Hello, I am now 2.5 weeks post-op. Prior to Lasik, my R eye was -9 and L eye was -8. My cornea thickness was 512 prior to surgery. At my 2 week check-up, I was reading around a -2 in both eyes with correction. She said to allow my eyes to heal, as I was a high minus and would require a longer healing time to appreciate the full benefits of Lasik. IF I needed enhancement, she would considering it after 3 months. After surgery, my cornea thickness is around 260, according to her 'working the numbers' and she would again need to 'work the numbers' before performing the enhancement, if necessary. From reading this site, I found that is is common to remove 12 microns for each diopter of myopia. If my math is right, that should have left me with 404 for my cornea thickness....meaning that there was 144 extra microns removed. Can anyone explain all this to me? I still have blurry vision. My right eye also has this strange occurance around lights, the light bends to the left, forming a cirle to the immediate left of the object. All my vision problems do seem correctable to 20/20 with glasses, as found during my office visit and with a friends glasses. Please offer me any insight that you can. I had Lasik, not Custom Lasik. The doctor's reason for this upon questioning was 'either because you didn't fit the requirements or it wouldn't have done you any good either way'. THank you again for any help.

Your doctor is referring to the thickness of the untouched cornea, not overall thickness.

The LASIK flap provides almost no structural support of the cornea. The support is almost entirely in the untouched area.

For about 50 years the ophthalmic industry has agreed that 250 microns are necessary to keep a healthy cornea stable. The more the better. Less than 250 microns, or an unhealthy cornea, and it is very likely that the cornea will become unstable and bulge forward. This is called keratoectasia, or just ectasia. This is a condition that you absolutely want to avoid.

After the LASIK flap was created, the laser would have ablated tissue under the flap. The doctor apparently has made calculations based upon an estimated flap thickness and an estimated ablation thickness. This is, in my opinion, NOT accurate enough for your circumstances. Depending upon how the flap was created, the variance can be from a low of 10 microns to as much as tens of microns. You only have 10 microns to spare and absolutely no margin for error.

If the doctor performed an intraoperative pachemetry (ultrasonic measurement under the flap), then the accuracy of the residual untouched cornea thickness measurment would be significantly greater.

Remember that "better" is always the enemy of "good enough". If you have only 260 microns of untouched cornea, I would very strongly recommend that you consider other forms of vision correction.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

Thank you, Mr. Hagele, for your response. I must admit that I am very scared at this point. Does it mean that the 144 microns that I can't account for is the thickness of my cornea flap? I do not recall her ever checking my thickness under the flap once the flap was lifted. She stated since I was a high minus it would take longer for me to heal, hence my prescription could still come down. I pray this is the case, as I am so afraid and upset now that I have paid a lot of money to damage my eyes. Forgive me if I am reduced to tears over this, but I feel very 'lied' to. I asked many questions repeatly about thickness and enhancements if necessary and I guess I just didn't make the correct decision. If I will still need glasses/contacts to see clearly, what have I accomplished other than to risk future damage to my eyes and limited function out of fear of damaging my flap! I am so upset.

Dear Julia,
Just hang in there. I can understand how you feel. We have seen improvements in numbers, in some it is to do with the healing process. Your doctor is right, as no doctor would do an enhancement in less than 3 months time, you will have to wait till then. At your 3 month check up it can be determined if you can still undergo an enhancement depending on the number left behind. Glenn is right in 10 microns being almost nothing to work with , but take it step at a time. Your blurriness could well be because of the numbers. However its most important to use lubricating eye drops for a couple of weeks after LASIK. Hope you feel and see better,
Safala

Dear Safala, Thank you for your kind words. I am very depressed over this. I was a -9 in the R eye and a -8 in the left. I will admit that I do see better uncorrected now than I did uncorrect before surgery, but if I still require correction, I don't see the point in all of the money spent, risks taken and overall fear of wounding my flap, etc. At my 2 week post-op, undialated I was reading a -2 in each eye with astigmastism R -.75 and L -.50. That is an increase of -.50 in the R and a decrease of -.30 in the L. I believe I may be around a -1.50 to a
-1.75 in each eye, upon borrowing a friends glasses. I guess I just want to know that there is, indeed a chance that I could reach 20/25 at a minimum without the need of an enhancement or corrective lenses, otherwise, I feel that I haven't accomplished anything. Thank you for all of your help and insights.

I am not a doctor but id like to give my opinion and words of reassurance. I can understand your frustration that you are still dependant(to a lesser degree)to glasses and I can see your aim was not having to wear glasses. Do you still see better as -2 than as -8? I would think the great reduction in minification should help some, everything you are now seeing is much less minified. Thats one positive way of looking at things.

