, but he was not a Lasik doc. I just saw my Lasik doctor again and discussed the light sensitivity. He told me to try wearing yellow-tinted glasses. He also wrote me a prescription for prednisolone drops after I suggested it. I think these drops are the right thing to try, but I do not have much confidence in his ability to treat me at this point. I have an appointment to see another Lasik doc in a couple days.

The best eye relaxation technique I have found so far is darkness. Other than that, sometimes when my eye muclses are sore I find it helpful to close my eyes and look as far as I can for 10 seconds in each direction. I thought the Bates method stuff has generally been debunked.

I notice relief when closing one eye, which is one reason I thought my problem was some kind of imbalance or convergence thing and I just needed to find the right pair of glasses. But I've tried wearing an eye patch for a whole day and still end up with strain and headache eventually. I think the light sensitivity makes my eyes tense up and then they are not able to handle any visually demanding tasks without really straining and getting sore.

Yes, sunglasses are helpful when outside or driving, but they are not enough.

I have not tried Alphagan. Night halos and starbursts are not terrible for me and seem like the least of my problems right now. I actually much prefer driving at night to driving during the day, especially if I have a long drive. Even though headlights are annoying, I feel much better when the sun is down.

I hope you have success with your other eye!
Ok, so I have one more crazy theory. Is it possible that some of the strain is due to the magnification difference with glasses on that are 0.50D different between eyes? The glasses make stuff a little larger in my right eye than in my left eye, but the difference is small. It just seems like my eyes often aren't comfortable working together for some reason. I notice a bit of relief initially when lifting up my glasses, but it is soon replaced with a worse strain as my eyes work to accommodate different amounts, particularly when using near or intermediate vision.

I was hoping the soft contacts would help test this idea, but it was uncomfortable and blurry most of the time so was hard to tell if it was helping. I suspect the fit was not good, but the lasik doc that gave them to me said the fit would not affect vision, only comfort, so if the vision is not good through the contact then there is no point trying to improve the fit.
Hi Gigi. I'm sorry you are having trouble. One thing I've learned is that the vision system is complicated and not everyone is the same so your experience may end up better than mine, hopefully. My symptoms really haven't improved. I still get a lot of eye strain every day and head aches most days. I'm still going to work but it sucks. I've been to several eye doctors in the last year but haven't found any real solutions so far.

Last December, I went to a second Lasik doc. He said he didn't see anything wrong other than a 0.5 diopter difference between eyes. He recommended not to wear any glasses and give it another 6 months and he was certain that I would adjust to it and it would be fine, but if not he could do an enhancement then. So I didn't wear any glasses for the first half of last year, but it didn't improve. I think I just got more headaches, especially when working on a computer. I started wearing glasses again after that and have found that (R:+0.25, L:-0.25) or (R:+0.50, L:0) seem to work out the best. It is still uncomfortable, but seems to help especially on the computer if I don't have the imbalance. Switching between wearing them and not wearing them makes things a lot worse so I just wear them all the time.

I tried taking prednisolone early last year. I think I took it 4x per day for a couple weeks and then tapered off over the next few weeks. I don't think it helped. I still have issues with light sensitivity. The eye strain is much worse if I am in a room with overhead lights or lots of windows and I am more comfortable after dark.

I started taking Restasis early last year. I ended up taking it for maybe 8 or 9 months, but I'm not sure if it did anything. I didn't notice any sudden changes in dryness when taking it or stopping it, but I do think dryness has improved a little compared to when I started it. I suspect that would have happened even without the Restasis. My eyes still dry out at times and are more dry than they were before Lasik, but it doesn't bother me nearly as much as it did in the first few months.

I saw another optometrist over the summer who does vision therapy. He did a bunch of tests for binocular dysfunction and thought my symptoms were from convergence insufficiency. He did not recommend prism glasses because something about I might keep wanting stronger and stronger prism. He recommended vision therapy instead, but I haven't done it yet. I think he also said I have around 3 prism diopters of exophoria. I don't know if that is unusual or not or if it would typically require someone to need prism glasses. I did end up trying glasses that had 1.0 Base In prism (0.5 in each eye) for a couple weeks just to see if it would help. I could tell they relieved some of the effort to converge and I think I had less tendency to get double vision on the computer, but overall they were more uncomfortable than my regular glasses so I didn't want to wear them longer or try stronger prism.

