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April 29, 1999 Well! Just where have I been, for Heaven's sake!? Imagine my surpise; I had never heard of laser refractive surgery until a member of a listserve to which I belong mentioned she was going to have LASIK performed on one of her eyes the next day, and requested some good wishes. All I could think of were the horror stories I had read about radial keratotomy. I thought--"She's nuts! No one's going to laser my eyes, unless it's absolutely necessary! NO WAY!" I've been wearing glasses for myopia since I was 11 years old, tried contacts (all kinds) 7 different times, and couldn't tolerate them, but, cut on my eyes? I don't THINK so! |
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April 30, 1999 Well, the list member reported back that she had 20/20 vision, and it only took 10 minutes. She was so glad to be rid of glasses and contacts. She couldn't say enough wonderful things about LASIK. Good for her, but I'm STILL not letting anyone laser my eyes. |
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May 16, 1999 I saw an article in Parade magazine about laser refractive surgery. Made it sound good, though it did point out the downside. This article stressed the importance of finding an experienced surgeon to consult if one were considering LASIK, and gave a brief description of the procedure. Nope, still not for me. |
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May 20, 1999 Some other people on the list serve were asking the member who had LASIK some questions. I was interested in her answers, I must admit. She continued effusive in her joy with having had LASIK, and continued to have excellent vision, with no complications. In her words, she was "thrilled." |
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May 21, 1999 I happened to mention to my boss that I had heard about this surgery. She told me her sister-in-law had had it done, and she would ask her if she minded talking to me if I wanted to. I said I would love to talk to someone who had actually had the procedure done. |
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May 24, 1999 My boss brought me an ad from a Winston-Salem, North Carolina newspaper announcing a seminar being presented by the Wake Forest University Eye Center on LASIK. It was scheduled for June 1, 1999, and required registration. I called immediately to register myself. It won't hurt to go and see what this was all about, will it? |
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June 1, 1999 The seminar was presented by Dr. Keith Walter, Associate Professor of Ophthalmology at Wake Forest University Eye Center. Dr. Walter gave a slide presentation and answered questions from the audience. Dr. Walter uses the VISX Star S2 excimer laser with the latest software, currently 3.1 version. He made it clear that, as in most things, there were no guarantees with LASIK, and that if one underwent LASIK, one may not get the results one wanted. Prior to the program, if one had glasses with them, one could have the glasses checked for the prescription, and Dr. Walter could use this to help evaluate whether or not one was a good candidate for LASIK (on a preliminary basis, of course). Conveniently, one could schedule an evaluation and consultation when the seminar was over. Wonder of wonders, I could get a Saturday appointment! And, as if that were not enough, it was for the next Saturday, June 5, 1999. Why not do it? It was just an evaluation--I was due for an eye exam anyway. My husband, who was along with me, decided he would do it too. |
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Glasses Prescription |
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Sphere |
Cylinder |
Axis |
Snellen |
| Right |
-6.00 |
+1.50 |
163 |
20/30-1 |
| Left |
-6.25 |
+1.00 |
007 |
20/25 |
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June 5, 1999 We had a 60 mile drive, so we left early Saturday morning. We got there a few minutes early, but in a very short time, JoAnne, a COT (Certified Ophthalmic Technician) who works with Dr. Walter, came out to see if we were there. We were, so she took us on back to begin the examination. First, she did a topography of my corneas, using Orbscan. I had to look at a light for a set length of time (seconds only), and she measured my pupils in dim light. She showed me the results on the computer screen, but of course it meant nothing to me. JoAnne explained that my corneas were sufficiently thick enough to have LASIK. Then, she took me to another room, where she checked my vision. My uncorrected Snellen rating was "off the chart." After that, Dr. Walter came in and checked my vision, as well. My eyes were dilated with Cyclogyl. After Dr. Walter finished, he told me I was a good candidate for LASIK, and that I had no cataracts or glaucoma. Due to my presbyopia, however, I had two options in how I could be corrected. I could opt for distance correction in both eyes and wear reading glasses, or try monovision--one eye (the left, the dominate one) for distance, and the right for close up. He told me that if I tried it and couldn't accomodate adequately, I could always undergo an enhancement to correct both for distance. Since the reason I was even remotely considering LASIK was to get rid of the glasses, I thought I would try the monovision. I suggested trying to wear monovision contacts to see if I could accomodate, and Dr. Walter agreed that this would be a good idea (actually, we both thought of this at the same time!). I was given contacts and the gear I would need to clean them, etc, and was scheduled for surgery at 9:00 AM on July 15, 1999. I was given an 11 page LASIK consent form before I left, so I would have plenty of time to read over it and ask any questions. H-m-m-m-m-m. Well, I can always cancel. |
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Best Corrected Visual Acuity |
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Sphere |
Cylinder |
Axis |
Snellen |
| Right |
-5.75 |
0 |
0 |
20/20+1 |
| Left |
-6.75 |
+0.25 |
90 |
20/20+1 |
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Next Six Weeks I tried those contacts, and several other strengths, over the next six weeks. I was not, however, able to tolerate any of them longer than 3-4 hours a day, so I really was not able to adequately evaluate whether or not I was going to be successful with monovision. Well, let's try it--I can always be enhanced if it doesn't work. I spent some time on the internet doing some research. Many sites were merely advertisements for specific surgeons and facilities, but I found a few independent sites. I really saw nothing that would dissuade me from going ahead. I also talked to my boss's sister-in-law, friends, and co-workers who had friends and family members who had had LASIK, and all of them had had good results. |
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July 14, 1999 Tomorrow's the big day. I've been cleaning my eyelids and around my eyes with the cleansing pads I was given the day I had my evaluation and scheduled my surgery. They are very drying to the skin, but, I was instructed not use any lotions or moisturizers. |
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July 15, 1999 Arrived at the center before 8:00 AM, and went down to the cashier to pre-pay for my surgery. Still could back out. But I won't. And I didn't. Back upstairs to the eye center. Within minutes, I was called back and received my pre- and post-op instructions, my little kit with eye drops, eye shields, tape, heavy-duty sunglasses, and a starter supply of artificial tears, discussed and signed the consent form (again, it was stressed that there were no guarantees, and I may not get the results I was looking for), and after discussion, agreed with the nurse that half of the regularly prescribed Ativan would be enough pre-op medication for me. I would take the other half home to help me sleep and rest this afternoon and evening. I was assured that tomorrow I could read or work on the computer if I wanted--it wouldn't hurt my eyes.
