Lasik Eyes Surgery - Nine years later

Author

Nine years later

crvc@wyoming.com

2005-04-08, 10:25 pm

In 1996 I went to Moran Eye Center in Salt Lake City and treated myself
to LASIK for my 40th birthday. I've lived with miserable night vision
ever since. I've tried everything. Most of my experiments came from
online suggestions from Surgicaleyes. A few were suggestions from
different ODs and MDs.

I tried yellow glasses. My dad mentioned they'd been issued to him in
Vietnam to improve night vision but he never saw any improvement from
them. I didn't either.

I tried driving with the dome light on. Then I tried driving while
shining a flashlight in one eye. I put illegal off-road headlights in
my truck then added equally illegal offroad spotlights. None of that
helped more than simply driving with high beams. So I jerry-rigged the
truck to keep both lowbeam and highbeam lights on all the time.

I tried miotic eyedrops. Diluted pilocarpine worked to suppress
starbursts and make driving a bit safer. But it's damn hard to put
drops in while doing 80 on the interstate. The trade-off is that while
helping the starbursts the drops destroy contrast sensitivity. I once
enjoyed jogging at night through a park. The drops made it impossible
to see the trail: rocks, roots, water, it all blends into the
darkness.

Someone on SE mentioned RGP lenses. I've gone through three ODs and
three sets of lenses and I can't tolerate the lenses for more than a
couple hours per day. At one of the recent eye appointments the doc
said I have a 1-2 second tear break up time. So he prescribed
Restasis. There's irony here: The insurance company deemed dry eye is
a result of elective surgery (LASIK) and won't cover the cost.

Today I went to Medline and searched LASIK NIGHT VISION. I got 33
responses, all medical reports published between Feb/2005 and Jul/1998.
All admit that night vision complaints are common, claiming anywhere
from 25% to 45%. Most patients aren't severely affected though. There
doesn't seem to be a consensus on what to do about them. Most authors
won't commit to a theory. Some say small ablations lead to night
vision problems while others say there's no connection.

Five years ago I visited a LASIK mill in Colorado. The surgeon said my
only problem is that the original surgery used a small laser. A repeat
surgery using his newer, wider laser would fix the problem. I thought
that was too simple an answer. Also the surgeon looked about 15 years
old.

Some reports claimed success treating night vision problems with
Customcornea. One report from Japan said there were no night vision
problems in patients with a 3mm ablation zone but 7-8mm blend. Maybe
that's the key.

This is the longest post I've ever made on this list. Well, it won't
happen again. I've decided I have to look into surgical help. I just
need to find the courage to do it. Maybe someone can stop this 9-year
nightmare.

Glenn - USAEyes.org

2005-04-08, 10:25 pm

Everything you have described indicates that you suffer from spherical
aberration. That means, in simple terms, that the periphery of your
cornea is not refracting light the same as the center of your cornea.
Apparently the optical ablation zone was small enough to cause you
these night vision problems. For details, see
http://www.usaeyes.org/faq/subjects..._pupil_size.htm

Although Visx and Bausch & Lomb's Zyoptix have reported good results
from Complex Wavefront Retreatment (CWR), only Alcon has been working
on algorithms specifically to treat people with your type of problem.
Dan Durrie in Kansas City has performed CWR on many patients with
overall good results, but not for everybody. While initial LASIK
depends upon an individual's unique circumstances, the success or
failure of CWR absolutely depends upon an individual's unique
physiology and previous treatment.

You mentioned diluted pilocarpine. Alphagan P is also used to reduce
the size of the pupil, but has fewer side-effects and is not quite as
dramatic of a change when compared to pilocarpine. If you have not
already, this is a treatment to consider while you decide what to do
surgically.

My recommendation is to be evaluated by a surgeon who has significant
practical experience with CWR and discuss in detail your situation.
CWR may or may not be best for you, but does offer a very real
possibility of reducing or eliminating your night vision problem.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

CatmanX

2005-04-08, 10:25 pm

WHile I agree with the general tenet of your post Glenn, once again we
get to the point that a) people do have post RS problems and b)
literature states the problem at 25-45% have night vision issues, which
is more than the 3% you constantly refer to.