I also tried wearing a soft contact in one eye again. I found a brand that worked out better than the contact I tried last year, but it still was hard to wear more than a few days in a row and also caused my vision to fluctuate more. During the short time I could get along with it, I did have less eye strain and less light sensitivity. I found it was best when wearing a +0.75 contact in my right eye. So I am still thinking about doing an enhancement to make my right eye less far sighted. I don't think it will eliminate the eye strain, but I think it would help.

I went to a third Lasik doc a few months ago and he thinks ciliary spasms are causing the eye strain. He thought I could have been over-minused before Lasik which could be part of the problem. He prescribed Cyclogyl 1% eye drops. One in each eye every night for 2 weeks. It didn't seem to help much.

So I think the eye strain is probably a combination of the convergence issues as well as possible ciliary spasms. It does seem to take different forms. Sometimes it feels like it is behind or around my eyes and sometimes it is more back in my head or on the sides of my head. If I was over-minused before Lasik, that might have been helping me converge since I think accomodation and convergence are linked somehow. My old -4.0 diopter glasses were also helping me converge at near distance. Then the 0.5 diopter imbalance just seems to complicate things and makes it worse.
If you were previously over-corrected in your glasses and that was creating accommodation to help you converge, then you should consider a pair of glasses now that over-correct your vision somewhat. I would have your optometrist use a trial frame with 0.50 diopter more minus (less plus) in the prescription to see how you respond. As far as the prism is concerned, that can be added to the trial frame as well to see how it works.

You have been struggling a long time. The entire point of VISION CARE is to relieve patients' symptoms. Worrying about prescribing prism because you might adapt to it and like it in your glasses fails the prime directive; we use whatever means available to us to fix problems. Would it be prudent to withhold morphine from a patient in severe pain? If you need prism in your glasses to restore your visual function, then we prescribe prism. Quite possibly that same doctor who is hesitant to use prism refers patients to have LASIK without any caveats.

Soft lenses are a waste of time. Previously you stated:

I was hoping the soft contacts would help test this idea, but it was uncomfortable and blurry most of the time so was hard to tell if it was helping. I suspect the fit was not good, but the lasik doc that gave them to me said the fit would not affect vision, only comfort, so if the vision is not good through the contact then there is no point trying to improve the fit.

He said the fit would not affect vision??? This is because your LASIK doctor has no understanding of soft contact lenses. You were four diopters near sighted before LASIK. Soft contact lenses will no longer fit unless they are specifically designed for post-refractive surgery and even those don't fit well. Custom post-rs RGPs by someone who actually knows how to fit post-rs corneas is the only thing to consider.
KS9,

I would echo Dr. Hartzok's comments. You have aberrations induced by your refractive surgery that glasses, soft contact lenses, and additional surgery do not and will not address. The imbalance of prescription is also contributing to your problems but if it were the only problem, you would have been completely relieved of symptoms with your trial experiments over all this time - which you weren't. As I previously stated, I see this problem regularly. Post refractive surgical patients are diagnosed with binocular dysfunction leading to the headaches, etc., go through many hours (100+) of vision therapy and are yet still sympotomatic. You DO have a binocular dysfunction but it isn't from any of the "normally" underlying sources - it is from the aberrations present from your post-surgical corneal shape. This can only be addressed with a well fit GP lens. Pursue this route with a doctor experienced fitting post-surgical corneas and you will find relief.

Best of luck.
Dr. Maller
Thanks for the responses. I guess I'm a little confused about the aberration thing. As far as i know, I just have a small spherical error. My vision with glasses is generally very clear. I don't have any major problems with halos, etc at night. I have had a wavefront scan that indicated low aberrations. It seems like whatever aberrations I have are probably not out of the norm for someone who has had lasik. So if aberrations are the cause of my symptoms, why doesn't everyone have these symptoms after lasik?

I'm not opposed to trying hard contacts. My intention was to try them over a year ago when I went to see someone locally who was supposed to be an expert in fitting RGP lenses on post-lasik patients and he steered me toward soft contacts instead. The other eye doctors I have been to since then have also steered me in other directions so sometimes it has been hard to know what to do.
KS9,

Just because you have aberrations that are within "tolerance" for a post-Lasik result, doesn't mean that you visual system is not being impacted by them. In answer to your query about "why doesn't everyone have these symptoms after Lasik" I would ask you why doesn't every car get 30 miles to a gallon of gas? The answer is the same - each system works differently, whether we are talking about a sampling of different cars or different binocular visual systems. Some people will have binocularity disrupted enough by the post-Lasik aberrations and become symptomatic like you, while many will have enough resiliency within their binocular visual systems to remain asymptomatic despite the post-surgical aberrations.