My husband was allowed in the laser room, and was able to sit close enough to pat my hand and watch the procedure on a closed-circuit monitor. I got eye drops, had my eyelashes taped back out of the way, prepped around my eyes with what smelled like Betadine (povidone-iodine) solution, and Dr. Walter marked my corneas with surgical ink, to help line the flaps back up when they were replaced. Dr. Walter explained each step to me before he did it, and demonstrated the loud noise that the microkeratome and the laser make prior to beginning, so it would not startle me during the procedure. He warned me that I would loose my vision during the application of the suction ring and while the flap was cut, and was terribly supportive during the entire procedure, frequently asking me if I was alright. I was told to look directly at the red light in the center of the laser the entire time the laser was applied. JoAnne was in the background counting down the seconds for me. I received 18 seconds of laser on the right eye (close-up) and 31 seconds on the left (distance). The right eye was done first, then the left. Dr. Walter warned me that, in his experience, most people found the left eye to be more "sensitive" to the flap cut. Sure enough, it seemed I could feel something "almost" like it was going to hurt, but didn't. Very hard to explain. Could be a sympathetic response. Also very hard to explain is the fact that there is a circle of light on the microscope around the laser beam, and this circle became clearer and clearer as the laser worked. When it was all over, and I sat up, Dr. Walter asked me if I could see the clock on the wall (apparently this is a technique taught in LASIK school!). I could, and much better than I could have before. YES!!! It worked!!! The worst part was removing the tape from my eyelashes! He then asked me if I had ever had a corneal abrasion on my left eye. I hadn't...not to my knowledge, anyway. He told me that when he cut the flap, the cornea acted like one which had had an abrasion in the past, and there was potential for a problem with the corneal epithelium because of this. He then took me into an examination room, looked at both eyes, and was pleased with how the flaps looked. He told me the haziness I was experiencing would disappear in a couple of days, and that I would feel some scratchiness for several days. I was sent on my way, with my instructions and my little kit, and would be checked back in the center the next morning, by Dr. Walter.
Back in the car, I put my sunglasses on, reclined the seat back, and closed my eyes for the hour and a half drive home. When I got home, my husband put in my Ocuflox (antibiotic) and FML (Fluorometholone, a corticosteroid) drops, put my eye shields on, and called my boss to update her. I took my Ativan, and slept for 5 hours. When I woke up, it was about 4:00 PM. I had something to eat, stayed up for about an hour, did the drops again, and took another nap. Two hours later, got up for about another hour, slept another two hours, got up and took some ibuprofen (just because), did the drops again, stayed up a while, and then went to bed and slept all night. Absolutely no pain, no scratchiness. NONE!!! Amazing! |
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July 16, 1999 I can read the time on the clock radio from across our king-size bed. I DON'T BELIEVE THIS!!! Before, I always had to get within 3 inches of the digital readout in order to see it. WOW!! I still have the haziness, but that was to be expected. Off to see Dr. Walter. First, JoAnne checked my vision, and told me I was exactly where I should be at that point. Combined vision was about 20/40. Dr. Walter came in, examined my eyes, and pronounced the flaps in good shape. He asked me if I had any problems, i.e. pain or scratchiness (which I hadn't), and told me my vision should improve every day, and wanted to see me again in two weeks. We ran some errands (needed cat food, more artificial tears, some sunglasses that fit!, and Cinnabons!!) in Winston-Salem (I actually drove a little around the mall) and then went home. I took several naps during the day, read my email, and otherwise just puttered around the house. Still no pain or scratchiness. Put my drops in as prescribed, and used the artificial tears (at least) once an hour as I had been instructed. I will follow Dr. Walter's instructions to the letter--I'm not taking any chances with my eyes. Slept well again. |
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July 17, 1999 This morning, I "thought" my vision was not quite as good as yesterday. But, since I had found in my reading that vision can fluctuate from day to day, especially at first, I was not too concerned. My husband had gone to a computer show with some friends, so I went out and ran some errands. My left eye was a "little" scratchy, so I just used the artificial tears frequently, and put my drops in on schedule. The haziness was a little better. I toyed with the idea of taking the eye exam to have my corrective lenses restriction removed from my drivers license, but resisted for the time being. |
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July 18, 1999 When I woke up this morning, I could barely see the clock, much less the readout! What's wrong, I wondered? Just some fluctuation, I guess--it'll get better during the day. But it didn't get better. The haziness was just about gone, but I could barely read the print in a hard back novel I was reading. This was a little depressing! Here I was expecting to get better, and I was getting worse. I found an internet bulletin board where mostly people who were unhappy with or were having problems from LASIK were posting. It is hosted by a physician, who also participates. I learned a lot of things here that I did not know. I wish I had found it prior to having the surgery. I seriously doubt that I would have changed my mind, but I would have been better informed about what I was about to do. I also got some wonderful support from others who had been through this. I then called my boss's sister-in-law to see if she experienced anything like this. She had not. OK, let's not panic. I know I tend to obsess; calm down, and call the eye center in the morning. I called my boss, who was expecting me to be back at work in the morning, and told her what was going on. First of all, I couldn't see well enough to drive the 30 miles each way to work, then I wouldn't be able to see to do anything (my job mostly involves paperwork) if I got there. She was extremely supportive, and made sure I intended to call the eye center first thing Monday morning, and asked me to call her after I knew what was going on. Finished up my four days of Ocuflox and FML, and am continuing with the artificial tears. |
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July 19, 1999 I called the eye center as soon as I thought anyone would be there and asked for JoAnne. She was out right then, but would call me back. I waited for a while, and was getting pretty antsy, so I called again and got JoAnne. I told her what was going on, and she asked if I could come on in to see Dr. Walter. OF COURSE I COULD!!! I couldn't see! So, off we went. JoAnne checked me first, and then Dr. Walter did. He asked me if I had had any pain in my eyes. I hadn't. The flaps still looked good, and there was no sign of infection. Good. But I still couldn't see well enough to function. I heard Dr. Walter mention the word "fingerprint" to the resident with him. Dr. Walter prescribed Muro 128 drops three times a day and Muro 128 ointment at bedtime, to help make the epithelium "stick" better. Wants to see me again in one week. I picked up the drops and ointment on the way home and started using them right away. The drops sting like fire!! When I looked at the package insert I saw that they were hypertonic saline (strong salt solution) and were used for corneal edema (swelling). While I understand "how" it works, I was a little puzzled as to "why" I needed it, and checked on the bulletin board to see if anyone else had run into this. I could have emailed Dr. Walter, but I really didn't want to seem like a complaining patient--not yet, anyway. I did get some help, and began to understand the rationale for the new drops and ointment. |
