In one of the messages I had a question for
Dr. Trattler. However, there was no answer for
that question.
Dr. Trattler mentioned that "some double vision will require early intervention".
My question was what sort of double vision requires early intervention? What need to be done? How serious is this problem? Since I have double vision after LASIK, I thought this was very
important, so I thought I would get an early answer! Did you just mention this or is there
a real scientific explanation to this? If this
something we should ignore?
Can the irregular astigmatism be corrected? If
a second surgery is performed can the vision
get worse? My doctor wants do an enhancement,
however, I am still not convinced that an enhancement can fix the problem. So, far I have
not seen much information here, does anyone has
any opinions on these problems?
It is unfortunate that the topography info is not really used in surgery. I think it is time to use this topography information to guide the laser
beam. Is visix or someone working on these?
Anyone has any information on any of my questions?

-H

Henry,
I am not a doctor, but I do have 3 years experience in the field of LASIK as a laser technician. I see that no one else has given you any answers, so I'll try to be of some help.

I understand you have double vision in both eyes. Well there are numerous possibilites as to the cause of this. Some of the possibilities are; 1) decentered ablation. 2) moisture on the bed during the laser treatment. 3) The laser beam could of had cold spots in its profile. 4) Astigmatism treatment was ablated at the wrong axis. 5) The laser was programmed incorrectly. 6) Epithelial ingrowth. These are just a few things that COULD have happened. I'm sure the doctors here at this site could add many more.

Whether or not retreatment could help, well there's no way of knowing without having all the information on your surgery. I'd suggest having a heart to heart with your surgeon. Share your concerns, questions, expectations, etc.. with him/her and ask for a detailed explanation of what he or she thinks went wrong. Ask to see your topography and have it explained to you.

Do you have irregular astigmatism? It is possible to treat irregular astigmatism, however I don't know if your surgeon has the technology to do so. If not, you may have to wait a year or so for FDA approved lasers that have that capability.

As for topography driven treatments. In theory it sounds reasonable, however topography driven treatments only treat the eye based on what a map of the cornea shows. It does not take into account other factors such as lenticular astigmatism. Topography driven treatments may be of use for enhancements though. A reliable version of this technology is still a ways away.

I wish you the best,

Rod

Rod,
Thanks so much for taking time to respond.
I still do not know the actual cause of my
astigmatism. Is it irregular astigmatism or
something else, god knows?. Like most physicians,
my surgeon has not explained anything yet. He
does not usually talk!. I asked him to get a
topo. but he wants the enhancement first.
Problem is he has too many patients. He performs
at least 30 sugeries per day and he even does
not remember who you are. I think there are
lot of problems and I do not want to post here.
What I am interested is in finding the
technical details. With your experience you
explained some details, I appreciate that.
I think physicians usually do not try to
explain the technical details.
Even in this site, there are lot of advise, but
I have not seen good technical info. However, the
information given by the others are very
benificial to everyone, especially to the
those who perfom LASIK.
I am planning to see another surgeon and find
the answers to my questions.
As you mentioned, I also had some doubts
about the way astigmatism was corrected.
You have very good things mentioned here
which are useful in asking questions and
also searching more information.

Thanks again,
Henry

It is so hard to know exactly what is going on with your eye without a complete exam. However, before even considering an enhancement, you must have a corneal topography. If you feel that your doctor is doing a poor job with poor communication, you should certainly take your eyes to someone else. You only have one set of eyes.
I can recomend 2 fantastic doctors who can give good second opinions in Dallas. Dr. Brad Bowman (www.corneatexas.com) is very experienced and will certainly take the time to determine what is going on with your eyes as well as explain everything in detail.
The second doctor (and this is by no means a second choice) is Dr. Jim McCulley, who is chairman of the department of ophthalmology at Southwestern Medical Center. He will also be a fantastic resource for you.
As for double vision after LASIK - this is of course abnormal. There are a variety of causes of double vision after LASIK, including irregular astigmatism, flap wrinkles, a decentered ablation or a central island. A corneal topography is the crucial test to determine what is going on with your eye.
Can you please provide followup, as I would like to know the exact cause of your double vision. Also, as you pointed out, it is not the number of laser surgeries are durgeon has performed, but the quality of the surgery and pre- and postop care!!!

