The wife is almost at 20/20. She still misses the D's and the O's. On the bright side, she can make out a few of the letters on the 20/15 line as well. However, those letters are a little blurry still. She still has halos but it's not that bad. She has stopped using the artificial tears awhile back because she just doesn't feel the need. The doctor recommends that she keep using. She said she would but somehow I doubt it very much. It's human nature. She's basically living like a normal person with good vision without being tethered to the glasses, contacts, or tear drops.
I'm actually disappointed that she hasn't hit hit her 20/20 benchmark yet. Then again, conventional wisdom say that it may take up to a year for recovery. Is almost 20/20 at 6 weeks with a -5.25 prescription good or bad? Who knows. Plus everyone heal at a different rate. We'll just have to wait for the 3 month post-op to find out.
I may be disappointed, but she's ecstatic. Being able to see the clock at night and not having to shuffle for glasses is liberating for her. Plus, not having to deal with contacts, losing a contact, and then having one stuck in the eye (which happens regularly for some reason) is another plus. Yes, she would definitely have this procedure again.
We have another surprise: she's pregnant. Of course, most LASIK doctors don't recommend getting pregnant for at least 6 months after LASIK. There goes conventional wisdom.
Sunday, February 19, 2012
Friday, February 3, 2012
3 Week Post Op Vision Quality
Remember, every individual is different. Just because your experience is different does not mean that there is a problem. Also, don't expect to have the same results because there are so many different factors including pre-op vision, perscription, existing higher order aberration and existing conditions such as dry eye symptoms, etc.
My wife had -5.25 pre-operative prescription. That means that about 80 microns of her cornea was removed. That is not a small number. It's like a minor wound versus a large wound. The minor wound would heal much faster. Most people who have had flawless vision the day after probably had low myopia to begin with. A test of how well the LASIK technology work is not to ask someone who had -1.25 prescription pre op but ask someone who had medium to high myopia. Many of the ecstatic reviews for LASIK by patients who claim they can watch TV in 4 hours and drive immediately the next day are probably from patients with low myopia. Low myopes will have exceptional results with any system even the 10 year old standard NIDEK laser. That's just the way it is.
Sift through the results and compare apple to apple. For patients with high myopia and astigmatism, exceptional results may be rare. However, if you have a low prescription, you should expect to drive the next day with low complications. Temper your expectations based on your individual characteristics.
LASIK is surgery and all surgery requires healing. For my wife, she was able to see the next day and her vision was hovering between 20/25 and 20/20 the day after. That is an outstanding result! However, the halos around light sources were pretty bad. She was not able to drive the first week because the halos were blinding. I am happy to report that she has been driving at night now with no problem. The halos are still there but they are not that bad. Other than the first few days, the halos are not disruptive or blinding.
Most doctors would tell you to expect up to a year for most post-op LASIK complications to go away. My wife is satisfied with the halos right now even if it never goes away. She would gladly trade her practical blindness for a little halo. However, with the vast improvement in the symptom with the halos from the first few days to now, I hope (and expect) that it will totally go away by 3-6 months.
The biggest issue any LASIK patient should worry about is dry eyes. I have minor starbursting naturally occurring in my eyes at night (I never even realized that this is not normal until I researched LASIK). It doesn't bother me. Just like the minor halos is not bothering my wife. However, the one thing that did bother her was the initial dry eye symptoms and the contact in the eye feeling. Luckily for her it quickly went away . She only used one tear drop the last three days, usually when her eyes get tired from reading the computer screen or her files.
My cousin had dry eye symptoms for an entire year. It "sucked" was his words. He had to constantly use the natural tear drops many times a day. My wife did not have dry eye symptoms pre surgery so it didn't bother her post-op either. However, if anyone has existing dry eye symptoms, that person should consider it as it's most likely will get worse.
My wife believes that her color/contrast and close up reading is superior now 3 weeks post-op as compared to pre-opt. You have to realize that her best corrected visual acuity was not that good to begin with. I have a feeling that it was due to her existing higher order aberrations. On the freeway, she previously was able to read signs at half the distance that I was able to even with her contacts. I was able to read signs a few seconds before she can make it out going 60 mile per hour. Her contacts corrected her vision up to a point, but beyond that distance her clarity just collapsed. Now, even with her eyes still healing, she is able to read signs much farther away. As you can see, she's very happy with her results at 3 weeks. She was able to see before with contacts, but she is able to SEE now without it. The quality difference is there, even with the nighttime halos.