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July 20, 1999 I stayed home again today. I didn't feel safe driving. Vision is no better. Used the drops and ointment as prescribed. And this is weird. Its almost like I can't think straight since I can't see well. I wonder what that means. |
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July 21-23, 1999 I risked the safety of everyone on the highway these three days; I drove to work. I got my work done, but it was a real struggle. Everything took twice as long to do, because my vision was so poor. I was having pretty significant ghosting, almost to the point of double vision. By the time I got home each day, I was totally exhausted! Continued drops and ointment. Vision not perceptively any better. |
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July 26, 1999 In to see Dr. Walter again. No change in vision. Under the slit lamp, the flaps still look good and there are no signs of infection. Also, there is no problem with my retinas, which are a possible source for poor vision. Dr. Walter then stained my corneas and looked at them with the blue light (this shows defects in the cornea that can't be seen otherwise), and tells me that the epithelial layer, or "skin," of my corneas has "wrinkles" in it, causing the poor vision. This is not to be confused with a flap wrinkle or epithelial ingrowths. These are more serious problems. Again, he asked me if I had had any pain. I haven't; just very mild, rare, scratchiness. He wants me to continue the drops and ointment for another week, to see if the epithelium will "stick" down, and if there is still no improvement, he will "scrape" the epithelial layer from my corneas and let them form a smooth, like-new epithelium. I will have to wear a bandage contact for a few days afterwards. OK, he's the expert. I asked for some interim glasses for driving, since I felt so unsafe, and I wouldn't dream of driving any place unfamiliar, because I couldn't see the road signs. He gave me a prescription for distance only. YIKES! I now have more astigmatism in the left, and some in the right, whereas I didn't have any before. Dr. Walter told me this was caused by the epithelial wrinkles. I had quite a few questions to ask, and I knew I was taking a lot of time, but Dr. Walter was very patient with me, answered all my questions, and said, "We're here for you, Barbara." That made me feel really good, because I believe him. I found out that my pupils were 4 mm in dim light, and that my ablation zone (area treated by the laser beam) was 6 mm with a 0.5 mm transition zone (area of "smoothing" between the ablation zone and my untreated cornea). This is good. It means that my pupils should not dilate larger than the area treated by the laser, lessening the chances that I will have starbursts, halos, glare, and arcs. I also found out that I didn't move during the ablation, meaning the ablation was centered well. Also good. |
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July 26, 1999: Residual Prescription |
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Sphere |
Cylinder |
Axis |
Snellen |
| Right |
-2.00 |
+0.50 |
019 |
20/300 |
| Left |
-3.50 |
+0.75 |
019 |
20/50 |
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July 28, 1999 Oh, Jeeze, I'm getting nervous. My vision is no better, and I am dreading this procedure. I emailed Dr. Walter for more information. He was out of town, but JoAnne got back to me and said they had discussed me (I'll just bet they did!!!) before he left, and she answered my questions. I will need to be checked for several days in a row after the procedure, and the bandage contact will speed the healing as well as make it more comfortable. OUCH! I knew it--it's gonna hurt! I emailed JoAnne with more questions. |
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August 3, 1999 Dr. Walter got back to me when he returned and told me the procedure would actually be more of a "brushing" than a "scraping" since the epithelial cells were loose already. Still sounds painful. Of course, my eye will be numb for the procedure. |
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August 4, 1999 Dr. Walter checked my left eye again, and the wrinkles were still there. Again, I am asked if I have had any pain. Still no pain, just a little scratchiness that resolves with artificial tears. Several residents and medical students have looked at my eyes, too (Dr. Walter explained to them that I am "abnormal"). I am amused at the descriptions I have heard concerning these wrinkles: from "Saran Wrap" to "itty bitty tiny bubbles." So, back to the laser room to use "the best microscope in the building" to perform the epithelial debridement. Numbing drops were instilled, and Dr. Walter used a WECK-CEL sponge to gently remove the loose epithelial tissue from my cornea. He then placed a sterile bandage soft contact lens in my eye. So far, so good. He offered me a presciption for Darvocet, but since it has made me nauseated in the past, I declined. I would take ibuprofen, I said. Heading home, about 10 minutes after leaving the eye center, my eye began to sting and burn. Nothing I couldn't stand, but no fun, either. I got home, took some ibuprofen and went to bed. After about an hour, if I kept my eye closed, it didn't feel too bad. But as soon as I tried to open my eye, I could feel the contact move and my eye teared. So, I stayed in bed with my eye closed as much as I could. Dr. Walter had instructed me to use the Ocuflox and FML left over from the initial procedure twice a day, and to come in for a recheck the next morning about 10:00 AM. When I put the evening drops in, about 11:00 PM before going to bed, my eye started to tear copiously, and was pretty uncomfortable. I put my eye shield on, just as a precaution, and tried to go to sleep. |
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August 5, 1999 I wasn't able to sleep, and at 1:00 AM, I realized the contact had floated out. YEOW!!!! Serious pain! Dr. Walter had already told me not to try to replace the contact if it came out, but to call the ophthalmology resident on call. I called and was told I could come on in if I wanted to, to have another contact inserted. My main concern was whether or not I was doing any further damage to my eye by leaving it out. I was told I was not, so I opted to wait until 8:00 AM and go in to see Dr. Walter. I didn't mean any offense, but it was going to have to get a lot worse before I would let anyone except Dr. Walter touch my eye! I took a hydrocodone tablet I had left over from a previous surgery, which helped tremendously for about 2 hours. Then, when the pain resumed, and it was too soon to take another pain pill, I took more ibuprofen, which did very little to help. I held off until 6:00 AM, took another pain pill and got very nauseated. We took off for the eye center, and arrived just before 8:00 AM. JoAnne took me right back and put me in a dimly lit room, and very shortly Dr. Walter came in. After numbing my eye, he checked it and said no damage had been done, and the debridement was half healed! Yea!! Another, "tighter" contact was placed, and I arranged to see Dr. Walter again the next day at about 10:00 AM again. My eye felt much better. I never thought I would be so glad to have a contact in my eye. We headed back home and I went back to bed to rest my eye. |
