Eye strain and headaches after Lasik

bzntho,

With the long history of LASIK (17 years ago), glasses may not be a viable option. It may not be as simple at that. You need someone who can evaluate your vision and your corneas. Barbara has sent you a recommendation. Hopefully that doctor can give you a complete assessment of your situation. Please keep us updated on new findings and any progress and, certainly, if you have any questions we can help you with.
Dear All,

What a great topic this is. Special thanks to KS9 for raising this, I found it amazing how you were able to describe your symptoms, as I find this the most difficult job to do, hence no one is able to diagnose appropriately. KS9, please come back and update us on your progress.

I have 99% of the symptoms mentioned by KS9 and am very very desperate now.. No one seems to be able to help or even diagnose the problem. The LASIK clinic performed all tests they could and find my vision to be perfectly sharp with no anomalies. I would like to share my story and, hopefully, someone will be able to give advice, as this current state is simply unbearable.

I first had my LASIK in 2012, which resulted in very weird symptoms that I could not define clearly. Seemed like constant pressure inside the head, lethargic feeling, continuous tiredness etc. I then went on to seek doctor’s advice as I suspected it may have been depression. Antidepressants did not help.
After LASIK my right eye vision was weaker than left eye, but only fractionally, around .25 diopters. I complained to my LASIK clinic about this and they started testing me with glasses first to see whether that improves anything. Finally, 1 year ago, they suggested an enhancement on my right eye, which I agreed to. This was done with LASEK this time. The recovery took around 6 months. At first it seemed like two eyes could not synchronise, distance vision was good with right eye, but working with computer was a nightmare. However, I could focus my eyes manually if I wanted, but they did not work intact, if I was to focus one eye on short objects, the other one would go out of focus, and vice versa. By around end of month 6, the vision settled in the right eye and something strange happened.. my left eye got worse on distance vision. Now they swapped! The right eye was sharp and left eye got a lot worse.
After further diagnostics and tests, we decided to do same enhancement on the left eye now (sounds crazy!). I was only hoping this would help. So it took another 6 months to recover with the left eye. Both eyes seems to have settled now and the distance vision is perfect now. However, the eye strain, head pressures (aches) are unbearable. It feels as though the vision might have been over corrected. However, the refraction is showing ideal results.
After reading KS9 post and all the comments, I can clearly say that I have exactly the same problem as KS9 and am now on a desperate side, as no one seems to be able to help. God forbid, but should this carry on, one may start getting suicidal thoughts.
I would really appreciate ANY help I can get! Any tip, any advise, any treatment… I am based in the UK, so am not American. It would be difficult for me to undertake some kind of extensive treatment in the US, however, should this be the last resort, I would go for it. Could any of health professionals like Dr DavOD or Dr Maller please advise. Ideally, could you please help with composing the diagnosis which I can then present to my clinic to explain what they are to do for me.
Thank you very much.
VJ
quote:
Both eyes seems to have settled now and the distance vision is perfect now. However, the eye strain, head pressures (aches) are unbearable. It feels as though the vision might have been over corrected. However, the refraction is showing ideal results.


Let me define refraction from the perspective of many optometrists and certainly LASK surgeons: The clearest lens prescription possible in the right eye and the clearest lens prescription in the left eye. Following LASIK, if the lens prescription in both eyes is practically PLANO (zero) then the LASIK procedure has produced "ideal results."

Refraction is not the singular determination of the lens prescription in each eye but the determination of lens prescription when both eyes are used together, i.e., binocularly. Most doctors do these determinations MONOCULARLY. But the best lens for an eye WHILE THE OTHER EYE IS CLOSED is not necessarily the best lens when both eyes are open. And, even if you determine the best lens for each eye while both eyes are open, it doesn't mean both eyes are functionally binocular. Perfectly fitted running shoes do not a runner make = clear vision in each eye does not guarantee perfectly coordinated and stress free vision.