Another big one is you wont need reading glasses for a long time, if ever as you have a natural focal point of half meter. You will have retained much ability to see from near.

A third advantage is your uncorrected vision improved tremendously, from perhaps 20/1000 to 20/100 to 20/150 by my estimate. When you wake up for a snack you wont have to fumble in the dark for your glasses. Youd also see the alarm clock, although a little blurry without having to reach for your glasses. Then theres the safety factor if you lose or break your glasses in an unfamiliar place. One whos 20/1000 would be in quite a jam unless he brought a spare.

I do hope your vision countinues to improve and you experience no complications(dry eyes, poor night vision, flap problems)when/if I get lasik I might tell him to dial in an undercorrection of perhaps -1 diopters as safeguard against overcorrection and also since I work on the computer many hours slight residual myopia means less eyestrain and accomodation for me and less dependancy on reading glasses while having pretty decent distance vision. If you have any other questions, feel free. I am not a doctor and what I say is my opinion :)

Ace, Thank you for your insight. I never even thought of my prescription making my world "minified". You have a positive attitude and that will help you through your surgery, should you decide to do it. I have had some side effects, which are even more frustrating. Currently, my R eye experiences a backwards C when looking at anything that refracts light. This is less so during the day, but as it becomes darker, this is much more pronounced. To look at a clock, I see the time with a bunch of backwards C's through it, as all the lights bend that way. Very odd. I wouldn't call this a halo, but more a bending of light. It is as if my vision is off center. I'm not sure. But it is correctable with glasses, as I have tried a friend's glasses to make sure it was a refraction error and not a flap complication before freaking out. :) Again, thank you for your kind words. If this backwards C would just go away, I wouldn't be quite as depressed over all this.

You tend to get used to minification. The best way to really tell the difference is contacts vs. glasses. My computer monitor looks two inches larger with contacts vs. glasses and thats with my -3.5 glasses. I am almost -5 but I use weaker glasses for the computer to reduce eyestrain. Backward C? is that what the disortion looks like? Sounds like regular astigmistim which glasses correct. Your eye may countinue changing even months after lasik so we are all hoping it changes for the better. Do you feel your dependency on glasses has been significentely reduced? Such as eating, reading, tv and computer without glasses. Whats your uncorrected vision now in each eye with what amount of refractive error?

I usually wore contacts, but began to have issues wearing them, which is what made me consider having Lasik in the first place. I would wear my contacts overnight, as I was told I could for 2 nights in a row, as I hated not being able to wake up and see. Plus, with my pre-surgery prescription (R-9 L-8), if I didn't have my contacts in and I didn't put glasses on, everything was just a huge blur. I couldn't even make out expressions on peoples faces. The distortion does appear as a Backward C. It's as if all light bends to the left in my right eye. I was informed that I have Eph. cell growth in that eye and it is located nasally. I am thinking maybe this cell growth is the cause of my visual disturbance. When I meet with the doctor again on the 5th, I will discuss having this removed as refraction doesn't fully correct the problem, but looking through the pinhole viewer does. I am praying my eyes will indeed continue to change and improve for the better. At this point, my eyes are reading between a -1.50 to -2. My dependancy on glasses has indeed been reduced, but I am unable to see clearly, and everything around me seems 'dim' indoors. At this point, I can't say this was the right decision for me as I can not see fully. I also now have a fear of touching my eyes, which was never an issue prior to surgery. I also lost some independance that I had with glasses/contacts as I am uncomfortable driving myself, due to my vision and if it rains, my vision is greatly reduced. I also don't feel I can see clearly enough to see things in the road that should not be there. A machine that you look into states my uncorrected vision is 20/30 in the left eye and 20/200 in the right eye. I am unalbe to read the chart on the wall clearly, though, in the office. I must admit I am disappointed. I asked all the questions I thought were necessary and the doctor came highly recommended. I made it clear that I didn't want the surgery if I could not obtain 20/20 vision. At this point, I pray for 20/25 in each eye, hoping for 20/20 using both. I know it is early, but I have never heard of anyone not being able to see so much more clearly the day after surgery. I am now that person. Most people say they are 20/20 or even 20/15, even high myopes. I have never been 20/20, nor even 20/25. I am very depressed over this, as I feel I have not only wasted money, but I will indeed still need glasses and contacts, plus I now have this fear of disloging the flap. Thank you for taking the time to speak to me, Ace.

You did say you are correctable to 20/20 with glasses after lasik. Do you see as well after lasik as you did before with glasses, meaning did you lose any lines of best corrected vision? I hope this isnt the case. I also have issues with contacts, they dry my eyes and after long enough they even begin to have a dull ache. My eyes very rarely become dry without em. Then I dont see well from near with contacts so they are only good for distance seeing.