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August 6, 1999 In to see Dr. Walter for a recheck. My eye was hurting pretty badly from the contact. I think I said something about there being "a boulder in my eye." That's how it felt. The contact was removed, and after staining my cornea, Dr. Walter pronounced it completely healed. It felt SO much better! I was told to use the Ocuflox twice a day, the FML four times a day, to use GenTeal Jel four times a day, and come back for a recheck in two days. I had a haze similar to that I had for a couple of days post-LASIK, and I could see a blurred area in the center of my eye, which was the "seam" left from the cornea healing from the periphery towards the center. One resident said the "seam" looked like a "stick man." This made me smile. My eye was a little scratchy, but otherwise not painful. I could already tell there was an improvement. Starbursts were greatly decreased, and the ghosting I had been experiencing was much better, too. Things are "looking" up. I am to see Dr. Walter on Monday, August 9. If I a· still having blurred vision on the left, he wants to check it, and if that has cleared up, we will do the debridement on the right. According to Dr. Walter, I am now essentially back at the one day post-LASIK stage. Much better stage than the one I was at three days ago. |
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August 9, 1999 I have seen a noticeable improvement over the weekend. It's not perfect, but definitely better than before. The haziness is gone, but there is still a little ghosting and blurriness. And...I can read the clock again!! My undilated refraction was -1.25 with no astigmatism, and I was seeing 20/50. We went ahead with the right eye debridement. The same procedure was used, only Dr. Walter used the "tighter" contact initially this time. I was instructed to stop the Ocuflox in the left eye, use it and the FML twice a day in the right, and continue the FML and GenTeal Jel in the left four times a day. I was to be rechecked the next day at about 10:00 AM. I went home and took a pain pill and went to bed. It was very uncomfortable to try to use my left eye and keep the right one closed. And, if I opened the right eye, it hurt! |
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August 10, 1999 When I saw Dr. Walter today, he took the contact out, because the debrided area on this cornea was not as large as on the left. OW! It hurt. After numbing it and staining my cornea, Dr. Walter could tell it was not completely healed, so back went another sterile bandage contact. I was told to continue the drops and GenTeal Jel as before and come back the next day for a recheck. I pretty much just lounged around with my eyes closed the rest of the day, because this contact was irritating my conjunctiva, and it felt better with my eyes closed. I was also tearing quite a bit if I tried to open my eyes. |
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August 11, 1999 My appointment today was in the afternoon, so by the time Dr. Walter saw me, I was really ready to get this contact out! Out it came, and I immediately felt better. A check of my cornea showed it was completely healed. The haziness was there as before, as was the "seam" ("stick man"). The ghosting was better, although not gone, as well. That evening, I was able to read, and only experienced some moderate scratchiness by bedtime. I put in my drops--FML--three times a day as instructed and used artificial tears once an hour in between. Dr. Walter had asked if I liked the GenTeal Jel. I can't say that I do. It caused blurriness, but worse, to me, it got into my eyelashes, dried and flaked, and I had a fear that these flakes would get into my eyes. That's when he told me to just use the artificial tears. I am to see Dr. Walter for a recheck in one week. |
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August 12, 1999 No great improvement except the right eye haziness is just about gone. I can still see the "seam." I "think" the left eye is better, actually! |
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August 13, 1999 My left eye is a tiny bit better, I believe. The right one now is just blurry, with no perceptible "seam." Went out of town this evening for the weekend. I was interested in seeing what road signs look like on the open highway. My overall sense is that my vision is better than yesterday. Definitely better than before the debridements. I still see ghosting, most pronounced on text of any kind--road signs as well as printed text. |
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August 14, 1999 Read some of a paperback novel, and found I was much more comfortable using a pair of drug store readers (weakest strength). The readers helped my distance eye vision, made the closeup vision on the right slightly worse, but helped overall. |
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August 15, 1999 Traveled back home today. Road signs still blurry at a distance due to ghosting, but quite clear when I get up close. Lights are pretty normal in the left eye, but appear to be two lights with the right eye, that converge into one as I approach. When I went to bed, I decided to read a little, and found I didn't need the readers! Slight ghosting noted with text, but not so much that I needed the readers. Progress is being made! |
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August 16, 1999 I drove to work today. Vision felt pretty good for driving, but when I got to work, printed text was fairly blurry, due to ghosting. I used the readers for about 2 hours, then found I didn't need them again. I "think" the ghosting is a little better. It is so hard to say, when the changes are so subtle each day, but the important thing is that there are positive changes occurring. I can't wait to see Dr. Walter on the 18th. I am anxious to see what my refraction is. |
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August 18, 1999 Haven't needed the readers today. I tried them for about 5 minutes a couple of times, but found they were more trouble than they were worth. I hope this continues. I drove to my followup today. JoAnne was impressed! Dr. Walter was very pleased with my progress, as was I. I saw 20/30 with both eyes, 20/30 with the left, 20/80 with the right, and 20/30 closeup with the right. Refraction is significantly better in the left eye. Ghosting is slightly better. My left cornea is in great shape, but the right appeared a little dry when viewed under the slit lamp. I am assuming that is because it is a little behind the left in healing. Dr. Walter said he is having to treat my eyes like PRK eyes, due to the epithelial debridement, therefore I am to continue the steroid drops twice a day for one week, then once a day for one week. Since long-term steroid use can cause glaucoma, JoAnne checked my intraocular pressure--normal, no signs of glaucoma. Will see Dr. Walter in two weeks--September 1st, for followup. I am very encouraged. Our goal is to get my left eye to plano (neither nearsighted nor farsighted), and my right to around -1.5, both without astigmatism. Best corrected visual acuity today--left: 20/20, and right: 20/25 +3. I have a feeling that changes are going to be subtle from now on. |
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August 18, 1999: Residual Prescription |
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Sphere |