I would be suggesting at this point, given the problems with RGP lenses
and use of meds (which is not a means of treatment I recommend) that
wavefront retreatment is probably the preferred avenue of approach.
Without seeing the topos, I would hazard a guess that your problem
stems from a small ablation zone and/or small blend, both of which were
common 9 years ago.

Retreatment would most likely widen the ablation zone and provide a
larger blend to reduce aberration.

Best of luck and email me if you need any further advice.

grant

serebel

2005-04-08, 10:25 pm

While I hope Kevin's problems will be aleviated, probably the only way
is surgically, I have to remind you that his surgery was done at a time
when it was mor a roll of the dice than it is now. If he had his
surgery at this timeline, I'm certain that he would have had a better
result. I have a friend who "couldn't wait" when lasik first hit the
scene and he was also f ' ed up. He wishes he had waited.

SErebel

Glenn - USAEyes.org

2005-04-08, 10:25 pm

Grant,

We have reviewed the actual patient outcomes of thousands of patients.
The unresolved complication rate at six months postop is about 3%.
Certainly a higher rate of complications occur, but for about 97% they
are resolved with healing or treatment.

Hopefully this patient can have the unfortunate experience of being
one of the 3% into being one of the 3% who finally had the problem
resolved.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Ragnar

2005-04-08, 10:25 pm

1996? You must have been one of the very first LASIK patients.
You certainly got your share of misinformation. That's what you get
by getting information from such places as Surgical Eyes.

I'd avoid those eyedrops. Those eyedrops are meant for temporary
treatment. In the long-term, you will get headaches and risk
complications such as retinal detachment.

It sounds to me like your eyes were in terrible shape before your
surgery, which is why you chose to have LASIK before anybody even
heard of it.

Your comment about not being able to tolerate RGP lenses rings a bell
with me. Many people can't tolerate them. One doctor I went to had
no clue on how to fit an RGP lens and it was like sticking toenail
clippings into my eye. I did find a much better OD who did a great
job fitting me with RGPs, but even with him, I did notice that
different brands of RGPs with the exact same specifications vary quite
a bit in comfort. I found the Hydrocurves to be superior to others.
But then, even after about 15 years of them, my eyes could not
tolerate them any longer - which is not uncommon for contacts.

As for Restasis.. that wouldn't help you anyway, so don't feel bad.
The doc who recommended restasis for you is incompetent.

I think you should go for a retreatment. The procedure has been
vastly improved over the last 9 years.

I'm curious about one thing... your primary complaint seems to be
night vision. Why are you outside at night anyway? Very few people
are.. and even then, it's only to drive from point a to point b. Even
then, the problem is with streetlights and headlights. Most people
sleep when it's dark out.

On 7 Apr 2005 11:13:35 -0700, crvc@wyoming.com wrote:

>In 1996 I went to Moran Eye Center in Salt Lake City and treated myself
>to LASIK for my 40th birthday. I've lived with miserable night vision
>ever since. I've tried everything. Most of my experiments came from
>online suggestions from Surgicaleyes. A few were suggestions from
>different ODs and MDs.
>
>I tried yellow glasses. My dad mentioned they'd been issued to him in
>Vietnam to improve night vision but he never saw any improvement from
>them. I didn't either.
>
>I tried driving with the dome light on. Then I tried driving while
>shining a flashlight in one eye. I put illegal off-road headlights in
>my truck then added equally illegal offroad spotlights. None of that
>helped more than simply driving with high beams. So I jerry-rigged the
>truck to keep both lowbeam and highbeam lights on all the time.
>
>I tried miotic eyedrops. Diluted pilocarpine worked to suppress
>starbursts and make driving a bit safer. But it's damn hard to put
>drops in while doing 80 on the interstate. The trade-off is that while
>helping the starbursts the drops destroy contrast sensitivity. I once
>enjoyed jogging at night through a park. The drops made it impossible
>to see the trail: rocks, roots, water, it all blends into the
>darkness.
>
>Someone on SE mentioned RGP lenses. I've gone through three ODs and
>three sets of lenses and I can't tolerate the lenses for more than a
>couple hours per day. At one of the recent eye appointments the doc
>said I have a 1-2 second tear break up time. So he prescribed
>Restasis. There's irony here: The insurance company deemed dry eye is
>a result of elective surgery (LASIK) and won't cover the cost.
>
>Today I went to Medline and searched LASIK NIGHT VISION. I got 33
>responses, all medical reports published between Feb/2005 and Jul/1998.
> All admit that night vision complaints are common, claiming anywhere
>from 25% to 45%. Most patients aren't severely affected though. There
>doesn't seem to be a consensus on what to do about them. Most authors
>won't commit to a theory. Some say small ablations lead to night
>vision problems while others say there's no connection.
>
>Five years ago I visited a LASIK mill in Colorado. The surgeon said my
>only problem is that the original surgery used a small laser. A repeat
>surgery using his newer, wider laser would fix the problem. I thought
>that was too simple an answer. Also the surgeon looked about 15 years
>old.
>
>Some reports claimed success treating night vision problems with
>Customcornea. One report from Japan said there were no night vision
>problems in patients with a 3mm ablation zone but 7-8mm blend. Maybe
>that's the key.
>
>This is the longest post I've ever made on this list. Well, it won't
>happen again. I've decided I have to look into surgical help. I just
>need to find the courage to do it. Maybe someone can stop this 9-year
>nightmare.

Ragnar

2005-04-08, 10:25 pm

On 7 Apr 2005 14:58:22 -0700, "CatmanX" <grantm@connexus.net.au>
wrote:

>
>Best of luck and email me if you need any further advice.
>
>grant

I don't recall anybody ever asking you for advice. I pity anyone who
does.

crvc@wyoming.com

2005-04-08, 10:25 pm

It's easy to assume that normal night vision is a trivial thing. Try
living without it and get back to me. Especially if your job requires
driving at night. Or you live 8 hours from your 75 year-old parents
and can't visit them because it requires driving at night. Or you were
once a decent ultra distance runner, sometimes running for 30 hours
straight, enjoying the stars, needing only moonlight to see the forest
trail.

Shitty night vision isn't the only problem caused by my LASIK. It's
just the one I have the most trouble living with.

Ragnar

2005-04-08, 10:25 pm

I was just asking you a question... now we have the answer. Did you
mention that your job requires you to drive at night or that you were
making 8 hour trips at night to your surgeon?
Whether one has LASIK or not.. driving for several hours non-stop is a
problem for any eyes. I bet it would be cheaper for you to fly to
your parents rather than drive.

Heres the next question... how long ago did you have your LASIK?
And why did you decide to have LASIK to begin with?

If I remember right.. you had your LASIK done 7 years ago? If so, you
were one of the first people to have it done.

On 8 Apr 2005 07:35:02 -0700, crvc@wyoming.com wrote:

>
>It's easy to assume that normal night vision is a trivial thing. Try
>living without it and get back to me. Especially if your job requires
>driving at night. Or you live 8 hours from your 75 year-old parents
>and can't visit them because it requires driving at night. Or you were
>once a decent ultra distance runner, sometimes running for 30 hours
>straight, enjoying the stars, needing only moonlight to see the forest
>trail.
>
>Shitty night vision isn't the only problem caused by my LASIK. It's
>just the one I have the most trouble living with.

crvc@wyoming.com

2005-04-08, 10:25 pm

I had surgery in late 1996. It probably was the early days, but I had
been going to the same LASIK clinic for three years before scheduling
the surgery. Surely they had perfected their technique by then, or so
I thought.

In researching LASIK I recently found my surgeon has published a survey
of his patients, claiming no serious side effects in anyone. It's
another example of the surgeon defining what is or isn't a
complication. His time frame for surveying his patients includes the
period of my surgery.