I am not exactly certain the 20/something that -8 or -9 would give but my estimates put it at perhaps 20/800 for your -8 and 20/1000 for your -9 so I know where you are comming when you say big blur. I am about -5 myself and I cant reliabily see the 20/400, I need more like 20/500 or even 20/600 to positivately make out what im seeing. Half the blur your seeing and its still bad. I myself have a hard time going around without correction

As for your backward C disortion, I am not a doctor so I cant give you a dianosis but your doctor can and may already have. Some of that might be astigmistim. What were you told before getting lasik? I know no lasik can guarantee 20/20 uncorrected, especially the higher your pescription is. I do hope you are corrected to 20/20 or as good as you were before lasik.

"but I have never heard of anyone not being able to see so much more clearly the day after surgery. I am now that person."

If we compare uncorrected to uncorrected you went from 20/1000 to 20/200. Your best corrected vision hopefully didnt get worse. You are right in saying theres still some blur. I have heard of many that ended up undercorrected or much worse, overcorrected among other problems. Hope you dont think im downplaying your displeasure, I am just putting it in a positive spin :) I was also thinking, wont a little myopia go a long way in not needing reading glasses? As ive said, I dont see well from near with full power glasses and contacts and I do alot of reading and computing. If you mainly do alot of distance seeing then yes good distance vision is preferable to good near vision. What has your doctor said when you voiced your displeasures? Your going on the 5th so you can discuss everything, including a PRK enhancement. I am not a doctor, myself but ive heard of PRK to enhance lasik to save corneal thickness. As for flap, just dont get poked in the eye or rub it vigiously and often. Its a pleasure to talk by the way.

Thank you, again, for your responses. I'm just very depressed about this. I am not comfortable in my own eyes. I want to SEE!! Been praying to God heavily about this, as I am crying every night over my situation. I know others have things much worse than me, but I feel that I brought on all this myself and I'm just not happy. I paid someone to make me not happy. I think I'm a -2 with astigmatism now. Yes, better than -9, but still not very good. I'd be happy with -.50 and no astigmatism. I can be mostly corrected in the doctors office and I believe it is 20/20. I just can't get the backwards bending of light fully corrected with refraction. I hope it's the cells and once I have them removed I will notice improvement.

Julia,

Being about 2.00 diopters myopic (nearsighted, shortsighted) is not as bad as you may initially think.

You did not tell us your age, but at around age 40 just about everybody will start to develop presbyopia. This is when the natural lens of the eye is unable to change shape to focus on items distant and items near. When presbyopia occurs, people need reading glasses or bifocals to be able to see both distant and near objects.

There are two ways to describe myopia. One is that you cannot see things far away so well. The other is that you can see things near very well. By being mildly myopic when presbyopia occurs will allow you to be able to see objects near quite well without reading glasses. In fact, people have surgery just to deliberate create myopia in the amount you currently report.

If you are at or nearing age 40, you may not want to rush into getting full correction. You may want that small amount of myopia.

You may not have received the outcome you want, but you may have the vision you will soon need.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

I was thinking what else to say. Someone already posted about presbyopia and I mentioned that in my previous posts. You dont have to be 40 to have presbyopia, it can start earlier and just get worse and worse, especially when you hit your 40s. Ive mentioned before that my ability to see from near with glasses is diminished and im only 23. I take my glasses off to read and im -5 diopters. I did order -2.5 glasses for reading. I could get bifocals but I prefer to have a seperate pair to read and the stronger pair for seeing in the distance. I can read fine without glasses but id have to be about 9 inches close and this makes my neck stiff sometimes.

I know you want to see, everyone does. Have you gotten glasses after lasik to correct your remaining -2 for the distance? Are you still going around without glasses? You also said while your vision is better, going from -9 to -2 was not worth it. I know some people get lasik just to get a partial correction. In your case, you wanted a full correction or not get lasik at all, is that right? You dont mind needing reading glasses?

