Finally, I can see clearly!

I had Lasik in February 2002. Until that date, I had worn contacts and glasses since childhood, so I was hopeful that I could once and for all say goodbye to them. I dismissed the little negative press the Lasik procedure was getting, convinced that "nothing like that would ever happen to me."

I never had great vision after Lasik, but within a year, I was developing intense dry eye, cloudy vison, headaches, and depression. I went to several different doctors for relief -- but none offered me any lasting help, and I could tell most had no idea what I was seeing through my eyes. The discomfort and depression worsened. "Enhancements" were suggested, but I knew better than to let anyone laser my eyes again.

I started reading the accounts of other Lasik casualties online, and started experimenting with the different artificial tears that were available, nutritional supplements, humidifiers, lid scub techniques, etc. You name it, I tried it. Some things eased the discomfort slightly, but nothing helped very much in terms of vision. One day I found a discussion on the Vision Surgery Rehab website about people who had success with doctors who were experienced RGP fitters. I contacted a few folks, and would up conversing with Dr, Ken Maller via email. This marked the beginning of the end of my suffering.

I was amazed right from the beginning as to Dr. Maller's willingness to email with me and answer all my questions (in detail) about the treatment he offers. I made an appointment and scheduled a trip to Fort Lauderdale. He spent a lot of time examining my eyes, explaining what he does, and what I might expect - all while be very supportive and understanding of my problem. The lenses arrived a couple of days later, and they were a near prefect fit. I COULD SEE 20/15 on the eye chart. The characters practically jumped out at me. This was after struggling and blinking and squinting to see 20/40 the day I came in the office. Dr. Maller said to me - "come outside with me into the daylight and see how that looks." It was a whole new world -- bright and clear. I could read the street signs far down the road clear as can be. I could see the detail and expressions on people's faces again. I could again tell if they were looking AT me or near me.

I still have some issues with up close vision and need reading glasses, but there's a strong possibility I'll be able to be fit for multi-focal contacts on my next visit to address that. But I can manage like this just fine.

I'm in my lenses 2 days now. Driving is so much better (and safer). I'm enjoying the high definition TV I purchased last year for the first time (so that's what they're all talking about!). I enjoy being able to identify friends across a crowded room again. Life is so much better. I couldn't be happier.

Thank you Dr. Maller!
Original Post
Peter,

Nothing gives me a bigger lift than a success story. Dr. Maller is highly skilled and very dedicated. I wish we could clone guys like him, Dr. Hartzok, and our other VSRN docs.

So happy that you are doing well in your lenses and that the world looks so much better to you!
Peter,

What type of lens were you fitted with and do you have any issues with corneal molding after removal at night (in other words the lens reshapes the cornea and you end up with uncorrectable vision at ight when you wear your glasses)?

Thanks,
In technical terms, I'm not sure I know what 'type' of lens I was fitted with, other than they are RGP's and slightly larger in size than the lenses I had prior to having Lasik.

I wear the lenses pretty much the whole day, and carry rewetting drops to keep my eyes lubricated (I still have dry eyes and lousy tear film). When I remove them at night, it's usually just to relax or go to sleep and I don't have glasses for this time (yet anyway). But yeah, my vision is bad - as it was before getting the RGP's. I'm not sure if the 'reshaping' has made it any worse, but it's definitely not better. Having great distance vision all day and then removing the lenses is quite a contrast. It is much like life before I ever had Lasik, except there are additional issues (more difficult to remove the lenses, the need for reading glasses for up close). But overall, my life is manageable now and there's no reason to be depressed over the state of my vision. And that is HUGE for me.
Dear epqe17,

Correcting post-rs aberrations and getting a wearable fit is not about types, it is about customization. Dr. Maller uses a ZWave system combined with his incredible experience at modifying the initial computer design. It is Dr. Maller's ability to refine the lens design at work here for Peter.

This has been talked about on the BB for years: The question of what "type" of RGP. If it was a matter of "type" of RGP, VSRN would put up links to manufacturers' websites. Instead, we (i.e., Barbara) scour the U.S. and beyond looking for fitters with real insight into RS issues. Unfortunately, such insight is a rare commodity.

