Any eye doctors?

[gottimd]

I got Lasik surgery about 2 years back and my vision was great, but it seems that recently, in certain lighting situations, my vision is getting worse.

My wife and I were at a dinner party recently, and she noticed that my pupils are much different in size than others. Could this be the source of the problem? I think when it is darker in the room, I guess my eyes struggle more and the pupils are much larger, and the opposite in lighter room situations.

I don't know if I should be concerned or not, or if my vision is failing slowly. I was hoping to check out here to get a serious opinion, before making an actual appointment with an eye doctor, just to make sure I am not crazy.

[Eaglesfan27]

I'm sure you know that it is normal for your pupils to dilate and become larger in darker situations. That being said, I'd recommend that you go back for a check-up with the doctor who did your surgery.

[gottimd]

Originally Posted by Eaglesfan27

I'm sure you know that it is normal for your pupils to dilate and become larger in darker situations. That being said, I'd recommend that you go back for a check-up with the doctor who did your surgery.

I know that, but is there a medical condition I should be aware of with symptoms of the pupils dilating way too much or way too little?

[Eaglesfan27]

Originally Posted by gottimd

I know that, but is there a medical condition I should be aware of with symptoms of the pupils dilating way too much or way too little?

Sure, there are quite a few - Neurosyphilis being among them (not that I'm trying to scare you.) However, it's hard to say which one you have (if any) without actually examining you. I think it would be a good idea to follow-up with your doc.


As an aside, I strongly considered going into opthamology. Besides peds and child psychiatry it was by far my favorite rotation/subject in 3rd/4th years of medical school. However, opthamology is a VERY oversaturated field in most parts of the country (particularly along both the East and West Coasts.)

[Ksyrup]

My brother is an opthamologist and is running his own clinic at Ft. Sill for the next 4 years until his term with the Army ends.

[Dutch]

I still on the fence about eye-surgery (although I would get the PRK version instead of the LASIK), and stories like this are what concern me about the long-term affects of the process.

[SFL Cat]

Originally Posted by Dutch

I still on the fence about eye-surgery (although I would get the PRK version instead of the LASIK), and stories like this are what concern me about the long-term affects of the process.

I tend to agree with you. There's just something about mixing cutting lasers and eyeballs that make me feel very uncomfortable.

[gottimd]

Originally Posted by Dutch

I still on the fence about eye-surgery (although I would get the PRK version instead of the LASIK), and stories like this are what concern me about the long-term affects of the process.

My vision is still better than it was. The thing that concerns me is that if its midday, I can see 20/20 fine, but once the sun starts to set, its weird how my vision gets a little worse. I get worried that something is going wrong with my vision, not in regards to the Lasik surgery, but some sort of disease that is blurring it at certain times. Figured I'd ask here before I make an appointment to get a quick answer or some possibilities so I don't go into the appointment blind.

[Raiders Army]

Originally Posted by Dutch

I still on the fence about eye-surgery (although I would get the PRK version instead of the LASIK), and stories like this are what concern me about the long-term affects of the process.

In darkened situations it's the same with me. At night driving it's like I'm wearing sunglasses. About a year and a half after getting LASEK and I'm still not used to it. That being said, I wouldn't trade it for anything.

[mtolson]

Gotti:

What was the major factor that led you to electing to have the surgery ? I could greatly benefit from having it but have been on the fence for fear that if something were to go wrong I could end up losing my vision. I just can't seem to get past that. I know there are risks with any type of surgery but for whatever reason eye surgery seems to cause me the most consternation.

[Coffee Warlord]

3 years almost to the day now. No problems.

[Grammaticus]

Yeah, you need to go see your eye doctor. The sooner the better.

[finkenst]

i'm going to get lasek next year i think.

[gottimd]

Originally Posted by mtolson

Gotti:

What was the major factor that led you to electing to have the surgery ? I could greatly benefit from having it but have been on the fence for fear that if something were to go wrong I could end up losing my vision. I just can't seem to get past that. I know there are risks with any type of surgery but for whatever reason eye surgery seems to cause me the most consternation.

The major factor? Well I couldn't stand wearing glasses, I was too lazy to jam contacts in and out of my eyes, especially after drinking (which is quite often). The surgery is nothing if you have some threshold for pain, and I mean a little threshold for pain. Think of the scene from Clockwork Orange. Anyways its not what has happened, but what will happen that worries me. I am afraid to lose my sight.

[Raiders Army]

Seems as if it's getting better:

Oct. 10, 2006 -- The widely held belief that wearing contact lenses is safer than having laser surgery for vision correction is being challenged.

