Lasik overcorrection dizziness / balance problems

Hello all,

I had Femtolasik 3 months ago and have had constant dizziness and balance problems ever since, the dizziness is not the spinning kind but the kind where you feel unstable and zig zag as you walk..been to 2 different gp's who have checked everything they could think of (blood, blood pressure, ears, neck, sinuses, throat, lungs etc.) coming up with nothing so the only explanation would be that my vision is causing the problems. My Lasik doctor was quick to rule out the surgery as the cause ( even after informing him that the problems began few days after the surgery, and I’ve never had balance issues / dizziness except when getting eyeglasses with a bad prescription a couple years back )

I was right: -1.00 -2.00 ax 166 left: -2.25 cyl -0.50 ax 5 Pre-op and now right: +0.75 -1.00 ax 0 left: +0.25 cyl: -0.50 ax 0

So my left eye is pretty okay but the right has been blurrier since the surgery, and the imbalance of +0.50 has been noticeable the entire time and of course the astigmatism doesn’t help things..could the overcorrection & imbalance cause the dizziness? the Lasik doctors answer was a firm no, got a second opinion from a eye doctor who was familiar with neuro ophtamologic things also said no, 3rd opinion was that I could have a slight vertical phoria and prescribed a 0.50 down prism lens for my left eye, have yet to try that..

Been wearing glasses for a couple of weeks now ( right: +0.75 -1.00 ax 0 left: +0.25 cyl: -0.50 ax 0 ), they seem to crisp up my vision and I can use the computer and watch tv again with no major discomfort but they don’t seem to resolve the dizziness and balance issues and I’m having a hard time adjusting to + lenses after wearing myopic glasses for 25 years..

other problems: dry eyes, starburst & halos, light sensitivity, poor vision in dim lighting outside, eyestrain, headaches and nausea, weird distorsions in vision sometimes..

At this point I’m starting to get realistic about all this, this was obviously not the prodecure for me and have basically let go of my dreams of not wearing glasses..just would like to feel normal or even semi-normal again and get on with my life, this has really stopped me in my tracks..

oh and of course the lasik doctor was rushing to do a second operation on my right eye to get rid of the -1.00 astigmatism ( quick and easy apparently ), commented nothing on the overcorrection, acted like he hit the mark with that..( in a prior conversation the same doctor said that nothing should be done before 6 months after the initial surgery, starting to feel that he’s really just trying to get rid of me as quick as possible.. )

anyone any thoughts?

thanks

Teemu
Original Post
Teemu,

My first impression is that you are surgically over-corrected even more than your present glasses prescription suggests. If that is, in fact, the case then yes, the over-correction could be causing several of your present visual symptoms.

You need to see someone who can give you a complete vision analysis - including a cycloplegic refraction. Also, if you have a vertical phoria, then the doctor who discovered that should have been able to demonstrate the benefit of the prism to you at the time of your visit.

Your pre-surgical spectacle correction is rather interesting. Did you ever wear contact lenses?
quote:
Your pre-surgical spectacle correction is rather interesting. Did you ever wear contact lenses?

I tried contacts a couple of times but didn’t stick with them because I felt that I could see better with glasses.

And yeah one doctor did a cycloplegic refraction with these results: +0.25c+1.0ax90/0c+0.50ax90

The doctor who suggested the prism did add the 0.50 down prism to my correction in the test frame and I tried it on, my feeling was that it definitely didn’t make things worse..
quote:
Originally posted by Teemu:
I tried contacts a couple of times but didn’t stick with them because I felt that I could see better with glasses.


Assuming you were fitted correctly... your pre-op glasses prescription had a mild prismatic imbalance horizontally that you obviously were adapted to. Contact lenses would have eliminated that imbalance which normally would be "plus" for most patients but I have seen situations where people were happier with glasses, i.e., what they were accustomed to.

quote:
Originally posted by Teemu:And yeah one doctor did a cycloplegic refraction with these results: +0.25c+1.0ax90/0c+0.50ax90


The right eye showed even more of a refractive imbalance than your present glasses.

quote:
Originally posted by Teemu:The doctor who suggested the prism did add the 0.50 down prism to my correction in the test frame and I tried it on, my feeling was that it definitely didn’t make things worse..


If you didn't notice a distinct improvement then the indication is to NOT prescribe the prism. I would pursue the need for stronger glasses at this point in time.
Thanks a lot for answering Dr. Hartzok, and so quickly!

About the prism, it was kind of hard to tell whether it helped or not, the dizziness / balance issues occur when walking and standing up, did try that for a little bit in the doctors office but still hard to tell, the doctor said I should have glasses made and try them for a longer period of time in normal daily situations..

"The right eye showed even more of a refractive imbalance than your present glasses. "

yeah noticed that also, so should I get a new refraction done, and should it be cycloplegic, would glasses based on those results work? because I’ve had 4 eye exams in a months time and the doctors all keep saying that the ( right: +0.75 -1.00 ax 0 left: +0.25 cyl: -0.50 ax 0 ) is my prescription for glasses..the last optometrist did an orthoptic examination ( she’s one of the leading optometrists in Finland I’m told ) and also came up with that prescription..

and one more thing, since I’m over 3 months out, I probably shouldn’t hope for much regression?

thanks again!
Younger patients (under 40) typically have larger pupils and agile accommodative ability (they can focus easily). When corneal refractive surgery over-corrects for nearsightedness, the visual system adjusts the focus by accommodating. This reflexively reduces the pupil size which, in turn, improves clarity. During refraction the patient will report that their vision is clearer with little or no lens when, in fact, they are actually farsighted. The chronic effort to maintain clarity by focussing causes discomfort and other symptoms. The subjective refraction (where we ask the patient which lens is clearer) becomes a tug of war: the subjective impression of clarity versus a more relaxed visual system. Digging out the refraction is challenging. Cycloplegic refractions can help this determination but the results are not always wearable since the eyes are not in their natural, un-dilated and un-cyclopleged, state. Automated refraction has no methodology to relax the focus.

The only reliable way to dig out the over-correction is by prolonged "fogging" of the patient's vision while doing bi-ocular refraction (refracting each eye individually while keeping the patient in a state of double vision). This can take time and patience but frequently discovers the over-correction.

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