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Lasik Eye Surgery Message Board

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I got Lasik surgery on both eyes on January 23rd and right now I am a little anxious about the long term results. I would very much like if someone on this board could comment on my experience and vision progress or lack thereof.

First I would like to tell you that I am a 55 year old man and I had presbyiopia as well as moderate myopia and astigmatism since I was ten. I wanted to undergo lasik surgery to correct my distance vision and knew right away that this would not help the prebyopia. I thus knew that I would still need glasses to work at the computer and to read.

Now, here is some information on my visual condition at the time I went to the lasik clinic in early January 2013 for an evaluation exam. Normal ocular pressure, normal peripheral vision, no sign of cataract, no dry eye, no sign of any corneal disease or other eye disease. Just a small scar on the right cornea, well below and to the right of my dilated pupil. The scar, given its size and location, was considered unimportant by the optometrist.

Here are my pre-surgery data:

Prescription for my 3 year old progressive glasses:
Right Eye: -3.75 SPH -1.50 Cyl 95 Axis (myopic astigmatism) add +2.25 (for presbyopia)
Left Eye: -3.75 SPH -1.25 Cyl 90 Axis (myopic astigmatism) add +2.25 (for presbyopia)

I could see most of the line below the 20/15 line with my glasses at my first evaluation exam at the lasik clinic

My manifest refraction pre-surgery was:
Right Eye: -3.50 SPH -1.25 Cyl 90 Axis (myopic astigmatism)
Left Eye: -3.50 SPH -1.00 Cyl 90 Axis (myopic astigmatism)

The reading of the topolizer pre-surgery was:
Right Eye: -3.25 SPH -1.50 Cyl 94 Axis (myopic astigmatism)
Left Eye: -3.25 SPH -1.50 Cyl 73 Axis (myopic astigmatism)

The topolizer images showed a regular corneal surface for both eyes.

I had a 6mm dilated pupil for each eye and corneal thickness was 615 microns for the right eye and 619 microns for the left eye.

I met the surgeon the day of the operation. I had Intralase SBK for the flap and Wavefront Optimized correction with the Allegretto Wave EYE-Q 400. The surgeon told me that he was going for a 6.5mm true optical zone plus a transition zone of few more millimeters, such as is normal for a wavefront optimized treatment. He also told me that he was using the manifest refration data to program the laser, plus a slight over correction of .25 diopters to account for expected regression. He said that there was an 80% to 85% probability that I would end up seeing as well as with my glasses after my vision had stabilized, given my age, my health condition and my actual refraction errors.

The sugery itself went very well. The immediate postop exam under the slit lamp confirmed that everything was looking good. I saw the world through a haze, which was normal. My wife drove me home. I kept the provided sunglasses all day, kept my eyes closed all day, except for putting on all the drops of course. The discomfort in my eyes was berable and had almost completely disappeared by the time I went to bed.

At my first post-op exam the day after, I saw 20/20 with my right eye and could see two letters of the 20/20 line with my left eye, that was a bit blurry. The corneal exam under the slit lamp showed everything was good. In fact, I was thrilled. That night I watched TV and everything was cristal clear with the right eye and still a bit hazy with the left. I went out and saw some haloes and starbusts from bright lights, but nothing troublesome. I could have driven without any problem.

Over the next few days, I noticed a few things. In broad daylight, outside (with the provided sunglasses on mind you) I tested my distance vision at around 20/15 using an eye chart. I was also able to accomodate clearly objects farther than 5 feet away. I took the sunglasses off for a few minutes and experience no light sensitivity whatsoever at noon on a sunny day in a very bright sunny landscape. I put the sunglasses back on according to post-op instructions. At night outside (without sunglasses), the halos and starbusts had diminished to almost the level experienced.I did not feel dry eyes but I knew they were dry because putting in artificial tears made me feel more comfortable and improved my vision for a moment. Inside during the day but especially in the evening under normal (not too bright lighting), I could not see anything clearly at 20 feet or less. I could not accomodate well at shorter distances than 20 feet and of course the closer the object the blurrier the image. Under those conditions, I became very aware that I now had astigmatism at 180 degrees: a luminous point at six feet, such as the power led on the tv, would appear blurred and also doubled horizontally with each eye and also with binocular vision.

I hypothesized that the much better day light vision resulted from a smaller pupil under such lighting, which increases depth of field as well as hides corneal aberrations outside the pupil diameter zone.

At my first week post-up exam, on January 30th, things were not as good, around 20/40 for each eye. Testing the refraction, here are the results:

Right Eye: +.75 SPH .75 Cyl 180 Axis (mixed astigmatism)
Left Eye: +.5 SPH .75 Cyl 180 axis (mixed astigmatism)

I told the optometrist pretty much everything I have written here so far on my post surgery experienced. He told me that the overcorrection he just observed was likely there on day one, but I could see 20/20 in his exam room on day one because of the remaining liquid between the flap and the cornea and possibly some inflammation, both factors influencing the refraction. Plus, my eyes were watery the day after and they were not a week after.

He told me to give it time, and that it would be up to three months for my vision to stabilize. He also said that each patient may heal differently and that is why the surgeon indicated an 80% probability of seeing as well without glasses after surgery as I was seeing with glasses prior to surgery. He also added that at three months deadline, an enhancement would be possible if needed.

I felt somewhat reassured.

Now, from my reading I know that the bulk of changes in vision post lasik occur within the first week. So, I think it is unlikely that I will not need an enhancement.

There is something else that I just considered today, in light of the fact that my glasses were at -3.75, my manifest refraction at -3.50, and my topographic corneal data at -3.25. This means that my eyes were always accomodating with my glasses and therefore would it be possible that my manifest refraction was erroneous because my eyes were so used to accomodate at all times that I did not have a relaxed lens?

Sorry for the long post, but any comments or opinions would be very much appreciated.

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