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Preserve our Eyes, not our Drops!

 

 

 

 


      

 

Testimonials: Post-LASIK Dry Eye

Foreword and remark on LASIK and other refractive surgery (PRK, Excimer, LASEK) particularly in the context of a dry eye state:

As always the final decision should be made by an ophthalmologist. However, Keratos, can only warn refractive surgery candidates that a therapeutic alea (risk) exists, even for persons who did not present previously any contraindication.  Among these potential risks are dry eyes – frequently underestimated by ocular surgeons – which may reveal to be a real disability. Amongst our members, we count several examples of that so-called minority… often silent… seldom considered… and certainly more important than many LASIK surgeons would like to admit. These invasive operations are all the more unadvisable when the patient already suffers from even a minor dry eye state (for instance a patient is unable to tolerate contact lens) or wound healing issues. You may seek additional advice from independent ophthalmologist (not involved in refractive operations) for a second opinion. At their slightest reticence, we would advise you not pursue the project. Modern ophthalmology may be able to correct refractive errors (with more or less success atually) but is certainly unable to re-establish corneal sensitivity in patients who lack corneal sensitivity or an appropriate lachrymal system in patients with chronic dysfunctional tear syndromes (and dysfunctional tear glands). Living with the need of constant artificial tears is not a panacea… believe us… and is frequently insufficient to regain eye comfort.

 Lasik induced dry eye testimonial by L (Portugal)

My statement is based solely on my personal experience. I do not intend to make a judgement or give an opinion about the pathology and its causes. Therefore my goal is simply to share facts, with people that may be going through a similar experience, with their relatives and friends, and, if possible to sensitize everybody, specially the medical community to the impact that this pathology has on life quality.

Since April 2003, following a surgery to correct myopia (lasik), I started to have a problem of eye dryness, lesions in the cornea and keratitis in both eyes. This situation got significantly worse in November of the same year. 

My decision to have lasik surgery was taken following a personal motivation and the opinion of three different experts, for whom I was considered to be a simple case, either for the surgery or for the use of contact lenses. I always refused the contact lens solution because just thinking about the logistics of the solution made me feel uncomfortable. 

However, during the surgery, the corneal epithelium of both eyes suffered a big lesion, being worst on the left eye, for which was estimated a recovery period of months. I had to use protection lenses. At that time, my cicatrisation process was slow, and created small scars, that improved nonetheless as weeks went by, and also my sight. The treatment was based on aggressive hydration (lubrication). During that stage I restarted working and despite not feeling well I managed to continue working and forced my eyes to work with computers and in an “intelligent” office, where you can not avoid air conditioning. 

In the spring I started to have allergies in the eyelids and inflammations in the eyes, which I never have experienced before. In fact I have never had problems with my eyes, only some feeling of tiredness at the end of a days work with a computer in an “intelligent” office. At that time, I started to wake up during the night with a deep pain that lasted about 10 to 15 minutes and stabilized leaving a strange feeling of a foreign body in my eyes, a light to medium sting when I blinked and a feeling of sore eye. My life quality began to be affected in a social manner. I started to avoid places with smoke, sitting outdoor in cafes or walking in windy days. Besides this, there was always an uncomfortable feeling in my eyes that prevented me of relaxing even in my spare time.The treatment consisted in aggressive hydration and histaminics.  

In August I was on vacations and I started to recover. I can not justify it with a single cause, but I think that several factors may have contributed, totally or partially, to my recovery: temporary punctual plugs, total rest from the use of the computer and aggressive environments, acupuncture treatments, and hydration of the eyes during the night (by the end of July I was waking up at night every two and a half hours). 

In September I felt better, but I suffered 3 or 4 small lesions in the epithelium after my return to work, situation that stabilized after a few weeks. When I say to stabilize I do not mean that I did not suffer lesions. What I mean is that I maintained my care with constant hydration (on an hourly basis or less) during the day and with 3 hours break during the night, and restrained myself from certain public spaces, which limited my social life increasingly. 

After a month and a half, for professional reasons, I went to a project, which made me a frequent airplane traveller, but no doctor disapproved it (with the exception of the acupuncture experts that I was attending). During the month I was in the project I was always very careful with the hydration, and during my airplane travels I always put compress with cold water in my eyelids as an attempt to maintain a moist environment. At the end of November I started to have small nocturne lesions. I returned to Portugal, and my doctor observed that I had lost my temporary punctual plugs. They were inserted again, but in the same week I had an ulcer in my right eye when I was waking up. 