A leading eye doctor says contact lens users are actually more likely to develop complications that lead to vision loss over time than patients who have LASIK surgery.

Based on their review of several large studies, ophthalmologist William Mathers, MD, and colleagues concluded that daily contact lens wearers have about a one in 100 chance of developing a serious lens-related eye infection over 30 years of use, and a one in 2,000 chance of suffering significant vision loss as a result.

The researchers calculated the risk of significant vision loss due to LASIK surgery to be closer to one in 10,000 cases. They reported their findings in a letter published this month in the journal Archives of Ophthalmology.

"One shouldn't just assume that contacts are safer," Mathers tells WebMD. "This may have been true at one time, but for the average person this is certainly not the case anymore."

Direct Comparisons Difficult

Between 20 and 25 million people in the U.S. wear contact lenses; about a million Americans have laser surgery to correct vision problems each year.

Mathers is an eye surgeon who specializes in treating vision-threatening eye infections at the Oregon Health & Science University's Casey Eye Institute in Portland.

"Several times a year, I have patients who lose eyes from complications because they've been wearing contacts and they've gotten an infection," he says. "By this I mean their eye has to be physically removed from their bodies."

Direct comparisons of the risks vs. benefits of contacts and laser surgery have been difficult because surgical complications are immediate and the risks associated with contact lenses accumulate over many years.

The risks associated with long-term use of contact lenses are greater when lenses are used improperly, but they remain even when wearers do everything right, Mathers says.

"Almost everyone who wears contact lenses violates some principle of proper use at some point," he says. "Either they don't wash their hands before putting them in or they use tap water [to store the lenses]. But infections can occur even when this doesn't happen."

Los Angeles ophthalmologist Kim Salz tells WebMD that sleeping in contacts dramatically increases the risk of infection.

"Out of 10,000 daily contact lens wearers, about one will develop a serious infection over the course of a year," he says, adding that risk increases to one in 1,000 for wearers who sleep in their contacts.

"We advise patients to never sleep in contacts, even if the contacts are approved for this purpose," he says.

Customized Surgery

Salz has been performing LASIK surgeries for the past 15 years. He says better lasers and better training have reduced the incidence of nighttime vision problems and other complications that were not uncommon years ago.

One big advance, he says, was the introduction of wavefront LASIK several years ago, which allows eye surgeons to customize the procedure for each eye.

A professor of ophthalmology at the University of Southern California, Salz says the risks of wearing contact lenses and having laser surgery are probably similar.

"In most cases the decision really comes down to patient preference," he says.

Mathers acknowledges that his risk estimates are "approximate and subject to change."

He adds that advances in both laser surgery and contact lens technology should make both approaches to vision correction even safer in years to come.

Bolded part me.

http://www.webmd.com/content/article/128/117072

[heybrad]

Just thought I'd bump this thread as my appointment for Wavefront Lasik is in about 2 hours.

[Marc Vaughan]

Originally Posted by finkenst

i'm going to get lasek next year i think.

Any idea what the maximum prescription they'll treat in America is*? - I'm pretty much blind without eyesight correction (birth defect, 13.5 in one eye around 13 in another) and love the idea of one day being able to wake up and actually see things clearly without having to stumble to the bathroom and put in contact lenses ...

*In the UK they won't treat someone with a prescription as high as mine, however I've heard rumours that America will ...

[GrantDawg]

Originally Posted by Marc Vaughan

Any idea what the maximum prescription they'll treat in America is*? - I'm pretty much blind without eyesight correction (birth defect, 13.5 in one eye around 13 in another) and love the idea of one day being able to wake up and actually see things clearly without having to stumble to the bathroom and put in contact lenses ...

*In the UK they won't treat someone with a prescription as high as mine, however I've heard rumours that America will ...

From my wife (former optician's assitant): at worst they can correct you to a point you'll not need as much other correction. But she says they have gotten to point now that they can correct pretty much to 20/20 most people.

[Chubby]

Originally Posted by heybrad

Just thought I'd bump this thread as my appointment for Wavefront Lasik is in about 2 hours.

hey brad

[Kodos]

Me afraid of surgery on my eyes. I keep waiting indefinitely for them to improve techniques. I am deathly afraid of ever losing my sight. I think I would rather just be dead than have that happen...

[spleen1015]

This is something I have thought about doing.

How much does this typically cost?

[finketr]

Originally Posted by Kodos

Me afraid of surgery on my eyes. I keep waiting indefinitely for them to improve techniques. I am deathly afraid of ever losing my sight. I think I would rather just be dead than have that happen...

That's why i didn't get it done.. Giving one more shot to contact lenses regularly.. Acuvue advanced for astigmatism are pretty comfortable so we'll see.