Cylinder |
Axis |
Snellen |
| Right |
-2.00 |
+0.50 |
010 |
20/80 |
| Left |
-0.50 |
+0.50 |
75 |
20/30 |
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August 20, 1999 This morning I was having more trouble with ghosting. I think it was because my eyes felt "tired," if that makes any sense. I had the feeling I was not focusing as well as I had the last couple of days. The readers helped. By noon, I didn't need the readers, and the ghosting had diminished back to where it has been for the last couple of days. |
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August 21, 1999 This morning I woke with the feeling that my eyes were "stronger." Hard to explain. The drugstore sunglasses I had been wearing were diminishing my visual acuity, so I went to the optical company at which I had had my glasses made for years. Ordered some optical grade sunglasses with Polaroid and UV protection. They look at you real funny when you tell them you don't want any prescription in the lenses. I felt reasonably confident this morning, so I decided to take the vision test to have the corrective lenses restriction removed from my driver's license. I passed! Now I'm legal. Very encouraging; another milestone passed. |
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August 24, 1999 Picked up my new sunglasses. Tremendous difference!! This was a good move. |
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September 1, 1999 Saw Dr. Walter today. My corneas were pronounced in "perfect" condition. My residual prescription has changed on the left. From -.50 two weeks ago back to -1.25 with more astigmatism. I don't know what that means. I have noticed, over the last few days, a little more fluctuation in my vision; some days not as good as others. Perhaps I have regressed. It happens. I rarely need the readers, though. Will see Dr. Walter in one month--October 6th. At that time I will have a dilated refraction and discuss enhancement at around 12 weeks post-LASIK. The astigmatism I am experiencing is correctable, so it is reasonable to think enhancement is the answer. Dr. Walter will be able to lift my flap, and therefore thinks I shouldn't have a recurrence of the epithelial wrinkles. I sure hope he's right! Snellen on the left has not changed, but close up on the right has improved to 20/25. I'm finished with the steroid drops; intraocular pressure good. Mid- and very close up vision are probably the worst. Dr. Walter thinks the mid-vision deficit is due to residual prescription. I'm doing OK, but will have some glasses made for distance only because I'm going to a concert in a couple of days, and I really want to be able to see the stage. |
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September 1, 1999: Residual Prescription |
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Sphere |
Cylinder |
Axis |
Snellen |
| Right |
-2.00 |
+1.00 |
166 |
20/80 |
| Left |
-1.25 |
+0.25 |
035 |
20/30 |
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September 13, 1999 This past week-and-a-half have been a little discouraging. No improvement noted. In fact, at times, I think I am seeing a little regression, especially in my left eye. I suppose that is to be expected. Sometimes, when my eyes feel "tired," my right eye (close-up), seems to take over, making my distance vision even worse. At this point, I am convinced I will need enhancement. I am using my glasses for driving just about all the time now. It just makes me feel safer. These glasses correct my left eye really well!! I hope enhancement can result in distance vision this good. Even with the glasses, the right is not as good--I don't know if that matters, since its for close-up anyway. Something else to discuss with Dr. Walter on October 6th. My close-up is still pretty good, although I still have the ghosting--that's no better. I have to start thinking about whether or not I will have the right eye astigmatism enhanced at the same time, or wait and see what happens if I get to plano in the left. Something else: I've been taking ibuprofen pretty regularly for the last few days, for sinus headaches. Last night I read a summary of a recent ophthalmology meeting at the Mayo Clinic. There was some thought that NSAIDS (non-steroidal anti-inflammatory drugs) can cause some vision problems with LASIK. It was not clear to me whether this is important early post-op or "forever." Will have to check this out more thoroughly. |
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October 6, 1999 Saw Dr. Walter for my 3 month follow-up today. My corneas are in good shape (pronounced "perfect"), and my intra-occular pressure is normal. But, as I suspected, I've undergone some regression on the right; I've needed to wear my glasses for any driving and for activities like mowing grass, etc. Ghosting has gotten noticably worse as well, due to the astigmatism on the right. I underwent both an undilated and dilated exam. My left eye is essentially unchanged as far as refraction goes, although my Snellen on the left has decreased to 20/50. I underwent topography, which looked good. Still have lots of cornea to work with. Dr. Walter explained the steps in the enhancement procedure--marking and beginning the flap lift under the slit lamp and then going to the laser room to finish the flap lift and complete the procedure. This time, my time under the laser will be very short. He told me to expect the same post-op schedule of drops and post-op visits. We also discussed the chances of my experiencing the epithelial wrinkling again--he believes it won't happen, because there won't be a flap cut, but of course we won't know for sure until its over. Dr. Walter warned me that my eyes may feel a little scratchier than the first time, due to the fact that the flap edges might be a little rougher from being lifted. Enhancement is scheduled for October 14, 1999. I am looking forward to it. I don't consider the need for enhancement a complication, but rather, a refinement. Since my pre-op prescription was almost -7 and -6, the fact that I need enhancement is not exactly surprizing. |
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October 6, 1999: Undilated Residual Prescription |
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Sphere |
Cylinder |
Axis |
Snellen |
| Right |
-2.50 |
+1.00 |
153 |
20/100 |
| Left |
-1.25 |
+0.25 |
021 |
20/50 |
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October 6, 1999: Dilated Residual Prescription |
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Sphere |
Cylinder |
Axis |
Snellen |
| Right |
-2.50 |
+1.00 |
159 |
20/100 |
| Left |
-1.00 |
+0.25 |
030 |
20/50 |
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October 13, 1999 Tomorrow's the big day! I sure am looking forward to this enhancement. I've been cleansing my eyelids with the Eye Scrubs just like before, for two days, now. I've got fingers and toes crossed that this will do the trick. |