Bill Trattler, MD
Miami, FL

Henry,
It is clear that you are quite distressed and obviously frustrated with your surgeon (or at least your choice of surgeons). Unfortunately you did know of his disposition or busy schedule before surgery. And if you did, it should have been a "red flag."

However, in defense of this excellent website, you need to know that it exists to provide advice and "lay" education to non-ophthalmologists. Technical medical or surgical issues are taught and learned in medical school and during years of residency training.
In addition, the docs who regularly participate do so as a free service. We do this after putting in a full day of work. This site is not a career. We try to help out as much as possible, but we do not owe, nor guarantee, anybody an expedient response. The only person who owes you an answer is your surgeon. Only he is truly qualified at this point to give you sound advice. He performed your surgery. He examined you post-op. He collected your fee.

But to get off my soapbox and try to give you some advice anyways: I think the reason for your double vision (also known as ghost image) is regular, not irregular, astigmatism. Regular astigmatism of even 0.75 to 1.00 diopters can cause this effect. How do I know? Well, after LASIK in my left eye, I had that much regular astigmatism and its resultant ghost/double image. So this is not just theory, it has been personally field tested. This should (but not always) be correctable with enhancement. Irregular astigmatism (this is theoretical) should result in a blur that is not readily perceived as a ghost/double image.
The best way to diagnose you situation is to check your prescription with lenses. If your vision is correctable, then you don't have significant irregular astigmatism, and you don't have to worry about it (after all, it is rare).

As far the double image that requires early intervention, that would be related to flap irregularites. If you had had a flap problem, I trust that it would have been addressed already.

I hope you will take Dr. Trattler's recommendations for consultation. That's really the best advice we can offer you. Without the benefit of a complete examination, everything I've typed is pure, educated conjecture.
Good luck, Dean Hu

>Henry,It is clear that you are quite
>distressed and obviously frustrated with your
>surgeon (or at least your choice
>of surgeons). Unfortunately you did
>know of his disposition or busy
>schedule before surgery. And if
>you did, it should have been
>a "red flag."

>However, in defense of this excellent website,
>you need to know that it
>exists to provide advice and "lay"
>education to non-ophthalmologists. Technical medical
>or surgical issues are taught and
>learned in medical school and during
>years of residency training. In
>addition, the docs who regularly participate
>do so as a free service.
> We do this after putting
>in a full day of work.
> This site is not a
>career. We try to help
>out as much as possible, but
>we do not owe, nor guarantee,
>anybody an expedient response. The
>only person who owes you an
>answer is your surgeon. Only
>he is truly qualified at this
>point to give you sound advice.
> He performed your surgery.
>He examined you post-op. He collected
>your fee. But to get
>off my soapbox and try to
>give you some advice anyways:
>I think the reason for your
>double vision (also known as ghost
>image) is regular, not irregular, astigmatism.
> Regular astigmatism of even 0.75
>to 1.00 diopters can cause this
>effect. How do I know?
> Well, after LASIK in my
>left eye, I had that much
>regular astigmatism and its resultant ghost/double
>image. So this is not just
>theory, it has been personally field
>tested. This should (but not
>always) be correctable with enhancement.
>Irregular astigmatism (this is theoretical) should
>result in a blur that is
>not readily perceived as a ghost/double
>image.The best way to diagnose you
>situation is to check your prescription
>with lenses. If your vision
>is correctable, then you don't have
>significant irregular astigmatism, and you don't
>have to worry about it (after
>all, it is rare).

>As far the double image that requires
>early intervention, that would be related
>to flap irregularites. If you
>had had a flap problem, I
>trust that it would have been
>addressed already.

>I hope you will take Dr. Trattler's
>recommendations for consultation. That's really
>the best advice we can offer
>you. Without the benefit of
>a complete examination, everything I've typed
>is pure, educated conjecture.Good luck,
>Dean Hu