The comment you made about seeing someone locally who was supposed to be an expert on fitting GP lenses on post-Lasik patients truly disheartens me, but does not surprise me which is what I told you in a previous post. If you were "steered" toward a soft contact lens option, I doubt that this fitter really understands post-Lasik corneal aberrations and how to address them properly. This marks my 23rd year in providing care for post refractive surgical patients. If you wish to address your struggle, find someone to work with that can properly fit you into a GP lens. Of course herein lies the problem. You will have difficulty finding someone that really can properly fit you into a GP lens.

I wish you the best is your search for this individual and the ultimate resolution of your problem.

Sincerely,
Dr. Maller
Like a story book, I read these posts in order. Hoping that I would like the ending. Cheering for the patient seeking relief. Instead I feel like I have read my lifelong sentence.

I agree, every "vehicle" is different. I got this LASIK procedure from the same doctor my sister and brother visited. They told me they hand no problems. My experience is much different.

Reading the progression of your symptoms through the months I find my symptoms and behaviors to be nearly identical. Such as originally thinking the problem would be un-even fix (both eyes are pretty good, but they don't work well together). Then imagining the problem is with the tiny eye muscles. Finally, just before reading this feed I have been strongly believing I am photophobic.

I am just now approaching 6 months. I have gone to an ophthalmologist for a second opinion. I made the appointment believing they were not affiliated with the doctor who performed iLASIK on me, but who knows. Each doctor has tried looking in my eyes for problems but since they cant see anything they dismiss my symptoms.

I tried a pair of +1.00 glasses for a short time, they did help in some ways. The initial doctor had told me to equate bad vision to dryness and add drops everytime. I followed this advice. Then after complaining many times he I told him I have been putting drops in every 15 minutes most of the day long and sometimes every 5 minutes. Only then did he suggest that there may be such thing as too many drops. But my vision was blurred trying to focus on a screen so as per the prescription, I added drops more often. Decreasing drops at that time did seem to make me a bit more comfortable.

The first week was actually great. I was telling people everything was perfect. After the first week my anti-biotic and steroid were complete. Right about this time adverse symptoms started showing up. First, some blur in my left eye. I worried that I had ruined the flap during sleep because that is when I noticed it. Looking up at the shiny brass surfaces of my ceiling fan. It was so vivid and crisp that first week. Now it became slightly blurred.

Then, walking around the yard I noticed a weird visual effect pass my vision. I actually thought at first it was just a drop of water on my lashes causing a bubble effect. I thought, "my vision is so good, i can see my eyelashes too well, along with this tiny water drop!" At about 3 weeks I was certain this water droplet was internal. It is a floater which instead of blocking light, like I'm familiar with, it refracts it like a fish eye lens. I'd say it is now about 7 times the size of the floater in my right eye.

When allergy season set in, I may have been affected more by allergies than I have ever noticed. I started taking allergy medication and decongestant, in part because the second doctor I visited, after she did not find any problems, suggested that the pressure/eye-strain problem could be allergies. This may have helped for a week or so, I didn't experience much eye-strain, but even continued use of these medications has ceased to help, I think the placebo affect wore off as reality set in that it was not actually helping. Ultimately, the troubles I was having with eye-strain came back as bad as ever.

The refractive/bubble floater has grown progressively larger, and I have now seen it twice with a black floater in the center of the bubble, whether this is just 2 foaters at different depths, or one floater I cannot tell.

This whole situation has been just unbelievable for me. I am treated like I am cant tell what the symptoms are, but I myself am overwhelmed with the many details of symptoms and I do not know how to distill the symptoms down enough to get a doctor to listen and help. Now reading that the main problem of my complaints, eye-strain, does not have a real solid solution... I want to pluck out my eyeballs and step on them, and then kick myself repeatedly for getting this elective operation.

I have a 6 month evaluation soon. I am not sure yet what topics to bring up. The doctor seems to get more annoyed the more topics/symptoms/experiences I share. I already paid him for the operation though, so I understand he has no monetary interest in it. I'll probably give up on him ever listening and he will get away with ruining my life for his profit.

