Hazy/Foggy and or Blurred Vision Post-LASIK

Hello,

I've been researching about my post-LASIK complications within this forum. I'll do my best to describe and I am asking Dr. Hartzok for his thoughts. I will leave a synopsis below as details are important.

I'm a white male, 41 YRS old. Had all laser LASIK performed on 5/20/2016. So,I'm about at 60 days right now post op and starting to lose my mind with LEFT eye complications.

As info: My glasses perscription was R -4.25 CYL -1.00 AXIS 140
L -4.25 CYL -1.25 AXIS 30

I was able to see 20/15 with those numbers with glasses above as a side note.



CONDITION EXPERIENCED: Hazy/Foggy/Blurry/Smeary vision with my LEFT eye and I described it as looking through a thin film of Vaseline on a glass window. Or it is like wearing a dirty contact lens that has a film on it of some sort causing some distortion as well.



LASIK Post Op Complications to LEFT eye:

Day 2 - Post Op I knew something was not correct. Went to day one post exam and was told everything is good even though I expressed multiple times my left eye is having major acuity issues. Was sent home told to wait no issues noticed. They removed the protection contact lens they placed after the procedure the day of.

Day 3 - Called the eye surgeons office and said I need to be seen for this LEFT eye issue . They said to come in and have one of the OD's take a look. Of course they performed and AR and said vision was 20/50. The interesting thing is that he said he noticed striae on the flap with the fluorescein check. They said no problem go home and wait, it will resolve on its own.

Day 4 - Called the office again and said something is not right, something is completely off with my LEFT eye. They said the eye surgeon that performed the procedure on me was there in the morning. I went in and here's what occurred. Using the slitlamp he examined my LEFT eye and said yes there are micro striae but should NOT cause any issues. He then proceeded to say, can you get to the other office to have it refloated? I was alone and could not really drive the distance. I called my parents to come out to the office for a ride to the "other" office where I assume the correct equipment was to refloat the flap. During the waiting for my parents to arrive, he went on to see other patients. He returned and decided to NOT lift and refloat but do the following:

I was sitting in the exam chair for the slitlamp, he placed numbing drops in my LEFT eye and waited a minute or two. He proceeded to use what I noticed was a sterile wooden handled Q-Tip the slitlamp for magnification and only stretched the flap trying to remove the striae I suppose. After he did that which was about 2-3 minutes and was done. My vision acuity was a complete blur afterwards. My parents arrive about 10 minutes after that and then told us he didn't want to refloat and make things worse. (At this time I had no idea what striae was nor would any other regular patient.) He said come back tomorrow at the other office to check on it.

Day 5 - Went to "other" office where in case he needed to do "something" I was at that location. He did a slitlamp exam and said there are still some "MICRO" striae and everything looked good. I explained that what he did the previous day did not help and was the same visual acuity. He said wait and go home and you'll be fine.

Day 10 - I called office and said my LEFT is not doing well, something is not correct with it. They said come in and they can take a look. Same eye surgeon that did my procedure examined me and said I'm doing "FINE". My parents were there and we were in complete awe that they can say that. I'm suffering and they can only tell me numbers from the AR and say, you're "FINE". Also the surgeon had completely horrible bedside manners throughout each of my exams. We ask for all my medical records when leaving that day for a second opinion.

Day 12 - Received a certified letter from the practice that performed my LASIK. They simply "politically" excused me as a patient!! I was in awe that the practice could not and did not want to see me as a patient any longer, ONLY for 30 Days for emergency only. Speechless. They simply didn't want to deal with me as a patient any longer since I was asking for legit answers to my concerns they skated over and over. So, they excused me.



SECOND OPINION INFO:

Day 1 - Was seen by a doctor who did my fathers LASIK 10 years ago. He did an full exam on me and really did not "review" any of the medical records I showed him. He briefly shuffled through them. Again, he as well did the fluorescein check since I mentioned the striae that the previous surgeon "messed" with. He said, "yes, you have some striae but nothing to be concerned about." He said give it time and you will be fine.

