Need Help with Headaches and Eye Strain 4 years post LASIK

In search of a solution to my current situation I've run across these forums and the wealth of information provided here. I'm confident with the help here I will obtain a resolution, and hopefully someone with similar symptoms will find my story useful. Of course, as mentioned several times on these forums, similar symptoms can have vastly different origins, but just knowing someone is out there struggling with the same pain and making an effort to push through is incredibly comforting. It has renewed my spirits reading KS9's thread, and so I've resolved to drive my head down, grit my teeth, and keep trudging to a solution.

I'll describe my symptoms below, and I hope to get a reference for an optometrist in my area who specializes in treating complications in post-LASIK corneas. I'm sorry for such a long post, but all of it is relevant in some way. Most of this attempts to describe the symptoms and serves as much to my benefit as to any doctor. Formally putting it to paper helps me better understand it all.

I had lasik nearly exactly 4 years ago (+- 1 week, October 2013, stupidest decision of my life). I don't have access to my medical files here (at University in grad school)but I will be getting them in less than a week. Pre-Lasik Prescription: OD: -3.25, OS: -3.25. I don't know my prescription post lasik precisely. For the past several years I've been much more concerned with the dry eyes and the severe higher order aberrations. My eyesight in bright sunlight always seemed razor sharp until the past two or three months, and in every follow up visit with the LASIK monkeys (and in the subsequent years 2014/2015 other optometrists) I had better than 20/20 vision. That has changed a bit recently (2016/2017). More on that in a minute.

During the first year, the worst symptom was the dry eyes. Aberrations and night vision were always bad, but dry eyes was crippling. I had a hard time keeping my eyes open because they would get dry so easily, and it made it hard to read text. The steroid and antibacterial drops helped the first week post lasik, but once I stopped taking them it took a huge turn for the worst. During this whole period the LASIK surgeons refused to acknowledge any problem and validate my fears or feelings. The eye drops were horrible, I tried several given to me by the surgeon and purchased several others but they only seemed to offer relief for maybe 15 seconds to a minute. The fish oil helped tremendously though. I turned to consuming copious amounts of it, which made those first months very bearable and I was able to at least function at maybe 80% efficiency. I was very sensitive to humidity fluctuations, and while the dry eyes improved slowly over the first year they still hurt if I had my eyes open while laying down. After 1 year I could stop taking fish oil (though it still helped Id prefer no supplementation). For the next two years the dry eyes was only really painful during summer, and I still couldn't turn on a ceiling fan or read prolonged periods laying down on my bed. This summer is the first time in four years where my eyes have finally healed enough that these two things are no longer limiting. My tear film is still drastically reduced compared to pre-lasik levels, I really miss that feeling of taking off my glasses and reading a mathematics textbook and rubbing my wet eyes when I got tired. Strange I know. At this point the dry eyes are not a huge issues, if I could restore preLASIK comfort that would be great, but the much more significant problem now are these perpetual headaches.

I think the next two complications are linked (the severe higher order aberrations and headaches/eye strain):

I've had eye strain while reading the computer since the procedure. I've never liked to abuse my eyes so I've always used a Kindle DX and actual textbooks for reading as much as I could, but this became much more necessary post LASIK. I would get headaches driving home at first, but after I forced myself to stop trying to accomodate for starbursts and stuff they mostly went away. The aberrations improved over the first two years but they seemed to have stabilized until recently. I would get headaches when using computers for prolonged periods of time, and text in movies, even the FBI warnings in the beginning, show signs of halos and artifacting.

Up until six months ago though, I would have to use a computer for extended periods to get headaches, and I would get relief when I gave myself a break. Starting in March, I now have a perpetual headache everyday, and this arises when reading anything now, even the Kindle or physical textbooks. And nothing I do helps. As a general rule, Ive completely limited all digital screen contact for the past three months. No TV or movies and very occasional leisure internet surfing (maybe two hours every five days). I don't use a smartphone (I bought my first one just two weeks ago), and I very very rarely use my iPad now. Even taking several days completely screen free hasn't helped. It is particularly bad at night and in the morning, and spikes precipitously when reading from a screen. The pain seems to subside during the day but I realized the past four weeks that this has more to do with my focus on problems than anything else. My pathetic attempts to solve interesting problems distracts me enough that the pain doesn't seem as bad, but once I'm done the pain is still there. My life right now revolves around reading and writing, and this has become utterly crippling. I'm a PhD in Mathematics, and my performance on one of my really important tests this September was just terrible because this whole summer I couldn't manage to get any quality work done. I remember talking with my mother about it, and I told her I felt like I was somehow getting stupider. I had this endless headache, so I couldn't focus on anything, and it gets worse when I actively read or stare at paper. I have to read text several times before I register the concepts presented, and the number of threads I can run in my head, and in particular the length i can carry a single thread has been drastically reduced. It's one of the scariest feelings of my life. After reading KS9's thread I looked up the symptoms of convergence insufficiency, astigmatism, and binocular vision dysfunction, and they all closely match the description I told my mom. I have difficulty concentrating, my attention span feels short, I have trouble keeping my place while reading, and I have trouble remembering what was read (i.e. registering concepts). I'm certain this is related to my vision. It immediately spikes everytime I read a monitor, and it hurts more when reading text carefully and solving problems intensely than when just idling about.

