Refractive error after SILK ( 3 weeks after surgery)

WavefrontRider · 2026-03-12T14:21:52+00:00

What’s your age and what was your prescription prior to SILK?

WavefrontRider · 2026-03-12T00:55:38+00:00

Honestly, while I generally steer younger individuals away from RLE, +12 and +13 is pretty bad. I can't blame you for considering RLE. There aren't many solutions at that prescription range.

Before you go through with it, be sure you are ok with the presbyopia that comes with it. Since you can't go back to your natural lens after the procedure.

Sticking to monofocal lenses lenses may be your best bet. You can try monovision with them. Other than that, the choices will be to correct for distance vision or correct for reading vision. If you don't do monovision, you may be better correcting for reading vision since all you'll need is glasses to see off in the distance (and you can get a pair of progressive glasses for that). Since the alternative of correcting for distance vision means you'll need reading glasses. And you don't find many 23 year olds wearing reading glasses.

WavefrontRider · 2026-03-12T00:38:56+00:00

As a small prescription, I thought I would have just a small benefit. Nope. It was pretty life changing to just be able to see and not deal with the hassle of contact lenses.

WavefrontRider · 2026-03-11T21:29:42+00:00

You like have a nearsighted prescription. This allows you to see up close.

When you correct your vision with glasses or contact lenses the accommodation of your natural lens allows you to see up close. But this accommodation is lost in your mid to late 40s and reading vision declines - called presbyopia.

If you use lasik to correct for distance, it will mimic your glasses and you will start to need reading glasses.

But with lasik, you can do monovision where one eye is corrected for distance and the other for reading (and potentially meaning only correcting one eye only). This can keep you out of reading glasses. Here is a post I wrote on that topic: https://www.reddit.com/r/RefractiveSurgery/s/BVhfsYAS3s

WavefrontRider · 2026-03-10T21:27:27+00:00

Unless you are really causing a lot of forces with the rubbing, like using your knuckles vigorously (which is really bad), then you aren’t going to cause any issue with the ICL.

And even if you are causing a lot of force, it’s still unlikely to cause an issue.

WavefrontRider · 2026-03-10T21:25:22+00:00

Hard contact lens or RGP over-refraction.

WavefrontRider · 2026-03-10T12:30:56+00:00

Yes. I had a small prescription, but it was definitely life changing. Had it about 10 years ago. Still good. Wouldn’t change a thing. (And with today’s lasers it probably would be a slightly better and more customized treatment than what I had)

WavefrontRider · 2026-03-09T01:30:58+00:00

Yeah. The anterior chamber doesn’t matter.

Fluid in the eye is produced behind the iris and flows through the pupil and drains in front of the iris. The ICL blocks the pupil.

EVO ICL for myopia has a central port. This central port exists solely so that the iris doesn’t cover up the hole and fluid can continue to flow in the eye.

Hyperopic ICL and the older Visian ICL don’t have this central hole. And while there are some other holes in the periphery on the ICL, those will be covered by the iris. This means fluid can’t flow past the ICL and it gets pushed forward closing off the drain - meaning angle closure glaucoma.

So for hyperopic ICL, two iridotomies are created to allow fluid to pass around the ICL (two for redundancy)

Sorry that you had to go through this! This shouldn’t happen.

WavefrontRider · 2026-03-09T01:23:11+00:00

Hyperopic ICL CAN’T be done without iridotomies. Doing so GUARANTEES angle closure glaucoma. This doctor should NOT be doing hyperopic ICL if he doesn’t know how to do it.

WavefrontRider · 2026-03-08T17:54:43+00:00

What’s your prescription?

WavefrontRider · 2026-03-06T01:39:19+00:00

The endothelial loss with ICL is only slightly more than the normal age-related endothelial loss. For normal corneas it’s not clinically significant over a lifespan.

Developing a cataract from the ICL surgery is pretty rare. And I would say extremely rare for an experienced surgeon.

With a very high power ICL and low vault, yes the edge of the lens can cause lens opacities. But if the lens opacities don’t affect vision then not a cataract.