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October 15, 1999 Had my enhancement yesterday. Everything went well--no problems. Right eye, 4 seconds of laser treatment, left eye, 5 seconds. I am so paranoid about my epithelium developing problems again, but Dr. Walter said the flap did really well, and smoothed back down perfectly. Got an antibiotic drop and a "pain" drop when the procedure was finished. Examination under the slit lamp showed the flap was in good alignment. I decided not to take the Ativan prior to the procedure, because I didn't want to miss anything. I was given a 1 mg. Ativan to bring home to help me sleep. I came home and went to bed--slept almost all day and all night. Was up about 2 hours total. Experienced haze just like before, but this time it was just about gone by this morning. Putting drops in as directed, and didn't even look at the computer or read until tonight. Went in this morning for my 1 day follow-up. JoAnne showed me the video of my enhancement. Pretty neat! Flaps look good except Dr. Walter said they looked a little dry. Right eye: 20/50 distance and 20/20 close up. Left eye: 20/30. Both eyes: 20/30. Still a good deal of ghosting, which Dr. Walter says is due to swelling. Vision seems a little sharper than pre-enhancement. Can't say there has been a dramatic improvement, though. I didn't even ask what the refraction was; figured it was of no value right now, anyway. Next follow-up, October 29th. Right eye feels great, but the left has been pretty scratchy today and this evening. Hopefully the steroid drops will help the swelling and scratchiness. Will call it a night early. |
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October 16, 1999 Vision seems a little diminished today. When I opened my eyes this morning, I felt a sensation like my eyelids were stuck to my corneas. Entirely too reminiscent of the two-day-after-LASIK situation. Also, sort of slightly depressed like the last time. I had such high hopes that this would fix everything--and it still may--it hasn't been long enough to tell, yet. Will just have to wait and see what happens. Have been limiting time reading or on the computer today, as well. Putting drops in as directed. I sort of dread tomorrow morning; what if my vision is worse, like the first time? Well, I've come this far... |
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October 17, 1999 Vision definitely diminished today, with even less sharpness and more ghosting. Scratchiness virtually gone until this evening. Basically, vision seems to be back to where it was post-debridement, before regression. The glasses I used pre-enhancement work pretty well (not perfect), so at least I'll be able to drive to work tomorrow morning. I'm hoping that it will improve throughout the day and tomorrow morning. If it doesn't, in the morning I'll call the Eye Center and see what Dr. Walter wants me to do, if anything. At least this time, I'm not beginning to panic, because I am pretty sure what the problem could be. And, it might just be a combination of fluctuation/healing/steroid drops, so I am handling it better until I find out more; trying to stay very busy so I won't think too much about it. At this point, I'm of the opinion that the problem is with me, not the procedure. I emailed Dr. Walter, who told me to call the Eye Center in the morning if I am still having problems, and he will probably want to see me. After the first episode of "wrinkling" I did lots of research. I am convinced that I have map-dot-fingerprint dystrophy, also know as epithelial basement membrane dystrophy (EBMD), which is why I have had this recurring problem after these invasive corneal procedures. |
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October 18, 1999 Vision no better today. No worse, but no better. Called the Eye Center and spoke to JoAnne, and described what I was experiencing. She told me she would talk to Dr. Walter and get back to me. She did, shortly, and said he wanted me to come in this afternoon. JoAnne checked my vision and said I was doing well according to the numbers: 20/30. Again, I didn't even ask what the refraction was. I saw Dr. Walter, and sure enough, I have an area of loose epithelium on the left eye. Not as large as before, but large enough to be noticeable, he said. This is not what I wanted to hear, but at least now I know I have not been imagining this. I think he was a little surprized to see it. I think he now agrees that I have EBMD, as I have suspected all along. Prescribed Muro 128 drops four times a day, and Muro 128 ointment at bedtime, to try to get the loose epithelium to stick back down. He doesn't want to debride just yet. OK by me. The good news is that the flap edges are still looking good, with no signs of epithelial ingrowth. Right eye looks good, too, except for some dryness. I am to continue the artificial tears every hour in both eyes. I will see Dr. Walter again at the October 29th appointment.
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October 19, 1999 I "think" I see a little improvement today. I have a digital thermometer in my office, on the wall beside a window. Yesterday, I could barely make out the numbers, but today they seem quite a bit clearer. Still quite a lot of ghosting, bilaterally. Both eyes show a little ghosting when reading close up and computer distance. Right eye (close-up) shows quite a lot with road signs and images in the distance. Left eye (distance) shows just a little with distance images. I am using the GenTeal Jel in the right eye, since it does seem to stay in the eye longer, to try to resolve the dryness Dr. Walter saw yesterday. |
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October 20, 1999 Vision seems even a little more improved today. Very subtle difference. Nothing drastic. Thermometer numbers perhaps a little clearer than yesterday. Ghosting perhaps a little better in the morning, but back to pretty much the same in the afternoon. Closeup for reading is good. I can see some very tiny letters, but there is still some ghosting. When I put in artificial tears, my distance vision becomes so crystal clear for a few seconds, just like before. The ghosting clears up and it is so amazing! |
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October 25, 1999 Each day brings a little something different--but oh!, such subtle differences. Left eye seems to be doing well; seems a little sharper than last week, but still a little ghosting for distance remains, more for closeup. Right eye is pretty good for close-up, but has considerable ghosting still for distance. I can "squint" it away, so I guess there's a chance there is still some astigmatism remaining in the right eye. Could be due to healing process, I suppose. Overall, though, I think there is improvement. Will post update and current refraction after my next visit with Dr. Walter on Friday. |
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October 29, 1999 The last few days have brought very subtle improvements for the most part. Went in for my 2 week follow-up today. First, JoAnne did a vision check, but no refraction today. Both eyes: 20/20. Left (distance) eye: 20/20. Right (close-up) eye: 20/20. YEA!!! We were so pleased, we did a "high five." Then, Dr. Walter came in. When he looked at my chart, he broke out in a wide grin, and said, "Wow. Look at that!" I think he was happy too ;-). Wow. This is just one reason that I am crazy about this place and these people! Still have fairly significant ghosting, most noticable in the right eye. Dr. Walter thinks this is probably due to the healing process, and will resolve with time, or could possibly be caused by some loose epithelial cells, which will, in all likelihood, also resolve with time and continued artificial tear use. More good news: no sign of the epithelial loosening on the left today. The Muro worked this time. Dr. Walter said both corneas looked perfect (I love to hear him say the word "perfect"), with no dryness or signs of loose epithelium, even with staining, and I could stop using the Muro and just continue the artificial tears. WHEW! Intraocular pressure still good. Next check-up is December 10, 1999. I will be very interested in what my refraction is at that visit. Plano, here we come! |
