Hello Doctor. I’m 48 years old. I had lasik surgery one month ago 8/19/2005, after surgery I didn’t have any problems. After one week my eyes were at 100% far vision (I was wearing -6 glasses). But I couldn’t see at close distance, the doctor seas it will be ok,
I have to read a lot and my eyes will sift to see better at close distance.
The problems began at third week when I start working, (I work with text and computer). After first work day my eyes were feel tired and heavy, at night I had very red eyes,
after I used a Systane eye drops, it immediately went to normal color. Now I have red eyes at night, but no problem at day time.
Another problem I have now: poor vision at the morning time, like I need -1 or -2 glasses, but by the afternoon my vision shifts back to normal almost 100%.
It also starts after I start working,
Also at the night or in the room with poor electric light my eyes not focusing .
Thank you.
Alex Prodan .

That could be the cause. It was for me only three months post op.

Sounds to me like you need reading glasses? I have similar problems when trying to read fine print or if the lighting isn't quite right. You can get a decent pair for less than $20 at Walmart....

it looks like your straining your eyes to see from near. You mentioned you got monovision, how much undercorrected is the non dormant eye? If its undercorrected to -1.5 you should see the computer fine without straining. If the undercorrection is less, it may not be enough. Im in agreement with SU reguarding reading glasses for near. For intermediate and far, you should see fine. Whats your distance vision now?

Hi Alex.

Apparently your LASIK surgeon didn't tell you that you would lose contrast sensitivity (the ability to distinguish things in dim light) with your LASIK surgery. This is a well known complication of LASIK and you deserved to know all about it before you consented to surgery.

LASIK patients often need a great deal of light to see, and experience poor vision in dim light or in conditions where there is artificial lighting especially the dreaded fluorescent light.

There could be many contributing factors that contribute to less light, and more poorly focusted light entering the eyes of patients who have had refractive surgery...

- Abnormal refraction across the LASIK flap, which never heals but rather remains an interface for life. There are always bowmans undulations in the flap. This means the flap is always slightly wrinkled after LASIK. This would scatter light, which means your cornea will not focus light as well after LASIK.

- After LASIK for myopia your cornea is also flattened. A smooth round corneal surface is better at gathering light than a flattened wrinkled surface.

- LASIK induces higher order aberrations. These are corneal distortions that cannot be corrected with glasses. They are also a source of unfocused light in the eye.

- You may have a decentered or undersized ablation. These complications are quite common. Even a small decentration can negatively impact visual quality. If your pupil is large, you will experience the irregularities induced in your cornea by the microkeratome and laser to a greater degree than someone with smaller pupils.

- A patient with large pupils who has an effective optical zone smaller than their maximal pupil size is also in trouble, as they will lose visual quality in dim light. The dimmer the room, the more aberrations come out AND you have light entering an area of your pupil that is not fully corrected. This describes my bad vision.

Please read the article below - you'll be stunned at the magnitude of the visual aberrations patients experience with increasing pupil size and perhaps you will understand a bit better what is happening with your vision.

As for the visual fluctuations - these could be due to corneal swelling that fluctuates throught the day, or could be due to the fact that your cornea was weakened by refractive surgery. Sleeping face down on your pillow could cause changes in your vision that last several hours in the morning. Also changes in your tear film (refractive surgery damages corneal nerves that are important in the maintenance of a proper tear film) could affect your vision throughout the day. Anyway, read the article below!
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Pupillary dilation from 3 to 7 mm in post-refractive surgery patients found to cause 28- to 46-fold increase in aberrations!

Just in case any of you large pupil patients were still wondering why your vision is not so great....

http://www.ncbi.nlm.nih.gov/entrez/...st_uids=9932992

American Journal of Ophthalmology
Volume 127, Issue 1 , January 1999, Pages 1-7

Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis.
Oshika T, Klyce SD, Applegate RA, Howland HC, El Danasoury MA.

Department of Ophthalmology, University of Tokyo School of Medicine, Japan.

