Phase 1: Getting your bearings and treating urgent complications
(posted: april 2003)
Goal 1: Understand the kind of things that might be wrong and where you fit in
Goal 2: Ensure you’re being properly looked after
Goal 3: Start writing
Goal 1: Understand the kind of things that might be wrong and where you fit in
Even before we get into all of that, we have a couple of things to say:
You are not alone! I guarantee you that there are other people, probably many, who have gone through almost exactly the same thing and for the same reasons. And even those who have different problems or complications can usually relate to some part of your experience. We are glad you are out on the internet now looking for information and we are sure you will bump into people with similar experiences during the process. It seems many of us were told by our clinics that we were the only ones, and it can be very frustrating and isolating to hear that. And it simply isn’t true.
Please don’t panic! Anything completely unexpected after eye surgery causes some natural panic. It’s not really necessary. Sometimes the healing process is just slower than expected. If you’re experiencing vision problems, they will almost certainly change and evolve over time and it’s quite likely they may improve. And in any case, it’s really important that you’re able to focus on some immediate issues and simply lay to one side any concerns about what your vision might be like long-term. Focus on doing things.
Now, the first step in dealing with your situation is getting a feel for what kinds of things could be wrong, so that you can start to get some ideas about how to pin down the specific problem(s) and get something done about it.
You might want to read our Complications for Dummies (and if you’re really interested, it might help if you read the other courses first — they are much shorter! - like Eye Anatomy for Dummies, Glasses and Contacts for Dummies, and Laser Surgery for Dummies). But we’ll summarise the main things here anyway.
There are basically five kinds of problems that could be going on. Right now we want you to only be concerned with the first two.
| What kind of complication |
Examples |
What to do |
| 1. Intra-operative complications |
Things that go visibly wrong during surgery, often problems with the LASIK flap — there might be a problem with the flap itself, or with the way it was laid down, or with debris underneath it. |
Most of these things are identified during surgery, so you may already well know if anything like this has occurred. If not, talk with your surgeon at the earliest opportunity to find out, and in any case ask for as much information as possible about the condition of your flap. |
| 2. Post-operative complications |
Conditions that develop after surgery, like infections and inflammations. |
If you are not sure whether any of these apply to you, discuss them with your surgeon at the earliest opportunity, find out what the condition is and what treatment you are getting. |
| 3. Acuity problems |
When you’ve been under-corrected or over-corrected, or your vision gradually regresses |
No urgent action needed. Do not rush into an "enhancement" until you are thoroughly acquainted with the issues. There are other ways you can deal with your poor vision in the short term. |
| 4. Vision quality problems |
Night vision problems, ghosting (double vision), halos, loss of contrast sensitivity, etc |
As above. Do not rush. You need time to thoroughly investigate things and be entirely confident of your diagnosis and treatment options before taking any major step. |
| 5. Dry eye |
Problems with the tear film like not enough tears, or poor quality tears |
If severe, go straight to the Dry Eye Management section, otherwise, just keep using artificial tears or whatever else your doctor has prescribed. |
1 and 2 are the short-term problems in the sense that it’s important you get good care for them right now. 3, 4 and 5 are more or less long-term problems, where, of course, you need to get answers and treatment, but where (with the exception of severe dry eye cases) there is no harm to be done by waiting while you focus on other things for awhile. Quite probably you don’t WANT to wait, because the vision problems may be so incapacitating that your life is disrupted; but unfortunately we must tell you that there is no quick fix for these problems and we feel it is very important to get your bearings and gear up for a thorough self-education process rather than rushing into an "enhancement" or further surgery of any kind.
It is very important to try to avoid any major decisions at this particular stage. Whatever standard care for immediately visible problems you can get, do but make sure all such things are taken care of before you move on to evaluating any bigger picture issues.