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November 11, 1999 Four weeks post-enhancement. Not much to report. Ghosting NO better--maybe even a little worse, especially noticable with text of all kinds: print, computer, and road signs. I can "make out" most things, but the distortion caused by the ghosting certainly diminishes vision quality. 20/20 vision with ghosts is not 20/20 vision, I'm afraid. Close-up vision seems to have actually deteriorated a little in the last few days--due to ghosting. Distance vision in left eye still very good. Slight ghosting still evident, but not enough to be bothersome. Four more weeks until my next follow-up. I will get a refraction then, and I'll see if there is still astigmatism, and if so, what options there are. I will need glasses for driving at night if this continues, because even lights have ghosts, in addition to slight starbursts. The starbursts are not bad enough to be a problem by themselves. Still using artificial tears several times a day. Eyes have been scratchy for the last several days, as well, presumably due to allergies. |
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November 16, 1999 This morning, when I woke up, both eyelids were "stuck" to my corneas, and I had some discomfort for about 30 minutes. Could be that ol' EBMD is flaring up again. |
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November 18, 1999 This morning, my right eyelid only was "stuck" with the same discomfort for about 30-45 minutes afterward. Also, my left (distance) eye was showing some increased ghosting (not starbursts--they are minimal in this eye) with lights and text. I emailed Dr. Walter with this information. I won't do anything until he tells me to. I feel confident that he'll tell me to start back on the Muro, though. |
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November 20, 1999 Recieved email from Dr. Walter. He said it sounds like I am having some "symptoms of small recurrent erosion," and to start on the Muro drops and ointment again. I agree. |
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December 1, 1999 Continuing to use the Muro drops and ointment. No discernable improvement in vision. In fact, vision is maybe less sharp in left, and still so much ghosting in right that it is impossible to tell. Ghosting on right is actually 3 images when I look through only that eye. Road signs are not clear due to ghost effect. Nighttime driving is no fun, either. Starbursts are not so terribly bad, but car taillights and peripheral landscape lighting and road signs have ghosting, which is disorienting. |
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December 10, 1999 Follow-up with Dr. Walter today. Ghosting and multiple images in right eye remain and are unchanged. Refraction left eye: plano with no astigmatism. Refraction right eye: -2.50 with no astigmatism. Hooray!! Astigmatism is gone. Dr. Walter isn't sure why the ghosting is so pronounced. He doesn't think it's due to the residual Rx, and still thinks it will improve with time. I am puzzled as to why my post-enhancement sphere measurement is the same as it was pre-enhancement. Snellen on left: 20/15-1; right: 20/200; both: 20/20. Overall, a good report, if you discount the ghosting. Re: RCE. Dr. Walter told me I didn't have to continue the Muro drops, but it would be necessary to continue the ointment for a minimum of 3 months, and preferably 6 months to avoid any repeat "sticking" of the eyelids to my corneas. He explained that every time I had the "sticking" I was set back to ground zero as far as healing was concerned. In order for the anchor cells to grow down though the epithelium and into Bowman's layer, any trauma such as this must be avoided. So, I will use the ointment, but I'm sure glad I can stop the drops--they burn so badly! |
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December 27, 1999 Continuing to use the Muro ointment. No recurrence of RCE since going back on the Muro. May be my imagination, and may be transient, but computer vision seems a little better today, as was the drive home from work. Didn't have to squint quite as hard to clear distance vision up. |
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January 1, 2000 Coming home from a New Year's Eve gathering at about 1:00 am, and having been up for about 20 hours, I noticed marked improvement in my night-time vision. Minimal starbursts, glaring, and very little ghosting on street signs, etc. Everything seemed very clear and sharp. However, after waking up after about 6 hours sleep, my vision had returned to what is now "normal," meaning ghosting. Started HRT (hormone replacement therapy) today. I've read that there could be a relationship between HRT and changes in corneal curvature. There seems to be some thought that the hormones can cause some hyperopia. Dr. Walter tells me he has never seen this happen in his practice, but had advised me to postpone starting the PremPro until my vision had stabilized, just to be on the safe side. He gave me the go ahead a couple of weeks ago. Other word-of-mouth physician sources also deny any experience with vision changes caused by HRT. |
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January 3, 2000 Oh, no!! Vision definitely worse today. Since I'm off from work, I slept later than usual, and woke with increased ghosting and blurriness. I'm wondering if the good vision of early morning on the 1st, after little sleep, and the worse vision this morning, after lots of sleep, have anything to do with each other. For example, could the theory that the weight of eyelids during sleep be relevant here? Scenario: After being awake for 20 hours, my corneas had resumed their normal curvature, resulting in good vision. And, after more sleep, my corneas were flatter--resulting in hyperopia, thus the poorer vision. By evening vision had improved some, but was not back to what I had been seeing. I think I'll experiment with my sleep theory. Or, it could be the hormones. |
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January 16, 2000 Vision is somewhat better than my last post, with no recurrence of this type of incident. I still have the ghosting in both eyes, though it seems to be fading slightly and the extra images seem to be drawing closer to the main image. The only way I can describe the effect on distance vision is to imagine what heat waves look like without the waviness. It's that type of blurriness. Overall I'm happy with my results. I'm pretty sure the deficit that I do notice is due to monovision. Since I want the monovision to last as long as possible, in case another treatment for presbyopia becomes available, I will probably keep this level of undercorrection on the right. |
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February 13, 2000 Not a lot has been happening for the last few weeks. Vision is virtually unchanged. Still very good vision in left eye, with the very slight ghosting in that eye having faded some, and continued ghosting in the right with no real change. Two days ago, when I put some Refresh Plus drops in, I noticed for the first time (I'm sure this is not new--I've just not zeroed in on it before) that the ghosting was almost gone in the right eye. Instead of 3 images, there was the one main image and a very faint second image, which was very close to the main image. I'm wondering if my eyes are dry, and if this is causing the ghosting. Dr. Walter has told me my corneas are not dry, but now I wonder if I am producing enough tears. I intend to ask him about this when I see him again in March. Yesterday was a breakthrough of sorts. For the first time, I went several hours in the morning when I didn't think about my vision or the ghosting. Either it was better for a while, or I'm just getting used to it. We'll see if it happens again. |
