hi, i posted 3 other messages but i thought i should give my visual history. before lasik i was OD +675 -4, OS +9 -5. i wore toric contact lenses for 17 years, (i am 31 years old) and never had a problem with dry eyes. immediately after the birth of my daughter a year ago i could not wear my contacts anymore, my eyes were very dry and eyelids were inflamed. for four months i isolated myself because i would not go out with glasses that magnified my eyes so much and searched for a doctor to perform lasik on me. most had turned me down not only for the high degree of correction i required but also because i have a bad case of nystagmus. i finally found a doctor who was willing to perform the surgery and the immediate results were incredible. i was seeing OD 20/30, OS 20/50. everything was really sharp and crstal clear for two days. on the third day i woke up and my vision was blurry and had regressed to 20/70. it regressed a little more each day for 3 weeks. and finally stabilized. four months later i got off birth control pills because a doctor said it would help with my dry eye. i immediately regressed again. my pres. was +325 -325 OD, +4 -4 OS. i had the left eye enhanced four months after the procedure and it was 0 -175. three months later i had the right eye enhanced (5 weeks ago) and my vision was flucuating between 20/30 and 20/50. but a couple of weeks ago i started using FML and Alrex because my eyelids were inflamed again with meibomianitis. last week i started noticing my vision was flucuating again, from one hour to the next. but i remained at 20/40. today i am seeing 20/70 with a pres. of +125 -2. everyday i wake up my vision is signifivantly worse. my question is could it be that my eyes are so dry, although i started noticing the flucuating vision right after using the topical steroid, or could it be the steroid, or could it be that i have nystagmus. im a new mom with a brand new nursing career and this has caused me such severe depression. i have watched my vision regress for 8 months now and feel as if im going to lose it. my vision was really good until the use of that steroid and did not flucuate or regress until then. also how may hyperopics enhancements can one have? is there any contacts on the market today that are similar to bandage contact lenses that would be available to me. the bandage contact lenses actually feel as if my eye is more lubricated than without it. i know that i cannot wear regular contacts because of my dry eyes. thanks so much for any help you can offer me.

First - I would love to know how you were treated - as your prescription is not even close to being with the FDA approved parameters. You had severe hyperopia with severe astigmatism, which is perhaps one of the most difficult presciptions to try to treat with LASIK. Most LASIK surgeons would not even consider treating you -as the chance that you would have a good result would be very low. So I am very surprised that someone even considered trating you.
I hope your surgeon explained that you were and still are at high risk of regression following all of your treatments - and you may continue to regress for many more months. Please in your reply tell me a little more about your procedure

- where did you have it
- with which laser

As far as your dry eyes - this is a serparate problem which you need to see your surgeon or a dry eye specialist for. Punctal plugs offer many patients with severe dry eyes excellent relief - so you should find out if you are eligible

Please let me know the answers to those questions, and as well I would be interested to hear what your durgeon explained to you prior to the procedure - did he/she discuss that your chances for a good rsult were low??

Thank you

Bill Trattler, MD
Miami, FL

howvever i would rather not disclose his name. the laser equipment he used the first time i believe was the visx star 2. and they now have a more expensive and better lasik machine. i was told by the surgeon that he could probably get me to 20/40 and he did. but like i said previous it regressed. but if i were to contine to regress at 5 weeks seeing 20/70 now i could actually go back to 20/200. im devestated. i already have punctal plugs in both upper and lower lids and that hasn't helped at all. also, my left eye remained at plano -175 for 3 months. it started regressing when the other eye regressed after is used the topical steroid for 2 weeks and maybe that changed the shape of my cornea. but in all honesty this doctor is incredible and has gotten me to see 20/30 and it last for 4 weeks. and the enhancement only required 2 diopters of correction for hyperopia and astigmatism. i just can't imagine regressing for several more months, that could bring me to near blindness and i am so scared. do you know of any other procedures i could look into once my vision stabilizes. i just can't imagine going back to thick glasses. thanks in advance again for your response. also can you tell me what CIM means when reading a topography result. i still want to try this again and hoping i can convince my doctor if there is still enough tissue left.thank you so much. also could the use of the steroid possibly have changed my cornea or was it that my eyes are so dry that when i wake up in the morning everything is so small and blurry, but after a few hours of drowing my eyes with tears my vision usually caught up, however now it's not. thanks again so much for your response.

i agree once again with dr trattler's response: it is very common for this type of correction to regress- even up to six months after the surgery- so i would not consider any further surgery until much time has passed and another complete evaluation of your eyes has been performed.

there should be contact lenses that would help to correct your vision, but that will require a great effort on your part and the doctors to find a pair which will fit your new corneas and be comfortable for you.

also, please keep in mind, that your eyes are improved from the very high correction you started with, and that the result you have is about what we expect from the limits of what we can safely treat with the laser.

debbie tennen, md

but exactly 8 days ago my vision was 20/40 and very clear. it was actually the best it has ever been. and if i were to continue to regress at the rapid rate that i am say for 6 months that would probably bring me back to 20/200 right? the first surgery that i had i regressed 325 diopters. as far as contacts goes again, do they have special contact for people with severe dry eye, something similar to the materials they use to make the therapeutic bandage lens. those feel wonderful on my eye, but i know i cannot wear hydrophillic lenses again. thanks for any input, but i would also like to know if you think the steroid or my nystagmus has caused me to regress? because like i said earlier my vision started to flucuate not long after using the steroid and it's no longer flucuating but regressing. also, is there a chance it could improve, like go the other way? thanks for you responses.

i do not think the steroids or nystagmus had anything to do with the regression, it is expected after your surgery

debra tennen, md

Please understand - regression means that you start out with a certain result, but the cornea heals into a different shape, causing your vision to "regress" The regression can take many, many months - and in general it is a faster process initially and then over time the regression slows until finally the cornea is stabalized.
The type of laser had nothing to do with your regression - the reason you had regression is because you had a severe prescription that is not normally treated with LASIK. LASIK is an excellent procedure for a specified group of people with certain prescriptions - many people do not fit into the range of expecting a good result. You are outside of the "good" range.
As Dr. Tennen stated, your vision is vastly improved from pre-surgery - and you should be atleast pleased that you have a much smaller prescription. However, remember that there are many issues when you start lasering multipke times, including problems with corneal thinning. You should not ruch to keep getting retreatments but should carefully weigh the risks versus the benefits.
As for your dry eye- an enhancement may further affect your dry eye condition. Since your eyes are so dry, you should first concentrate on getting the dryness treated, because this would certainly affect your result as well if you trie to have an enhancement.

Best of luck

Bill Trattler, MD
Miami, FL

i only have one more question for you, can the dry eye have caused me to regress? because like i said everything is really small when i get up in the morning, but gets a little bigger and clerar as the day goes on. thanks

There has not been a report or finding that the level of dry eyes impacts the risk or rate of regression. However, it is very important to treat dry eyes after LASIK with lubrication

Best of luck

Bill Trattler, MD
Miami, FL