RGP Fitter in Dublin Ireland?

Hi. I will try and be brief in explaining my problem. I live in Dublin, ireland, and had Lasik in late 2007, having been reasonably myopic before hand. After surgery my vision was “better than 20/20”. I am going through very real difficulties, however, and although I don’t like to sound like a downer, I have to say they really are effecting the quality of my life in a very negative way.

My problem is difficult to describe, I have not found the correct terms for what it happening. I still have vision that is not far off 20/20, but it is as if there is something in the air, that effects the light. I have a lot of trouble reading text, both on screen and paper. I move my head this way and that trying to see around the light that is getting in the way. I actually find that if I close one eye I can read much more easily, but with both eyes open it is slow and stunted. It also helps to follow the text with my finger. Otherwise is is like the letters on the page dance around and confuse my eye.I often feel seasick when I am trying to read. It tires me to read even a couple of pages, like my brain is working overtime to convert what I am seeing. I bought some computer/anti glare glasses, which help a little for both screen and paper, although they don’t fix the problem.
I went back to see my surgeon a couple of weeks ago to discuss. She was sympathetic, but at the same time did not really think I had a problem, since my vision still seemed good by the chart reading metric.

I read during some of my trawling of the internet about how in some cases Lasik can leave irregularities on the cornea that result in little distortions. In some cases this can be eased by RGP lenses which create a new ‘smooth’ cornea, I asked my surgeon bout whether something like this might be an option but she dismissed the idea pretty out of hand, because lenses are the ‘old way’.

So now I don’t kow what to do. I don’t know if there are lenses that could help me or not, but I would like to talk to someone who isn’t ‘against’ lenses. So I am looking for advice. I read on this forum of an optician Burnett Hood in London who is a good RGP fitter, and London isn’t too far for me to go, although if there was someone in Ireland that would be much more convenient for me, especially if a number of consults would be needed?

Thankyou in advance for any help or advice you can give me.
Original Post
Dear Dublin,

Being 20/20 does not mean that everything is hunky-dory with your vision. LASIK providers use 20/20 as a benchmark for their work since that is what they promise their customers. However, there is much more to comfortable, highly functional vision than being 20/20.

First... a few questions.

1. Were these symptoms present following your LASIK in 2007 or have they come on gradually over time?

2. At your visit a few weeks ago, did anyone refract you, i.e., did an examiner show you various lens combinations and ask you which lens was better? It is extremely important that this be done manually with an experienced examiner who is willing to take the time to determine is there if a refractive IMBALANCE between the two eyes. The examiner MUST use good technique and take the time to find an accurate spectacle prescription. I would suggest visiting an office that does not do LASIK.

3. Relative to #2, what is your spectacle prescription?

4. If these symptoms have come on gradually since your original procedure, I would be less worried about corneal irregularities and RGP solutions.

Start with the basics and get to a very solid refractionist. I have an idea that your prescription has either shifted since 2007 and/or your ability to tolerate an initial imbalance or over-correction has diminished.

Please report what that examiner finds.
Hi Dr Hattzok

Many thanks for your reply, and your thoughts. I will address your points in order.

1. Yes, these effects were noticeable immediately after i had the LASIk surgery. At first I thought it might be temporary. After a while I came to accept that it would not be, but I presumed that whatever the outcome of the surgery I would need to accept it. In 2009 I went back to full time education so I have been doing much more reading than I would have in the previous year and it was at this stage that I realized how difficult reading had become for me. Additionally I feel like my eyesight has regressed a little in the last year or so, which maybe had compounded the original problem.

2. Yes. I visited a regular optician about two months ago and had one done. The optician felt that my vision was good. She said that she felt that the small improvement that glasses would offer meant that there was little point in getting them.

3. I have had an eye test done in the last two months. The result:

Left eye; -0.24 (SPH), -0.25 (CYL), 180.0 (AXIS), 6/5(Near-ADD)

Right eye; -0.24 (SPH), -0.25 (CYL), 5.0 (AXIS), 6/5(Near-ADD)

4. I am sure that the symptoms have been present all the time. i remember a few weeks after the surgery starting a new job, and finding that the text on the screen 'glowed' in a strange way that meant reading it difficult. I managed though, and hoped that it would go away with time as my vision settled.

I must say that on the two recent occasions I have had eye tests for the purpose of geting spectacles, no combination seemed to help with the problem so I did not have any glsases made. Do you think i should try doing this and wearing them for a couple of weeks?

Many thanks for your help.
If the problem has been there since the original LASIK procedure, then it could be (1) some degree of corneal irregularity that could be helped with properly-fitted RGPs and/or (2) a binocular vision instability that may have been sub-clinical (present but without symptoms). Visual complications of LASIK and other refractive surgery procedures present in a variety of contexts. Depending on the pre-existing visual system, the visual system attempts to integrate the changes but is not always successful. There are a number of variables, many of which have not been researched since the industry does not attempt to find negatives with the procedures.

Check with the doctor that Barbara referred you to and let us know what you find out.
Dear Dr. Hartzok and Barbara,

I would like to give you an update on my situation if I may.

Last month I visited the doctor that Barbara put me in touch with. It was an interesting conversation although I feel like I now have more questions than answers.

He told me almost immediately that I have large pupils, and he would not have been surprised if I had experienced glare and halos since LASIK for this reason. I downplayed my glare issue, as I did not think that that was my problem, although I really did not know.

As my main problem is with reading the solution he has initially proposed in spectacles with colored glass. We did a test to see if I found it easier with certain colours, of which purple was my favorite. I am still waiting on the glasses to be delivered so I am unsure of ho much they will help me.

Having thought about things since the appointment I feel that maybe I understand things a little better. I realise now that I do see halos. I had not thought about it, and assumed that the way I saw streetlights, for instance, was the way everybody sees them.

At night it is not a big issue for me because I seldom drive, and it is not too severe. But the same effect bothers me in other instances, mainly when viewing screens, even in brightly lit rooms.

I notice the same glowing effect on signposts when I am outside, during the day. The effect is much less noticeable when I am wearing sunglasses on a bright day.

I wonder if it is the size of my pupils contributing to a sort of halo effect ... I do experience increasing discomfort whenever I use a computer for more than a couple of minutes. Perhaps it is too much light going into my pupils?

I will see how I get on with the glasses once they have arrived, to see if they make reading any easier for me, and then take update you again.

Apologies for the long note.

Many thanks for your time,

Kind Regards
Ask your doctor if he/she can prescribe Alphagan (brimonidine) to be used on an "as needed" basis. Alphagan is a mild drug for glaucoma that is well tolerated. One side effect of the drug is that it prevents pupils from dilating as much in low light situations. This mild effect is, in some cases, just enough to take away the halos and glare associated with large pupils/small ablations. Most patients only use it once or twice a day and then only when they want. Try the 0.2% concentration. It may not be called Alphagan in Ireland, so be sure you mention the drug name brimonidine to him. Tell your doctor that we are specifically recommending the drug for the reduction of natural mydriasis.

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