I know my night time aberrations are severe, I don't remember the actual scores I obtained after lasik, but I'll post it after I get those records. I know my spherical aberrations, coma, and trefoil scores were all significant. I used to always go running at night, and with contacts I had very sharp night vision. I never once consciously noticed an aberration, and in fact I absolutely loved nighttime exercise. Now if I'm cycling to school I worry about leaving too late because in the dark I loose virtually all contrast of the asphalt. On my next day follow up after the surgery I remember my brother driving me to office at 6 in the morning and being so worried as night lights were smearing all over my vision. Glare really distorts my night vision. What's weird is that I don't really see bad artifacts while reading a monitor up close, but I know for certain that just because I don't consciously see them that they aren't forcing my brain to work harder as it perhaps tries to reconcile smeared images and multiple focal points or something.

Also, the past three months my distance vision is faltering a bit, especially at night. I can't recognize people's faces who are further than 30 feet away in a twilight plaza (not nighttime). It looks to me like the aberrations are now worse all the time and that is the underlying cause, but it may be due to myopia I suppose. During the day I can see that my distance vision is impaired but I can't tell how much. Last December I believe I measured off by .25(can't remember + or - but will verify) in both eyes at the optometrist. Back then I didn't notice any decrease in distance vision.

I don't have any sensitivity to light. At least, none that I'm aware of. If I spend the entire day outside I actually feel better since I'm not reading or focusing on anything close up. The headache never completely subsides though

After reading a couple of similar threads here, it seems the recommended course of action is as follows???:

Find an optometrist who specializes in Post-RS corneas (I'm hoping finding a high quality doctor in southern california shouldn't be a problem)
Have him do two types of refractions. A manifest with lots of fogging to prevent accomodation, and a deep cycloplegic.
Have him do a binocular/accomadative assessment.
Have him do a tear test maybe to determine how bad the dry eyes are? (I haven't had one done since the surgery).
Have him use an aberrometer to see my scores for aberrations are.

After this is done we can determine whether this is mostly a binocular or monocular refractive error issue (meaning simple diopter/astigmatism/prism correction or vision exercises) and could be corrected with spectacles. If the spectacles doesn't correct the issue, then they will need to consult about RGP. This is where my fear spikes

From reading on the internet, it seems like a consultation from such a specialist regarding RGP's would be extremely expensive. Of course I suppose I have no one to thank but myself for making such a boneheaded decision to purchase LASIK in the first place. Is there a general dollar amount range it will likely cost? Scleral contacts sound so promising, just the thought of my headaches, night time aberrations, and dry eyes finally subsiding made me so happy, almost emotional. I've been told by multiple optometrists that these complications were all permanent, which is why I had resigned myself to this current condition. The only reason why I read into all these things now is because the pain/distraction is debilitating now. I can't effectively work around it anymore. But if just the consultation for fitting RGP's cost 5000, I'm utterly screwed. Being a grad student I live pretty much month to month and I'd hate to eat up so much savings. Perhaps there is financing I suppose? I'm starting to think I may try to obtain a refund from the surgeons who performed the surgery. The strange thing is that of the 10 people I asked about LASIK, all but one said it was the greatest thing they ever did. That is the last time I ever let someone operate on me without being properly informed of all the complications and research.
Original Post
quote:
Originally posted by Archimedes:
I'm sorry for such a long post," - No need to apologize. We've been doing this a long time.

After reading a couple of similar threads here, it seems the recommended course of action is as follows???:

Find an optometrist who specializes in Post-RS corneas (I'm hoping finding a high quality doctor in southern California shouldn't be a problem) - We'll be in touch with you.

