Can residualastigmatism improve 6 weeks after Epi-LASEK?

[Mktdf]

Toric IOL implanted Mar 19 & 22. Left eye started at 6.0 diopters...right at 7.50 of astigmatism. Epi-Lasek May 4.  Residual astigmatism left eye .5.  Right eye 1.5.  Distance vision is not good.  Can right eye improve still?

[Bsj74]

5 months later.  Left eye .25 astigmatism, right eye .75 so further improvement was made.  Distance  vision at 20/30.  Using 1.5 over the counter readers and no lenses for driving.  Had to be patient.

[JohnHaganMD]

glad you've done well

[NightHawkGuy]

I also had cataract surgery (about 6months ago) with a monofocal toric IOL but only in my right eye since my left eye won't need surgery probably for several more years.   I had about 3D cylinder astigmatism in my right eye and from optometrist eye exam refractions I have about 1D residual astigmatism but the power ended up very close to PLANO for distance focus.  

I'm getting about 20/25 uncorrection distance vision most days, varies at times maybe between 20/20 and 20/30.  Of course I would have liked to have gotten that astigmatism down closer to zero, but I expected due to all the variations in individual cornea healing, etc. that a perfect result was not realistic.  But considering how poor the vision was before the surgery, I think this was a very good result.

I still need glasses anyway since my left eye needs correction for about 2D astigmatism and the very small Rx for my right eye gets it to 20/20 at the same time.  When the time comes for my left eye to need cataract surgery, I will hope it can get closer to a perfect result but I won't expect that.  Best expectation would be able to be glasses free around the house for casual things, but expect glasses for best vision for driving, reading, etc.

If someone didn't have a cataract that affected the eye's vision significantly, I wouldn't recommend lens replacement surgery just for trying to be glasses free.

[John C Hagan III, MD, FACS, FAAO]

Good advice. thanks for adding your experience.

[John C Hagan III, MD, FACS, FAAO]

That is amazing result given how much you started with.  It's possible the 1.5 D residual astigmatism might continue to recede but likely not to the level of the LE.  Glasses should correct the residual astigmatism.

[Mktdf]

I sincerely appreciate your response.  I had been told I would need glasses for reading but not for distance.  To end with glasses after this financial, and time, investment would be disappointing.

[John C Hagan III, MD, FACS, FAAO]

You have clearly misunderstood what can and cannot be "promised"   Using the most advanced equipment possible it is not possible to 100% of the time end up with the desired post operative uncorrected refractive target. No one can do it all the time. Moreover the more myopia, the more farsighted, the more astigmatism a person has the success rate falls rapidly.  With 6 and 7.5  diopters of corneal astimatism your cornea is 3-4 standard deviations from what we are usually dealing with (less than 2.5 diopters of astigmatism).  To expect to end up with post operative refractive error for distance of 0.00  is highly unrealistic.   I do a lot of 2nd opinions and consultations. I just saw a person that had spent $7500/eye (total of $15,000 out of pocket) in the belief he would not have to wear glasses for anything.   He can see great with glasses that have very mild prescription but he's a 'glasses hater" and is unwilling to wear glasses when he wants to see his best.  Moreover he had a copy of the consent he signed and it clearly says that there is no guarentee that he will not need glasses for some things for best vision.   You set yourself up to be disappointed because your eye was so lopsided that even a good result has disappointed you.

[John C Hagan III, MD, FACS, FAAO]

Anyone and everyone that reads this: THERE ARE NO GUARANTEES WITH ANY TYPE OF SURGERY. THAT'S WHY YOU SIGN A CONSENT FORM THAT ACKNOWLEDGES THE RISKS THAT ARE ALWAYS PRESENT. NO SURGEON ANYWHERE, EVEN THE BEST IN THE WORLD CAN PREDICT THE POST OPERATIVE RESULT 100% OF THE TIME.  SURGERY ALWAYS, ALWAYS, ALWAYS INVOLVES SOME RISK JUST LIKE DRIVING YOUR AUTOMOBILE OR FLYING IN AN AIRPLANE.

[Mktdf]

Thank you, Doctor, for your clear and direct second reply.

[Mktdf]

Dr. Hagan,. I have great respect for your qualifications and years of experience.  I feel compelled to share that my original goal/expectation was to have cataracts removed and receive a new script for glasses.  I was presented an option to have vision that was better than I ever had.  I carefully asked if the the amount of astigmatism in both eyes might not make my eyes too big a challenge and was repeatedly assured that I would need reading glasses only.   That said, what I have learned from you has been helpful if not desired.   Thank you.

[John C Hagan III, MD, FACS, FAAO]

You are welcome.  I will point out that there is often a significant discrepancy between what the physician says and what the patient hears or remembers. This has been documented many times including at the Mayo Clinic where they tape recorded "informed consent" discussions with patients then after surgery systemically questioned patients on what they remember being told.  Over half the patients don't remember being told important risks such as infection, bleeding, death, cardiac arrest. Some even denied it when they listened to the surgeon talking to them on tape.  There are many reasons why this happens: forgetting, not understanding medical terms, 'cognitive dissonance" which means we tune out things we don't want to happen or that make it more difficult for us to have surgery or treatments, physicians with more communicative skills.   Also a big disconnect  physician says "this is what usually happens" patient hears "this is what will happen"  e.g.  "After surgery most people see much better and many are able to do without glasses for many things:  patient perceives "After surgery I will see much better than I have ever seen and not have to wear glasses".     That being said there are surgeons that paint rosy pictures for everyone to enhance their surgical schedules. We have several in our area.  Best of luck.