I had Lasik surgery over a year ago for very high myopia and astigmatism. The vision seems clear, except for ghosting / double vision in both eyes. The right eye has ghosts to the upper left, the left eye has them to the lower right. The doctor keeps putting me off on an enhancement and I am getting concerned. What caused of ghosting? The Dr. said the flap is fine. The ghosting was present from day 1, and seems to vary depending on the distance to the object. None of my Lasik friends have this issue. What questions should I ask the doctor? Should I get a second opinion?

Any information is appreciated.

Mike,

There are many causes for the ghosting. It should be fairly easy for your surgeon to detect, especially if it is due to what is called irregular astigmatism. Often the laser does not ablate the cornea evenly and leaves little bumps which cause ghosting and, if the bumps are big enough, double and triple images and worse. It’s also possible that you may have a slightly decentered ablation.

Has your doctor done an orbscan with the setting to a 0.5D scale? If it is set to 1.0 or 1.5D setting it will mask the problem (which is what some doctors like to do). You can also get a wavefront diagnosis that would provide good information.

Find a doctor who is an expert in treating lasik complications and get a good exam and he should be able to tell you definitely what your problem is. Lots of doctors don’t want to be bothered with working with the people they have harmed because they prefer to have fresh paying customers in the chair.

You can also find lots of good information at www.surgicaleyes.org. There are numerous doctors there who can help. Dr. Trattler is the best doctor on this site but he seems to be AWOL over the past few weeks.

Best of luck,

Terri

Mike,

Ghosts tend to be caused by an irregularity in the cornea; often this is just normal astigmatism. Astigmatism is when the cornea is not spherical like the top of a ball, but elliptical like the back of a spoon. Sometimes ghosting is exacerbated by dry eyes.

Astigmatism can cause multiple focal points. The majority of the light focuses on the center of the retina and this provides the main image. The point of that spoon shape at the outer edge of the cornea will allow a small amount of light to focus slightly off the center of the retina. This light to the side of center is what is providing the ghost image.

You describe a single ghost created in each eye at different locations that existed from the first day after surgery. This would indicate regular astigmatism, not irregular astigmatism. You stated that you had very high myopia and astigmatism. It is probable that the surgery did not correct all the astigmatism. Sometimes in refractive surgery astigmatism is induced by creation of the flap or other problems, but your surgeon has ruled out flap related problems.

If the problem is regular astigmatism, a pair of glasses made to accommodate the astigmatism may provide clear vision. If you the problem will resolve with corrective lenses is a good indication that an enhancement will be able to correct the ghosting. My bet is that you find when you are in a well-lit room or outside on a sunny day the ghosts dissipate. This would be because of reduced pupil size.

An easy test for astigmatism is to put a small hole through an index card then look through that hole with one eye while covering the other. Be sure to do this in a dimly lit room. As you move the hole around you will probably notice that the ghosting is gone.

Your eye is doing this naturally (looking through a small hole) when you are in a well-lit environment. The pupil is smaller and is not letting the light that is passing through the astigmatic component of your cornea reach the retina. The multiple focal points are still there; they are just not reaching the retina and being “seen”.

What will answer many of your questions would be to ask your doctor for a current prescription. This will tell you exactly how much (if any) astigmatism you may have.

Since it has been over a year since your surgery, your eyes should have settled down and the availability of an enhancement seems appropriate. It may be that your doctor understands his limitations and is uncertain if his techniques and technology will correct your problem. It may be that the doctor is delaying an enhancement for other reasons. Whatever the case, you deserve an answer and you should receive that answer before the doctor’s contractual obligation to provide the enhancement expires.

If your current doctor is not able or willing to provide the answers and care you require, I would highly recommend a second opinion. Our organization does not have an affiliated surgeon in Michigan, but Dr. Trattler is a good source of referral for top surgeons.

Although none of your LASIK friends have had this issue, residual astigmatism is a common problem for people with high myopia and especially people with high astigmatism. One cannot judge his or her own probable outcome by the result of a few friends. Everyone is different.

Glenn Hagele
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org

I am not a doctor.

Mike,

Glenn is correct in that it could be residual regular astigmatism. This can be corrected immediately with a pair of glasses. It is really odd that your doctor would let you suffer for over a year without offering you glasses.

Please see a specialist who works with people who have been harmed by refractive surgeons.

Best of luck,
Terri

Today: Dec. 2005

I had lasik surgery in Nov. 2000 (Michigan Eyecare Institute, Dr. Walter Curkrowski). The operation gave me double vision in both eyes when objects are more than 10 feet away. I cannot read road signs! Because I can read the eye charts, they say I have 20/20 vision and my eyes cannot be corrected any 'better'.
I just had my eyes checked (mapped...) at Lasik-Plus. I was told the wave front machines, custom cornea were approved by the FDA for improving perscription, but not for fixing ghosting. Because I do not have much of a perscription, there is not much they can do.