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Complications for dummies By: Rebecca Petris Last updated: April 2003 |
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Stuff that happens because some of the other stuff happened
It’s actually pretty simple. Well, to be honest, for all we know it might be complicated, but since all we know is the simple stuff, that is all we can tell you. Basically, there’s only two kinds of things you really need to worry about at all urgently, as in potentially being call-your-doctor-on-the-weekend urgent or I’d-better-do-something-this-week urgent. Those two are clunky stuff and icky stuff. If you have any of those, you should usually not have too much problem getting diagnosis and treatment — although usually does not mean always, so if you’re worried, don’t hesitate to get a second opinion just as you would with any other serious medical condition. You may be interested to know that you could have really trashy vision but without having any immediately worrisome things of the clunky or icky types, and that may or may not prevent you from exacting revenge by telephoning your doctor at all hours of the day and night. Of the non-urgent but troublesome long-term problems, the easiest both to identify and do something about is fuzzy eye chart stuff . Then there is messy vision stuff, which are may be difficult to diagnose and will almost certainly be even more difficult to do anything about although if you’re lucky (in which case we’ll be terribly jealous because we weren’t) some amount of it might just go away on its own. Then there is dry eye stuff which there are no easy fixes for but many good strategies for managing and those will keep you busy for a few years to come. Finally, there’s the stuff that just happens because some of the other stuff happened because of the surgery.
This is structural stuff. Many of these are big obvious things going on, like busted flaps, but others like corneal ectasia may be progressive and not quite as easy to identify right away. Hopefully though these things are all obvious enough to not have to fight about too much. (I was going to say that the good news is they are really pretty rare, but that’s no consolation if it’s happened to you, so it’s not really the good news.) Some of these things are serious enough to result in a corneal transplant, which sounds really scary, but there is actually very good technology for it, so at least there’s a good fallback for the worst cases.
This is nasty things like DLK and infections and oedema. Yes, they are nasty, but there’s also a reasonably straightforward treatment protocol. In other words there’s something active they can do about it that’s not surgery, which is kind of nice if you don’t like surgery. These are a little more common than the clunky problems but still much less common than the other problems. The good news is, usually, they treat them and then it’s over. Eventually. Bottom line, it was bad while it lasted, but it usually doesn’t last forever. (Did those of you who were told LVC usually works just fine detect the use of the word usually in there somewhere?)
These are the really easy things like undercorrection and overcorrection and regression, where the only problem is that the whole thing failed. They didn’t get to that magic "20/20" in one eye or both, or they went way past it, or they got there but didn’t stay there. Most people don’t realise that if it didn’t work the first time, they probably ought to find out why before they go on getting "enhancement" after "enhancement" thinking that either their corneas, the laser or the surgeon will behave better after a short break. So they basically keep running the car back and forth on the same road to see if they can hit the chicken racing from one side to the other. Some of them get lucky. Some of them end up getting there but picking up some clunky or icky problem, messy vision or dry eye problem along the way. Some of them pick up some of those other problems and also DON’T get there. Bottom line, you should wise up quickly to the mobile nature of the target and if "uncorrected acuity" is the only problem, i.e. you CAN wear glasses and see well, don’t just stand there sweating, wear them. If it’s not the only problem, well, you’ll just have to deal with the other ones first.
All the stuff like ghosting and trashy night vision and reduced contrast sensitivity, that make everything look awful or hard to see, but where you still might be able to read the eye chart if you stare at it long enough, especially if they leave the lights on. These are usually long-term problems. Now, by long-term I don’t mean that yours will necessarily last long-term but just that they aren’t "conditions" or "events", they’re just kind of the way your eyes are now. The symptoms themselves may go away or diminish or they may stay or they may get worse. There are really only three major possibilities for dealing with these: the very difficult but reversible solution with predictably good results (wearing rigid gas permeable contact lenses), the very easy but irreversible solution with completely unpredictable results because it’s experimental (Wavefront surgery), and the very very very difficult solution with reasonably predictable results (corneal transplants). — That’s speaking broadly. There are other things that might help temporarily like drugs to make your pupils temporarily smaller. — Bottom line, there is no easy fix, but there may be achievable workarounds.
All the stuff they call "dry eye" — when your eyes don’t make enough tears, or don’t make the right tears, or the tears aren’t getting spread around properly because your eyes are bumpy or the tears aren’t made of the right stuff anymore — plus the additional bad stuff all these problems can cause, like corneal erosions and abrasions and ulcers. This too is a tough nut to crack, but at least we don’t have to talk about surgery. Most of us have to kind of come up with our own recipe by experimenting and seeing what works. It usually includes making more tears and/or better tears (unclogging and stimulating the glands that make tears), supplementing the tears (with fake ones, but being very careful to get really friendly ones). It may also include plugging the drains to keep tears in the eyes (punctal plugs), protecting the eyes (especially at night — covering them to keep tears from evaporating), taking certain vitamins, reviewing other medications or systemic problems that might be exacerbating things, and more. There is no easy fix.
Stuff that happens because some of the other stuff happened This includes things like eye pain (which generally happens for a reason, and it’s kind of silly to just say "I have eye pain because of the surgery" but you may well not know exactly why you have the pain), severe headaches (which can happen as a result of various combinations of fuzzy vision or messy vision problems), dizziness, imbalance, peripheral vision problems and accident proneness (which can all happen as a result of certain messy vision problems), and anxiety disorders and depression (which are basically par for the course). We have tried to be reasonable here. We are certainly NOT including anything and everything bad in your life that can somehow be blamed on your surgery. We mean only symptoms that are probably caused by other symptoms which were directly caused by the surgery. We will not bother discussing the futility of trying to blame any of this on your surgery, particularly when your surgeon isn’t admitting that even the stuff that happened because of your surgery happened because of your surgery.
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2003 by LaserMyEye Limited. All rights reserved.
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