Goal 2: Ensure you’re being properly looked after
First and foremost, you need to be in the right hands. For those of you who have a problem that really needs to be identified and treated quickly, or who don’t know whether you do, this is critical. Good care should take precedence over everything else including price! It doesn’t matter if your surgeon has done thousands of surgeries. What matters is his level of expertise in treating problem cases and particular in treating problems like whatever it is that you have. If you have any doubts whatever, any reason to think the clinic might not be fully on top of the situation, or even simply feel uncomfortable or rushed, you should seriously consider getting a second opinion from a corneal specialist very, very soon. Trust your instincts.
What do you have a right to expect? Your surgeon himself should have time for you and should take your concerns and your symptoms seriously and should keep you thoroughly informed of everything that is wrong and everything that is being done about it and what your prospects are. You do not have to settle for less. This is one situation where no matter how unassertive you may otherwise be, or may habitually be in a doctor’s surgery, it’s important that you be assertive. Even bring a partner, family member or close friend to an appointment with you if you think it will help you stand firm in requiring proper care. Your eyes are everything to you and you deserve proper care if you’re facing problems after eye surgery.
Second, when we say "being properly looked after" we don’t necessarily mean that your surgeon should identify and solve whatever problem(s) you are experiencing. There are actually many types of things that could cause vision problems and only some of them are things that your doctor can see by examining you. What we want you to concentrate on right now are conditions that need treatment, or things that happened during surgery that may need repair sooner rather than later. We’re talking just about short-term problems right now, because we can’t tackle everything at the same time. If there are long-term problems, you still first need to ensure there are no short-term things going on or that if there are, they get treated or dealt with properly.
Third, go to your appointments prepared. Think of it as taking control. We recommend that you read our sections on Follow-Up Appointments and, if communication is strained, Communicating with your Doctor before your next appointment. We have a handy checklist for you with some useful questions to ask. Most of all, consider what you want to accomplish in the appointment and stand firm when you get there.
Finally, make sure YOU know how to look after your eyes properly. Follow the instructions with any eyedrops you have been given. If your eyes feel dry, try not to overdo it with the lubricants (for example, don’t use them every 15 minutes) because this will dilute your natural tears and make the problem worse. They may tell you not to rub your eyes for a certain number of days. Don’t count the days — you should never, ever rub your eyes anytime after this, and especially not in the first months. If there is any chance at all that you could rub your eyes at night inadvertently, keep wearing the eye guard every night until you are sure there is no risk anymore. — On the other hand, don’t worry about over-using your eyes. There’s really no such thing. If you need or want to rest them, do, but if you’re experiencing vision problems don’t be afraid that you might make your vision worse by, for example, reading too much during healing.
Goal 3: Start writing
We think it’s extremely important to write everything down. Think of it this way: It doesn’t take much effort, and the payback can be huge.
Start a little eye journal. It could just be brief notes in your diary, even. Note down any vision problems or pain since surgery, especially if things change at all day to day or during the day. Make at least a brief note about it every day. This will help you to identify any trends, and it will be a handy reference to take and show your doctor if that helps. Most of all, it will force you to be more observant about your eyes, because if you write down anything you’re probably going to want to be thorough, and so you will start noticing more about your eyes. Every bit of information is potentially useful material, now or later, to find out what’s going on with your eyes.
We also suggesting taking the opportunity, before more time passes, to write down everything you remember from the visits, conversations and consultations at your clinic before surgery, the surgery itself, and all the appointments you have had since then. There are things you may not understand the significance of at this point but which may later prove to be relevant. We think that you should know that not everything that happens during your appointments goes into your records so your memory may be very important, for example, if you go to a second opinion doctor and need to give him historical information.
Obviously, if somewhere down the road you find that there has been a serious mishandling of your situation and you start to consider seeking compensation, such a journal will be invaluable, but that is not the reason we are recommending it right now — that is just a side benefit a few people might get. For the moment, we are simply concerned with arming you with all possible tools to quickly and efficiently find out what’s wrong with your eyes and what to do about it.
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