This is a continuation of my Lasik diary which described my enhancement and events thereafter. For a review, I had my original Lasik surgery on January 11, 2000 at the Laser Vision Institute of Altamonte Springs, FL. The surgeon was Dr. Nancy Tanchel, who recently transferred to a new laser institute in Virginia. Though the surgery was generally successful, I was left with some peculiar visual anomalies, including numerous floaters, a very annoying string-like object in my left eye, and a very annoying problem in which bright objects appeared to be smeared downwards.

After having Lasik, I began reading of others who experienced floaters after surgery. The theory is that the suction applied while cutting the flap literally peels of old retinal deposits of proteins and suspends them. In other words, Lasik can kick up a bunch of floaters. In some cases people report they eventually settle down, but after nearly 10 months, mine are as bad as ever. I see almost a spider web of strings and several big bits floating around, including this one string-like object that is always in the central field of vision of my left eye. This is one floater than doesn't float and it has been very annoying.

Examinations by several OD's, as well as corneal topographies, could find no explanation for smearing phenomenon I mentioned. They had hoped that it was related to my residual astigmatism, but I did think that .5D of astigmatism could cause such a huge smear.

Anyway, for review, here are my original pre-op numbers and my pre-enhancement numbers at the 6 month mark:

Actually, the right eye regressed a tad and is between spherical and -.25D, which isn't too bad, actually, with basically no astigmatism. Except for the floaters, this eye is basically a major success story.

The left eye has come a long way, but the story is less successful. As I detailed earlier in my diary, the surgeon was going for monovision. As the number shows, I have weak monovision, but the residual astigmatism really impacted my vision. Also, not being able to see distant objects clearly has been very bothersome to me. As many others who had Lasik complain, vision indoors seemed blurry. But, as I have painstakingly detailed, it has been that smearing issue that leaves me irritated, perhaps because it is something that no one has been able to explain why it exists.

Anyway, back to the diary. I was relieved when Dr. Markle, the local OD I have been seeing, recommended that I get an enhancement. The new laser center doctor, Dr. Thomas Teather, apparently was willing to perform slight enhancements to those like me who had small residual prescriptions but were not happy with their vision. Dr. Markle told me of a local police office whose residual .25D of astigmatism was impacting his shooting accuracy, and an enhancement by Dr. Teather cleared up his problems. He was not sure if the enhancement would help my smearing, but I thought it was worth a try. I was also happy to get rid of the non-functional monovision I had, and I was looking forward to having my flap lifted and cleared out, just in case it was the source of my string-like object (though everyone had assured me there was no flap debris).

I arrived at the laser center shortly before my appointed time of 10 AM. After a while I was called back and I had a routine eye check by the staff OD (sorry, I forget his name). He wanted to make sure I understood that by having the enhancement I would lose my monovision. I told him it was working out for me anyway, and since I hoped to resume flying, I actually wanted the best distance vision I could have. I mentioned to him the smearing problem and the floaters. He told me he had a string-like floater like I had, but that nothing could be done. He had no explanation for the smearing.

Oh, I forgot to mention that I had the corneal topography done before the exam, and after the exam they measured my corneal thickness, which I believe was 487 um. Soon after I had my eye scrubbed, given a fresh post-surgical kit (sunglasses, steroid drops, eye drops, etc.) and I was number 2 for the operating room.

While waiting, a young woman before me told me she was back for her second enhancement. She praised Dr. Teather, saying she thought that Dr. Tanchel had been very nice, but that he was even nicer. When I met him, all I could think of was "The Kid". He looked so young! I guess he is in his late 30's, but he could have passed for late 20's. He, indeed was very friendly and, soon enough, he came for me.

I found myself back in the laser chair. Dr. Teather told me that my correction was too slight for the laser to do, so he had to fool it. That is, he would see how much time the laser calculated for it's minimal setting and he would manually stop the laser 1/3 to 1/2 of the way through. I thought that was cool. I ran a quick mental calculation and figured I would be getting maybe 5 seconds of laser time. I based this on getting a little over 30 seconds the first time, which corrected for about 3D. Thus, it seemed that there was about 10 seconds of laser time per diopter of correction. Of course, this was very crude, as both myopia and astigmatism enter into the equation.

I was rotated under the laser head and Dr. Teather went to work. My right eye was covered and eye drapes were placed on my left eye and the eye speculum attached to prevent me from blinking. He put in the numbing drops and started peeling my flap back. I asked him if there were many problems peeling a 9 1/2 month old flap, and he said they usually went ok. After less than a minute with me, he had it back, telling me if lifter rather easily. (I am not sure if that is good or bad!) Without really telling me, other than to stare at the red light, the laser started. He was counting down and the laser stopped after about 7 seconds. That was a little more than I had expected, but within the ballpark. The flap was put back, I could feel him smooth it out, and before I knew it, the shields and speculum were removed and he came around to help me stand up.

He led me over to a slit lamp for an examination and did a little more smoothing out, then led me out the door shortly after 12 PM. He said I did great and that I should be seeing fine within a week. I thanked him for the enhancement and was one my way. Oh, I had mentioned to him the smearing problem to him almost in passing but he had no comment.

About an hour later I had a couple of shooting pains in the eye, but they were very brief. I had been that it might feel like there was something in my eye for a day or two, but other than those brief shoots of pain, I experienced no discomfort. I rested that afternoon and was seeing fairly well that evening, but noted that my up close vision was noticeable degraded. I hoped it would up the next day. At bed time I re-familiarized myself with those blasted eye shields and tape.

