Goal 1: Get thorough diagnosis for any long-term problems

Goal 2: Learn about treatment options and consider decisions to be made

Goal 3: Adjust your routines and your lifestyle to meet your needs

Goal 1: Get thorough diagnosis for any long-term problems

Vision

Now, your short-term conditions have resolved themselves and you’ve allowed a reasonable amount of time for your eyes to heal and for your vision to start bouncing back. But after the weeks or months you have allowed, your vision is just not acceptable and you aren’t able to see well with glasses. If you were among the lucky ones who know exactly what is wrong and have no doubts in their mind whatever, you would have skipped right past this section, so I’m going to assume that you either don’t understand what’s wrong at all, or aren’t entirely sure you’re getting all the facts you need to know.

Vision quality problems are difficult to pin down. Perhaps you have one of the really exceptional doctors who gets right to the bottom of it, but again, if you did you wouldn’t be here. The unfortunate fact is, it is quite possible no one doctor is going to have all the answers for you. You just have to consider it a mystery, find all the clues you can and get as close as you can to unravelling it.

We have no magic answer for you — just pointers, some combination of which may help you:

• Second opinion doctors: This is kind of hit and miss. For Jon, Maggie and me, the second opinion didn’t really provide any definitive or detailed answers any more than the original surgeon did. But it may bring something new to light and is certainly worth a try. (We do have one or two doctors who we trust enough to send other people for diagnosis.)
• Testing: You definitely want to get standard topography, Orbscan, and Wavefront analysis. Your surgeon will have done either standard topography or Orbscan, or possibly both. If you have not had Wavefront analysis, that in itself is sufficient reason to seek a second opinion. — Make sure that you get colour copies (hard copy or electronic) to take away with you. (There are other tests that could be important for you, but which unfortunately are probably not available at your neighbourhood clinic - like VHF digital ultrasound scanning, which can analyse your corneas in much greater detail than anything else, or tests of specific vision quality deficiencies, like contrast sensitivity testing.)
• Many of us have been able to get clues to the problem by consulting eye doctors over the internet/email. See our Links Library, Forums section, or contact us for suggestions. There are a number of eye doctors, primarily in the US, who are very generous with their time and may be happy to share their thoughts about your topographies.
• Don’t be surprised when everyone expresses completely different views about your topographies. This is one of the most frustrating things about getting diagnosis if this kind of vision problem, but don’t despair. Someone, somewhere is going to say something that makes sense to you and that you have more confidence in.
• Research. Use this site. Use our Links Library to find other sites. Find people or case studies with similar symptoms and similar topographies and absorb all the information you can.
• Do not underestimate the importance of systemic influences on your vision. Women in particular have many hormonal factors (pregnancy, lactation, oral contraceptives, HRT may all affect the vision and eye dryness).
• Also do not underestimate the role of dryness in your vision. We worry particularly about people who have reduced sensation in their eyes and may not be aware that they have a problem that needs treating.

At the end of the day, nothing beats swapping stories with others. We can all help each other.

Finally, bear in mind that you don’t necessarily NEED to know precisely what is wrong. Depending on your circumstances, it may simply not matter other than as a matter of curiosity, because quite probably the treatment options may be identical irrespective of differences in the minutiae. Additionally, depending what treatments you are willing to consider, there may be even less point trying to chase down elusive answers. If you are dead set against further surgery, then it is not really going to matter to you whether your problem is a decentred ablation or central islands or a tiny optical zone — all that matters is that you’ve got problems with your ablation.

You also may not be able to pin down exactly WHY whatever problem you have occurred. Again, your willingness to consider further surgery may determine the importance of this question. — Things like poor performance of the laser itself, or inadequate hydration of the corneal stroma during surgery, well, good luck ever getting a definitive answer about those. However, the one part of the WHY equation that we think you have a reasonable chance of pinning down is where nothing, or little, did in fact "go wrong" and where your poor optics for the most part resulted directly from the equation of your prescription, your pupil size, and the ablation pattern given you.