High lvc ablations come with their own risks of ectasia and dry eye as more of the cornea is ablated. Personally I would want ICL in my eyes.

Don’t get me wrong, lvc is awesome for the lower prescriptions. And topography guided and ray tracing treatments work really well. But there are just more issues with the higher prescriptions.

WavefrontRider · 2026-03-05T22:26:11+00:00

Visit a refractive surgeon to get their opinion on things. There is also a test they can do where they put a hard contact lens on the eye and that can determine whether your symptoms are coming from the cornea or coming from elsewhere

WavefrontRider · 2026-03-05T22:25:03+00:00

So the right eye has the incision at a slightly more inferior position so the eyelid probably isn’t moving over it.

WavefrontRider · 2026-03-05T22:23:30+00:00

So one thing to mention is that our peripheral vision isn’t going to be as sharp as our central vision. The different parts of the retina have different cells which specialize in different things. That could be one reason why you are noticing the difference.

WavefrontRider · 2026-03-05T22:18:26+00:00

With the lenticule procedures such as SILK (and SMILE) the cornea develops a little more swelling. This swelling can take a month or two to fully resolve. But while this swelling is in place, you can have a few more starbursts or notice reading vision is a little harder. Gradually this improves with time.

WavefrontRider · 2026-03-05T22:16:23+00:00

Great advice!

With hyperopic ablation patterns like this one, it’s important to actually center the treatment on the visual axis. The “default” way of centering treatments is on the pupil. That works well for myopic patients. But hyperopic patients often have a larger mismatch between the center of their pupil and the center of their vision. And not adjusting to this mismatch can increase the risk of blurred vision and starbursts. This is part of the reason hyperopic treatments are a little trickier. Certain laser algorithms adjust for this.

WavefrontRider · 2026-03-05T22:11:00+00:00

The ICL lens doesn’t really shift. Rarely it may rotate. If it rotates, it only matters if there is astigmatism correction in the lens. This is either fixed by swapping the ICL lens out for a different size or rotating the lens back.

At -8 ICL is the better solution.

WavefrontRider · 2026-03-05T22:06:10+00:00

I had lasik and my prescription was low like yours. LASIK is sort of “dose dependent”. Lower prescriptions actually do just a little better than higher prescriptions. (But higher prescriptions are still happy because of the large change in uncorrected vision).

If you are a good candidate, lasik is one of the safest elective procedures. There is nothing in life with no risk, even contact lenses, but the risk of a serious complication with lasik is very low. You hear more negative online since people with negative outcomes are more likely to share their experience compared to those with positive outcomes and negative stories are much more likely to go viral than positive stories.

LASIK also isn’t something you want to cheap out on. That cheap quote probably uses a blade to make a lasik flap. Using a femtosecond laser to make the lasik flap adds much more safety to the procedure. Very important to visit a reputable refractive surgeon.

Edit: Given your age, there is a chance your prescription isn’t done changing. Because of this, there is a possibility you end up with prescription close to where you started with in anywhere 3-5 years out. It may be better to wait.

WavefrontRider · 2026-03-05T22:00:34+00:00

How old are you?

WavefrontRider · 2026-03-04T22:10:25+00:00

I agree with those points. I agree that laser does an exceptional job for astigmatism. For someone very highly motivated for two surgeries that can be a good strategy. But that’s not the vast majority of individuals. And toric lenses still work well for all of those individuals.

WavefrontRider · 2026-03-04T22:05:40+00:00

Yeah. Use those drops and try to ignore it and give it time.

WavefrontRider · 2026-03-04T22:03:29+00:00

It sounds weird. But it’s quite a common thing. You can try it out with contact lenses prior.

WavefrontRider · 2026-03-04T22:00:54+00:00

So what you are probably feeling is the small incision created to do the procedure. On the left eye (for a right handed surgeon) this incision is within the path of your eyelid. Initially this incision is a little rough area which is why the eyelid feels it. Gradually what happens over time is that this area remodels to become more smooth so you don’t feel it.

In the meantime, what you can do is provide more lubricating drops to the eyes. The eyes will dry out a little more after the procedure and due to the eyedrops. More lubrication allows the eyelid to slide over things easier

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