Have him do two types of refractions. A manifest with lots of fogging to prevent accommodation, and a deep cycloplegic. - The former, absolutely. The latter (deep cycloplegic) not so much. The fogging technique is critical but fogging on post-LASIK patients is challenging. The time spent is critical.

Have him do a binocular/accomadative assessment. - That goes along with first determining any residual refractive error that can undermine binocularity.

Have him do a tear test maybe to determine how bad the dry eyes are? (I haven't had one done since the surgery). - Essential but you probably already know the answer to that issue.

Have him use an aberrometer to see my scores for aberrations are. - Helpful to the analysis but any and all PRE-LASIK clinical data would be wonderful. Unfortunately this data you said is not available?

After this is done we can determine whether this is mostly a binocular or monocular refractive error issue (meaning simple diopter/astigmatism/prism correction or vision exercises) and could be corrected with spectacles. If the spectacles doesn't correct the issue, then they will need to consult about RGP. This is where my fear spikes. - Depending on your circumstances, spectacles may have definite limitations but there is no need to fear RGPs if they solve your problem.

From reading on the internet, it seems like a consultation from such a specialist regarding RGP's would be extremely expensive. ... Is there a general dollar amount range it will likely cost? - Unfortunately there are many well-intentioned ODs in the country who have no idea what they are doing when fitting post-LASIK patients with RGPs or sclerals. Hence, VSRN.

But if just the consultation for fitting RGP's cost 5000,... - I don't know where you got that figure but that is extravagant. If there was such a guru who was worth $5,000 just for consultations he/she would probably be known to us and no one I know charges that.

I'm starting to think I may try to obtain a refund from the surgeons who performed the surgery. - A refund would be highly unlikely.

The strange thing is that of the 10 people I asked about LASIK, all but one said it was the greatest thing they ever did. That is the last time I ever let someone operate on me without being properly informed of all the complications and research. - LASIK is plastic surgery on your corneas and as with all plastic surgery, the outcomes are not always what the patient had hoped for. Collectively, patients with your particular issues should be studied as a group. There are probably a dozen or so PhD thesis topics just waiting for researchers but most patients like yourself get swept under the proverbial rug.

Your assessment is quite lucid. As I said, we'll be in touch.
Hello Dr. David Hartzok (clever username haha, or maybe I'm misinterpreting it??)

Firstly, thank you so much for your immediate reply. As I mentioned with Barbara I can't believe there is a free resource out there dedicated to helping patients like us experiencing complications after LASIK. I appreciate it so much. After reading some threads here I had renewed hope for resolving these issues, and this is reinforced and amplified through gestures like this.

I've scheduled an appointment with an optometrist (Can I list his name) in the VSR Network for next Friday. I was hoping to do it this week but his schedule was full, I suppose he must be that good.

Helpful to the analysis but any and all PRE-LASIK clinical data would be wonderful. Unfortunately this data you said is not available?

Ironically, I'm actually extremely close to the center that performed the refractive surgery. I am going to try and pick up all my medical records from my pre-LASIK consultation and all the followups. Also, I do remember the past 5 optometrists I've been to over the last 8 years or so. They should have kept all my medical records no? How long do optometrists typically keep clinical data? If they have the records I can probably have them faxed to the new optometrist right? I had some of the followup paperwork at my parents but not with me, and it was only some of the aberration data post lasik.

I don't know where you got that figure but that is extravagant. If there was such a guru who was worth $5,000 just for consultations he/she would probably be known to us and no one I know charges that.

Yeah this number is super high, I guess the people answering this general question online come from a selective pool. They were all estimates of people who traveled outside their hometown. Several of them visiting Dr. G in Texas with his wavefront sclerals, and this seemed to cost 4000 overall. Then there was also a gentleman in the thread here about receiving refunds from LASIK that said his cost was 6000, and that yearly exams were over 1500, with a single lens of 750. I was like whaaaa Eek. Those are the only people who have openly talked about the cost involved. Your words are comforting to know that even if this becomes costly, it shouldn't approach that number.

A refund would be highly unlikely.

Figured as much, which is why I haven't pursued it. I revisited the idea only recently as a sort of last resort if the cost becomes too burdensome to overcome. If the only resolution is expensive sclerals I may advise with some free law counselors that are here at school for grad students, but I understand this is unlikely to bear fruit. From your reply though I should be able to make it work.

