Poor vision after Lasik eye surgery

[akraut]

I have had 2 lasik eye surgeries.  The first one was a year ago and the second one was 6 months ago.  After the first surgery I could see 20/40 but was given a prescription for glasses, the glasses helped.  After 6 months I had my second surgery.  It has been 6 months and I now can only see 20/60 bilat. I was a 7.5 rt and 8.0 on the left prior to my first surgery.  I have had all tests done and have been told my eyes are "textbook" healthy.  I was told today that the only explanation is possible optic neuritis.  I have had no pain except after the eye surgery, no problems with colors.  I have a very high sensitivity to light. I cannot see to drive in the evenings.  Could this be from the two surgeries?  Should this been evaluated when the doctors were seeing me prior to the eye surgeries?
I am 33 years old no medical problems.  Help I am extemely frustrated.

[John C Hagan III, MD, FACS]

If your best corrected vision (that means even with glasses worn over you LASIK cornea) is 20/60 then something indeed is amiss. If you mean you see 20/60 without glasses but glasses correct to 20/20 then there may be no disease present only a less than perfect LASIK operation.

Assuming you can see 20/60 and no better even with glasses the most common cause would be irregular astigmatism from the lasik, or interface scarring or wrinkles in the flap.

A cornea topography and an independent consult with another refractive corneal ophthalmologist should tell whether these LASIK complications are present.

If the front of your eye looks perfect and there are no LASIK complications then you need to see a neuro-ophthalmologist and its very important to do so. You can use the Find An Eye MD feature on www.aao.org and select neuroophthalmology and enter your geographic location.

JCH III MD Eye Physician and Surgeon

[akraut]

I saw a retinal specialist.  I cannot wear glasses, they do not improve my vision.  The specialist did multiple tests and all have shown my eyes are healthy.  There is no explanation to why I only see 20/60 other than optic nerve damage.  There are no problems with the retina, no clear cataracts, the flaps are smooth bilateral.  I had severe pain after the enhancement 6 months ago after the surgery.  I was told I had multiple abrasions and the dr had a very difficult time lifting the flaps during the surgery.  I was told by the retinal specialist that if the dr was not looking for optic nerve damage it would have been missed.  Could this damage be caused by inflammation to the optic nerve from the enhancement surgery.  It is really weird to me how I was fine prior to the first surgery.  After the first surgery I saw 20/40 but could wear glasses to see 20/20.  Right after the enhancement I had severe pain bilat and could not see as well as before the surgery and now only see 20/60.  I am told I have no astigmatism.  I have been told more than once "I am a mystery patient".  I am just curious if the lasik surgery could have caused the inflammation which lead to my optic nerve damage?

[John C Hagan III, MD, FACS]

You can do your own search of the ophthalmic literature but I have not heard or read of lasik enhancements causing optie neuritis or macular edema.

Again you are the kind of patient that neuro-ophthalmologists were made for. Please see one in the near future.

JCH III MD