So other than the backward bending of C in one eye and -2 residual myopia, is there anything else about lasik that you are unhappy about? Your feedback can help others make a better informed decision. I have talked to others, one lady was thinking about lasik and she decided not to do it since she was informed she might still need glasses since shes -9 and lasik might not correct all of it. Others want lasik and say being -2 is much better than -9, they are so tired of glasses that just reducing their dependancy on them was well worth it. I await your reply and enjoy talking. I hope your July 5th appointment comes with good news. Let us know what your optomalogist has to say when you visit on the 5th

Well, this is how I personally feel. When I wore my contacts or glasses, I could see near and far 'clearly'. Now, I am not seeing much clearly at all. Near is clear in the left eye, but not the right. Distance seems a little clearer in the right, but not the left. No, I didn't ask for monovision and also my refraction in the office is the same for both eyes. So I have no explantion for this. I am depressed because if I still require glasses to 'see', then I might as well saved the $2500, bought some really nice prescription sunglasses and tried more contacts to see if I could get back into wearing them. My goal for surgery was to have the same vision I had with contacts/glasses, without needed C/G. I would accept wearing glasses to drive at night, but to be honest, I truly miss seeing the stars at night clearly. This is a very important part of my life, and now I don't have that. This depresses me even more. Simple things, like watching tv is a chore as it is not CLEAR! So yes, generally speaking -2 is better than -9, but not when you still require correction to 'see' and enjoy things around you. I could be 'vain' and take the glasses off, but then I am missing out. If I hadn't had the surgery, I could just go on as I was. Now, I am afraid of the flap, I have cells in my R eye and I can't 'see'. I hope this makes sense as I feel like it doesn't. I just wish someone had told me 'no, don't do it'. But all of my friends and family were with me on this and also, all of the surgeons patients were happy. I PRAY TO GOD that I just need more healing time. 6 months will pass anyway, if I have my crystal clear vision within that time, then yes it was worth the wait. If not, then no, I will continue to be full of regret.

I saw the surgeon yesterday, she thinks since my eyes were more hydrated than others, it caused the laser to take less tissue than planned and that is why I still have a refractive error in both eyes (-2.00). The refractive error is generally the same now in both eyes vs. prior to Lasik (L-8 R-9) which would make the hydration theory taking less tissue make sense, I suppose. Also, the cells will be removed on Friday to see if that clears up the bending of light that I see, since it doesn't go away with refraction. I have to wait for an enhancement, since you shouldn't have one before 3 months and even then they want to be sure you are stable in your vision before they do anything. SO, I will have to get glasses in the mean time to keep my sanity. It's ok though. As long as everything can be fixed, it's just fine.

I'm nervous about the cells being scraped, but I know God will see me through it all and all will be ok.

Can anyone shed some light on the scraping? Thank you.

We were wondering how your visit with the doctor went. So the fix will be attempted Friday? How long will it take to correct the strange backward C shape bending of light? As for -2 glasses, I thought you already have them? How much corneal thickness do you have now that the doctor says the lasik evaporated your tears instead of more cornea so maybe this leaves more thickness. I still would not want the cornea to be too thin or risk ectasia. When the time comes for an enhancement, will you choose to enhance only one eye for monovision to ward off reading glasses?

"Also, the cells will be removed on Friday to see if that clears up the bending of light that I see, since it doesn't go away with refraction."

We havent heard from you and its Sunday. Can you see better now? Do you have glasses for your -2 myopia yet? Did the cell removal improve your vision any? Also did the doctor say you can get an enhancement? How thin are your corneas now?

No, I don't have glasses for my -2 myopia yet. I was borrowing a friends before. I still need to address that need with my surgeon. Friday we didn't test thickness or anything, we just cleaned the cells. She said to give it two weeks before we judge anything and she'll do another topography. I'm now back to steriod and antibiotic drops and sleeping with goggles again. The flap lift went perfect, Thank God!!! I'm praying that the cell removal will indeed clear up the backwards c and then I'll make the decision about an enhancement (with enough corneal thickness) to have both to 20/20, monovision or leaving well enough alone. I know that for my mental health, having the bending light gone will be fantastic! That was something that was not an issue prior to surgery, so having residual refractive error I can deal with, not something new that wasn't going away with refraction. SO...God and time will heal this and I will make my decision from there. Thank you for your concerns! ;)

We are curious to hear from you again. How is everything going now?

I saw your other thread. Did the scaping of cells help any? I noticed you are down to -1.75 How well can you see now? Do you have enough cornea for an enhancement and do you want to risk an enhancement and also give up some ability to focus from near? As for pinholes clearing the problem, then maybe the problem is not centeralized. If your vision in broad daylight is just fine because of your pupils being small, this also explains matters. If your glasses do not remove everything, you may have irregular astigmastim and high order abberivations. As for floaters, they often settle down after a while. Have you gotten any recent topographies? This might be the key to diagnosing any problems. Hope to hear from you again and I wish you improvement

We are interested in any new news you have. Has your vision slowly progressed so you are now -1 or -1.25? Has the backward "C" improved or vanished? Is your vision good enough now to have little dependance on glasses? Whats your uncorrected vision?

Hi, was going thru the entire sequence of events, but whats the latest???? am pretty keen to know how the vision is after the lift?