Dry Eye

There are many tests that can be done to identify specific problems with your tear film. At this writing, we are not yet aware of anyone who has gone through extensive diagnosis beyond the most common tests (Schirmer’s, tear break-up time, and fluorescein staining) or benefited practically if they have. In our experience post LVC dry eye conditions are, like the vision problems, tough nuts to crack and are best solved via stepping through all the different known treatment options and finding a combination of things that works best for you.

Eye Pain

Some laser vision correction patients experience chronic pain that their eye doctor can find no immediate reason for. There are a number of medical avenues to pursue, from ophthalmology to neurophthalmology to other unrelated fields. Now is the time to learn about these and start working your way through them to try and identify what is the problem. Often however one has to find a balance and realise that sometimes the solution will come before, or without, full understanding of the cause itself. Quite possibly your best resource in these situations is other people who have "been there" as they will give you ideas on potential diagnoses and/or methods of pain relief that they have explored. Please see our subsection on Persistent Pain in the All About Complications section.

Goal 2: Learn about treatment options and consider decisions to be made

The first hurdle here is gaining a thorough understanding of what the options are and what the respective risk/reward profiles of each are.

Generally speaking, there are two approaches to the most common sorts of LVC-induced vision quality problems (ghosting, loss of contrast sensitivity, loss of best-corrected visual acuity, GASH/night vision problems, and so on): specially fitted contact lenses, and surgery. Contact lens options include rigid gas permeable lenses, macrolenses, and sclerals. (Even if you are considering surgery, you may want to try contacts first — they are also useful as a diagnostic tool.) Surgical options may include further LASIK or PRK procedures or other types of laser surgery, and corneal transplants, of which there are two kinds. You will need to thoroughly acquaint yourself with what these surgeries can and can’t accomplish, what’s involved, and most of all what is known about the results.

Obviously your first consideration will be which of these solutions is most likely to be successful for you, in the right hands. Then there is the all-important question of whose hands are the right hands — quite possibly the proximity of someone with a strong track record in solving a particular problem may override all other factors. You will want to only be seeing someone who has been successful treating cases like yours and you may want to speak with other patients before proceeding.

For further laser surgery, where the results are the least certain, risk tolerance will be an important factor in your decision.

For transplants, the practical implications of the long healing time will be an important consideration.

For any of these options, cost, including travel costs where applicable, will also be a factor. Contact lenses may sound like a cheap, easy solution but they simply are not. (There certainly are the lucky few who are successful RGP wearers with minimal effort in fitting, but whoever they are, we have not yet met them.) You may need to find out in advance what your insurance will cover.

There may be employment issues. If you need time off work, you may need to discuss this with your employer and even look into taking short-term disability leave. Before engaging in any major surgery, you may also want to find out details about your long-term disability insurance and how it works, so that you can ensure you will have something to fall back on if your ability to work is ever endangered.

Then there are personal and family considerations. For women considering starting or expanding their family, there are a number of issues (read about them in our section for Women). There will be a practical impact on your family or partner that needs to be considered and you will also need to ensure you have the support you need, both practical and emotional.

Eventually, you need to make a decision, but it needs to be an unhurried, measured, well-informed decision, and one that you alone are making.

Goal 3: Adjust your routines and your lifestyle to meet your needs

Obviously by now you’ll have been forced to adjust in some ways. But accommodating your needs short-term is different from making longer-term adjustments. Emotionally, it can be a considerable struggle to come to a point where you accept that this may simply be the way it’s got to be for the foreseeable future. Only you can decide what size chunks of time are right for you to deal with. Clearly it is preferable to think of the problem as temporary, pending new solutions for your vision, but on the other hand you simply cannot remain "in limbo" forever. You have to find the right balance between hope that there may be a better solution, and acceptance of things as they are. For everyone, the timing and the manner of reaching this point will be individual.

When you decide that now is the time, you will be able to focus more on everything from minor aspects of your daily routine (where you may benefit from our Tips for Living and Working with Compromised Vision or Dry Eye section) to bigger decisions involving work, leisure activities and more. You may have family or a partner you need to involve in your decisions or on whom you are relying for support to implement certain changes. We encourage you to seek support and counselling to make these leaps in the best possible way for you.