Even if you were comfortable wearing glasses or contact lenses prior to LASIK, it doesn't automatically follow that your two eyes will work together comfortably AFTER LASIK. This has been shown time and time again and yet LASIK centers are not interested in screening patients for latent binocularity problems PRIOR to LASIK. Why? The reasons are (1) they don't know how to screen patients for latent binocularity problems, (2) they don't CARE to screen patients for latent binocularity problems and certainly (3) they don't understand how refractive surgery can create binocularity problems and even more certainly (4) they don't want to spend more time only to turn away a potential customer. Consequently, refractive surgery centers are highly unlikely to figure out problems of binocular vision which, based on your post, you almost certainly are experiencing.

You need an optometrist who will do a thorough BINOCULARITY EVALUATION of your visual system. We used to just call that an eye exam but what passes these days for an eye exam falls very short of a thorough binocular vision analysis and I can guarantee your LASIK center can't provide that for you.

We (VSRN) are finding it more challenging to locate optometrists to perform what used to be referred to as 21-point exam. If you can find an optometrist who actually knows what a 21-point exam is, then you may have found someone who can help you. Suffice it to say that your initial problem sounds like a binocular one, the change in your prescription in the right eye was the response to a binocularity problem, followed by the change in your left eye which was a further response. So, while LASIK has pushed you into seeing clearly in each eye alone, the procedure has exacerbated the underlying binocular issue and left you with symptoms you never had prior to LASIK.

I see many non-LASIK patients who present with multiple pairs of glasses they have acquired, all of which failed to relieve their symptoms. I didn't invent solutions for these patients; some very smart no-longer-living doctors figured things out years ago and the word was passed down to me and my colleagues. But it is up to my colleagues to USE THE KNOWLEDGE, just as it was up to Luke Skywalker to USE THE FORCE.
Dear Dr DavOD,

thank you very much. I will do my best to find the proper specialist to perform proper binocular checks (21 point test), as you suggested. But could you tell me, from your knowledge and experience, is this fixable? Can the life get back to normal (even if glasses are needed), or is it a defect that has no cure yet? Have you ever had any patients with such post LASIK problems and have you helped them? If so, how did you do it?
VJ Janc,

I am sorry to hear of your post-Lasik straining/headaches. Your complaint unfortunately isn't really all that unique.

My practice is nearly 100% devoted to care for the irregular cornea and as such my exam chair is typically filled with post-Lasik patients like yourself. Dr. Hartzok has given you sound information and a good plan to move forward in resolving your strain/headaches. In my experience with post-Lasik patients suffering these symptoms, disrupted binocularity and even disrupted monocularity (accommodative dysfunction due to the multifocality and irregularity of the post-Lasik cornea) are the trigger leading to what you are describing. The "refraction" of the post-Lasik multifocal cornea isn't all that useful in rooting out the problem and often the "refraction" shows very little error i.e. "they told me that my prescription is only -0.25D, etc." so that I should be happy with the vision. As Dr. Hartzok correctly stated, the presence of only very small refractive error can indeed provide clear vision but this doesn't mean that that eye is functioning properly monocularly or in concert with the other eye binocularly.

In answer to your question regarding the possibility of "fixing" this problem, even with glasses, the answer is, glasses "may" be able to restore a properly balanced system to a level below the threshold of symptoms but the underlying problem is rooted in the optical irregularity contained in each of your post-Lasik corneas. Glasses typically do not address this problem at all, but a gas permeable contact lens, either corneal or scleral, does have the ability to neutralize much, if not nearly all of this issue.

Your path to resolution should start exactly where Dr. Hartzok recommended, in finding an adept Optometrist in binocular vision. Should this doctor's treatment plan successfully provide remediation, you will once again have clear AND comfortable binocular vision. Should this fail to resolve the issues, your next step would be to find an expert gas permeable contact lens fitter experienced in fitting post-surgical corneas. Sadly, it is becoming exceedingly difficult to find such a fitter which is why so many patients fail with gas permeable lenses. Still, this journey to find such a fitter is well worth the effort.

Best of luck to you and keep us posted on your progress.
Sincerely,
Dr. Maller
I am very pleased to see Dr. Maller's response.

