Hi everyone,

New member here seeking post-PRK astigmatism advice.

Brief rundown:
I had monovision PRK in the right eye only, 22 days ago. I had a -1.25 prescription with 0 astigmatism. Today the notes say Sphere 0.00, cylinder -2.50, Axis 003, BCVA 20/20, BCVA +/- -1 ghosting effect

I have followed all post op instructions and was treated by Dr. XXX in California. The surgery and healing process was uneventful from what it seemed.

I have had and continue to have ghosting and double vision. On topography maps, the area that is questionable is the entire top half of the pupil area, which is blue in color and supposedly flat, not there pre-op (which was documented by my surgeon this morning).

He believes that the epithelial layer is remodeling and that this will subside on its own. He did an ECC yesterday and says it looks normal. I am concerned about decentration or a surgical error. So far, my optometrist has been unable to help with the astigmatism through glasses as he says it appears somewhat irregular. He did say the epithelial layer appears to be laying flat without any "bumps" at this point in the recovery.

The optometrist and the surgeon are at odds about whether this an issue on the epithelial layer and if it will self-resolve.

The surgeon wants to look at the topography every 3-4 weeks and decide what to do, if anything, in 3-4 months.

Since this is affecting near and distance vision it's making it incredibly difficult to drive or work. Everything is blurry and ghosting.

Of importance to note.. The blue area has shrunk on the topographical image in one week.

Any thoughts on whether you'd tend to believe it's the remodeling of the epithelial layer, or an ablation error?

Thank you in advance. Worried and not sure what to do.
Original Post
Hello, mischik.

(I crossed out the name of your surgeon. We have a policy of non-disclosure for liability reasons.)

I would need to see two things:

1. Do you have copies of your post-PRK topographies that you can post or send to me?

2. Do you have copies of any pre-op or post-op Orbscans or Pentacams? (Most surgeons rely on these.) If you have post-op Orbscans, that will suffice for #1.
I'm posting an update for those who are reading this thread that may be looking to see what happened, in a similar situation.

Im 6 weeks post op, and saw both the Optometrist and Surgeon this week. The astigmatism is down from a 2.00 2 weeks ago to a 1.25, significant improvement - at least on the dials.

The fact that it is changing has the surgeon believing that the issue is uneven epithelial layer. He said IF he had ablated incorrect or there was a decentration issue, it wouldn't be improving by definition.

The optometrist said he is "optimistic, for the first time in my case." The topographies show much less "blue" (flat area) on the cornea, shrinking and less deep.

The surgeon said he wanted to see me in 3 months rather than every 2 weeks, and the Optometrist is sticking with every 2 weeks.

In terms of my actual visual acuity (my perception of it), day time is much better (of course, because the astigmatism is right in the middle of my pupil, so the less dilated it is, the less of the astigmatism is in view). I can read some street signs now during the daylight.

Distance vision is improving faster than intermediate or close vision.

I would say at this point my distance vision is 80% of what I would expect (I expected to see very clearly by now, like I did with my other eye after PRK). My close up vision is probably 50%. Ghosting is the only issue - I can see "through" the ghosts sometimes and that vision is pretty close to perfect. It's the ghosts getting in the way.

The fact that the astigmatism has dropped in half in 4 weeks has both doctors optimistic. I will post back what the results are in a few weeks to this forum for those who are viewing and seeking reassurance or just general info. At this point, I've read 145 academic articles on the topic and trying to stay as informed as I can. I'm not yet to the point where I am happy that I did this - but I can possibly see a point in time where that may occur, whereas 3 weeks ago I would never have said that.

More soon...

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