Nobody told me what a starburst was. A nurse mentioned a few patients
had temporary halos but didn't explain what a halo was. That was a
close to a warning as I ever got. This was years before SurgicalEyes
produced photos that showed accurately what night vision is like for
LASIK malcontents like myself.

I'm hoping my doctor simply screwed up. It's possible that's the case
since he doesn't practice LASIK anymore. I'm hoping another doctor
will have better luck, assuming I have the guts to try it again.

Linda

2005-04-08, 10:25 pm

crvc@wyoming.com wrote in message news:<1112970902.536666.284020@f14g2000cwb.googlegroups.com>...
> It's easy to assume that normal night vision is a trivial thing. Try
> living without it and get back to me. Especially if your job requires
> driving at night. Or you live 8 hours from your 75 year-old parents
> and can't visit them because it requires driving at night. Or you were
> once a decent ultra distance runner, sometimes running for 30 hours
> straight, enjoying the stars, needing only moonlight to see the forest
> trail.
>
> Shitty night vision isn't the only problem caused by my LASIK. It's
> just the one I have the most trouble living with.

I agree. Even though my night vision is good now, it was terrible
after my first Lasik surgery. It took an enhancement to fix it. Mine
was caused by being undercorrected. Seemed great during the day, but
night was a whole different matter. I had to wear -1.25 contact lenses
until my enhancement. This was difficult in itself because I was still
dealing with the dry eyes that happen for a few months after Lasik. I
was told to avoid driving at night until the 2nd surgery. I was a bit
afraid that it would never be fixed, but I was fortunate. Night vision
difficulties are scary, no doubt about it. Until you experience it,
you really can't comment on what it's like. 2 years down the track, I
am without glasses or contacts, see great at night and brilliantly
during the day. Best decision I ever made (although one of the most
expensive).
Regards,
Linda

Ragnar

2005-04-11, 6:14 pm

9 years ago... there have been about 10,000,000 LASIK procedures done
now. 9 years ago, that number was under 10,000 I'm sure.

I don't understand why you keep going to doctors and don't do
anything. How old are you now? I think you said your parents are 75.
Maybe you should just have some IOL's put in and be done with it.
Then you can complain about floaters.

I still haven't seen your motivation for getting lasik done in 1996
when almost nobody even heard of the procedure. Did you think that
some procedure which removes about as much tissue as the diameter of a
pencil eraser to a depth of the thickness of 3 sheets of paper would
magically make your eyes perfect?

On 8 Apr 2005 14:27:28 -0700, crvc@wyoming.com wrote:

> I had surgery in late 1996. It probably was the early days, but I had
>been going to the same LASIK clinic for three years before scheduling
>the surgery. Surely they had perfected their technique by then, or so
>I thought.
>
>In researching LASIK I recently found my surgeon has published a survey
>of his patients, claiming no serious side effects in anyone. It's
>another example of the surgeon defining what is or isn't a
>complication. His time frame for surveying his patients includes the
>period of my surgery.
>
>Nobody told me what a starburst was. A nurse mentioned a few patients
>had temporary halos but didn't explain what a halo was. That was a
>close to a warning as I ever got. This was years before SurgicalEyes
>produced photos that showed accurately what night vision is like for
>LASIK malcontents like myself.
>
>I'm hoping my doctor simply screwed up. It's possible that's the case
>since he doesn't practice LASIK anymore. I'm hoping another doctor
>will have better luck, assuming I have the guts to try it again.

crvc@wyoming.com

2005-04-11, 6:14 pm

In 1974 I read an article in Parade Magazine about eye surgery for
myopia. A boy in the USSR had taken a soccer ball in the face. His
glasses shattered sending shards into one eye. All the Russians could
do was tape the eye closed for a week. When the tape was removed, the
boy had perfect vision in the eye. That was the start of the RS
industry. Soon the Soviets developed the RK procedure. Americans
and Europeans traveled to Moscow to have it done.

Over the years since reading that article I kept track of innovations.
The most bizarre I can remember involved using a microkeratone to slice
off the front of the cornea, freeze it then grind it like a contact
lens to the patients prescription, then reattach it to the eye.

