Poor vision post lasik

I had LASIK at a very well regarded opthalmologist office last Thursday.  My vision never improved to what I would call "good."  I started off at 20/450 in both eyes, approximately.  Currently, my right eye reads at 20/40 and my left at 20/70.  After going back to the doc yesterday, he looked and informed me that it was likely due to very dry eyes (which I have never had before, or else I never knew it) and that the pits/imperfections in the corneal surface were to blame for my poor vision, and that the tear layer wasn't there to "smooth things over."  He inserted temporary tear duct plugs, gave me preservative-free drops, started me on Restasis, and asked me to come back in a week, with the final words being "this will take some time."  Frankly, I'm pretty scared- it is very hard to read, use the computer, drive, etc.  I'm faithful since this guy is well regarded, but nervous the same.  What should I expect by "takes some time"?  Am I looking forward to (bad pun intended) months of really poor vision?  If it doesn't resolve, what other options might there be?  Granted, I'm only 5 days post-op, but it's close to debilitating.

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

It is too early to panic and the explanation give you is not an uncommon scenario. However if you're not comfortable ask the surgeon to refer you for a second opinion from another refractive surgeon.

JCH MD

[dsdive]

Thanks Dr Hagan.  Trying not to panic.  Jus to ease my mind, are there options other than what we're doing now, should this not work?  I think the common response is "oh ****- what if this doesn't do anything?"  Keepin' the faith...

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

IT is very very rare for someone to have their vision after lasik worse than before. If you are not better next visit then consider asking for the second opinion.

JCH MD

[AnnaE]

I have read many posts like yours. Some people resolve it. Some redo it. Do a search here. It must be very difficult.

[dsdive]

I've read many as well.  Hard to do right now, but I manage.  The best news is that when I put drops in, for about 3 seconds, everything clears up nicely.  Then it fades back to "normal" which isn't very good.  So to me that indicates that the tear layer is missing or in poor shape- not to mention that is what Doc told me.  Since I've never experienced dry eyes, I'm hopeful it'll come back, but it is very frustrating to say the least.  Just not sure what to expect- will it take a week, multiple weeks, MONTHS?!?!  Tough to tell, and doc can't really say with any certainty.  I go back to see him about every 7-10 days for the next several weeks, so I'll have a chance for 2nd opinion, but hopefully find out what other options are available if this doesn't help resolve it now.  Definitely not fun, and others have had it worse than I do... confident it will resolve, but right now feeling a bit of regret.  As Dr Hagan said, not in panic mode, but worried nonetheless.

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

The fact it clears up with tears is VERY encouraging as things like flap problems, scarring would not do that. Remember that Restasis take 6 weeks to begin to work.

JCH MD

[dsdive]

I should clarify... my R eye, which is currently the better, clears to perfect with tears for 3 seconds.  My left eye, which is the worse, clears slightly- noticeable, but not to near the same degree, before it too fades.  Doc checked flaps and scars and said that everything looks perfect.  So it sounds like we're on the right path.  Need to go back after the 8 day samples run out and get the Rx, which I am not looking forward to ($$) but anything is worth it!

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

Good luck
JCH MD

[bbuzz]

My daughter who had PRK recently is taking Thema Tears Nutrition (it is a pill) and another vitamin and has had a lot of success getting rid of dry eyes.  I have used Restasis and frankly can't see much difference.  I'm using it after cataract surgery.  It is very expensive.  Even with my insurance paying some it was $100.  

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

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[dsdive]

I'm going to trust my doctor's judgment and work with Restasis for a few months- the challenge is that my vision is not good and I don't want to rely on Restasis as my only solution.  I've been taking omega-3s and have pushed the tears pretty heavy (using Optive) in the hope that the cornea will heal as soon as it can.  Otherwise, things are gonna be a bit rough for the next little while until this all gets figured out.  I go back to see him Monday.

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

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[dsdive]

OK, back from 11 day post-op.  Doc is somewhat mystefied, which I don't like.  There has been no improvement in either vision nor tear production in the past week.  Kept me on Restasis to see if that'll help over the next month or so.  Also told me to start TheraTears and to d/c my standard omega-3's.  Has me on preservative-free tears every hour (which is great since I get about 5 seconds of good vision post the drops).  At next appointment in 10 days, he'll likely put in permanent duct plugs.  What is unnerving to me is that many people complain of dry-eye post-lasik.  Why is mine affecting my vision to such a degree?  So let's play this out- suppose the supplements/restasis/plugs ultimately don't result in better vision... what then?  Still pretty worried.