Among my wonderings includes, would my vision return to being as good as I remember the first week if I get back on the steroid? Or, perhaps it was the anti-biotic that was sustaining my good vision by fighting off bacteria that my eyes have become susceptible to? I do sometimes feel like the pain in the back of my eye could be pressure from swollen tissues.

What is the possibility that some foreign body, organism, or virus has been introduced into my system through this operation? I have even had pink eye for the first time in my adult life at about 2 months after operation. My wife and I have both also recently noticed a white pimple like bump that has just shown up in our pubic areas (we are completely loyal to each other, there is no question of infidelity).

This list of concern goes on and you are only getting a sample of it. As you can tell, this is driving me crazy. And I know if this continues this situation will mark my decent into deep depression and grumpy old man days, if I make it that far.

One thing that concerns me about reading the above post is that all the technical terms are things which have not been mentioned to me. Why does my doctor keep telling me, "get use to it", "everyone has floaters" (even though he has never heard of this bubble floater), and "You're thinking about it too much."

______________________________________
Since your asking, I'll give more detail. My LASIK doctor's office visits are broken up between two Doctors. Before the operation I got to talk to the main doctor mixed with the side doctor. After the operation is complete, I have only gotten to see the side doctor. This is despite specific request to see the main doctor.

At one week when I started having problems I called the office multiple times and had extra visits to talk about adverse conditions. The main feedback I got at this time was to "ensure to get drops every waking hour", and, "you'll get use to it, stop thinking about it." And he even brought in the concept, "your an engineer, you are obviously over thinking things."

Among my own search for finding relief, I conceived the idea of trying +1.00 glasses. Before deciding to buy them, I called the office and asked if one of two options might help my symptoms. Try +1.00 reading glasses, or try wearing a patch over the eye that has the most pain. The receptionist responded that I should definitely not try a patch, but that +1.00 glasses could be a good attempt.

I believe this is one of the instances where the receptionist took my question and asked the doctor. Either way, I also spoke to him in a later follow-up and mentioned that I tried the +1.00 glasses. He sparked up and asked if it worked. I said that at best, it might have delayed the eye-strain. But it was by no means a fix. I get the same general benefit from wearing the pair of tinted lens provided by the LASIK visits. And so this is what I do, I have these glasses on my head all day long. I put them over my eyes everytime I feel the eye-strain. The eye strain does not go away completely, but it is absolutely more bearable.

I just turned 30 years old before getting the surgery, so it is not likely that I need reading glasses for the usual reasons.

I keep mulling over the many details in my head and wonder which, if any of them are indicative of my situation. Most of them I have attempted to present to the doctor to promote thought and possible diagnosis or at least tests. But the abrasive nature of the rushed meetings has proven these visits are not only short, but also useless.
If I could be in control of my own medical practicing, I have a few things I would like to try until finding a solution:

  • A thorough course of antibiotic(s) which could eliminate any bacterial infection. I actually consider this a good possibility because I also have had frequent nose pain most my adult life, along with my crooked nose. Plus anytime I forget to brush my teeth I am quickly reminded with pain that has me thinking there is something lerking around my face just looking for weakness.
  • Start another course of the steroid that would target the same muscles targeted after the operation. Use this to see if the added strength eliminates the eye strain. If so at least it will have been narrowed down to being a muscle fatigue rather than infection.
  • Get imaging taken of eyes to detect any problems. This was actually suggested as a possibility by the second opinion doctor, but the doctor only mentioned that I COULD go to a general doctor and ask for the testing. Since she didn't actually provide some sort of recommendation for it I haven't put much emphasis on this yet (not even two weeks from this visit yet though).

Unfortunately, I have not yet been too convincing when I visit doctors. Most have ended up ignoring my opinion of what I would like to try. How do I get a doctor to get me a prescription for antibiotics just to rule out this possibility? Or am I completely off base and have virtually zero chance for antibiotics to solve this issue?
quote:
Originally posted by speiCee:
If I could be in control of my own medical practicing, I have a few things I would like to try until finding a solution:

  • A thorough course of antibiotic(s) which could eliminate any bacterial infection. I actually consider this a good possibility because I also have had frequent nose pain most my adult life, along with my crooked nose. Plus anytime I forget to brush my teeth I am quickly reminded with pain that has me thinking there is something lerking around my face just looking for weakness.

