I was far-sighted left +4.00 and right + 4.75 annd had Lasik vision correction with wavescan and custom vue 3 month ago. Now I am -2.00 on both eyes with +0.75 astigmatism in both eyes. The amount of overcorrection is obviously not acceptable and I will have to go thru an enhancement. Any advise what I should watch out for and why something like this can happen?

Martin,

Sorry to hear of your troubles, but you are probably not as bad off at it may first appear.

Something that is troubling is that you say you were hyperopic and received Wavescan and CustomVue. This is cannot be exactly accurate.

Wavescan is the name for the Visx wavefront aberrometer. This is a diagnostic device separate of the laser and I have no doubt that your doctor did use the Wavescan aberrometer to evaluate your eyes. CustomVue is Visx’s name for wavefront-guided excimer laser ablation. The FDA has not approved Visx CustomVue for hyperopic (farsighted) patients. It is the Visx S4 that is the wavefront-guided CustomVue laser. You must have had conventional LASIK on the Visx S3, not wavefront-guided CustomVue LASIK on the Visx S4.

Hyperopic refractive surgery is much more challenging and much less predictable than myopic (nearsighted) refractive surgery. It is common to have overcorrection, undercorrection, regression, and fluctuation in vision. At three months postop, your eyes should have settled down quite a bit, but regression may still occur. For you that would be a good thing because regression would bring you back to normal vision.

You could have additional surgery to correct your current myopic state, but I would recommend that you delay that as long as is comfortable for you, but at least six months. You want your eyes to regress as much as possible before you have more tissue removed to correct the myopia. Myopic correction is more predictable, and you are now a very moderate myope.

If you are near or past age 40, you may want to keep a bit of that myopia. It may help reduce the effects of presbyopia. You may want to read http://www.usaeyes.org/faq/subjects/monovision.htm.

I recommend that you discuss these issues at length with your doctor, and then seek a second opinion before you make a final decision. It is always good to be certain that you are being properly guided and fully understand the risks and benefits of enhancement surgery in a situation like yours.

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

I am not a doctor.

Dear Glen,

Thanks for your reply. Obviously I have been charged for a treatment that is not approved/appropriate for my case.

The more disturbing problem I have is that the amount of overcorrection and astigmatism in my eyes has increased during the 3 month healing process. I started with -0.75 nearsightedness and +0.25 astigmatism and ended at 3 months with -2.0 nearsightedness and +0.75 astigmatism. It seems that the deterioration has slowed down but I would be interested in reasons for this development. In addition I have a halo in my dominant eye that is bugging me (reasons?).

If i read your comments right you are not convinced that I should do the enhancement. I have consulted another doctor for a second opinion but he directed me back to my operating surgeon and didn´t want to get involved. I will have to do the decision about the enhancement based on my current knowledge.
What are the potential risks and how long can the flap in the cornea be reopened? I am concerned that if I wait too long the chance for complications is increasing. How much nearsightedness would you recommend to keep for the upcomming presbyopia(I am 41)?

Thanks again for your advise.
Martin

Martin,

I suggest that you discuss with your primary doctor exactly what technology was used for your surgery. It appears that there is not a very clear line of communication. Before either of us condemns the doctor, allow the opportunity for an explanation.

Your progressive myopia is rather surprising. It is not totally unheard of, but normally hyperopic treatment regresses – not progresses. The lack of responsiveness from your second opinion doctor means that you still don’t have the information you need. It is the prerogative of another doctor to “not get involved”, but you need to find a doctor who will provide a full evaluation and give you the straight answers. If you need help in this regard, feel free to contact me directly.

If the halo in your dominant eye is in low light environments, such as driving, that is very commonly caused by high order aberrations (HOA) called spherical aberration or coma. This can be evaluated with a wavefront diagnostic that will measure all your HOA. Depending upon the situation, an enhancement surgery with a wavefront-guided ablation may be appropriate.

Whether or not you should have an enhancement will be your decision, but it appears to me that you have not yet attained all the facts necessary to have an informed opinion. A serious talk with your primary surgeon seems in order, and a second opinion from someone who will get involved seems like a good plan.

BTW, by “getting involved”, I mean be willing to diagnose any existing problems and provide you with a prognosis. At this time, that appears to be all you need. A second opinion doctor may not desire to participate in any litigation or provide continued care, and it is perfectly appropriate for a second doctor to decline non-emergency care. In any case, the first step is just to get an independent opinion of where you are today. What to do after you have that information is the next step.

The potential risks of an enhancement surgery are essentially the same as with the initial surgery. The flap can be lifted for years after LASIK. The flap does heal, but it is possible to separate the flap at the interface (see http://www.usaeyes.org/faq/subjects/complete.htm). It appears that you really do not need to be in a rush about this decision. I would check with your primary doctor’s policy for retreatments. It may be that after a certain time enhancements will be with an additional charge.

The issue of how much nearsightedness to remain for monovision is one that is IMO best determined by the use of contact lenses. Start with 1.00 diopter residual myopia contact and adjust up or down from there. When you find a correction that works for you, that correction should be the target if you have an enhancement surgery.

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

I am not a doctor.