Doctor Hu:
Sorry about the other post. First time to post on a board - guess I don't have the hang of it! Hopefully this one will be right!
I want to thank you for your post regarding the ghosting problem you had with your own surgery. Being able to ask questions of a doctor who has had the same experience is a blessing. I have ghosting or double vision in my left eye which was treated with LASIK on 1/6/00. My right eye remains untreated for the time being. My pre-op left eye was -4.75 -1.25 164. My untreated right eye has the very same prescription with -1.00 astigmatism. I have been concerned about the "ghosting" which has been evident since surgery. My last visit with my surgeon was for a two week checkup last Friday. She suggested that I was "undercorrected and that the ablation seemed slightly off center and that I had had trouble fixating during the surgery" as cause for my problems. Of course "slightly off center" and the idea that I was moving (although I was certainly trying hard!) sure didn't sound very good to me and I immediately was quite concerned! I went to another LASIK surgeon this week for another opinion and his impression was that I was undercorrected (I actually refracted undilated in his office at -2.00 and autorefracted at -2.25), had what he thought might be an "island" from topography which may resolve, and there was no evidence of decentration. While the feeling of being "centered" was encouraging, I am still a bit baffled and would appreciate your help. I am currently wearing a contact in my untreated eye and glasses of -.25 -1.25 05 for my treated eye. The glasses do seem to eliminate or at the least almost eliminate the ghosting while watching television. Things are almost always somewhat blurry even in daytime out of this eye, so I have not been able to totally reassure myself that it is corrected with these glasses. My refractions have been all over the place since the procedure (although my first refraction post op was plano with -1.50 astigmatism), generally getting more myopic, and my vision seems to reflect this being blurrier and blurrier. Nighttime is especially out of focus (even with glasses) and driving with two eyes like this would be impossible!
I have a few questions that I would appreciate your response to:
1) Would a residual prescription for myopia cause more blurriness in dim light than in daytime? Although my vision is much much less than desirable during the day without the glasses and not wonderful with the glasses, nighttime is very blurry even with glasses (perhaps the -.25 myopic correction is okay for day and not night?). One concern I have is that there may still be ghosting which is causing this blurriness and not just residual myopic correction.
2) How do you end up with the same astigmatism (at least for now) that you started with - and on a different axis?? I thought the lasers were fairly precise and to have this "different" astigmatism and remaining myopia is a mystery to me. I sorta feel like they used the wrong prescription!! I was trying so hard to focus on the light, but perhaps I did not?? I cannot express to you how "wrong" the vision is out of my eye without these glasses. It is blurry and a mess!
3) My main concern at present is the "strangeness" my eye feels. I cannot wear my contact in my untreated eye without wearing my glasses. The treated eye actually feels crossed! It is like my eyes cannot work together. Is this the astigmatism? Does it cause this sensation? I did wear a toric and nontoric lens combination at one time and did not have this, so I just don't get it - different axis causes a different effect? Help! I do function fairly well with the contact and glasses (in bright light sometimes, though not always, seeing quite well in fact), however there is a "spacey" feeling I assume is caused by the magnification difference??
I would so appreciate your answers. I do feel encouraged that the glasses seem to correct the ghosting. How did you cope with the ghosting you experienced? I know having one eye treated and being "unbalanced" may be causing some of my "strange" feelings, but your opinion would be appreciated. Did you have an enhancement and did the ghosting clear up with this or on its own? I do hope you are experiencing wonderful vision! Thank you for helping me!
Pam

You are currently 3 weeks out of surgery and you have been found to be undercorrected. as well, the laser altered the astigmatism rather than eliminated the astigmatism.
To provide you an answer as to why this is the case is impossible. Some people end up undercorrected after LASIK. As well, if you did not stay out of contacts for a few weeks prior to LASIK, your eye may not have had the opportunity to completely unmold.
As for suggestions, many patients in your situation will wear a contact lens to treat the residual refractive error for a few months while the eye heals, and then consider an enhancement.
Best of luck

Bill Trattler, MD
Miami, FL

Pam,

Firstly, be sure to start a new posting you have a new issue so that you don't get mixed up with someone else's discussion (I know it's your first time...so that's OK).

Second, I should compliment you on doing the right thing. When in doubt, seek a second opinion. It's far better to be examined than to discuss theory on the net.

As far as your vision, residual myopia and/or astigmatism can cause ghosting. This should for the most part improve with glasses. However, all people do naturally become a little more myopic in dim light (simple optical errors that are a part of our eyes), so your glassses may be right just for daytime. In addition, your vision may fluctuate day to day usually only in the first month, but can continue to 3 months. Also, large pupils can cause ghosting (sometimes called halos) in dim lighting.

Induced astigmatism is what you seem to have. The can happen with LASIK. In fact, I have some in my left eye. It was initally a bit annoying, and it took a few months to get comfortable with it. Keep in mind, however, that I'm one of those very particular types, unlike some people who have no complaints with the same results. Forunately my right eye is perfect. This has happened to a few of my patients too, and it's bothered me a lot, because it's hard to explain how it happens. Fortunately, the few unlucky ones adjusted too.
So LASIK is great, but like everything else in life, it is not perfect, even with the best surgeons and lasers.

