LASIK Rehab options?

I posted my personal story details under 'Personal Post Op Stories' here.

The quick and short of it is:

I had LASIK performed in 2001, and my day vision is great, my night vision is another story. I have halos, starbursts and ghost / double vision. Objects in the dark are no longer defined, instead are blurry. My eyes have not changed much over the years. The surgery itself was by the book, but they didn't make the lens large enough to handle my largely dilated pupils in low light conditions.

I am looking for information / help on if it is possible to correct and who might be best contacted, and I am happy to answer any questions to help.

Thank you.
Original Post
Thank you Doctor, for responding.

I actually don't remember on my nearsighted / astigmatism values before the surgery, and just contacted my old doctor for the records. When I receive them, I'll post those values.

The myopia was bad enough that my hand was blurry if I held it arms-length away from my face, and if I held my finger tip as close as I could to my eye, I could see the details of my fingerprints without issue.

Are the contacts something that can be measured at a regular vision doctor, or would I need to visit a certain type of specialist?

And, thank you regarding Alphagan, I'll discuss with my primary care provider as well.

You'll PCP will probably prefer it if your eye doctor prescribed the Alphagan. Presently Alphagan is available at 0.1% concentration but the generic is brimonidine in 0.15% and 0.2% strengths. The drug is normally used to treat glaucoma but a mild side effect of the drug is miosis. You would use it a half hour or so prior to driving and/or being out and about in low light or night time.

Nearsightedness and farsightedness do not correlate with patients' natural corneal curvatures. Corneal refractive surgery (LASIK, PRK, RK, etc.) alters the corneal curvature in a way that regular design contact lenses won't fit well, so lenses have to be specially designed. The problem is finding expert fitters who understand the mechanics of post-LASIK lenses. Our president, Barbara Berney, maintains a list of fitters (i.e., the network) with whom we have had positive experiences with in prior cases. Finding fitters is not an easy case because even doctors who believe themselves quite capable do not always grasp post-LASIK designs. I'll have Barbara check her list with your area.
Thank you Doctor.

I some other another questions if you have time.

When I visited one LASIK provider, they were actually able to measure my eyes and were able to reproduce the artifacts I see in low light. I was completely amazed that was even possible. The images were black, with the starburst/halo affects as grey renderings. (I guess to put it in image prospective, it would be like turning the contrast way up on one of these simulated images until all that were left was the affect and a dark background). Are you familiar with this device? It was part of the checkup process of a LASIK review I had performed in GA. I wish I asked for those records at the time, but when I realized that not every doctor had this capability, and I checked back, they no longer had a copy of my records.

I see many people here using the recommended vision simulator to reproduce the issues, and I'll do my best to see if I can come up with a comparable rendering and add that within my experience posting for people to see.

Also, would PRK be a reasonable follow-up procedure? I had one LASIK doctor suggest the procedure to help my effects, and seemed to think it would be possible to correct the low light issues (high-order aberrations or not). (Of course, not without its risks, as the doctor stated). Do you feel that is a reasonable course of action, too risky, or probably not recommended in any instance? I'd like to get the perspective of someone who has been assisting the community regarding these issues on an ongoing basis.

I apologize for the delay in responding.

It sounds like your LASIK provider was using an aberrometer. This may be used as a guide for further surgical procedures, if indicated.

From your reported history of LASIK in 2001 (as well as so many other post-LASIK patients from that time frame) it's obvious that your pupil diameter in low light is larger than your ablation (optical correction created by the laser) diameter. IMO the number one advancement in LASIK technology occurred when surgeons began to "blend" the ablation diameter into the unablated cornea via a secondary ablation (blend zone) to help ameliorate the discrepancy between ablation diameter and low light pupil diameters. The question now is whether this discrepancy can be moderated by another surgery. It would seem logical to create a blend zone with PRK except that you would be burning the edge of the existing flap. Would such a burn create secondary problems with the flap? I don't know. There used to be an adage "never zap (with PRK) a flap." It is done but, I think in all cases, the secondary PRK burn diameter is SMALLER than the existing flap. (The reason for zapping a flap is to alter the final refractive error.) I have no direct experience with using PRK to simply blend a previous LASIK.

I will refer this matter to a VSRN consulting refractive surgeon and get back to you.

Again... sorry for the delay.

Hello Doctor.  I know it has been a few years.  Its been a crazy ride!  I've been referred to a surgeon a few years ago that did several tests, but in the end, there's no guarantee that an additional surgery will aid me.  We were able to rule out all other possibilities other than my eyes pupils becoming too large in the dark.

I do know that I can use Pylocarpine, but I'd rather stay away from using these drops on a regular basis.  Has there been any advancement over the last couple years in treating these side effects?

I hope you and everyone else here are doing well!

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