    There is NO indication that you need an antibiotic.

  • Start another course of the steroid that would target the same muscles targeted after the operation. Use this to see if the added strength eliminates the eye strain. If so at least it will have been narrowed down to being a muscle fatigue rather than infection.

    Steroids following LASIK do NOT target muscles. Steroids would not add "strength" to eliminate eye strain.

  • Get imaging taken of eyes to detect any problems. This was actually suggested as a possibility by the second opinion doctor, but the doctor only mentioned that I COULD go to a general doctor and ask for the testing. Since she didn't actually provide some sort of recommendation for it I haven't put much emphasis on this yet (not even two weeks from this visit yet though).

Unfortunately, I have not yet been too convincing when I visit doctors. Most have ended up ignoring my opinion of what I would like to try. How do I get a doctor to get me a prescription for antibiotics just to rule out this possibility? Or am I completely off base and have virtually zero chance for antibiotics to solve this issue?

Asking a doctor for antibiotics when none are indicated would be a waste of time, for him/her and for you.

Have you been refracted and by whom?

Having read all that you have written (and you can read all you want), without a clinical education and experience it is impossible for you to put any of this into a logical perspective. Finding your own solution is unlikely.

Barbara has attempted to help you in her email response.

Many doctors don't grasp post-LASIK issues, particularly if they are visual in nature. Finding those doctors is not a slam dunk. Hence the role of VISION SURGERY REHAB NETWORK.
Thanks for the response. Yes, Barbara has been very helpful in emails.

I do not know If I have been refracted. I have seen two eye doctors. Most of the tests they have performed they have not told me the names of them. The general definition of refract refers to the bend in light due to transition from one medium to another or in medical terms it refers to measuring focusing characteristics of the eye.

Both doctors performed some tests beyond the Snellen eye test. I shared with Barbara in email one case:

quote:
... Dr Coleson showed me [a slide] and asked if I see double vision. I had already started blinking because the image was doing something weird to my vision. I stated that as I keep blinking the white parts appear to fill in with some black. He told me that I am just redistributing my oils by blinking and moved on from that slide.


The other doctor also stood in front of me (this doesn't seem like a very technical test) and moved her hand to clock positions and asked if her hand disappears. I said no in each position. I wouldn't say her hand was clear in every position and my eyes wanted to move to clear up the area in question.

There were other tests performed. All in all, the tests that were performed have all resulted in the doctors (2) saying there is nothing detected. The secondary doctor suggested that my next step should be to visit a general doctor and request a scan of tissues around my eyes.

The secondary doctor also suggested the problem could simply be allergies. I have had some allergies in the past, including eye pain. I have only rarely taken any medication for the allergies though. And I have never had a long lasting problem. If allergies are part of my problem, they are not the entire problem. Further, even while taking Alertec and Suddafed the eye pain still shows up sooner or later depending on the actual situation.

Vision is very important to me. I have had some pretty hard depression and underlying fear that I will have to just deal with vision problems and pain for the rest of my life. I am searching and learning everything I can about this topic, not only to try and find a solution.

I realize that I will likely not find the solution on my own in the end. However, it is evident that even professionals that get patients into this situation do not have the experience or training to help them get out of it in an acceptable time frame.

I am very thankful for the help that VSRN is providing. It looks like VSRN will be a great stepping stone in my future story of my LASIK recovery. On the other hand, I got into this mess in some ways uneducated. I believe it will be best for me to seek as much understanding of eye problems related to my symptoms as possible. In the end it will hopefully guide me to accept the correct treatment or ask the right question(s).
Refraction is the "better one or two" test, asking you to choose between one image versus another. Your best bet is to get a refraction from someone outside the refractive surgeon's office. The refraction should make every effort to BALANCE the two eyes as well as determine if you are over-corrected. Refraction determines the lens prescription that provides the clearest vision. If a lens correction fails to provide clear vision, then it's necessary to determine WHY a lens fails to correct your vision.

First things first: The refraction sets up the analysis of your concerns.
Ok, yes, both doctors performed the refraction test. In all cases no perscription is suggested because my vision is 20/15.

At the surgeons office I have gotten the refractive test twice. One time he told me the correction is perfect except i have a minor .5 diopters of astigmatism. The second test, two months later, he told me everything is perfect and that there is, "no lens there in front of your eye."