Corneal molding can occur even with successful RGP use. In some cases, the molding can be beneficial; post-wear vision is sometimes better than pre-wear vision. A well-fitted RGP should not create excessive molding. Too often, however, fitters will use a lens which is several diopters too steep centrally, producing significant post-wear blur. Steep fitting is often a by-product of attempting to use too large an optic zone on the RGP, perhaps the most common mistake in lens design. This is where the insight of the practitioner and customization of the lens design is so critical.

What we are asking of RGP lenses and practitioners who fit them is to work within an entirely new paradigm. That is, to fit lenses to corneas that bear practically no resemblance to anything nature has created. Post-RGP lenses are not really lenses in the traditional sense. They are more of a corneal prosthesis - attempting to undo the changes created by a surgery that has physically subtracted corneal tissue. Post-operative corneas present parameters that are much more individual and unique than naturally occurring ones. Attempting to use RGP "types" and designs that are a carry-over from non-surgical conditions is incredibly naive. Even so-called "post-surgical" brands are only as effective as the parameters available AND the ability of a practitioner to accurately customize the fit. For this reason, VSRN's network can only expand in relation to the number of practitioners who undergo the required fitting epiphany.
Peter, Dr. Hartzok,

Thanks for your replies. I do speak from experience as someone who had Lasik seven years ago with -8/-9 nearsightedness, 2.5 level astigmatism and immediate issues with GASH from an ablation zone that was too small. Over the years I have tried Scleral lenses (no corneal molding, but too uncomfortable), ZWave (wearable but corneal molding that lasted days - could see with my glasses at all) and recently SynergEyes (very wearable due to the soft periphery, but again days of corneal molding).

I continue to wear glasses and am very careful driving at night (still have about 1.5 diopters of astimgatism), but I am going to continue to search for the crisp vision (without GASH during night and indorr lighting) I used to have prior to Lasik.

When I ask for type I am looking for the lens that has the greatest flexibility in design to allow a larger optic zone on a flat cornea (with the soft periphery). In any case, more lenses are being made every year and I am hopeful for the ideal fit in the future.
quote:
When I ask for type I am looking for the lens that has the greatest flexibility in design to allow a larger optic zone on a flat cornea (with the soft periphery). In any case, more lenses are being made every year and I am hopeful for the ideal fit in the future.



You complain that you experience significant spectacle blur with corneal lenses and with Synergeyes. And yet you post that you are looking for a lens that allows "a larger optic zone on a flat cornea." The two are mutually exclusive; followed to conclusion, you are looking for a monocurve lens to fit a multicurve cornea. You have already stated that you have a small ablation zone so the area of your cornea that is "flat" is not large - it is small. A large, flat optic zone on an RGP does not fit a small, flat optic zone on your cornea.

Corneal molding of post-RS corneas INCREASES as one attempts to create larger optical zones. THIS is the paradigm shift that I just posted above. The vast majority in the CL industry are not getting this so patients who have "researched" this should not be expected to get it either. Applying CONVENTIONAL thinking to highly NON-CONVENTIONAL situations leads nowhere so the idea that "more lenses are being made every year" does not imply that more will work. The ANTERIOR optic zone is in control for post-RS lenses but everyone is hung up on the posterior optic zone. People are still at the "heaven revolves around the earth" stage.
OK. I have a small, elliptical ablation zone (4mm x 6mm) with larger pupils (7-8MM at night and indoor light). Regardless of the optic zone I am seeking I don't understand why developing a lens to fit the flatter cornea can't be made. The optic calculations being done with ZWave lenses were designed to more closely match the surface of the cornea, correct?
It's not just the flat cornea that makes designing a lens so tough. Beyond that ablation zone, the cornea has retained its curves, and it's in the secondary and tertiary transitional curves that the difficulties arise. There is no precise way to measure those curves at this time, so only with dumb luck or an expert skilled in calculating those curves will a post-RS lens provide clear vision with a good fit. Those additional curves are also part of your optical zone and will affect your vision as well as your comfort.

