Joel Hunter, MD Refractive Surgeon, Hunter Vision Updated 10/31/18 11:34 AM
Side-effects are those effects that happen even though we don’t mean for them to happen. Usually, it means there’s an effect we’d rather avoid. But not always. Intra-ocular pressure usually decreases by a few points after RLE, thus slightly lowering your chance of glaucoma. It’s certainly not the goal of RLE (in most cases), but it’s a nice side-effect. The side-effects most people want to know about, however, aren’t the good or neutral ones.
There are two main side-effects with negative implications after RLE:
The first one is dry eyes. It is exceptionally rare for someone to develop permanent dry eyes after RLE. Since it is a function of healing, dry eye symptoms usually dissipate and then vanish entirely about six months after the procedure. But for the occasional person who develops dry eye symptoms during that initial post-operative period, it’s a pretty annoying problem.
The main reason dry eyes are an annoying problem to treat is because the feeling of dry eyes, or fluctuating vision, can come and go at any time while you’re awake. It’s rarely a constant, every-moment, kind of problem, but having symptoms randomly is still frustrating. It’s also frustrating because the treatments for dry eyes take a few days to weeks to help usually.
Treatment for dry eyes is almost always a specific type of omega-3 oils and some medicated drops to take a few times throughout the day. I’ve not had a patient yet where the symptoms couldn’t be treated till they go away. Still, it’s annoying needing any extra drops or pills when your neighbor didn’t have to do that part of it.
What’s interesting about dry eye treatment is it is almost always based on trying to speed up a process that will happen naturally anyway. In most cases, we are just trying to push forward to the point where the symptoms are naturally gone. I’ll usually tell patients about the temporary nature of their symptoms to reassure them of one fact: if the treatment for this is more annoying than your symptoms, then there’s no need to treat something that’s going away naturally.
The other side-effect is the vision. About 1 in 10 patients are almost on target after RLE. It usually means great distance vision, with near vision that only almost good enough. Or it means great near vision, with distance vision that’s just not quite clear enough. We fix that with a LASIK treatment to get to 100% of the goal. It’s rare for someone to need glasses during the couple months waiting for LASIK, but again, it’s very annoying having almost perfect vision. It's mostly because if you see well enough, you can pick up on mild levels of blur pretty easily.
In the majority of cases, however, folks are right on target for distance and near vision after RLE. But having eyes with good optics for distance and near is only part of the equation. There’s almost always a waiting period for your brain to “learn the language” of your new eyes. Processing of vision in your brain’s visual cortex, which creates the image you see, is complicated past what any of us can really fully understand. It’s amazingly adaptive, though.
As your visual cortex adapts and learns your new eyes, the improvement in vision is noticeable. It’s called neuro-adaptation, and it’s a built-in gift of the human brain. Symptoms of night vision, or vision being 20/20 or better but not “clear,” slowly improve over the first few months. The only variable is an ever-improving facility in vision processing.
The common side-effects of RLE are thankfully relatively rare and easy to treat. For side-effects specific to you, however, no words I write will help as much as a consultation complete with all the information that diagnostics and imaging can reveal. In most cases, however, whether it is dry eyes or neuro-adaptation, the main treatment for common side-effects is time. Not years, but sometimes a few months. For most of the symptoms, the goal is to help make life better until your body fixes things for you. And if it is a problem that your body can’t fix, like having almost perfect vision, usually a simple cure like LASIK will get you the rest of the way there.