Random Musing
So why do LASIK patients post op have starbursting and halos? The reason is most likely due to higher order aberrations. As I discussed previous posts, all LASIK procedures tend to induce higher order aberrations. Even people with normal vision has it (I do) and contacts or glasses cannot fix HOA. Even the machines that claim to be neutral (optimized) or corrects it (guided) tend to induce HOA. The fact that her halo issue is diminishing tells me that it is not due to her pupil size at night but due to the higher order aberrations which tend to be highest immediately after surgery. This is the reason why patients with existing high HOA should select a technology that attempts to fix it. That doesn't always mean that it can fix it (or in most cases limit it), but the studies have shown that patients with high HOA tend to have better results post-op with wavefront-guided technology. Optimized technology attempts to avoid creating new HOA but that doesn't mean much--all LASIK procedures tend to create HOA! Here is another study comparing HOA and the technologies. Notice that with the VISEK, 1/3 of patients had reduced HOA while 1/3 had worse even with the attempt to correct HOA. However, with the optimized version 60% of the post-op patients had worse HOA post-op with only 15% having improved HOA. If it can't get better, it should stay the same, not worse! Higher Order Aberration is a hugely important factor that should be a consideration for all patients with high myopia.
http://en.wikipedia.org/wiki/LASIK#Higher-order_aberrations
http://www.eyeworld.org/ewsupplementarticle.php?id=252
My wife had -5.25 pre-operative prescription. That means that about 80 microns of her cornea was removed. That is not a small number. It's like a minor wound versus a large wound. The minor wound would heal much faster. Most people who have had flawless vision the day after probably had low myopia to begin with. A test of how well the LASIK technology work is not to ask someone who had -1.25 prescription pre op but ask someone who had medium to high myopia. Many of the ecstatic reviews for LASIK by patients who claim they can watch TV in 4 hours and drive immediately the next day are probably from patients with low myopia. Low myopes will have exceptional results with any system even the 10 year old standard NIDEK laser. That's just the way it is.
Sift through the results and compare apple to apple. For patients with high myopia and astigmatism, exceptional results may be rare. However, if you have a low prescription, you should expect to drive the next day with low complications. Temper your expectations based on your individual characteristics.
LASIK is surgery and all surgery requires healing. For my wife, she was able to see the next day and her vision was hovering between 20/25 and 20/20 the day after. That is an outstanding result! However, the halos around light sources were pretty bad. She was not able to drive the first week because the halos were blinding. I am happy to report that she has been driving at night now with no problem. The halos are still there but they are not that bad. Other than the first few days, the halos are not disruptive or blinding.
Most doctors would tell you to expect up to a year for most post-op LASIK complications to go away. My wife is satisfied with the halos right now even if it never goes away. She would gladly trade her practical blindness for a little halo. However, with the vast improvement in the symptom with the halos from the first few days to now, I hope (and expect) that it will totally go away by 3-6 months.
The biggest issue any LASIK patient should worry about is dry eyes. I have minor starbursting naturally occurring in my eyes at night (I never even realized that this is not normal until I researched LASIK). It doesn't bother me. Just like the minor halos is not bothering my wife. However, the one thing that did bother her was the initial dry eye symptoms and the contact in the eye feeling. Luckily for her it quickly went away . She only used one tear drop the last three days, usually when her eyes get tired from reading the computer screen or her files.
My cousin had dry eye symptoms for an entire year. It "sucked" was his words. He had to constantly use the natural tear drops many times a day. My wife did not have dry eye symptoms pre surgery so it didn't bother her post-op either. However, if anyone has existing dry eye symptoms, that person should consider it as it's most likely will get worse.
My wife believes that her color/contrast and close up reading is superior now 3 weeks post-op as compared to pre-opt. You have to realize that her best corrected visual acuity was not that good to begin with. I have a feeling that it was due to her existing higher order aberrations. On the freeway, she previously was able to read signs at half the distance that I was able to even with her contacts. I was able to read signs a few seconds before she can make it out going 60 mile per hour. Her contacts corrected her vision up to a point, but beyond that distance her clarity just collapsed. Now, even with her eyes still healing, she is able to read signs much farther away. As you can see, she's very happy with her results at 3 weeks. She was able to see before with contacts, but she is able to SEE now without it. The quality difference is there, even with the nighttime halos.
Random Musing
So why do LASIK patients post op have starbursting and halos? The reason is most likely due to higher order aberrations. As I discussed previous posts, all LASIK procedures tend to induce higher order aberrations. Even people with normal vision has it (I do) and contacts or glasses cannot fix HOA. Even the machines that claim to be neutral (optimized) or corrects it (guided) tend to induce HOA. The fact that her halo issue is diminishing tells me that it is not due to her pupil size at night but due to the higher order aberrations which tend to be highest immediately after surgery. This is the reason why patients with existing high HOA should select a technology that attempts to fix it. That doesn't always mean that it can fix it (or in most cases limit it), but the studies have shown that patients with high HOA tend to have better results post-op with wavefront-guided technology. Optimized technology attempts to avoid creating new HOA but that doesn't mean much--all LASIK procedures tend to create HOA! Here is another study comparing HOA and the technologies. Notice that with the VISEK, 1/3 of patients had reduced HOA while 1/3 had worse even with the attempt to correct HOA. However, with the optimized version 60% of the post-op patients had worse HOA post-op with only 15% having improved HOA. If it can't get better, it should stay the same, not worse! Higher Order Aberration is a hugely important factor that should be a consideration for all patients with high myopia.
http://en.wikipedia.org/wiki/LASIK#Higher-order_aberrations
http://www.eyeworld.org/ewsupplementarticle.php?id=252
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