After that visit, I started to research this "cornea flap Striae" and want it may cause. I was in awe. Correct me if I'm wrong, but this striae can cause some significant issues if not taking care of. Now that I was in much better understanding of striae I made a 2nd appointment with my 2nd doctor telling them I'm having a lot of issues with my LEFT eye still.

Second appointment 15 days later with another full exam minus full dilation, he again said all is well and sees no issues. I then proceeded to question the "STRIAE" and what his meaning of it is. He told me they are superficial wrinkles and that they are in line of view of my axis since I asked where are they located. I said well wouldn't that create "ANY" issue with visual acuity? He really began to "skate" around the issue as well and said wait and come back in 3-6 months to try glasses! I'm speechless.


I've moved on to a 3rd opinion, had full exam again and said they see the micro-striae as well and not sure what it is causing or IF it is causing my vision issues in LEFT eye. They have told me that they reside in line of viewing axis. They are cornea specialists and are seeing what next steps can be made. It can take months just to be seen or make an appointment each time.


Dr. Hartzok what are your thoughts/suggestions? How do you rule out striae issues? Can they be removed at any time?

I noticed you are in PA, I would be happy to have you do a full evaluation on me and determine how to resolve my LEFT eye complications. In my understanding, any "wrinkles" or striae in the cornea flap sound like they should be dealt with properly and or ruled out. If I can send you a PM and or even make a appointment to see you I have more details but only provided a high level here on the forum. I have all my operative information and all scans you can make sense of I'm sure. Thank you and hope to hear from you soon.


Regards,

Todd S.
Original Post
Todd,

Your acuity was 20/50 on Day 3. Are you saying that your vision is still 20/50 in the left eye?

If there has not been any improvement at all since Day 3 and since no one is willing to lift and refloat the flap, I have to assume the stria are not significant from the surgeons' and the assisting optometrists' position. The surgeons and corneal specialists responsibility as eye doctors does not start and stop on potential flap issues. You are still a patient with a loss of vision that is unexplained. You are not merely a LASIK "customer" you are, first and foremost, a PATIENT who has developed reduced vision "on their watch." Your reduced vision requires a DIAGNOSIS and, to that end, they need to be digging deeper.

Whenever I encounter a patient with reduced vision, even in patients in whom I can see a problem, I always do an OCT scan to rule out macular issues. There are numerous conditions that cannot be seen without an OCT imaging device. That would be a given. I would do a SUBJECTIVE refraction, not an automated refraction. This is critical because automated refractions are not always accurate, particularly on LASIK patients. Thirdly, and they MUST have done this, I would think about corneal surface irregularity (irregular astigmatism) which can be diagnosed via corneal topography. You didn't mention this. Do you have copies of your corneal topographies (in color)?
Dr. Hartzok,

Last exam they said I can read a 20/20 line. This was without any AR done at the corneal doctors office, they don't believe in them for accuracy. I was right on board with that comment. Of course my vision is far from 20/20 clarity, it's a mess to put lightly.

I had a OCT done from the 2nd doctor opinion and he said nothing to me about it of any concern. I didn't even see it other than it was printed out and put in my file. This doctor did do a SUBJECTIVE refraction twice that I saw him and mentioned only a slight under-correction but that was expected since I was only about a month into recovery/healing. He said give it time..

Yes, my 3rd doctor had performed new corneal topography (on June 26th) and two other specialized scans for which I do not know the names for them. The doctor did say he can see the striae on the scans or on at least one of the scans. I don't have copies in color but can get them anytime I suppose if you can take a look. We can PM privately as needed on those.

I do have the operative form from what was "dialed" into the refractive laser with two sets PRE-operative Orb scans (corneal topography). One done 2 months during my eval and one completed the day of the procedure.

Also, I forgot to mention that the suction cup that creates the flap "leaked" vacuum and caused a hematoma or hemorrhage to my eye. The surgeon had to try 3 times before switching out for a new cup and tilting my head so my nose would not hit the arm of the laser equipment as it tilted down. Basically, my entire white of my LEFT eye was bright red for 3 weeks post op. I was told repeatedly that had no impact on my outcome. I still consider it "trama" to the eye and swelling had to occur.