Yes, life can get back to normal. If the problem with your binocularity can be resolved with glasses, then that's simple. But, a potential underlying issue creating the binocularity problem is how the peripheral vision remains uncorrected following LASIK. Rigid gas permeable lenses not only sharpen central vision but, and this is unique to rigid contact lenses, correct peripheral vision as well. So, if no glasses can be found to adequately resolve your vision issues, prescribing rigid gas permeable contact lenses is the next consideration.
Thank you both. I am currently composing a letter to my current LASIK clinic and also to a general NHS (national health service), which is a social healthcare in the UK. Hopefully, I will get them to do appropriate binocular testing and consult regarding rigid gas lens.

However, should my efforts be unsuccessful, can you kindly send me some info about your own VSRN clinic please? Specifically, having read about my symptoms, is any treatment available at your clinic, giving the fact I am a foreign national. If so, please give me some estimates: 1. How long would i need to come to US for? How much (approx) the treatment could cost me?

Thanks
VSRN is not a clinic. VSRN attempts to triage vision surgery patients and suggest means to resolve those patients' issues. In some cases, that means referral to specific clinicians who have shown unique abilities at diagnosing the underlying causes and providing remedies. Many eye doctors lack the necessary understanding of vision complications that follow some surgeries and these patients are then left with no where to turn. VSRN tries to find them solutions.

Dr. Maller, who responded above, possesses remarkable expertise in fitting post-surgical patients with rigid contact lenses and is a proven affiliate of VSRN.
Thank you Dr DavOD.

Dr Maller, I am looking forward to hearing from you. Please also expand a little on the rigid lense and how it is fitted. Is it same as contact lense, which you put in and remove daily, or is it a lense that is somehow fitted surgically and remains in the eye forever?

All info is very appreciated.
VJ Janc,

Dr. Maller does not post here regularly. You can check his public profile by clicking on his name to the left of his post. You can then Private Message him or email him.

A lot of your questions can be answered by reading the archives - previous posts here on VSRN. Much information has been posted and repeatedly posted regarding RGPs that can be very informative regarding your situation.

Rigid lenses are contact lenses, some fitting within the confines of the cornea (corneal RGPs) and others that fit well beyond the cornea and onto the sclera (scleral RGPs). Both are removed daily. Either of these types need to be custom fitted by an experienced fitter.

Vision rehab following refractive surgery is not specifically about rigid gas permeable lenses. Many patients experience other issues with their vision that do not require RGPs.
Hello,
Going through all these posts, It was like I'm reading my Lasik story. Had my Lasik on July 2017, but having eye strain and head pressure all day. I even feel the head pressure and sort of head ache feeling while waking up as well.

Before Lasik, My eye prescription was:

R: Sph -1.5 | Cyl: -0.50 | Axis: 160
L: Sph -1.5 | Cyl: -0.50 | Axis: 20

On my 1 month visit post-Lasik, I complained my doctor about sensitivity to lights (specially while working on computer), head pressure and eye strain. I was prescribed with Restasis, Lotepred Forte and Systane. It didn't help much.

On my month 2 visit, I complained doctor with same and also told having head pressure and strain while driving at night to the extent it is impossible for me to drive longer than a hour. He told me I will have to use glasses of minor power to resolve head pressure issue while driving.

He advised me to have glasses with following prescription:

R: Sph -0.25 | Cyl: -0.75 | Axis: 40
L: Sph 0.0 | Cyl: -0.75 | Axis: 150

The glasses DID HELP me during driving at night and while working on computers. I was no longer having head pressure and eye strain with glasses. But the head pressure and eye strain was still there even if I take off the glasses for few minutes. It's very hard for me to even look at computer screen without glasses. I used to work at computer without glasses for hours before LASIK.

On my 3 and 6 month visits, I again complained my doctor about head pressure, eye strain and head ache without glasses and my inability to work on computer without them due to light sensitivity and strain. After all, the only purpose of Lasik was to get rid of glasses. He ruled out any abnormality and told everything in tests is normal and things may get better regarding light sensitivity and head pressure in future.

Now, It's been around 8 months, I have the same issues - eye strain, sensitivity to light (while working on PC), head pressure, occasional headache due to strain. It's like someone has clutched my head and I feel so much relieved when I press my temple and forehead with fingers.