- LASIK is plastic surgery on your corneas and as with all plastic surgery, the outcomes are not always what the patient had hoped for. Collectively, patients with your particular issues should be studied as a group. There are probably a dozen or so PhD thesis topics just waiting for researchers but most patients like yourself get swept under the proverbial rug.

I would be all for contributing my data and experience to such research. If a student ever comes to VSRN asking for volunteers to share this let me know. Anything to help them understand the problem better, that way they can maybe one day eliminate all these post-LASIK issues. It's so hard to convince people not to do LASIK. Two people who I've advised against LASIK got it anyway, and even today I tried to convince someone closer to me not to do it. I think the problem is that I'm the only person they've ever asked who's had significant negative effects from the procedure, so it almost seems worth the risk.

If I can get my records tomorrow I'll post it, and I'll update this thread as the rest of the process unfolds.
Archimedes,

One of the reasons why refraction post-LASIK is so complicated relates to the accommodative-pupil reflex - namely, when we accommodate our pupils constrict. In cases where the patient has residual farsightedness, constriction of the pupils actually offsets some of the aberrations. But, when a plus lens (to correct farsightedness) is placed before the eye, whatever relief the lens provides is offset by a slight enlargement of the pupil. Hence, there is a tendency to not find latent farsightedness. When patients are being fitted with RGP lenses, the aberrations in questions are checked by the RGPs and the full prescription can be discovered and prescribed.

I have often felt that LASIK surgical centers are not particularly good at the pre-op refraction determination. They are especially bad at post-op refraction. Refraction is so much more than sphere, cylinder and axis.

The fitting process accomplishes two things: (1) It determines how many of your symptoms can be resolved with an RGP, telling us how much of the problem is essentially on the corneal surface and or related to any pupil size / ablation diameter issues (causing low light halos, etc.) (2) Successfully fitted lenses can then be prescribed the fully correct any residual refractive error and that, often, helps minimize binocularity issues brought about by the LASIK.

The more records you can gather the better. If you want, upload them to me and I will weigh in on what might be the issue. When LASIK was young these records were a treasure trove of data that often allowed me to zero in on problems. Today's records, unfortunately, generally lack the detail that was once the norm. It goes along with LASIK becoming passe in a clinical sense whereas when LASIK was new, everyone was following the guidelines originally laid out by the FDA during the pre-approval days.
Hello Dr. Hartzok,

So I visited the surgery center to ask for my records and they said the MD there had to sign off on it before they could release it to me. I should get it by the end of the week though.

About the accommodative-pupil reflex, I had read your explanation in KS9's thread here. At first when I read it I was very confused because I thought you had mistakenly wrote +.5 diopters instead of -.5, and then when I realized you actually meant +.5 I was even more confused since I didn't understand why the pupil would dilate during accomodative reflex. Given that it does, the misdiagnosis made sense, but even now I don't see why the pupils dilate. Given the little I know about cameras, I've always related pupil size to the aperture of a lens. In a camera I'll change aperture to increase or decrease light exposure on the sensor or change depth of field. But I don't understand why focusing on things up close would necessitate a change in either of these variables. If the human eye is focused on a point 2 feet away, and then changes the optical power of the eye to focus on a point 10 inches away in the same lighting conditions, I can't see any need to decrease light exposure. Does increasing depth of field by closing aperture improve ability to focus up close?? Maybe increasing depth of field lowers the power demand of the lens since technically more 3D space comes into focus on retina?

Archimedes
Does increasing depth of field by closing aperture improve ability to focus up close??

From an evolutionary viewpoint, man is not a nocturnal creature so improving near vision (depth of field) in daylight conditions would theoretically provide a survival advantage while not significantly reducing the needed illumination on the retina.
Hello Dr. Hartzok

So I have obtained all my LASIK records, and have them in PDF file format. Is there a way I can send them to you in a private message?

I think there is a good amount of information in them. I've spent about an hour looking at them so far and later I plan to spend some more time to properly formulate any questions about it. I really hope this is illuminating for an optometrist.
Hey, after the LASIK surgery, one should always wear reading glasses, while coming in contact with sun rays and artificial lights. A month before, my mother gone through cataract surgery, So after the surgery, she was advised to wear reading glasses continuously for few months.
LASIK and cataract surgery are two completely different procedures. Wearing reading glasses is only necessary if one needs them for close reading. One is advised always to wear sunglasses while out in the sun. There is zero protection from bright lights, sun or otherwise, while wearing reading glasses. Many LASIK patients are unable to wear generic glasses of any kind, and must have prescription eyewear.

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