RK Fluctuation

I had RK surgery 7 1/2 years ago. For about 6 years it was perfect. Then I started needing reading glasses which was okay. About a year ago my vision started fluctuating. I didn't know what was happening. I couldn't focus. I went to a doctor who said, "here's a prescription for glasses. come back in two years." I did not get the rx filled. I went to another doctor. It seems that my cornea is flattening even more while I sleep and I cannot see in the mornings. I mean "I cannot see" I cannot focus. It is awful. I have to use 250+ readers. Then I put on progressive glasses that I have just in case. A new doctor has given me contact lenses to try in the mornings or to sleep in so that I can function. I wear them 4 + hours and then don't need them. But everyday is different. It is so unpredictable. I'm so depressed. It is difficult to work and to concentrate. HELP. Has anyone else experienced this? Or heard of it? My doctor is very supportive, but he hasn't had any other patients with this problem.
Original Post
I am afraid it is not good news. I am 8 years out and still have fluctuation in my left eye. My right eye I cannot focus and have ghosts. The left eye is still fluctuating and at night I cannot see much of anything. It is very depressing. I am just over 50 and I am loosing hope in ever seeing the world I once did with glasses. Its strange, you said your doctor never had anyone else with this problem, my doctor said the same thing. He also told me that if it did not clear up I would be the first in history it did not clear up on. Guess I am in the history books. Do I sound ticked, sure am, every day, every night.
I have been on Lotemax which has greatly reduced my vision fluculations. I have yet to get a decent explanation, why this works. But when I go off it, my vision gets worse. Your situations could be completely different, but it worth asking about?

"Nothing works as good as the original equipment."
sblount,

Your problem is hardly unique; lots of post RK patients have the fluctuation problem, including myself. In fact, the only long-term controlled study of any type of refractive surgery, the PERK (Prospective Evaluation of Radial Keratotomy) study, showed that >50% of post-RK patients 10+ years out had significant daily fluctuations in their measured prescriptions. The PERK study, and the subsequent history of RK surgery, hype, mass marketing, and the huge number of problem patients it would create down the line is a parable and warning for all the even-bigger refractvie surgery hooplah that has followed. I am sorry you have found yourself in this position and hope that all these laser surgery patients are luckier than us a few years out (although, perhaps very wisely, no similar long-term study was ever conceived for LASIK or PRK, so it's hard to predict).

But all is not without hope. I don't know or remember all of what Raxelrod has tried, although he's been here a while, BUT, some of us have found some relief with RGP contact lenses. You'll need to do some work and search around on this bulletin board, but there will be valuable insight there to gain as you start learning more about your problems.

In the short term, you might try working with your current doctor to measure your prescription at different points during the day to get a handle on where it winds up. Working with an optometrist to measure my prescription in the morning, mid-day, and late afternoon has helped me out in the past, even though it means I have to carry around several pairs of glasses (and it's very expensive and it takes a while and some luck to get the right set of prescriptions). Generally, there are probably repeatable patterns more so than you might think in your visual fluctuations day to day. But not measuring you systematically (e.g. only seeing you during mid-day or "randomly") is not going to help you.

In the long-term, as supportive as your current doctor is, you need to find a doctor, perhaps off this board, perhaps elsewhere, that has experience dealing with post- refractive surgery patients, and preferably also in fitting them with RGP lenses. If your doctor doesn't know anyone else with this problem he is either lying (which I doubt) or quite typically hornswaggled as per usual by his profession's faith and infatuation with refractive surgery. Meaning, he is not bad, just ignorant of what's going on out there. Sorry to be so blunt.

Good luck ,and be very very strong- this is a battle you can win to find relief for your problems. Be realistic and know, however, that it will take some work on your behalf, and you might not reach "perfection", only a more tolerable set of circumstances and some crutches to help you through, like a lot of us have found out.
can flattening of the cornea happen after Lasik. Someone told me that 2 weeks after Lasik, she was sunbathing without anything covering her eyes and she regressed from the heat and UV light. Her prescription never returned to 20/20 and is about 20/50. She is wearing glasses and will not get an enhancement (smart).
I am told that it can becaue both procedures flatten the cornea to get the same result. Good luck to your friend.

quote:
Originally posted by rads55:
can flattening of the cornea happen after Lasik. Someone told me that 2 weeks after Lasik, she was sunbathing without anything covering her eyes and she regressed from the heat and UV light. Her prescription never returned to 20/20 and is about 20/50. She is wearing glasses and will not get an enhancement (smart).
quote:
Originally posted by rads55:
can flattening of the cornea happen after Lasik. Someone told me that 2 weeks after Lasik, she was sunbathing without anything covering her eyes and she regressed from the heat and UV light. Her prescription never returned to 20/20 and is about 20/50. She is wearing glasses and will not get an enhancement (smart).


Sounds like a bunch of unrelated circumstances to me, although I know one woman who used to post here who I believe claimed she got DLK from opening an oven to remove a pan of cookies shortly after LASIK. I was skeptical at first, but then as I recall, it turns out there really was some published scientific research to support her claim about the heat and the DLK soon after LASIK. She posted as "BJB" I believe.

I've never heard anything about UV light, sunbathing, and radical prescription change after LASIK. The lesson from RK, my point was, is that some substantical long-term consequences, such as hyperopic drift and persistent fluctuations many years after the surgery did not become apparent until many years later, and only because such a study was rigorously designed and followed. No such study in place for the surgeries that followed, so trends (and therefore treatments) will be hard to follow in the years to come.

My take is in the short-term (<5 years), there do not appear to be major trends on the order of trends following RK in regression or progressive flattening after myopic LASIK, based on the lack of studies even suggesting such a thing. That being said, who's really looking for the evidence?
For Brian ---Thanks for your post. I have been off the air for several months since I get down if I read and write too often on this site. At any rate, glad to see you again posting. I don't know why I thought you no longer posted and were off the air. The reason I enjoy your posting is that yoiur case seems to be very mirrow mine and, I suspect, many others. Personally, after 10 years postop RK, and a PRK last year to get my hyperopic eye back to a matching myopic condition with the other eye, I can also attest to a continuous problem with unstable corneal fluxuations. Mine are documented at about one and one half diaopters daily. Historically, I tried RGP's over the past four years without success but I have always wanted one size to fit all times. With the vision fluxuations, it just will not happen. I like your idea and I am going to see if I can get the optometrist to agree to multiple refractions and several RGPs. It sounds tough even as I write it. Last thought, at least for today, I am somewhat at peace with the bad eyes even as I prepare to try the RGPs again or ulimately do what my corneal surgeon wants to do...PKP.
In the 20 years since my RK, visual fluxuation is a daily event. I had come to the conclusion it was the same with most RK's but recently found out others do not always suffer from it. Is it possibly more likely in people who had large correction in their surgery.

I try to always have my eyes checked and Rx made at the same time of day. At least I know the correction is consistant in the daily response. For me earlier in the morning seems to work best. I always figured that if the correction is good around 10 am then my eyes would therefore be stressed less trying to focus during the day and my vision would then fluxuate less during the day. Then again, you could say that is a bunch of bull too!

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