Problems after PTK/PRK surgery with eye prescription

[JoeyHyppia]

Hi, I know I’m grasping at straws but wondered if anyone had any advice.
I used to work as a business analyst, but I began getting light sensitivity & headaches, so had to give my job up. It transpired I had a corneal scar on my left eye, hence in the Autumn of 2016, I had PTK surgery followed 2 months later by PRK surgery. A few months later, the light sensitivity cleared, hooray! My surgeon said now the cornea has healed, I can go to a regular opticians & get some glasses for both distance & VDU work. I got glasses from Specsavers Easter 17, and though the vision is perfectly fine, I am getting headaches when I wear glasses. I tried two types of standard prescription, also tried varifocals, soft toric lenses, but the headaches continue. And trust me, I persevered with them. And I couldn’t understand the headaches as like I say, the vision with the glasses is fine. I went back to my surgeon in Harley Street who said the problem now is that there is too much of a difference in prescription between my left and right eye. (Left eye I had surgery is +1 distance,+2.25 reading, my right eye is -1.75 distance, -0.25 reading. My surgeon suggested one day acuvue moist of -2 prescription in just right eye to bring them in line. This certainly seemed to do the job for long distance, so this was positive. However, my right was very good at short distance, so by wearing the contact lens, I am effectively losing the short distance. The surgeon said now the eyes are more in line, all I need is reading/VDU glasses. However, I have tried 3 different opticians, and I still get headaches when I wear the reading glasses.
I have now spent a small fortune on surgery and various pairs of glasses, but I’m now at my wits end. All I want is to get back to work working at a PC. The surgeon says the next step is to get standard LASIK surgery on my right eye, but do I really want to spend a couple of grand to effectively lose the close vision in my right eye, and I’m not totally guaranteed it will eradicate the headaches.
Any advice? ...I feel like there must be a simple answer, but I have seen various eye professionals in the last few years, but alas I am still unable to return to work. Like I say, I’m now at my wits end!

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

I am at a loss why you had PTK on your LE. Presumably it was also myopic like your RE before the surgery.  Why would they change it from myopic to farsighted (+1.00 or hyperopic) since you lose your near vision and you create the wildly unbalanced glasses RX you have now (aneisometrophia) and they should have told you that you most likely would not be able to wear glasses comfortably  (+1.00 and -1.75 are wildly unbalanced).  This should have been done before you spent all that money.  Given that RX the headache is not hard to explain.  If you have lasik on the RE then your glasses RX is  plano  RE  +1.00 LE   If you are over 40 you will need progressive bifocals and you still might have trouble using the eyes together.  You may need to see a different Harley street cornea/refractive surgery.  What is your age?   Why had not previous eye doctors told you you had scar on the LE?

[JoeyHyppia]

Good morning,
Many thanks for the message, that helps, I didn’t even know there was a formal name for my eye imbalance issue, so that certainly helps to fill in some blanks.
I’m 46, and have worked in front of a computer screen all my adult life. In 2012 when I was 40 I began to experience headaches/migraines & light sensitivity, and I always felt my eye was the problem. In the following 2 years, I went to 4 separate opticians, my GP, a neurologist, and not one of them mentioned the corneal scar on my left eye. It was only late 2014 that I decided to explore eye laser surgery, I was informed of the corneal scar.  The NHS tried various things but no joy. Hence my visit to Harley St, the purpose of the PTK & PRK procedures were not with regard to vision correctness, but the removal of the scar. I believe the corneal scar was distorting light entering the cornea, hence the light sensitivity, hence the headaches. The PTK I believe removed the scar, the PRK effectively finished the job by smoothing the whole surface of the cornea. So like I say, the surgeries proved effective in resolving my light sensitivity, but I certainly wish they had informed me beforehand of the potential eye imbalance issue. The surgery appears to have resolved one type of headache, but caused a different type of headache!
I hope that helps answer your questions. I’m Just curious, but when you say that if I decided to go ahead with LASIK on the right eye, why do you suspect I might still have trouble using the eyes together? In theory, as this resolves the eye imbalance issue, would I not then be able to wear the glasses without headaches?
I do hope I’m making sense. Also, just to confuse the issue, I also have a bit of astigmatism. The best recent prescription I have had to date is:
Right   Sph   Cyl   Axis                     Sph   Cyl   Axis
            -1.5     -1    108  Distance       +1  -1.5   102
          -0.25     -1    108      Near    +2.25  -1.5   102

Any advice would be much appreciated. Many thanks.

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

First of all its likely that the eye strain and headache you had doing your work after age 40 was presbyopia and could have been solved with progressive bifocals.  You did not represent  your glasses prescription correctly in your first post. You have to include all the RX not just the sphere. With the astigmatism part it makes the difference between the two eyes much less. However you should have been told that you would have all these problems. I don't see anyway to fix your problem without surgery on your RE which will result in loss of your near vision because of your age and the face you read ok because you are myopic and they would be correcting that. So they would do lasik on RE to "match" it to LE and your vision without glasses will not be very good and to see well you will be in progressive multifocal glasses (some people incorrectly call these no line bifocal),  you have almost 2 diopters difference in the RE and LE now.  So yes likely it would eliminate the pain from the unequal glasses RX you have now but without glasses things won't be clear not far not near not intermediate.