From that day onwards and during several months I went through a very complicated stage. The idea of having an ulcer whenever I woke up created in me a feeling of insecurity and fear. I spent days trying to make sense of patterns that could allow me to have a reference framework of cause and effect, and whose only result was just the frustration of achieving nothing. I started to shorten the sleeping periods to avoid the recurring lesions on my cornea, but that did not work too. Days went by walking around at my home, with pain in my eyes, or in the best chance, with stings, burn, and a foreign body sensation, besides a contained feeling of despair. The treatment was still constant hydration and my doctor told me about the definitive punctual plugs. At that time, my doctor explained to me that I had the syndrome of serious eye dryness and keratites due to a loss of sensibility in the cornea. As in the process of cicatrisation the epithelium did not adhere to the deep parts of the cornea, the probability of tearing off whenever I woke up (the eye gets dryer while I am sleeping) increased significantly, and that led me to have recurring lesions in the cornea. 

My doctor kept telling me that he did not see any reasons that I should not overcome the situation. It was all a matter of time for the affected nervous tissues to recover, a process that could take 2 or 3 years. The exception was the functioning of the lachrymal system that he considered difficult to recover to the normal levels. Regarding the treatments, my doctor considered that the most appropriated was a lot of hydration, punctual plugs and letting the body do the rest. His attitude was always firm in the sense of not using antibiotics, steroids and definitely not analgesics, with the exception of when I had the ulcers, because then I had to use protection lens for some days/weeks and the pain in the first days could (and they were) be very strong. 

This diagnostic was confirmed, by two more doctors that considered, regarding the situation of my cornea, that maybe it was not the time to try therapies based on steroids or other more recent therapies. 

In January I made the definitive punctal plug and I started on a macrobiotic diet with the goal of helping the process of recovering my eyes and stabilization of my nervous system, which my counsellor considered to be an important factor, given that my sleep quality was very bad for so long and that could be contributing negatively to my recovering. At the end of that month, I had another ulcer on my right eye, and my doctor chose to scrap my corneal epithelium. My process of recovery was very quick, the cornea became transparent and I started to be a little more confident. However, my left eye continued to suffer small lesions, I was getting very tired and started to loose weight significantly, although I attributed this fact to my diet. 

In March I returned to allergies in my eyelids and inflammation in my eyes, which made me stay more at home. I felt everything was prejudicial, cold, wind sun…I do not have to emphasize that watching television, working with the computer, reading, were activities impossible to pursue since November, or in the best of chances, they were pursued in small doses, never at night and only in the days that I felt better. 

Following my friend’s suggestions, I went to two more doctors. One told me my left eye would never be good, although he admitted not being a specialist in corneas, and the other suggested I could have rosacea. Following this, I went to the dermatologist, that always accompanied me through my problems of allergies/eczema, but he did not agree with that diagnostic. According to his opinion, my eczema stemmed from contact (excess of drops in my eyelids and being constantly cleaning with anti septic gauze), aggravated with spring dust and city pollution. 

I made medical analysis to detect self immune diseases (arthritis, Sjorgen syndrome) which result was negative, just as my ophthalmologist doctor had predicted. For him, the cause was always the loss of sensitivity in the corneas. 

In May, following an infection, I had erosions in my left eye, and a big ulcer, and my doctor opted to do again a scrap of the epithelium, a process that had made my right eye improve. (the cornea of that eye was transparent and the sight was pretty good). I returned to histamine and did the definitive punctal plugs. The recovery of this eye was also good, although the sight was slightly worse than the one of my right eye, because it seems I was left with a post surgery scar mark. 

Meanwhile, my doctor opted to start prescribing me steroid drops at bedtime, in order to try to stabilize my sleep, as he was aware that I woke up every night, for more than a year, and since November, at periods of 1 hour, 1.5 hour or 2 hours in the best days, and he thought that could be making difficult my own recovery. 

Since June, I started to improve in a more sustained manner, from my eyes and my general well-being (which is correlated, if not synonymous). Some days better than others and always watchful to any sign that could lead my to take protective actions, that consist in staying at home and doing a aggressive hydration of the eyes. At that time I started to rest in the afternoon (half an hour to an hour) and I realized that my discomfort and end of day stings diminished. Slowly I started to wake up not so upset and managed to wake up within periods of 3.5 hours to 4 hours. 