Indeed, your vision should feel strange with two eyes together. The prescriptions are likely different enough to cause you image size disparity that would be tough to handle (another well-documented optical principle).

Since you are still a bit myopic with astigmatism, then you should be good for an enhancement. Just wait until your eye has stabilized. In the meantime, try to get by. And by no means do anything on your unoperated eye.

Finally, I'm glad that you are not decentered. Indeed, excessive eye movements can lead to decentration and undercorrection. However, please don't bear the blame alone (and don't overtly blame your surgeon either) because good fixation and centration are dependent on patient and surgeon together. The patient stares (as best as possible) at the light, and the surgeon watches the eye movements. Tiny movements occur with everybody and make little or no difference, but if large movements occur, then the surgeon can pick up his/her foot and stop the laser for a few seconds while the patient refocuses.

Whew, I'm tired now. Hopefully this helps you understand your situation better.
Good luck. Hang in there.
Dean Hu

Thank you so much for your response! I will try hard to be patient and hope that an enhancement will be possible for this eye. I have a one month appointment with my original surgeon in one week and I will see what she has to say. She did suggest sending me to someone in Boston - I think I may take her up on that. His name is Jonathan Talamo. Have you heard of him? I think my other issue now (other than coping "unbalanced"!) will be being super cautious in having anything else done, however, I can't say the thought of staying like this is a fun one! But I know I will have time to consider things as this eye heals and stabilizes. And I will not do anything to my other eye until this one is resolved - that is for sure!
Dr. Trattler had mentioned the possibility that results such as mine might be influenced by not being out of contacts long enough before the procedure. I just wanted to let him know that I was out of my soft contacts for at least two months prior to the surgery. I will talk to my doctor about wearing a contact in my treated eye and how long I need to wait to do this. Having at least some "balance" would be great and would really help on the coping side of things! Thanks for the suggestion!
Your posts have helped me stay optimistic and I thank you! Please let me know if you have heard of Dr. Talamo. Perhaps he would be a place to start?
Thank you again for your kind response. I will write to you and let you know how things are going!
Pam

i have met dr talamo many times at our opthalmology meetings and find him to be a very honest, intelligent, and talented doctor. i would definitely trust him with my own eyecare.

he seems to be one of the good guys.

debra tennen, md

hi pam,

since you're asking advice from complete strangers, i'll throw in my two cents. i had lasik on 1/6 on my left eye and 1/13 on my right eye. my left eye came out "perfect" and i have problems similar to yours with my right eye.

first of all, i think you are very wise to hold off on your other eye. i absolutely would not do anything to your second eye until you are satisfied with your vision in the corrected eye. although chances are good your other eye will come out fine, there is always the possibility that your second eye could come out worse.

secondly, i would NOT rush into an enhancement. if you visit surgicaleyes.com you'll see that a great number of people with really messed up eyes have had multiple surgeries to correct an initial poor result. my doctor is still optimistic that my vision will improve greatly over the next 3 - 6 months. i'm not so sure, but if not, i've already decided to hold off on an enhancement. i know that in the next few years there will be much superior technology to correct my irregular astigmatism, and i'd rather wait 3 years than make a poor and irrevokable decision now. i know i'm being very cautious, but i think that once you have a poor outcome, you have to be.

in the mean time, you are VERY early in the post-operative stage. i understand how difficult it is to be patient, but i think you need to give yourself a couple of months to heal before you even think about another surgery.

best of luck!
--karen

Karen:
Thanks for your response. I do hope your vision is improving...
I will be very cautious with any additional surgery. The process of making a decision to have the initial surgery and choosing a surgeon was a long one...I guess what is important to me is beginning the process of finding some answers. And I know more healing is necessary before I can really get those answers.
What is your vision like out of the eye you say is similar to mine? I don't know if I can post my e-mail address here, but I will try and see if it works. I would love to hear from you! Perhaps we could share our progress, any information we learn, and give some needed encouragement to each other!
Pam

Dr. Trattler,
Thanks for the names of the doctors and
the advice. I was planning to see another
doctor. I'll check the availability of
these doctors and make a decision within
next few days.
I'll post the details after my
visit.

Thanks

-H