Originally Posted by spleen1015

This is something I have thought about doing.

How much does this typically cost?

$3-4K seems to be the going rate around here for the latest technology, etc.

[wade moore]

Originally Posted by Marc Vaughan

Any idea what the maximum prescription they'll treat in America is*? - I'm pretty much blind without eyesight correction (birth defect, 13.5 in one eye around 13 in another) and love the idea of one day being able to wake up and actually see things clearly without having to stumble to the bathroom and put in contact lenses ...

*In the UK they won't treat someone with a prescription as high as mine, however I've heard rumours that America will ...

I don't know the exact numbers, but I know that my mother had VERY poor eyesight - couldn't function without vision correction and she now has 20/15 vision.

[Eaglesfan27]

Originally Posted by Kodos

Me afraid of surgery on my eyes. I keep waiting indefinitely for them to improve techniques. I am deathly afraid of ever losing my sight. I think I would rather just be dead than have that happen...

Me too. My grandfather went blind in part due to a botched eye surgery in the late 70's early 80's.

[SackAttack]

I'll keep my trusty glasses, thanks.

[Dutch]

Originally Posted by heybrad

Just thought I'd bump this thread as my appointment for Wavefront Lasik is in about 2 hours.

Good luck, I go for my first preliminary appointment later this month.

[Dutch]

Another bump and an update. I went in on Wed for PRK surgery at the U.S. Army's hospital at Landstuhl in Germany. Everything went pretty well.

I was going to give a detailed response to how the surgery went, but thought in the end it was too gross. So I deleted it.

In a nutshell,

WED -- surgery for PRK -- Didn't feel a thing. Immediately after surgery, I had SEVERE double vision for about an hour. I think it was from the band-aid contact being out of place. Lots of drugs, including the highlight for pre-op -- Valium.

WED & THU -- My eyes were uncomfortable for about two days, I had a hard time keeping my eyes open, but no pain. Heavy doses of eyedrops and painkillers probably helped.

FRI & SAT -- Blurred Vision, this is normal and due to part of my eyes healing. No discomfort. Have to remain on top of my drugs/drops, but down to a few different types of drops and only 800mg motrin are left (The Army & Air Force drug of choice btw).

SUNDAY morning update: Blurred Vision is still there, but much improved. I get these contact band-aids off on Tuesday. I just can't wait for the blurred vision to go away, then I should be home free.

From what I can tell and from what I read prior to the surgery, everything is normal. I'll let you know if I go blind, thankfully I can type without seeing.

[Dutch]

oh, and while I'm thinking of it, gottimd, any updates for us?

[Passacaglia]

Congrats, Dutch! I don't think I could do it -- I can't even handle trying to put a contact lens in my eye, and I'm horrible about eye drops, so lasik surgery doesn't seem like it's going to happen. It would be nice not to have to deal with glasses, though.

[Dutch]

Originally Posted by Passacaglia

Congrats, Dutch! I don't think I could do it -- I can't even handle trying to put a contact lens in my eye, and I'm horrible about eye drops, so lasik surgery doesn't seem like it's going to happen. It would be nice not to have to deal with glasses, though.

Thanks.

I've always been extremely sensitive to putting contacts in my eyes (and eye drops in my eyes for that matter), until I figured out that if you don't actually look straight at what you are doing it's not so bad. It definately goes a lot smoother if you look left, right, up, or down while shoving crap in your eye! The white part of your eye is about 100 times less-sensitive than the pupil is.

[Marc Vaughan]

Originally Posted by wade moore

I don't know the exact numbers, but I know that my mother had VERY poor eyesight - couldn't function without vision correction and she now has 20/15 vision.

I'm in that category (I can see approximately 4-5 inches without correction, beyond that distance is just a blur - a coloured blur (ie. I can with caution make my way around a known room) but thats about it).

I wear contacts and have done so since I was about 13 (my glasses were literally 1'' thick - hence my preference not to wear them ) ....

I both love and am terrified by the idea of eye surgery, on one hand I've always dreamt about being able to wake up and see without glasses/contacts - on the other hand I appreciate the fact that with correction my vision is 'ok' (its just good enough to be able to drive) and am wary of risking what I have.

PS - Does anyone know if you have to be 'awake' for the surgery - that would freak the heck out of me.

[Dutch]

I'm pretty sure you have to be awake, because you have to focus on a red dot. There really is no pain associated with it though and you take valium first so you are way braver pre-op than you are right now. And the area that the laser is focusing on is so minute and with today's technology, every time you even think about moving your eye (you won't), the laser reacts and "pauses" till you look back at the red dot.

