I need post-lasik corrective lenses, but why can't I find the right ones?

[lunawa]

Hi, I had lasik 8 years ago, with mixed results. My vision improved but I'm still suffering from dry eyes. Less than a year after the surgery, my eyes started to strain, grow tired, and I noticed deep furrowing. I know it's not uncommon to wear corrective lenses later down the line, but I didn't think it would be this soon. In any case, I went for an exam and got some glasses--they didn't help. For the first week or so, with only moderate wearing, they provided much relief to my eyes, but thereafter, the lenses triggered some optic nerve(s) that heavily strained and tired my eyes, making furrowing more common and pronounced. Long story short, I've been to four optometrists and one opthamologist over the past six years and the matter hasn't been resolved. I've tried all sorts of lenses (single vision, progressives, even ones with prisms for reading), but nothing's helped. I've more or less stopped wearing glasses (but I know I need them) and can only wear them for a few minutes to "recalibrate" my vision and provide some momentary relief. (Also, not sure what this could mean, but without glasses, my eyes have a tendency to want to gravitate to the bridge of my nose, like they want to cross.) Any idea what could be going on that the numerous eye exams aren't revealing? Are there other tests that could pinpoint the problem?

Thanks for your feedback.

[JohnHaganMD]

Need some information:  1. What is your age.  2.  Please write out the most recent glasses prescription you were given.

[lunawa]

I'm 44, and my last exam was only six weeks ago. I ordered progressives from that visit:

OD: sphere (+0.25), cylinder (DS), axis (-), add (+1.00)

OS: sphere (+1.00), cylinder (-0.50), axis (070), add (+1.00)

[JohnHaganMD]

Your problem is not unusual at all.  FIRST: when you had lasik it should have been explained to you that that would not keep you out of glasses the rest of your life.  Even if you had no post lasik refractive error 0.00 RE and LE some time between age 40 and 44 you would predictably have trouble with reading and near tasks just like people that never needed glasses when younger. More over as you got older you near vision would get much worse, need stronger reading glasses (that is why at the store they are on a verticle shelf starting with +1.00 and going to +3.25.   At some point you would have trouble with intermediate distances (computer and shelves while shoping) and need a different pair for that distance.  still later (60-75) you would have trouble with distances like 10-15 feet.  

Now if you don't wear glasses your eyes have to work extra hard at near (use 90+%) of total focus power.  To be comfortable should not use more than 50%.   So taking glasses off and on does not work well for your problem.  When you get your next pair of progressives you should just put them on and wear them all the time. It may take 1-3 weeks to get use to using them and your eye muscle to relax and let the glasses do the work. You will notice your near vision without glasses will be worse, that's because your eye muscle doesn't want to work at 90% again.  The glasses don't make your eyes weak, aging does.

The treatment of dry eye which sometimes follows LASIK and also gets ore common as we get older, especially in women, has been outlined here many times and I will not go into at length.

[lunawa]

I appreciate your response. So you see nothing wrong with the prescription and that it's just a matter of forcing my eyes to adapt to these progressives?If, as you advise, I wear them all the time over the course of 1-3 weeks to adapt, do you foresee my eyes muscles relaxing and a reduction in these strained, intense furrowing? Thanks again!

[JohnHaganMD]

You MUST understand I have no idea if that is the right glasses prescription for you. It's like showing me a pair of shoes and asking me if they will fit your feet and I have no idea nor measured your foot size.

[JohnHaganMD]

If you still have the glasses RX from what you are wearing and from previous exams they should be similar.  That is not an usual or difficult to adjust to glasses RX.