Patient presented the following:
42 year old male

Pre-op : OD -5.75 +1.00, OS -5.50 +1.00, no diplopia or astigmatism BCVA=20/20 both eyes

Surgery: (done on 2/23/01)
Flap thickness = 160um
OD abalation = 58.4um
OS abalation =58.3um
Nomograph Sampling base = Approx 1000 refined to 200 (I subsequently learned that I was the first patient to undergo lasik using my doctors own nomograph)

18 hours post-op -- 20/15 both eyes

7days post-op right eye=20/60 -- Left eye= (overcorrection) +1.25 plus diplopia

Completed 1 week rx of econopred, ciloxan
Currently using Predforte(3days x4)
followed by acular(left eye only) for 1 week

The Good:

Flaps healing normally
No infection present
No vaulting of the corneal flap
Minimal inflammation present
No evidence of corneal haze or irregular astigmatism

The Bad:

Consistent Halo effect
Consistent Starburst effect
Slight planning of the corneal flap
Slight striation of left flap (more later)
Left eye is virtually useless due to the surgically induced diplopia

Reponse from MD:

Your diplopia was caused by "your eye movement during the laser procedure"

Questions/Comments:

Frustration is me: After having a next morning reading of 20/15 in both eyes---and silly me thinking things are great........Whoa......have things gone over the cliff or what? I have the unenviable position of watching my vision degrade on a daily basis! And night driving -- not unless I'm in a abrams tank! To think I paid $4500.00 for this (no lasek mill for me) My "MD" is a highly regarded corneal surgeon in my state. Top notch according to "Ocular Surgery News" which did a bio on this "expert".

More about striae......MD says that I do not have a "traditional striae" the description is as follows ... you do not have a wrinkle or fold in the flap, but a set of lines where the flap was probably folded and has since reformed......

MD is unconcerned and using Acular as an attempt to regress the left eye overcorrection.

Questions:

Possible causes of diplopia in left eye?
What caused the left eye overcorrection?
Why is my vision degrading as I heal?
Approximate timeframe for discontinuation of a-tears?
Approximate timeframe for stabilization of visual acuity?
Is further enhancement suggested?
Any suggestions?

Gracias! Jim

Jim,
It is dissapointing to hear a doctor blame the patient. It is the doctor's responsibility in general to make sure that everything is going well during surgery, and if a patient is restless or cannot stay still, then either more sedation or anesthesia is necessary, or the doctor needs to hold the eye still him or herself. But you are not to blame!!!!
to answer your questions - you first have to know that LASIK is a procedure where a person's refraction and other information is entered into the computer, and then the laser treats the underling cornea surface after the flap is made. Although the goal is to shoot for plano (0.00), some people will be a little over and others will be a little under. This is why people require enhancements, and hopefully your doctor explained prior to surgery that there was a certain risk of needing an enhancement. Sometimes acular can help cause regression, and if that is the case, your eye with post op hyperopia may end up just fine. If not, you may need an enhancement in that eye.
The concerning thing is the double vision - which is caused by one of the following:

1. Residual astigmatism
2. Irregular astigmatism
3. Central island
4. Decentered ablation
5. Flap wrinkles/striae

A corneal topography can pick up numbers 1-4. A temporary glass prescription will eliminate monocular diplopia cause by #1. Causes 2-4 are identified on topography, and custom laser treatments are sometimes needed if they do not improve on their own.

Striae/wrinkles are folds in the flap that can distort vision. If there is no improvement with glasses, and number 2-4 are not seen on topography, then flap wrinkles may be the cause. If so, they need to be fixed - and the sooner the better.

To answer the rest of your questions, you may be on tears from weeks to months to longer, depending on the dryness of your eyes. Vision can take from 3-6 months to stabalize, and it is only at that time when one can determine whether an enhancement would be helpful.

I hope this helps

Bill Trattler, MD
Miami, FL

First, Let me express my sincere appreciation to you for taking the time to respond with a detailed answer. As the tone of my letter suggested, I'm frustrated with the results of my surgery. Top of the list is the induced double vision in my left eye. Followed by an initial excellent result 20/15 both eyes, only to watch this result diminish rapidly. I felt taken back when my surgeon implied that the diplopia was caused by me.

Today, I'm 11 days post-op and curious when I should have a corneal topography done? Again thank you for your earlier detailed response.

Sincerely, Jim

Topography can often give an answer immediately, so I personally will often get topographies in many situations and then follow the topographies over time to see if things improve on their own.

Please let me know what the topographies show and please let us know if you get an answer. If you are unsure or unhappy, you can also get a second opinion.

Best of luck

Bill Trattler, MD
Miami, FL