At the second doctors office they again stated that my eyes were 20/15 vision. I am actually not recalling them doing the astigmatism test, though I am certain I told the assistant I may have some astigmatism. Unfortunately, the only document they sent me out with is details about the visit codes rather than results.

I think I need to call both offices and request my official records. I have never actually done this before. Is there a best timing to this sort of thing? Should I wait until after my 6 month check up or is it OK to do it now and still attend the 6 month check up? I assume that existing in my records should be the exact outcome of visits, such as .5 diopters of astigmatism, etc.
Your records *should* have the results of any tests or examinations, but it will depend on how thorough your doctors are about writing stuff down or dictating, if they use electronic records. There is no good or better time to request your records, as you are entitled to them under the HIPAA provisions of the law. There may be information in your records that can shed some light on the situation.

You are also entitled, after any visit to your doctors, to request a copy of the details of your exam for that day. You have to ask for it in some places, in others, it's standard practice to print out notes or make a copy of handwritten notes.

So, here's the thing about 20/15, 20/20, etc. Unless you have NO aberrations, no irregular astigmatism, the snellen chart does not have a true picture of the state of your vision. You may very well be 20/15 with some prompting, and maybe a part of the 2015 line, but if, as in my case, you look at the chart and see ghosting (three images) and glare, with loss of contrast, it can be very difficult to determine just exactly what you're seeing. Quality of vision does not seem to enter into the surgeons' equations. It's important to get your records so that when you go to see an independent doctor for another opinion, you can send your records before hand (make copies!), or bring them with you at the time of your visit.
quote:
I believe this is one of the instances where the receptionist took my question and asked the doctor. Either way, I also spoke to him in a later follow-up and mentioned that I tried the +1.00 glasses. He sparked up and asked if it worked. I said that at best, it might have delayed the eye-strain. But it was by no means a fix. I get the same general benefit from wearing the pair of tinted lens provided by the LASIK visits. And so this is what I do, I have these glasses on my head all day long. I put them over my eyes everytime I feel the eye-strain. The eye strain does not go away completely, but it is absolutely more bearable.


And the two doctors you have seen work where? They are the two doctors who work where you paid to NO LONGER HAVE TO WEAR GLASSES, correct?

At your age you could very well read the eye chart without glasses even if you are over-corrected. But if you get some relief from your eyestrain with the +1.00 reading glasses then over-correction is a very real possibility.

This is why I asked "who" refracted you. I don't care about their names; I just needed to know if they are part of the same facility.

Refraction AFTER LASIK is more challenging to perform and can generally miss an overcorrection, especially if performed monocularly and if the examiner is not considering over-correction as a possibility. You need to be examined by someone who is not involved in refractive surgery who can provide you with a deeper assessment of your vision.
quote:

And the two doctors you have seen work where? They are the two doctors who work where you paid to NO LONGER HAVE TO WEAR GLASSES, correct?


Yes, the original office, where I paid with the objective to get rid of corrective lenses is where I saw the first 2 doctors, surgeon and follow-up OD. The OD did the "better 1 or 2" test at this facility at 3 months recovery.

At the second-opinion facility they also did the "better 1 or 2" test. This was at 5 months recovery, only 2 weeks ago.

Here is where I struggle. I think that under the right conditions some adaptability is possible and necessary. I also feel like my exact condition is relatively minor compared to some cases, but it is a drastic change compared to my previous vision that was painless. (I only had two flaws, nearsighted and one floater in my right eye. I should have left "pretty dang great" alone.) Yes I can see distance quite well, but once I start focusing on content a slight pain is present and ever growing until I cant put up with it and have to shade my eyes. And along with this progressive pain the large, new floater in my left eye also becomes increasingly noticeable and distracting.
Everything you have said here suggests that you need an in-depth vision analysis. You have symptoms associated with the use of your eyes. You have experienced some relief with +1.00 readers. You just haven't found an O.D. who can deliver an answer. Consider an O.D. who is a member of COVD - College of Optometrists in Vision Development - www.covd.org
Hello! I had the surgery Lasik in 1998 had many problems and had to redo twice but after that period I came back to wear glasses adapting get along with them. However two years here have got a lot of headache and nausea with the use of glasses. Last year I made about five prescriptions for glasses and no worked my vision with these glasses are good but I can not use them for long. next week I will be traveling to the United States new York and Miami case has any optometrist to indicate would be grateful to make a very precise prescription.

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