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February 22, 2000 The last week has been full of ups and downs. I decided to use lots of artificial tears to see if I could detect any overall improvement in the ghosting. At times I thought I could (might have been wishful thinking), and then again, there didn't seem to be any difference. Then, after several days, I definitely noticed less pronounced halos around reflective road signs in the dark. Actually I guess it's more like the signs are "glowing" rather than halos, and I've determined that the ghosting in the right eye causes this "glow." This past weekend, my vision seemed sharper than it had been, but that's gone now. I can still see well, and my distance vision is as good or better than I could be corrected with glasses, so I hope these are normal fluctuations. Am I whining? Not really. Just being human, I guess. And so paranoid about the RCE. |
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February 24, 2000 Uh oh! Yesterday, when I first opened my eyes in the morning, my left eyelid definitely "stuck" to my cornea. I had noticed a couple of mornings prior to this that my eyes felt drier (despite using a humidifier right beside my bed and drops several times a day), but this was different. And my left eye was painful for a while, just like when it happened before. I've used the Muro 128 ointment every night without fail, and just plunked down $18 for a new tube a few days ago. Yesterday morning and this morning, the "glow" on the reflective road signs was more pronounced than it had been for a few days. The eyelid sticking is not a good sign, and I suppose it indicates that I'm back at day one in the left eye again. And I've been using the Muro a little more than 3 months this time. Drats!!! I think I'll email Dr. Walter to see if he thinks I should go back on the Muro 128 drops. (Yuck!) I wonder if I'll eventually have to have a debridment to get back to new epithelium in order to stop this cycle. I had no recurrence after the first debridement until I was enhanced. Another complicating factor is my allergies. I'm going to have to start the Claritin back soon. Just a few warm days and being outside for a few minutes has stirred up my allergies for the Spring. I plan to start gardening this weekend, weather permitting, so it'll be time for the Claritin, and the extra drying that goes along with it. Wonderful. |
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February 26, 2000 I did email Dr. Walter and I got an answer back this morning. He told me to go back on the Muro 128 drops (waaaaaaaa!). He said it looks like that epithelium just doesn't want to stick back down. He said that if it keeps happening, we'll have to talk about him doing another procedure called a "stromal micropunture" to "spot weld" the epithelium back down where it belongs. Lovely. In the words of The Grateful Dead, "What a long, strange trip it's been." |
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March 20, 2000 Check up with Dr. Walter. Corneas look good--no signs of loose epithelium. Wants me to continue the Muro 128 drops and ointment. I'm having lots of itching and scratchiness which Dr. Walter thinks its coming from my allergies. Gave me a prescription for Patanol drops. Follow-up in 3 months. Visual acuity: Left eye (distance) 20/20+2, Right eye (close-up) 20/100 and reading 20/25. This was a morning visit, and I feel I'm a little farsighted in the morning for a few hours. I can usually read on a 20/20 level for closeup. Next appointment is an afternoon one again, so I'll have a better comparison then. Still having the same amount of ghosting--no change there. Not much else to report now. |
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June 15, 2000 Ghosting continues. And, although I've only missed one night of Muro 128 ointment, I've had three episodes of epithelial "sticking" since I last saw Dr. Walter. May just be something I will have to learn to live with. Will see Dr. Walter on June 28 for follow-up. |
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June 28, 2000 Saw Dr. Walter today. Said corneas are perfect, with no defects whatsoever. Both eyes: 20/20, left eye: 20/20 (couple of letters on 20/15 line, too) and right eye: 20/100 for distance and 20/20 close up. Right eye refraction is now -1.75. I could tell it had gotten better. Dr. Walter said that since I don't have any ghosting while reading close-up, that he feels the right eye ghosting for distance is related to my monovision (and associated residual presription). He also said I could miss some nights of Muro 128 ointment and it probably won't hurt me (big grin from me!!). Next follow-up: November 8, 2000. |
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January 27, 2001 Interesting happening. For about a month now, I've been having recurrent vertigo, probably caused by environmental allergies. I've been on Allegra and Nasonex nasal spray since 1/17/01. Last Monday, January 22, I had a severe attack, which caused me to go to the local ER for treatment. I received an IV dose of droperidol to stop the nausea/vomiting, and was sent home with 2 Ativan to help me sleep. Saw my MD on Wednesday, 1/24/01, at which time I got an injection of Decadron/triamcinolone to "dry up" my sinuses and inner/middle ears, and was started on a Z-Pak. Was in bed with eyes closed from Monday until Wednesday, up a little on Thursday, and almost all day on Friday. This is when I noticed my vision had deteriorated. I'm wondering if the steroid had/has anything to do with this. If there's no improvement by tomorrow evening, I'll email Dr. Walter for his take on it. |
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February 3, 2001 Whatever the cause, vision seems to be back to normal. Whew!! |
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February 19, 2001 Another vertigo attack a week ago. I've been tentatively diagnosed with Meniere's Disease, or idiopathic endolymphatic hydrops. Have noticed that vision has changed again. As in, close-up eye is seeing better at a distance, and close-up vision is not as clear as it was prior to this. Current treatment is a diuretic and low salt diet. Could be dehydrated, which is affecting cornea? Will keep a check on it. |
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February 28, 2001 Vision fluctuating wildly from day to day. Sometimes distance is super-sharp, sometimes not good at all. Close-up still not back to normal. |
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March 20, 2001 I stopped taking Allegra. Vision improved almost immediately, and is back to normal. Whew! |
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May 9, 2001 Saw Dr. Walter today. Vision both eyes: 20/20; distance eye: 20/20; close-up reading: 20/20; close-up distance: 20/80. Intraocular pressure normal in both eyes. No evidence of loose epithelium or wrinkles. For the time being, I will continue the Muro 128 ointment since I had a "sticking" episode in March. Maybe forever. Next follow-up with Dr. Walter in one year. |
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May 15, 2002 Had annual eye exam today. Vision both eyes: 20/15-2; distance eye: 20/20; close-up reading: 20/20; close-up distance: 20/80. Everything checked out perfect. I have only the occasional "sticking" episode now. Next follow-up with Dr. Walter in one year. |
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June 3, 2003 Had annual eye exam today. Vision essentially unchanged. Everything checked out perfect. I have had more of the "sticking" episodes this past year. Next follow-up with Dr. Walter in one year. |
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