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My vision seems to be fluctuating after LASIK, what’s going on?

By Joel Hunter, MD | 3/21/18 12:09 PM
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LASIK has come a long way in a few decades. There was a time — and this is super gross to think about — when this kind of vision correction involved suturing the top layer of the cornea down at the end of the procedure. It was a big ring of stitches all the way around the front of the eye. And people were paying money for that! Of course, when there were no other options for vision correction, it probably made sense at the time. As it often goes, however, technological progress makes the previous versions look silly. In the field of vision correction, it moves past silly into looking primitive and cringe-inducing.

Correction means change.

Despite the progress, vision correction still involves an irreducible component. And that component is correction. Something about the eye has to be corrected in order to correct the vision. And correction means change. When you change living tissue — whether it is surgery or a tattoo or a tan — you are adding a variable to a system that was already in motion before you got there. You are changing the system. And living systems react to change.

So in its current form, LASIK is a few minutes long and of that, only a few seconds are actual laser treatment. It is about as minimally invasive as you can get. But we are still correcting the vision (which is good!) and that causes a change to the system (which is neutral) and living system react to change (which is sometimes annoying). The reaction to change in this scenario is fluctuations in the vision.

What can cause those fluctuations in vision?

Well, the list is as long as a bookshelf, but in the case of LASIK, we can almost always narrow it down to one key element. The surface of the cornea. That surface is comprised of a layer of cells called epithelium. And epithelium is very particular in regards to working conditions. In order see clearly, it must stay perfectly smooth and glossy. The conditions required to keep it that way involve a system that’s specific and sensitive. And boy howdy, does LASIK ever give it a variable that can cause it to react.

When the surface of the eye is treated with lasers, the thin layer of tears that bathes the epithelium in smoothing goodness at all times is decreased. It is almost always temporary, and usually curable even in rare cases where it isn’t, but the decrease in tears causes the epithelium to change. Sometimes it is smooth and clear, sometimes it is unpolished and cloudy. It can be both of those at the same time in different places on the same cornea. And it can change weekly, daily, or even hourly depending on how close you are the procedure.

Here’s the good news.

Those fluctuations are rarely very dramatic. It usually means a difference between perfect 20/20 and less perfect 20/20. Also good news, the fluctuations decrease in frequency and severity as the tear film returns to normal in the first few months after LASIK. There are treatments to help decrease the frequency and severity at a much more rapid pace, so it is worth asking your doctor about it if you notice those fluctuations. The best news of all is that, while the fluctuations disappear as the temporary changes resolve, the correction that caused them in the first place is designed to be permanent. With good LASIK, the wonderful change to the system — that caused the short-term fluctuations — corrects the vision permanently.

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These articles are brought to you by Hunter Vision. We help people in Orlando discover life after glasses and contacts.
 
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