It should come as no particular surprise that doctors and patients may be speaking different languages. In the world of laser vision correction problems, however, it is only after surgery that the patient finds himself and his doctor underneath a new sort of Tower of Babel: Doctor and patient were working together and speaking the same language just days before surgery and then — poof! flap, zap, ensuing confusion.

Why? Consider this:

In doctor-speak:

Vision = Refractive error (plus, of course, the odd ocular disease, binocular vision disorders, and so on). The greater the refractive error, the worse the vision.

In patient-speak (before surgery):

Vision = Same as doctor-speak, only not articulated quite so technically. Basically, there are seeing people, blind people, and people who wear glasses or contacts. Oh, yes, and one of my parents had cataract surgery. Oh, and my neighbour’s son has "lazy eye". But for normal people, it’s a question of whether you wear glasses and how thick they are. Thicker = worse, because they’re sort of ugly when they get that heavy.

In patient-speak (after surgery)

Vision = What I see.

So what’s the problem here? The doctor continues, as always, to think and talk in terms of refractive error (your eyeglass prescription — the amount of short or long sight and so on) which was all well and good before surgery, but afterwards, it’s a whole new world and refractive error is ONLY ONE VARIABLE in the equation of your vision.

After surgery, usually the most common disconnect between patients and doctors occurs over what constitutes good or bad vision. Before laser surgery, it was all well and good to think of vision simply in terms of refractive error (your eyeglass prescription — the amount of short sight or long sight and/or astigmatism you have). But after laser surgery, the world has changed.

The fact is, you thought the worst that could happen with laser surgery (short of getting your eyes mutilated and going blind) was that they undershoot or overshoot and you carry on wearing glasses or contacts. Whereas in reality, laser surgery does much worse. It causes irregular shapes and features on your corneas (the part of your eye that the laser whacks) that interfere with light passing into your eye correctly. They also cause one part of your cornea, the centre part, to be different enough from the part around the centre that light coming into your eye is, especially when it’s dark, hitting your eye after passing through two very different kinds of surfaces on the way. These are known as "bad things". These cause bad optics. These cause the kinds of problems you are probably experiencing. There’s more to it, of course, but those are two of the very most common problems that cause your vision to be screwed up in a way that your doctor’s instruments don’t measure — like the double vision, or the glare and starbursts you get at night.

So, what DO your doctor’s instruments measure?

Well, he’s probably going to look at your eyes through a slit-lamp. You know, put your chin on the thingy and stare at his ear. There’s a lot that he can see through that thing, but he definitely cannot see those irregularities on your corneas.

He’ll also refract you — you know, see what line on the chart you can read by yourself, then put you in front of a machine (or wave a lot of lenses in front of your face) and do the old "Better 1, or 2?" that goes on and on till he gets you as good as you can get. That doesn’t tell him anything except your glasses prescription. The fact that you’re seeing two, or three, eye charts, or you’re having to stare at the screen for several seconds before answering, makes no difference to him whatever. THIS IS THE MOST IMPORTANT PART OF THE EXAM TO HIM. This tells him, did we hit the target or didn’t we? If not, how far off are we? To you, of course, it may well be immaterial. If you see the 20/20 line but can’t drive at night or tell your brown socks from your black socks, you are 20/unhappy.

He’ll probably take some fancy pictures: topographies, and/or Orbscans. These will show some characteristics of your corneas, their refractive power, and corneal thickness. If there’s anything really visibly bad going on, like the part they lasered is way off centre, or they’ve whacked off so much of your corneas that the pressure in your eye is causing it to bulge, they can see it from these exams. They ought to be able to see more than that, and they may well start mumbling about "irregular astigmatism", but whether they give you any truly useful information from it is doubtful.

If you’re lucky and he’s got a wavefront scanner, he’ll be able to come up with some numbers that really do prove that, no, you’re not imagining things and there really IS something wrong with your vision.

But for the most part, your doctor is thinking and talking in terms of refractive error — what line on the chart you can read. THAT IS THE COMMON STANDARD OF SUCCESS IN LASER VISION CORRECTION. Get used to it. It’s wrong, and it’s unacceptable and you most certainly should not accept it for yourself, and LaserMyEye is working very hard to change it, but in the meantime this is what you need to know to keep things in perspective when you’re talking with your doctor.

Patients who don’t understand this, but have vision disturbances, AND are stubborn AND whose eye doctor is any good at topography analysis AND s/he has a wavefront scanner or can send you someplace where they do, and appreciates what that stuff means, may eventually find their eye doctor talking in an intelligible dialect. But we make no promises. You still need to understand it for yourself.

If you have read and understood everything in this section so far, that is a good step towards eventually being able to communicate with your doctor in the way that will lead to him being of more service to you.