When surgical lasers came out I saw an article in a Salt Lake City
paper about its use to clear corneal scars. I had gotten rusty metal
in one eye a year earlier so I went down to SLC to see about having the
scar removed. They said give them a year to get better at using the
laser.

I went back a year later, didn't feel comfortable with what they were
telling me so didn't do anything.

I went back a year later and by then they were pushing laser surgery
for myopia.

About a year later I saw the FDA report that said LASIK was the safest
refractive procedure. No mention of side effects that I recall.

If I did anything wrong, it was having complete faith in the doctor.
It never occured to me that I could be damaged by this or any doctor.
I remember the doc telling me I was an excellent candidate for laser
surgery. I would be able to throw away my glasses.

The night vision problem has changed me, making me a somewhat bitter,
unpleasant person to be around. It's bad enough that I'm finally
willing to see another doctor, but I won't go in blindly, :-) expecting
this person to be a miracle worker.

You asked about my age. I said in the original post, I had surgery
nine years ago, for my 40th birthday. Duh.

Ragnar

2005-04-11, 6:14 pm

I have a feeling that the story you are referring to is more myth than
reality. I have seen many versions of that same story. Sometimes
it's a coal miner, cosmonaut, etc. RK (radial keratotomy) goes back
way further than that. During WW2, a Japanese surgeon was doing RK
type surgery on POWs. At the time, the tools were not precise enough
and the experiments were a failure.

On 9 Apr 2005 09:42:31 -0700, crvc@wyoming.com wrote:

>In 1974 I read an article in Parade Magazine about eye surgery for
>myopia. A boy in the USSR had taken a soccer ball in the face. His
>glasses shattered sending shards into one eye. All the Russians could
>do was tape the eye closed for a week. When the tape was removed, the
>boy had perfect vision in the eye. That was the start of the RS
>industry. Soon the Soviets developed the RK procedure. Americans
>and Europeans traveled to Moscow to have it done.
>
>Over the years since reading that article I kept track of innovations.
>The most bizarre I can remember involved using a microkeratone to slice
>off the front of the cornea, freeze it then grind it like a contact
>lens to the patients prescription, then reattach it to the eye.
>
>When surgical lasers came out I saw an article in a Salt Lake City
>paper about its use to clear corneal scars. I had gotten rusty metal
>in one eye a year earlier so I went down to SLC to see about having the
>scar removed. They said give them a year to get better at using the
>laser.
>
>I went back a year later, didn't feel comfortable with what they were
>telling me so didn't do anything.
>
>I went back a year later and by then they were pushing laser surgery
>for myopia.
>
>About a year later I saw the FDA report that said LASIK was the safest
>refractive procedure. No mention of side effects that I recall.
>
>If I did anything wrong, it was having complete faith in the doctor.
>It never occured to me that I could be damaged by this or any doctor.
>I remember the doc telling me I was an excellent candidate for laser
>surgery. I would be able to throw away my glasses.
>
>The night vision problem has changed me, making me a somewhat bitter,
>unpleasant person to be around. It's bad enough that I'm finally
>willing to see another doctor, but I won't go in blindly, :-) expecting
>this person to be a miracle worker.
>
>You asked about my age. I said in the original post, I had surgery
>nine years ago, for my 40th birthday. Duh.

Glenn - USAEyes.org

2005-04-11, 6:14 pm

There are a lot of stories regarding the start of RK. They are
probably all true to some extent. As we have had demonstrated here
time and again, truth depends upon the person speaking it. RK was
developed in Japan, but was greatly refined by Fyodrov in Russia. He
taught others who refined it more and taught it to even more people.
Nobody comes up with an totally new idea - all ideas are built upon
the discoveries of others. At best you can come up with a new twist
on an old idea, or a new application of existing ideas. Einstein said
that if he saw farther than others, it was because he was on the
shoulders of giants.

Our western friend has populated the Internet for as long as I can
remember and the experiences have always been the same. I have not
had the pleasure of meeting him, but have no doubt about the
authenticity of the difficulties he has endured.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.