PURPOSE: To compare changes in the corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis. METHODS: In a prospective randomized study, 22 patients with bilateral myopia received photorefractive keratectomy on one eye and laser in situ keratomileusis on the other eye. The procedure assigned to each eye and the sequence of surgery for each patient were randomized. Corneal topography measurements were performed preoperatively, 2 and 6 weeks, 3, 6, and 12 months after surgery. The data were used to calculate the wavefront aberrations of the cornea for both small (3-mm) and large (7-mm) pupils. RESULTS: Both photorefractive keratectomy and laser in situ keratomileusis significantly increased the total wavefront aberrations for 3- and 7-mm pupils, and values did not return to the preoperative level throughout the 12-month follow-up period. For a 3-mm pupil, there was no statistically significant difference between photorefractive keratectomy and laser in situ keratomileusis at any postoperative point. For a 7-mm pupil, the post-laser in situ keratomileusis eyes exhibited significantly larger total aberrations than the post-photorefractive keratectomy eyes, where a significant intergroup difference was observed for spherical-like aberration, but not for coma-like aberration. This discrepancy seemed to be attributable to the smaller transition zone of the laser ablation in the laser in situ keratomileusis procedure. Before surgery, simulated pupillary dilation from 3 to 7 mm caused a five- to six-fold increase in the total aberrations. After surgery, the same dilation resulted in a 25- to 32-fold increase in the photorefractive keratectomy group and a 28- to 46-fold increase in the laser in situ keratomileusis group. For a 3-mm pupil, the proportion of coma-like aberration increased after both photorefractive keratectomy and laser in situ keratomileusis. For a 7-mm pupil, coma-like aberration was dominant before surgery, but spherical-like aberration became dominant postoperatively. CONCLUSIONS: Both photorefractive keratectomy and laser in situ keratomileusis increase the wavefront aberrations of the cornea and change the relative contribution of coma- and spherical-like aberrations. For a large pupil, laser in situ keratomileusis induces more spherical aberrations than photorefractive keratectomy. This finding could be attributable to the smaller transition zone of the laser ablation in the laser in situ keratomileusis procedure.

"Successful LASIK" is an oxymoron.

The flap never heals. It cannot heal. All it can do is form a scar at the margin of the flap which is only 28% as strong as a normal cornea. The flap itself does not bond to the underlying cornea and can be dislodged or lifted years later.

The corneal nerves that play a vital role in tear production never fully regenerate. A scientific peer-reviewed study proved that at 3 years post-op the corneal nerves are still less than 60% of pre-op densities. LASIK induced dry eyes is common and for many patients is a life-long sentence.

The suction ring used during the cutting of the flap damages the delicate structures inside the eye including the retina, vitreous, and optic nerve. Many patients report increased floaters (posterior vitreous detachment) after LASIK, and some experience retinal tears or detachment, lacquer cracks, macular holes, macular hemorrhages, optic neuropathy, and retinal vein occlusion.

LASIK corneas are not as stable as normal corneas and can begin to bulge weeks, months, or even years later, potentially resulting in loss of the cornea. This bulging is a response to the normal intraocular pressure. A LASIK-weakened cornea sometimes can no longer withstand this outward force. The FDA used a best-guess safety limit of 250 microns of cornea under the flap when LASIK was approved. Since then it has been shown in the medical literature that 250 is not a safe limit, even though the vast majority of LASIK surgeons, who are too busy doing LASIK to follow the research, are still using an unsafe limit of 250 microns. And the FDA does not have the backbone to modify the approval, allowing the LASIK industry to continue this unsafe practice that jeopardizes the well-being of millions of patients.

There is permanent damage in 100% of LASIK corneas -- debris in the space between the flap and the underlying cornea, undulations and microfolds in the Bowman's layer -- presumably because the flap doesn't fit to the altered corneal bed, haze, epithelial cells under the flap, acutely and chronically reduced keratocytes, epithelial thickening, collagen fibril disorganization, collagen lamellar disarray, and abnormalities of the Descemet membrane.

Quote from one peer-reviewed study: "However, the presence of pathologic findings up to 7 years after LASIK indicates that the process of
corneal stroma wound healing never completely regenerates histopathologically normal corneal stroma."

Loss of night vision quality after LASIK occurs frequently, according to a 2002 report by the American Academy of Ophthalmology. For some patients, particularly those with large pupils, this complication can be debilitating. Since this is a "frequent" problem after LASIK, I wonder how many of the approximately 8 million Americans who have had LASIK are out there on the roads at night endangering their life and the lives of others who share the roads with them? A recent study showed that up to 50% of LASIK patients are impaired when driving at night. Yet this serious threat to the public health is down-played and swept under the rug by the LASIK industry.

And then we have the problem of the white wall of silence. Doctors are pressured by their peers not to testify for patients who are victims of LASIK malpractice. They are threatened by their own insurance carriers, which could put them out of business. And they are concerned about giving LASIK a black eye by helping a patient seek justice for the harm done to him or her in a public forum like a court of law. They cave in to the pressures, leaving patients without any recourse -- medical, legal or otherwise. So doctors just get away with it and standard of care and informed consent continue to be basically non-existent. And the FDA says it's not their problem (they regulate the devices, not the doctors).

So who's looking out for the patients? Who's going to warn them that 1/3 of their corneas will be nearly sliced off, leaving them with a structurally weakened cornea that can begin to bulge years down the road? Who's going to warn them of the seriousness of LASIK-induced dry eyes, that the nerves never regenerate, and that painful dry eyes can be permanent? Who's going to warn them that LASIK, all LASIK -- conventional and custom, induces higher order aberrations in all virgin corneas, effectively reducing the quality of their vision? Who's going to warn them of the damage the suction ring can do to the structures inside the eye? Who's going to warn them that the flap never heals?

You would think doctors would be protecting patients. Wake up and smell the coffee. Money is what drives them, not a desire to heal the sick. They don't deserve to be called doctors. They are no better than used car salesmen.