March 1st 2006 had Intralase with Customvue to correct myopia L -4.25, R -4.50. Had -.50 astigmatism in right eye.
Left eye came out perfect, 20/20, no problems. Right eye came out 20/40 with ghosting and double vision. Most noticeable complaint was seeing multiple traffic lights at night which would converge as i approached.
June 26th, 2006 had customvue enhancement on right eye to correct problem. I was told the surgery went well and my cornea looks clear, however my distance vision is now much worse, about 20/60 and night vision is horrible. Now seeing MORE multiple images of traffic lights. There has been no improvement since.
I keep my eyes well mostened with preservative free tears several times a day.
If any doctors can shed some light on why my vision has worsened i would appreciate it.

Do you have your current prescription? The multiple images indicate astigmatism or other corneal irregularity. Your current prescription would be very helpful, if it is available.

Glenn Hagele
http://USAEyes.org
Lasik Patient Advocacy & Surgeon Certification

I am not a doctor.

Glenn

my cycoplegic refraction before the rt eye enhancement was -75, -75 cylinder

i had a refraction done 2 days ago (without dilation) that showed me a -1.50, -.50 cylinder AFTER my enhancement.

I don't understand why my distance vision regressed so much after the enhancement.

Thank you for the response.

It is difficult to compare results using a pre-enhancement cycloplegic refraction and post-enhancement manifest refraction, but the numbers are clearly going the wrong direction and this really does not make sense. Your current refraction does not explain multiple images in low light environments, but would explain one ghost image. When you look through corrective lenses is the vision fully corrected? If lenses resolve the problem, then you only have a refractive error situation and that would be relatively good news.

Has the doctor diagnosed keratoconus? Keratoconus is a naturally occurring disease of the cornea that causes weakness that often presents as astigmatism. Keratoconus normally presents before the fourth decade of life, but long-term use of rigid gas permeable (RGP) contact lenses may hide the effects. Although keratoconus can be problematic on its own, it can be exacerbated by refractive surgery.

Has your doctor ruled out ectasia? Ectasia is a forward bulging of the cornea due to weakness of the tissue induced by surgery – not by disease such as keratoconus. If a healthy eye has at least 250 microns of untouched tissue, ectasia is not normally likely to occur.

Was the wrong correction entered into the laser’s computer for your enhancement surgery? This is rare, but it can happen. The doctor would have the printout from the laser in your medical file to be checked. Changing a minus to a plus would provide the result you have attained.

As you can see, I’m only able to make educated guesses as to what went wrong. It will be a doctor who evaluates your eyes and reviews the medical records who will be able to make a real determination as to what went wrong. If your doctor is unable or unwilling to answer this rather important question, then it would undoubtedly be wise to seek a second opinion. You want to know why this has occurred before you have any more surgery, and you need to know the cause before you know what to expect and how best to resolve your vision problems.

As soon as appropriate, you should investigate using contact lenses to resolve the refractive error. If soft contacts don’t do it, a rigid gas permeable (RGP) lens may be very helpful.

Glenn Hagele
http://USAEyes.org
Lasik Patient Advocacy & Surgeon Certification

I am not a doctor.

Hi Glenn,

I do not have keratoconus and i believe i had 550 microns of cornea before the first surgery. They did mention that i had "very thick" corneas.

I am able to be corrected to a 20/20-2 with a refraction, but white box surrounding the letters looks ghosted. For the most part i only see multiple images with traffic lights, other lights (such as headlights) appear double from a distance as well as road signs.

My concern is that there has been no improvement at all in my vision with the enhancement.

Is it possible the enhancement "didn't take" due to excessive moisture on the cornea??

I am really unhappy with the vision since i am rt eye dominant, but i was told to wait it out and my next appt is in a month.

Should i get a second enhancment? I am worried about lifting up the flap again and pushing my luck.

Thanks

Hi John,
Welcome to the Intralase club. If you read the horror stories you will find that the majority are Intralase cases. Take a look at a full moon and tell me what you see. After Intralase I see 3 mooons with the bottom drawn way down and it looks like it is raining off the moon.
I'll bet that when the sun is low in the sky it seems like there is a film over your eye too, doesn't it?

yes John, as soon as dusk arrives, my rt eye vision is VERY blurry, now worse since the enhancement

from a distance one traffic light appears as 5 or 6 circles in a blob.

