Ok, you had LASIK one month ago. You had PRK one month ago. What should you expect?
Most people who had LASIK or PRK a month ago may not even read this, because they’re seeing fantastically well. In fact, more than 19 out of 20 people can see the 20/20 line on a standard vision chart a month after LASIK or PRK, without any help from glasses or contact lenses! However, you still may have some glare or starbursts around lights at dusk or night. You still may see better after you’ve been up for a while, or worse if you’re dehydrated, sleep-deprived or overworked. It still may get a little better for several more months. If you don’t think you could see the 20/20 letters on a vision chart even in daylight a month after your laser vision correction, it’s almost always due to one of two things: dryness of the surface of your eyes, or residual prescription (nearsightedness and/or astigmatism).
Dryness: “But they don’t feel dry!”
Almost everybody has some degree of dryness after LASIK, but it varies widely. Symptoms of dryness can be either blurry vision, feeling like your eyes are dry, or both. A lot of people don’t feel like their eyes are particularly dry, just that their vision fluctuates, is foggy, blurry, or some other word for less than perfect. This is very common at the one month post-op point. The hallmark of dryness is fluctuation. You may wake up with blurry vision that gets better throughout the day. Your vision may be better a few minutes after putting artificial tears in your eyes. Conversely, some patients see better when they’ve slept well, but their vision gets a little worse after working on a computer for many hours. In general, I’d say about 30% of our patients have at least some dry eye symptoms at one month, and 3% at six months.
Who gets dry eyes?
On average, there is a little bit less dryness when we are in our 20s and 30s and more as we get into our 40s and 50s. Most 20-somethings say, “Yeah, my eyes were a bit dry for a while, but after a few weeks I didn’t notice it.” We also tend to observe more dryness in women than men. It does get better, but can take both time and therapy in the form of things such as artificial tears, thicker drops, or even lubricating ointment at night time. The dryness will return to your baseline. That is, if you had dryness before LASIK, you will likely have it afterward.
Things to do for eye dryness:
- Give it time! It can get better for months after laser vision correction. I’ve even heard patients say it can take up to a year
- Use artificial tears frequently throughout the day
- Take breaks. The 20/20/20 rule is to take a break every 20 minutes to look at an object 20 feet away for 20 seconds. Is this unnecessarily complicated? I think so. Just take breaks from your screen.
- Drink lots of liquids
- Get enough sleep
- Take Fish Oil 2-4 grams per day (Nordic Naturals is a good brand).
- Gel drops before bed. If gel works well for you, great. Sometimes patients have said they dry out and leave crusty eyelids
- Lubricating ointment:
- Same ingredients as Vaseline
- Messy, but won’t dry out.
- It will blur your vision, so put it in right before bed
- Run the tube under hot tap water for 20 seconds to thin it out
- Use the smallest possible amount just inside your eyelids
- Artificial tears in the morning may help wash it out
- Wash you face normally help remove it from your eyelids
- Punctal plugs: this sounds scary, but is super easy. The idea is that we “put a stopper in the drain” We have a tiny (nasolacrimal) duct in the inside corner of our eyes that takes away our tears. This is why you sniffle when watching the Hallmark channel. The tears run into your nose. If we block that duct, the tears will stay in your eyes longer, and help protect the surface of your eyes. I usually place a temporary plug first, which is a tiny collagen cylinder .5mm x2mm that goes easily in the duct. They may give relief for up to two months.
- Medications: certain medications can dry out our eyes, mouth, skin. Most of the time, stopping the medication isn’t a great option, because, hey, you’re not taking it for fun. It’s good to know, however, and may inform the treatment.
- Prescription drops: Restasis and Xiidra. My opinion is that these are waaay overpriced. They may work in some patients, but I’ve never been impressed that they’re effective, they take up to three months to ramp up, and they’re over $600…yes, $600 for Restasis and just under $600 for Xiidra per prescription as of this writing on goodRx.com. Who do they think they are? If your insurance covers it, it may be worth the copay, but I simply can’t in good conscience recommend that you spend that much for an eye drop.
- “My partner says I sleep with my eyes open.” This isn’t that unusual, and can make your eyes reeeeal dry. In addition to the above, sometimes I’ll suggest buying a roll of paper tape at the pharmacy. Take a 3-inch piece, and just before sleep, place it up and down (vertically) from above your eyebrow to your cheek on just the worse eye. In a day or two, that eye will feel better. You can do it on both, but that can make you claustrophobic when you wake up.
- There are more things to do, but they get more cumbersome, so we try the easy things first.
My Eyes Aren’t Dry, it’s been three months, and I’m blurry.
The second, and much less most common reason for your vision to be less than perfect is residual prescription. At SharpeVision, our patients achieve 20/20 uncorrected vision 96% of the time by the one-month postoperative visit. About 2% of people need additional laser treatment to get to 20/20 or better vision due to a slight remaining nearsightedness or astigmatism. This touch-up or “enhancement” is easier to do than the original procedure, and is more accurate, because there’s much less prescription. The risk for needing additional laser increase slightly for patients who have prescriptions above -6 diopters, or who have high degrees of astigmatism. The vast majority of the time, even patients who have very high prescriptions get perfect results.
Our recommendation at the one-month mark is to check each eye individually. One way is to first cover one eye, and look at a license plate that’s in good light and about three car lengths, or 20 paces away. If you can just barely make out the license plate numbers and letters, you probably have about 20/20 vision. Repeat with your other eye covered. To assess your vision for “mono-vision” (for folks over 45), if you can comfortably read your phone and computer, roughly 1 to three feet away, you are doing well.
If you have any questions or are not seeing as well as you think you should be, give us a call. If you’re doing well, we recommend that you return to your regular eye doctor for annual visits about one year from your exam with us. If at some future time you feel like your vision has worsened a bit, and your eye doctor says you have a slight nearsightedness or astigmatism, that’s what the LASIK4LIFE plan is for. Approximately one percent of patients who have undergone laser vision correction have needed a slight touch up with every year that goes by. Another way of saying this is that about 9 out of 10 people are still seeing well 10 years after their laser vision correction, and about one out of 10 has needed a touch up.
We hope you enjoy your vision immensely at one day, one month and one lifetime. The biggest compliment you can pay us is to tell everyone you know who wears glasses or contacts about how easy it was and how wonderful it is to have had laser vision correction. Please write us a review on Google and Yelp. It is our tremendous privilege and pleasure to have helped you to live a life free of glasses and contact lenses. May you enjoy it always.
-Dr. Matthew Sharpe