I think the chances of coming away with worse vision is less than one in 1,000 surgeries. And the chance of ending up with 20/20 or better is like 95 out of 100. Or some crazy insane success rate.

Now, to be fair, I think people with really bad eyesight make up most of the non-success stories. It's all proportional. My eyesight was 20/200 which isn't too bad, but I've known some folks that are blind as a bad that can see perfectly now.

If you are far-sighted, you might not be eligible, and if you have a large acataracht, they may not want to do the surgery. They had to reshape my eye a bit, apparently since I was developing one. Cool!

[dbd1963]

I did Laser eye surgery of some kind five years ago. It was not as hard to do as you think going in. There isn't any discomfort during the surgery except the weirdness of having your eyes worked on. You don't see for most of it because of the way they peel back your lens to carve away what's under it. You just get a sense of light and nothing else. But it was not very traumatic, probably because of the medication. At least, I don't remember it very well.

I remember much better the next few days of eye discomfort. You can't see, and your eyes bother you. But a few days later, you CAN see, and you don't have to wear glasses anymore. My vision was pretty bad. They couldn't correct me to 20/20 but they got much closer than they thought they might. I'm at about 20/25 or so they said.

After 40 years of being blind as a bat, I was very glad to be able to see normally. I have a pair of glasses I can wear to get my vision to 20/20, but I hardly ever wear them. I would say the operation is worth it, so long as you know you have a good doctor.

[Dutch]

Just wanted to update this. I had blurred vision (and bad double-vision at night) for about 3 weeks continuing after surgery. The doctor took me off the steroid drops and within a couple of days things got better.

They continued to improve. Now, Just over two months have passed and my vision is probably 20/20 or better. I can't remember the last time I could see so well, actually, even with glasses!

So this was definately worth it.

[PilotMan]

Last year, Mrs PilotMan had PRK. Because of my travel and her homeschooling we decided to do one eye at a time. PRK was chosen because is safer and has less complications afterward. .Hher vision had only been correctable to 20/30 with glasses and they thought that was the best that they would be able to get. So if she had any problems then she would still need glasses. She also had severe halos at night and very poor depth. We also used the custom wavefront to maximize the surgery specifically for her.

Had both surgeries and she said it hurt quite a bit for a week. A lot of pain. But as her eyes healed the results were great. We are almost a year out and her eyes did correct all the way back to better than 20/20, and her night vision is normal now. All of her light sensitivity has returned to normal as well.

This has effectively changed her entire life. Worth every penny of the 3k it cost.

[gottimd]

Originally Posted by Dutch

oh, and while I'm thinking of it, gottimd, any updates for us?

No updates, vision is still the same. My wife keeps yelling at me to go back to the doctor and accuses me of not doing following up. I did go back to my scheduled follow ups, every single one of them up to 6 months proceeding the surgery and everything was fine. It wasn't until around the time I made that post (2 years ago then, now almost 4 years) and the problem remains. I don't know if it is from natural aging that my eyes are failing or if these types of Lasik surgeries "naturally undo" themselves after awhile.

One factor I think that doesn't help the case is that I am glued to a computer for my job and I am not sure if that is ruining my eyes as well. My day time vision continues to be great.

[gstelmack]

I remember reading not too long ago that in the debates over the safety of various eye surgery techniques (some push to require warning labels to more accurately lay out the risks involved), it was shown that eye surgery done by the military is about 10 times safer (1/10th the risk of major complications) than civilian surgery. No mention if this was because the subjects just tend to be healthier overall, or if the military simply has better / more careful surgeons, or if the civilian numbers are brought down by assembly-line operations that care more about doing as many surgeries as possible vs successful surgeries, but it was an interesting note.

[Sun Tzu]

My Wife had it done a few years back, by the same guy who does all the 49ers (qeue the 49er jokes now). Anyways, she hasn't had any problems and actually has slightly better than 20/20 vision. Her sight was awful before, and is great now. The best 4-5k we've ever spent.

[PilotMan]

Originally Posted by gstelmack

I remember reading not too long ago that in the debates over the safety of various eye surgery techniques (some push to require warning labels to more accurately lay out the risks involved), it was shown that eye surgery done by the military is about 10 times safer (1/10th the risk of major complications) than civilian surgery. No mention if this was because the subjects just tend to be healthier overall, or if the military simply has better / more careful surgeons, or if the civilian numbers are brought down by assembly-line operations that care more about doing as many surgeries as possible vs successful surgeries, but it was an interesting note.

The difference is that the military only does PRK surgeries. The lasik eye flap has many more complications than the PRK scrape method. The overall surgery is about the same other than that.