They tell me that I am stuck with that lighting double vision thing so you may be too. I suspect that the Intralase method leaves your corneas too flat and makes light reflect. There is a full moon right now. Go out tonight and look at it and tell me what you see.
Also take a look at a TV screen with the lights off in the room. Do you see video trails shooting out into the center of the room depending on the scene?
Three stoplights in a triangle where there should be one is what I see from two blocks away.

John in Wilmington,

I assume that what you seek is a resolution to your vision problem. To find that resolution it is important to find the actual cause of the problem. I believe that your ire toward Intralase may be misplaced.

The Intralase femtosecond laser microkeratome is only used to create the Lasik flap. It does not change the refractive error. With the minor exception of biomechanical changes within the cornea due to the release of internal stresses by the creation of the Lasik flap, the work done by a microkeratome (whether it be mechanical or laser) is neutral in regard to refractive error.

Unless you had unusual edema (swelling) that may be related to a laser created Lasik flap, there is not much that a femtosecond laser could have done to cause multiple images. Edema would normally resolve with healing within a few weeks.

Multiple images are normally caused by an irregularity in the cornea. The flap itself may be quite regular, but the laser ablation of tissue underneath the flap could be irregular, the placement of the flap after tissue ablation may be irregular, and/or Lasik induced temporary dry eyes may cause irregularities. The method that the flap was created is not likely to have caused an irregularity unless there was some major disruption during flap creation.

To what has your doctor attributed your poor vision?

Glenn Hagele
http://USAEyes.org
Lasik Patient Advocacy & Surgeon Certification

I am not a doctor.

Since enhancement, my doctor says I'm seeing 20/20. That is from a snellen test only. They haven't ever put me through a refractive test again. My doctor did tell me that I would continue to have higher order abberations and she could not correct it.
In the early mornings and late afternoons, I see haze, or what some describe as a loss of contrast. At night anything lit at a distance produces multiple images. The full moon is a very weird spectacle!
I was happy that enhancement took away the poke in the eye feeling that I had in my left eye. it was never explained why.
Glenn, I have talked to other people that have my same symptoms after Intralase. Most people that used the old blade type of surgery are happier with the results. I was told that the suction ring method with Intralase is causing a lot of problems and I had swelling for months post surgery. The left eye was much worse and that is the eye that had extreme pain during surgery.
BTW Glenn, as you scan through the horror stories on this board alone, have you noticed how many of these people had Intralase?

Let me give you a statistic: 97% of all auto v. pedestrian accidents occur while the pedestrian was within the marked crosswalk. Now an analysis of that statistic: A marked crosswalk is the most dangerous place for a person to cross the street.

My point is that with about 50% of all Lasik patients having the flap created with a femtosecond laser (according to Intralase), it would be reasonable to expect about half of all problems to be patients who had IntraLasik.

The question is really about whether a flap created with a femtosecond laser is more or less problematic. Many studies have shown that the flap created with the femtosecond laser is more accurate in thickness and size than one made with a mechanical microkeratome. Yes, IntraLasik does have its quirks, but none that would cause the vision you describe.

Your symptoms are consistent with residual astigmatism and dry eyes. Is this a diagnosed problem? The Snellen 20/whatever test is really not going to be very helpful for night vision problems unless the test is performed in a low light environment. There are many tests that can help diagnose the cause of night vision problems. It sounds like you need those tests.

Glenn Hagele
http://USAEyes.org
Lasik Patient Advocacy & Surgeon Certification

I am not a doctor.

Glenn,
I believe that after enhancement, my vision is as good as it is going to get. They are telling me that the astigmatism is cleared up. Still, faces at a distance still aren't clear. I still have the contrast issue as do other Intralase patients.
I don't think I have dry eye but I do still have a lot of irritation from allergies. This allergy inflamation started with surgery and has never let up. I get relief from a drop called patanol and I see best when taking it or pred forte. Dry eye drops actually degrade my vision severely.
I don't believe that 50% of the lasik patients in my area are doing Intralase. The office that did me is the only one in the area, yet there are many blade type offices.
BTW, how does anyone know just how many digruntled Intralase customers there are anyway? Nobody is tracking it and patients complaints are ignored by the idustry. At least they never responded to me except for a monthly e-mail solicitation for surgery. Somehow I ended up on a potential client list.

sorry to hear of your bad results. Thanks for the intralase warning. If its causing all those problems, it needs to be stopped and instead, epi-lasek done. Ive heard epi-lasek and prk give the best results and the least complications, one reason being no flap.