Hello. I had LASEK done 8 days ago. My vision is still blurry. I can see okay enough to get stuff done, but driving would be too risky at this point. I just noticed today that my left pupil is bigger than my right pupil. Is this somehow related to my healing process? My left eye can see better in the distance but not well up close and my right eye is just the opposite. My eyeglass prescription prior to surgery was -6.75 (w/ a slight amount of astigmatism) in my right and -7.75 in my left. I'm on Pred Forte 4xs a day and Zymar 4xs a day as well as Restasis. I was told that I have dry eyes and my corneas are swollen and that's the reason for the blurriness. The pupil thing is just weird to me. Anyone have any thoughts on this? Thanks!

Ericka

It is possible that the medications you are taking are causing the pupil size difference. It may also have existed before surgery, but you didn’t notice. Patients become very vision aware after surgery, especially if they did not get the “20 Minute Miracle”.

Your doctor has diagnosed some edema (swelling) of the cornea. This would make you a little more myopic (nearsighted, shortsighted). Myopia could explain your poor vision, but I suspect that epithelial healing is part of the equation.

The epithelium is the outermost layer of cells on the cornea. During LASEK these cells are mortally disrupted with an alcohol solution, move aside, the laser treatment is performed on the exposed area, and then the epithelial cells are repositioned over the treatment area. The purpose of this epithelium manipulation is to reduce the probability of corneal haze and reduce discomfort. For details see http://www.usaeyes.org/faq/subjects/lasek.htm

The thing is; those cells are dead or dying. Although epithelial cells are the fastest reproducing cells in the human body, they do take some time to regenerate. The system also needs to figure out which cells are dead or dying, and replace them. This can result in a wound response like edema and delayed vision recovery.

You may want to ask your doctor for a manifest refraction (which is better, one or two?) on your next visit. If the quality of your vision is excellent with corrective lenses, then your epithelium is probably in good shape and you either have residual edema or unresolved refractive error. If even with corrective lenses the quality of your vision is poor, then you may have epithelial or other issues that need to be investigated.

The very best thing you can do is be patient and keep your eyes lubricated. Dry eyes will exacerbate vision problems, can cause edema, and can cause very poor quality of vision. Even if you don’t think your eyes are dry, make a lubrication routine and keep to it. You cannot over-lubricate your eyes so long as the artificial tears are preservative-free.

Glenn Hagele
CRSQA
http://www.USAEyes.org

I am not a doctor.

I actually did have a manifest refraction done yesterday and it made very little difference. I still saw quite poorly through whatever lens I looked through. I take it that my epithelium needs more time to heal. Not to mention the corneal edema. What are you talking about when you say "other issues that need to be investigated"? Thanks for your help!

Ericka,
I've had a similar reaction ever since Intralase more than 7 months ago. A manifest refraction test is now useless because it changes depending on how close the technician is standing to the machine. The slightest movement between one and two throws it off. That's how light sensitive my eyes are now and you may have the same problem. I'll bet if you go out side and look at a white sheet of paper under sunlight, it will take at least 20 minutes for you to be able to see indoors. Pupils just don't react right anymore and it seems to be a mystery to the people at my Lasik office.

John,

Extreme light sensitivity is a known problem after flap creation with the femtosecond laser (IntraLasik). When warranted, treatment is steroid eye drops. The condition is temporary and will disappate with or without treatment. The cause of the sensitivity is not understood and it does not affect similar patients.

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

I am not a doctor.

Thanks Glenn but after over 7 months of this crap, I have lost faith that my eyes will ever work like normal eyes again. I have been on Pred Forte for 7 plus months to no avail. The warning label that comes with Pred Forte has me scared that I will get cataracts or glaucoma. My surgeon finally told me on my last visit that I have higher order abberations that probably can not be corrected with enhancement. So from what I have read, that leaves me with flattened corneas and bad vision that can not be corrected with enhancement or glasses.
If I was a surgeon and knew that I had done that to someone's eyes with Intralase, I would never use it again.

"Other issues" means anything that your doctor can see and we can only guess.

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

I am not a doctor.

One of my pupils is now larger than the other one also after my Lasik surgery. It's has not changed after 6 months. I KNOW the surgery had something to do with it. No one can explain it and most want say that it was either "like that before" or "it just coincidentaly changed after the surgery." I do not listen to this, because for one, I've looked at my eyes for 28 years. I would've noticed before the surgery if one of my pupils was significantly larger. The coincidence theory doesn't do it for me either. I believe there is something to do with the surgery itself or the healing process that can affect pupil size. It just seems rare and no one can (or wants to) explain why it happens.