I live in Pakistan and unfortunately, we don't have many good doctors here who would understand this issue. I am looking to check if any of members who have posted here got some relief with eye strain and headaches? If yes, how? Also, is my issue similar to KS9 or Dr. Hartzok can recommend something else? It would be my pleasure to have some comments from VSRN Doctors on my issue.

Thank you
quote:
I used to work at computer without glasses for hours before LASIK.


Hello, Usman.

This particular sentence above stood out for me. The fact that you used to work for hours without glasses begs the question as to why you were probably MORE COMFORTABLE without glasses. First, prior to LASIK you were nearsighted; reading or using a computer WITHOUT glasses is the equivalent of wearing reading glasses. Your eyes did not have to accommodate (focus) for close work. Now you have a small degree of astigmatism which when placed into glasses does improve the clarity slightly but the correction simply ASSURES that you are no longer nearsighted so the symptoms are not relieved. Being forced to accommodate when reading for hours on end is a little like expecting me to do pushups; it's too strenuous. I am not in shape for it and YOU are not in shape to accommodate for hours at a computer. Given enough time and effort, I might improve on my pushup ability and you might improve on focusing post-LASIK but there is no guarantee that either of us is up to the task.

LASIK is all about getting rid of glasses. LASIK providers fail miserably at ascertaining IN ADVANCE of the procedure your HABITUAL eye postures for both accommodation and convergence. (Actually, they don't even try. In fact, the majority of eye care providers are woefully inept at such analyses.) The industry does nothing to screen for potential issues in this regard. LASIK practitioners simply look at your refractive error, plug the numbers into their system, cut a flap, ablate the cornea, lay the flap back down and then congratulate themselves and you on having had a successful outcome - SUCCESS BEING BASED PURELY ON NEUTRALIZING THE REFRACTIVE ERROR. In your case, neutralizing the refractive error is not how you used your eyes for reading. Nearsightedness is not a disease that needs to be eradicated from the body. Nearsightedness (uncorrected) can be very nice for reading. Now when you read your eyes must focus using the ciliary muscle within the eye and this extra effort also causes your eyes to converge (turn in) more than necessary for the distance at which you are reading. While some patients may adapt and adjust easily, others may find if extremely difficult. The clinical term for eye strain is asthenopia and, in this case, I guess we could call it "iatrogenic" asthenopia.

How your particular visual system operates is singularly unique to you. Just as each of us has our own style of walking, we have our own "gait" in how we coordinate the use of our eyes, how the ciliary muscle focusses in coordination with how the external ocular muscles converge and how the muscles posture to move across a page of print smoothly and comfortably. Imagine trying to run with your hands in your pockets; it would certainly throw off your running form and speed since we use the swinging of our arms to coordinate with the movement of our legs. It's only natural. Similarly, LASIK ALTERS THE NATURAL COORDINATION OF YOUR EYES. And like I said before, some patients adapt and adjust while others struggle and are uncomfortable. Finding an eye doctor who knows anything about this (even though they may have trained for it in school) is difficult and becoming even more so as eye examinations are increasingly inadequate in this regard.

Did you have a successful LASIK? By currently accepted clinical and industry standards - YES. Currently accepted standards is the elimination of the refractive error. Current clinical standards are also HIGHLY UNSOPHISTICATED in that they fail to address the visual system AS A WHOLE, a shortcoming that can leave the patient in miserable circumstances. I believe you are a classic proof of that assessment.

What I would do, at least for now, is recommend trying to restore your pre-LASIK reading posture by prescribing R +1.00 -0.75 x 040 and L +1.25 - 0.75 x 150. This is your present distance correction with +1.25 added to both eyes. This will approximate your pre-LASIK situation of reading without glasses. These glasses would just be for reading and the computer. Hopefully this will relieve the eyestrain you are experiencing. This correction is to reduce the stress in your visual system and hopefully will afford you some carry over relief for other activities.

There may be other factors contributing to your symptoms that I cannot assess based on the information available to you. But attempting to restore your pre-LASIK reading and computer posture is a start. Hopefully, over time, your visual system will adapt and adjust to the LASIK.

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