Waking up, I quickly noticed that my close up vision remained bad. I could not see things clearly with several feet of me, and reading a newspaper with my left eye was out of the question. I wondered if I had been over-corrected.

I saw Dr. Markle at 10:10 AM. An auto-refraction was done, but I was not told the results. Dr. Markle did a eye chart test, showing my right eye with a weak 20/20 and my left eye with a weak 20/25. This showed my left eye to be slightly better than before. The slit lamp exam showed no problems. He told me that I was bit overcorrected, presumably since the surgeon expected some regression, but that I was otherwise fine. I again asked for a copy of my exam, where I discovered the results of the autorefraction: +.50 -.75 X 028. Yikes! I went from -.25D of myopia to +.5D, and I gained .25D more of astigmatism!

Well, actually, my vision seems better than these numbers. I mean, I feel like I could easily have .5D of hyperopia since my near vision is terrible, but I wouldn't have believed I had .75D of astigmatism. My distance vision seemed as good in my left eye as in my right. Regardless, the bad near vision was not too unsettling as my right eye could pick it up, and reading glasses worked just fine at corrected it, anyway. In summary, at the end of day one, I felt better about my vision.

Speaking of the end of day one, I was anxiously awaiting darkness to get a good indication of any changes to my smearing problem. Well, at first I looked at the moon outdoors. On Halloween night, I was able to see three four new moons - the real one and 3 smeared one. On this night, there was still smearing, but only two moons. That was a somewhat good sign. Back inside, I went back to my bedroom with that red light that first alerted me to this problem. Not so good. I now had two smears - the same big one as before and a medium sized one at a different angle. Well, it is still early in the healing process, so maybe that extra one will die down in time.

Today, it seems like my near vision might be just a touch better. I hope this is the beginning of a trend. I couldn't read the newspaper with it this morning, but things seemed better in the afternoon. Also, that string-like floater is behaving itself much better. It is still there, but it seems to have shifted position such that it is not a constant irritation. The smearing problem continues, but night vision (other than the extra smearing) is still good. That is, halos and other types of star bursts are not a problem. The eye feels very good - no discomfort at all. Also, my distance vision remains very good, maybe even a little better than my right eye, which makes me think the astigmatism is not .75D, but maybe half of that.

I have continued to do well. There has been no discomfort at all and my distance vision seems to be better, though I still can't see up-close with my left eye, though it seems to be a tad better than before. I feel that I must surely remain overcorrect and have not regressed much, if any.

I returned to see Dr. Markle. First, I was given an autorefraction by the technician which, sure enough, showed me to still be farsighted by .25D, with -.5D of astigmatism. This is an improvement of .25D in both readings so, maybe I was slowing regressing after all. I then had my eye exam. Dr. Markle told me that everything looked great, then he proceeded to do a refraction on me. Well, come to find out, I was plano, though I still had -.5D of astigmatism. So, I guess my problems reading now are truly due to old age (ugh), and the reason I can still read (somewhat) with my right eye is because it still has that -.25D of nearsightedness. Of course, as time marches on, that eye will begin having more problems. I was surprised, though, that -.25D could make that much difference in reading. I can now better understand people in their 40's having Lasik, getting to plano, and having to immediately wear reading glasses. So, surprisingly, I still have monovision.

Anyway, for review, here are my original pre-op numbers, my pre-enhancement numbers, and my latest post-enhancement numbers:

Overall, I am much happier now with my vision. I can see a little better indoors and outdoors in the sun, my vision is fantastic. The string-like floater I have mentioned is still there, but it seems to have moved a bit and is not quite so objectionable as it was. It can still be annoying, but not quite so bad. Unfortunately, the smearing problem remains unchanged. No one seems to know what it is, so I guess I am resigned to live with it. With my left eye being better, my night vision is still better overall, though.

With it being nearly a year since this odyssey began, I can finally start to reflect upon what I have been through. The main question I have to ask is "Knowing what I now know, would I go through this again?." The answer is difficult, if not academic. Though I do not regret having had the surgery, if I knew this is how it would turn out, I would not have done it. I, rather, would have chosen to wait a few more years. Thus, I have no objections with the surgery, but for one with my degree of astigmatism, I think that better lasers are coming. For those with moderate myopia and little astigmatism, I would not hesitate to recommend the surgery (assuming all other risk factors have been taken into account). I do believe that I have sufficient cornea that, in the future, I could be subjected to a next generation laser (Wavefront, perhaps?) that could correct for the light smearing. Also, I hope that new surgeries will be perfected that can suck out these danged floaters!

So, if you are reading this and trying to decide if Lasik is for you (and if you have read this far, send me an email message - you are a hardly sole indeed) I would simply recommend that you chose both your surgeon and your laser. Don't get too excited by either the promise of perfect vision or by the technology. Ask questions and make your own decision about what is right for you and for your own particular situation.

As of July 2003, nothing has really changed any more. I did see a different OD who did a corneal topography and noted that I might have some mild asymmetrical astigmatism, which might account for the smearing. While not a good thing to have, it is something that might someday be correctable. Still, I am doing well and I am bothered far more by the floaters than anything else. A reader of my site did write me and let me know about www.eyefloaters.com, which features a doctor who claims he can treat floaters with a laser. The treatment is not cheap, and I am not giving it any consideration at this point, but for those with large strands of floaters, this just might help.