I don't know why, but I'm fixated/concerned on this whole striae issue and why it was not correctly dealt with from day 3 post op. With it being directly inline axis of my vision, this has to cause some issue with clarity or contributing to at least one of my symptoms.

Thanks for the quick reply and being such a outstanding physician who actually cares for patients and their concerns.

What do you need from me as next steps?
Dr. Hartzok,

It will take a bit of time to get the color ones as I have to request them from the offices. For the time being, I'm sending a PM with the pre-op orb scan and operative report to start. These are in black and white only until I can get color.
quote:
Also, I forgot to mention that the suction cup that creates the flap "leaked" vacuum and caused a hematoma or hemorrhage to my eye. The surgeon had to try 3 times before switching out for a new cup and tilting my head so my nose would not hit the arm of the laser equipment as it tilted down. Basically, my entire white of my LEFT eye was bright red for 3 weeks post op. I was told repeatedly that had no impact on my outcome. I still consider it "trama" to the eye and swelling had to occur.


Anyone/All...

Can someone elaborate on the number of times suction or vacuum can take place during the cornea flap creation process with LASIK? Is there documentation out there stating this protocol? Smashing the suction ring down on the eye several times WILL create trama and significant eye inflammation/swelling, cornea re-shaping, etc. that has to inevitable.

I'm finding out that the procedure should have been "ABORTED" by the 3rd attempt. Also, the actual flap creation was not started, the suction loss was PRIOR to the first two attempts. Changing out the cup on the 3rd try.

Please share any information about this. Thank You.
Hi Dr. Hartzok, I hope this makes sense and will try to keep my update brief but concise.

Continuing seeking help with my poor post-lasik vision in 2016 & 2017, here's what unfolded in about one year + 6 months. Specifically since my last posting here on VSRN.

I found a refractive surgeon who had the proper diagnostic equipment and is very established. I had a consultation with his staff and they performed many tests and scans no one has done prior. Actually, I've never seen so much expensive equipment it was impressive. However, equipment is only part of the equation, right. Just the consult was over $1K. This was January 2017. 6 weeks later I received a email from the doctor and made a correct diagnosis and provided a treatment plan. I had to plan the trip as this was in another country, yes the expense was massive. So far, 3 trips to another country is wearing on me. Treatment was in May 2017, this summer.

As a suspected from day one, "significant centrally located micro-folds" in both eyes.

The treatment plan was to be conservative with a Trans-Epithelial PTK followed with a "wet polish" of the stroma surface. NO or very little stroma tissue to be removed. The wet polish was explained to me as the after the micro folds are removed, the stroma is "flooded" with BSS and the excimer laser is fired (~6 secs.) directly into the BSS which does not remove stroma tissue but only the irregularites that are sticking up into the BSS solution. This is to create a smoother stroma surface. Bandage lenses placed and wait 5 days for the epithelium to close up. Oh my.

Over the course of 3 months my vision was well a mess. I was told this is just like PRK without any correction performed. I took off the first month of work because my vision was quite awful, everyday vision fluctuations were off the charts, I struggled to put it lightly. Night time forget about it, just sleep.

Dry-Eye: I had permanent dry-eye post lasik, but nothing like this, after the TE-PTK, pure misery, nothing helped but lay with my eyes closed most of my waking hours. I think I used gallons of drops with no avail. I got really bad about 2-3months after the PTK.

The dry eye pain/burning was so bad in BOTH eyes, I went to a dry eye center here in Pittsburgh. Diagnosis, MGD. ALL glands plugged up and little to no oil was expressing. Lovely, this was not checked prior to the PTK? My TBUT times are 2 secs OS and 3 Secs OD, that is low. I'll get back to dry eye in a moment or a follow up posting.