My doctor told me about a new medicine (Restasis), that seemed to have good results in stimulating the tears production, but that is only sold in the USA (however, cyclosporine is available elsewhere). The efforts to obtain this medicine, from my doctor and myself, were not successful, which I, after all I have gone through, consider at least absurd. About the medicine and supports, there would be a lot to write about. I just comment the fact that there is not a minimum of sensitivity and even knowledge about these pathologies in terms of the consequences to the daily life of people that suffer from them. At a given point, my eyes stopped supporting drops with conserves, which led me to use preservative free lubricating eye drops and serum in individual doses. Besides the eventual toxicity of the preservatives, not all the drops provided relief for some reason I do not know, and I think doctors in general do not know too. What I know is that regarding drops in individual doses, their cost are not shared by the National Healthcare Service in Portugal, making them very expensive. In my case my monthly budget with eye drops varies between 300 and 400 euros, which is a amount impossible to cope with for many people, which leads me to the question, of what alternative do people have: less hydration of the corneas, using drops that are also aggressive to the eyes? And the long term results in the corneas health, which is already enough compromised?! Not to mention the talks in the health centres where there seems to be doubts, more or less subtle, about the suffering we have. 

I returned to work in the end of August, working half day in the office and half day at home, and without putting to much effort in my eyes while using the computer. As my job is demanding at that level, it is almost pointless to say that my health limitations may have negative consequences at the professional level. Anyway, I try to keep in mind that although my eyes go through positive and not so positive stages, I consider they have been gradually improving, which allows me to release gradually the emotional and physical tension I accumulated during this stage. 

Today, 14 months after the crisis, and one year and 9 months after the surgery, I may say that I am better. Of course I still continue to hydrate aggressively my eyes and using cortisone, and I still have several limitations: I can not travel by plane for an undetermined period, I work at my office only half day, I keep reading to a minimum, just as watching TV, I have not been to a cinema or theatre, I avoid closed spaces (the effect of tobacco is terrible). In short, I save my corneas to work. Besides that, I continue to hydrate aggressively my eyes (today I can do periods of 1 to 1.5 hours at day and 4 hours at night), I keep using cortisone, and doing some resting periods during the day. Regarding practical consequences and more or less structural: I changed my diet to try to balance my organism as much as possible, I try to reinvent my hobbies and work methods in order to reduce the pressure on my eyes, and everything that might have an impact in my corneas, and at last or specially that, I try to learn to live again with the accrued tiredness of yet another setback.            

 

 

Matt (USA)

I had LASIK in 2006 and I have experienced such intense, chronic eye pain in my post-LASIK life that I can count on one hand the number of times where I went for over 30 minutes without being aware of the pain in my eyes. Based on what I have learned, I would NOT recommend LASIK to anybody!

An eye doctor who has worked with many post-LASIK complication patients said it best when he stated; “My feeling is that LASIK surgery and other refractive surgical procedures exist solely to enrich doctors and the corporations that manufacture the laser equipment and not to benefit mankind.”

I understand that there are people who are “happy” with their LASIK outcome. However, these same people would have been happy with glasses and/or contact lenses had they never heard of LASIK. For those of us who have had bad outcomes (and believe me when I say that we are not as small of a % as the LASIK industry would want you to believe), we are left to live with various complications including, but not limited to poor vision, eye pain, and dry eyes.

I should note that I have 20/20 vision from LASIK, but I wish that I could turn back the clock when I wore glasses and did not experience chronic eye pain and severe dry eyes. LASIK MD’s often have very few options to fix LASIK complications. Therefore, if you become one of the LASIK complication statistics, you will find yourself in a place you wish you never knew existed.

The cornea is the most highly innervated tissue on the surface of the human body. When the cornea is damaged, the corneal nerves can emit an incredible amount of intense physical pain. Having said this, there are very few people in this world who truly understand eye pain and can sympathize with it. Most people who have not had ocular surface damage from LASIK or through the use of preserved drops or through natural problems like autoimmune diseases have no idea how much pain the eye can produce.

I will also point out that it is amazing what a story like the Wall Street Journal (WSJ) article titled “A Closer Look At Dry Eye” can do for public awareness of the issue. I have a relative who finally "got it" that dry eye can be debilitating simply because a post-LASIK dry eye patient was quoted in the WSJ article as stating that “Dry eye just sounds so trivial, but it’s a disability”. Just the fact that this statement was printed in the WSJ made it valid in my relatives’ eyes. The fact that he has heard it from my wife during conversation just didn't seem to make it sink in like a media article.

I have learned the hard way that when it comes to your eyes, you must have a good dose of healthy skepticism when it comes to what is recommended to you by the eye community including eye doctors. There is a very good reason why most eye doctors where glasses and do not get LASIK. I am equally confident that if an eye doctor needs eye drops, he will reach for drops that are preservative free.

Unfortunately, the eye community does not feel a sense of obligation to insist that a harmful procedure like LASIK be terminated or that pharmaceutical companies should produce preservative free drops whenever possible and charge a few extra cents for the added cost. Remember, the health and well-being of your eyes are at stake and the last time I checked, we only get two eyes in this lifetime.

Remember that additional testimonials may be available in both French and Portuguese if you read any of these languages.

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