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 Problems After Laser Vision

Correction

Complications, solutions, prevention...

Dayton, Ohio

     Fortunately, problems or complications after laser vision correction tend to be infrequent.  But if you are that one person in 1000 or 10,000 having a problem, the incidence for you personally is 100%.  Some problems do get better over time even without any treatment.  But for those few patients who are experiencing persistent problems or complications, you may be looking for new or better solutions. Choosing the right surgeon with the latest technology can go a long ways towards preventing many of the problems listed here.  Some people are simply not good candidates for any refractive surgery, and many more complications can be prevented by not having surgery if you are not a good candidate.  It is important to realize that laser eye surgery involves some compromises in exchange for the freedom and convenience of not having to wear glasses or contacts.  Our advice, expect to see well, but don't expect to see perfect.  Not everyone ends up 20/20, but most are happy with the improvement they achieve.

     Dry eyes is the most common minor complaint that most people experience after laser eye surgery or laser vision correction.  Of the two types of laser vision correction, LASIK tends to have more dry eyes afterwards than PRK.  Most doctors will have you use artificial tears drops for the first few weeks and months until your eyes natural moisture returns to normal.  Many people also find it helpful to take Flax seed oil--one or two capsules taken by mouth per day. Many health food stores and pharmacies carry Flax seed oil obtainable without a prescription.  In more severe cases, your doctor can put microscopic tear plugs in the tears drains to keep your tears around longer.  If you live in a dry or cold climate, you may find it helpful to use a humidifier.  Those more at risk for problems with dry eyes include patients with arthritis, thyroid problems, dry eyes before surgery, postmenopausal women, and those taking medications that tend to dry the eyes (e.g. antihistamines, antidepressants, etc.).

      Undercorrections and overcorrections are not really complications, but are part of doing laser vision correction.  Depending on your prescription, age, and amount of astigmatism you have from 2% to 20% chance of needing to have an enhancement or second procedure to fine tune your results.   If you did well with your first surgery, that speaks well for you doing well with an enhancement.  But there are some risks even with enhancements, thus if you are seeing "pretty well", you may not want to have anything further done.   

   Night glare, or rings and halos around lights are very common the first few weeks after surgery from swelling.  Some patients can experience more prolonged difficulty with night vision. This usually occurs when the pupil becomes larger than the laser treatment zone, or if there is some refractive error left over.   Some doctors will prescribe a medicine called Alphagan to help with night vision.  Alphagan is actually a glaucoma medicine, and coincidentally has the side effect of preventing the pupil from dilating past 4 to 5 millimeters.  Most night vision problems do improve over time.  Many times this problem can be prevented by measuring your pupil size before surgery and using a laser treatment that is as large or larger than your pupil size.  There are older generations of lasers that can not perform larger zone treatments, and these should be avoided.  People more at risk for prolonged night vision difficulties include those who have never worn contacts, have larger pupils, have thinner corneas, or are on medications that cause pupil dilation (some antihistamines and antidepressants).  Also see correcting vision problems below.

    Halos and ghosts can have several causes including irregular healing of the cornea, flap wrinkles, central islands, excessive healing, or astigmatism.  The solution is directed at the particular problem and may involve relifting and smoothing the flap, possibly with some further laser treatment.  The best prevention for this problem is to choose an experienced and skilled surgeon; often times these problems can be prevented before they happen.  If your having problems with this and not getting answers from your surgeon, you might want to seek a second opinion from another respected LASIK surgeon in your area. Also see correcting vision problems below.

    Irregular corneas can result from problems with creating a LASIK flap, irregular or off centered laser treatments, or inconsistent healing after surgery.  This problem can cause all of the symptoms mentioned above including poor night vision, halos, ghosts, and glare.  Until just recently, doctors had few tools to combat this problem.  Just recently the FDA has approved Alcon's LadarVision laser for a new variety of laser vision correction known as wavefront treatments or CustomCornea treatments.  This holds the potential to smooth or reshape these irregularities and offer patients improvement in their vision.  Also see correcting vision problems below.

   Correcting vision problems with wavefront treatments.  Recently the FDA approved an exciting technology called wavefront CustomCornea by Alcon.  Wavefront treatments measure the eye at over 200 different points and create a customized map of the distortions of your eye.  Until just recently, doctors were limited to measuring only simple lower order aberrations/distortions of the eye such as nearsightedness, farsightedness, and astigmatism.  Now they can not only measure more than a dozen, and more exciting they can treat them as well.  Currently this is approved for patients having LASIK for the first time, but is still considered an off-label use (not yet approved) for patients with prior refractive surgery.  Some patients seeking a retreatment will benefit by waiting for further refinement in CustomCornea treatment algorithms before proceeding.  Seek an opinion from a respected surgeon for the best advice.