I'm about 6 months "post-theraputic" TE-PTK. The procedure corrected ONE symptom. The "vaseline" vision in the Left eye greatly improved about 90%.

However, I now have a laundry list of new symptoms that surfaced in BOTH eyes. Vision is as Barbara describes it, "Visual Trash".

RIGHT EYE:

Significant ghosting in Right eye. Especially hi contrast lettering like whites and bright greens, etc. They are vertical and up to the 11 o'clock position. Indoor vision is a pure mess. Signs and lighting streak vertically and to the exactly 11 o'clock position the ghosting does. LED's and indication lights have the same vertical "spikes" to the 11 o'clock position. At night, same spikes and lighting like house porch lights spike and are a mess. Digital signage, like a gas station price sign, forget about it, very challenging to read. So, there is root cause of the same abberation going on I suspect.

I have blur and seems the last few weeks things are regressing and or becoming worse. It seems like a astigmatism for sure of some sorts. Currently vision fluctuations occur all day long, evenings worse as the eyes tire. I note as the right eye epithelium was healing and doing it's daily massive fluctuations and to current day, it seems as the epithelium is "loose" or to some sorts. It never seemed correct as it healed, like it got stuck in a "bad" state.

Grade 1 haze noted. I don't really see it but I'm sure it is added to acuity issues. I was told that the PTK had about 1-1000 chance of haze developing, well I have it. The surgeon even said he doesn't like to use Mitomycin C because it is a strong drug and I agreed since I already knew what it was. I was on FML for 1 1/2 months but was scheduled to be on this for 3 months then taper. The BAK made my eyes much worse and I'm a steroid responder so my IOP's were in the 20's. Then I had to take Brimonidine (AlphaganP) to counter the high IOP's. That has BAK in it...what a vicious cycle. I'm OFF all Rx drops as of today as they were making matters much worse for me as far as dry eye and pain goes. Plus, long term use of topical steroids is known or may cause other issues I just do not need.



LEFT EYE:

Ghosting vertically, 12 o'clock position. Especially hi contrast lettering like whites and bright greens, etc. Indoor vision is a pure mess like the right eye maybe a little less. Signs and lighting streak vertically and to 1 o'clock position. LED's and indication lights have the same vertical "spikes" to the 1 o'clock position and even the 12 o'clock position. I also have other "spiky" positions but are limited to the upper half of my vision.

Grade 2 Haze noted. I do see it with certain lighting and a certain angle. Same notes as Right eye about meds mentioned above. The burning and inflammation were/are so high this is why I suspect haze development. At least this is my understanding of haze, it is a lot of inflammation.

Vision fluctuations often throughout the day.



Combine use of both eyes, there is a "V" like spike off many light sources. Especially LED's small round lights and so on. Almost all of my abberations are in the upper half of my vision. Between both eyes, these abberations occur from say 9 o'clock to the 3 o'clock positions. Lower quadrants do not have any that I can see of.

Refractive Imbalance between both eyes. Not much, but enough to provide headaches that are another symptom to juggle. I've tired 2 pairs of glasses here in the states and they are like wearing binoculars, not even close. As you, Dr. Hartzok mentioned, refracting Post RS patients is difficult and takes time, something most clinics will not dedicate. So, glasses are not a solution at this time.



I know these are brief summaries but getting words down for thoughts and suggestions.


Question:

How can removing the epithelium and making the stroma "smooth" create even more problems? Did it reveal the higher order abberations?

This procedure is suppose to help eliminate surface "irregularities" particular the microfolds, which were graded as a 3 during my consult. He said grade 4 is the worse he has seen in his clinic. The microfolds are indeed now no longer, but have a rag bag of new or worse symptoms. I was told this is a "process" and this was step-one. Well, step-one has been worse and honestly is not getting any better. I was told 3-6 months to settle out. I have to stop typing my eyes are burning. I'm getting at the end of my rope.


Dr. Hartzok, what are you thoughts?

P.S. I wanted to private message you as well and will soon. You most likely know this surgeon that provided my diagnosis and treatment.

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