The Zwave lens is only as good as the fitter. The technology is not well understood, and there is, no exaggeration, only ONE Ken Maller. He is, to my knowledge, the only true expert in this system, but his expertise has more to do with his long experience fitting difficult corneas and his understanding of the physics of optics than anything else. Maller is the doc who teaches all the other docs how to use the Zwave system. As with most sophisticated technologies, an exceptionally talented human is required to get the most from the machinery.

Small optic zones? Mine is 3.4 mm. Tiny. Before I discovered that I am unable to wear any kind of lens due to damage to my left eyelid in a second surgery and extreme dry eye, Dr. Hartzok fitted me for RGPs. The clarity of vision was amazing for that brief period when I was wearing them and the comfort in the right eye was good.

There are different methodologies for successfully fitting a post-RS lens, but the one thing they all have in common is a practitioner who understand the nuances of the physics of optics. Practitioners are, as VSRN has discovered over the past three + years since we started seeking them out, very few and far between.
Without even seeing your topographies I know they probably have a red circle just outside the ablation zone. Topography measurements in this area will often read dioptric measures in the 50s even for patients who had myopic LASIK. Prior to LASIK, this degree of curvature was nowhere to be found on a normal, healthy cornea.

Yes, the center of your cornea is now flat and the topo shows that but the topo also suggests that the surface is, in fact, quite steep outside of the ablation zone. Can we rely on the topographical data? I used to think so but, it so happens, that that circular area on the topo, so common in LASIK patients, also shows up on PRK patients. In a LASIK patient a case could be made for the excess flap tissue heaping up around the flap edge. But with surface ablations? I don't know. Particularly in the case of surface ablations, how would the cornea end up being so much steeper than the pre-surgical cornea? Although this ring of steep tissue is fairly wide, the only explanation I can conceive for this is that it represents a rather abrupt edge of the ablation. If the representation is an artifact of topographical systems and, since a topographer reads it this way, generating a lens from the data would incorporate that artifact into the lens design. Evidently Ken Maller makes some adjustment which means that ZWave is dependent on the doctor's skill and insight into fitting the post-ablation cornea.

In my own case, I look at the topos primarily to assess post-operative vision quality, looking for irregularities that can be addressed by an RGP. In terms of fitting RGPs, I ignore that "steep" area and those numbers entirely. I fit an RGP to fit the peripheral cornea and the central cornea. The secondary curve on the lens is calculated to transition between those two curves. Does every lens look exactly the way I want to see it in my mind? No but the lenses tend to be more wearable than other lenses I tried and my methodology works for me. The ZWave system works for Ken Maller because of his extensive experience with it. He knows what he is looking to see in the lens design. His design process is not simply a matter of inputting the topo data and post-op refraction into the ZWave software.

If the central lens curve follows the curvature of your central cornea and is then extended (by making the optic zone larger) beyond the ablation zone, that lens surface is now many microns above the actual lens surface, making the lens unstable on the eye and uncomfortable. To fix the stability and discomfort in this case (with a large optic zone) a practitioner typically steepens the central lens curvature, causing the lens to vault the central cornea, frequently by many diopters. This degrades vision quality and increases the potential for corneal molding. The only way to avoid this is to keep the optic zone smaller and the central lens curve aligned with the central corneal shape.

What is being overlooked in all this is that the optics of tri-curve and tetra-curve lenses are not limited to the "optic zone." With smaller OZ lenses, the secondary curve contributes to the vision correction as well. The secondary and tertiary zone optics on contact lenses have not been studied from what I have observed. Evidently the industry experts consider these as mere fitting curves and not optical. It is an obvious area of study, worthy of a thesis. It also requires specific knowledge of how lathes cut secondary curves on RGPs. In fact, the way the secondary curve is cut could go a long way at improved fit and reduced GASH.

The frustration with post-ablation RGP rehab is NOT that questions go unanswered, it is that no one seems to know what questions to ask.

Add Reply

Likes (0)
×
×
×
×