Having some blurry vision after lasik can be scary. Did something go wrong in correcting my vision? We all spend lots of time on a computer these days. Many people use computers for their work. The fear of losing vision with lasik is especially evident if it suddenly becomes harder to see and use the computer following a lasik procedure. But fortunately there are some well known causes for a blurry computer screen after lasik. The first day after lasik, everything is expected to be blurry. But beyond the first day the biggest factors causing the computer screen to be blurry after lasik is dryness and variances in your eye prescription.
Within the first day after lasik
You will have some blurry vision if you are trying to read your computer screen immediately after getting lasik done. Everyone will have some blurry vision that first day after lasik. While your vision may be better than what it was without glasses and contact lenses, it won't be close to full strength. This will make seeing small details more difficult (not only on the computer but elsewhere in your life as well). This is all normal and will heal up within the first 24 hours.
After the lasik laser treatment, sterile water is used to reposition the lasik flap in place. The lasik flap absorbs some of this water and becomes slightly swollen. The swelling of this lasik flap causes everything to be hazy and blurry. But the cornea has a natural mechanism to pump out the swelling. As the water is pumped out of the lasik flap, the vision improves. This happens within the first day.
Beyond the first day of lasik the causes of a blurry computer screen after lasik narrow down.
Dryness
Probably the most frequent cause of a blurry computer screen after lasik is dry eye.
Most people associate dry eye with a burning pain or scratchy feeling. But dry eye can cause a wider variety of symptoms. One symptom of dry eye can be fluctuation of vision. What you may notice is that immediately after blinking, the vision improves for a second or two but then rapidly becomes blurry again. Here is what is happening:
It's all about the tear film
On the surface of the eye is a protective liquid coating called the tear film. This tear film has different layers including a watery layer (which is what we think of when we think of tears) and a protective oil layer on the surface of the eye to keep everything in place and prevent evaporation. Every blink of our eyelids works sorta like a squeegee to maintain the smoothness and uniformity of the tear film. The smoother and more uniform everything is (by having a healthy tear film), the better vision we get. Vision must pass through this tear film before it reaches the cornea and the rest of the eye.
In dry eye, the tear film can become unhealthy and unstable. Instead of staying nice and smooth and uniform, the tear film can break down and become irregular in between our blinking. When the tear film becomes irregular, it scatters more light and makes our vision more blurry.
This causes fluctuation of vision. Immediately after blinking things are fine (since the eyelids smooth the tear film out), but a few seconds later the tear film breaks down, dries out and becomes irregular - vision becomes blurry.
This fluctuation of vision can be more or less be present all the time, especially if you had preexisting dry eye prior to lasik, or it can come and go without any good reason. Some days you may notice that your vision is a little bit more blurry than other days.
Computer use makes it worse
When we are working on the computer, we don't blink as frequently as normal. This is the case with any task that requires cognitive demand. We are just too much "in the zone" to worry about blinking. This lack of blinking will cause your eye to dry out. The tear film dries out more and there is more fluctuation of vision. This is commonly described as Computer Vision Syndrome.
Why is it worse after lasik?
Lasik will cause a short-term dryness for everyone. After lasik, our eye has a reduced ability to produce natural tears. Typically, when our eye notices that it is drying out, it sends a signal to produce more tears. There are tiny nerves all throughout the cornea that take care of this role.
During lasik, a lasik flap is created and a laser is used to remodel the cornea. These processes disrupt those nerves within the cornea. As a result, this signal pathway is broken - for the short term. Eventually these nerves grow back; it just takes a few months.
This causes the eye to dry out more than usual. We just don't have as much tears on the surface of the eye as what we typically have before lasik. Less tears on the surface provide less of a buffer to keep the tear film nice and smooth. It takes more drying to break up a thick tear film than to break up a thin tear film. Vision can fluctuate more with the dry eye after lasik.
Best ways to treat dry eye and improve computer vision
When treating fluctuation of vision after lasik, the main goals are to thicken the tear film more and create a healthier tear film to reduce the instability
- The most simple way is more frequent preservative free artificial tears. Artificial tears help supplement our own natural tears to keep the eye from drying out as frequently. When you are working on the computer, you may find that you need to use tears a little more frequently - up to every hour. Artificial tears come in different consistencies; some are thick, some are thin. If you find that the tears help but just don't last long enough for you, look into gel-based preservative free artificial tears. These will last longer on the surface of the eye.
- Omega-3 or fish oil supplements. Taking an omega-3 pill will help improve the oil layer on the surface of the eye. Having a good thick oil layer helps prevent the tear film from evaporating away and really improves the stability of everything. While it doesn't have immediate effects, it helps improve everything over time.
There are lots more treatments for dry eye: punctal plugs, prescription eye drops, lid scrubs, etc. Be sure to talk with your eye doctor to find out if any other treatments would work well for you.
The prescription of the eye isn't optimized for computer
Once the dry eye is sorted out, there are a few prescription reasons why the computer screen may be more blurry after lasik.
Presbyopia & lasik
Within our eye is a natural lens. This natural lens gradually changes over time. For people in glasses and contact lenses, the change in this lens causes their reading vision to decline in their forties. They find they need to wear reading glasses over their contact lenses or go into progressive glasses (but some near-sighted individuals find that all they need to do is take off their glasses or take out their contact lenses to read). This change in the natural lens is called presbyopia. Eventually as the presbyopia progresses, it becomes harder to see the computer.
Lasik can't prevent or slow down presbyopia. Unfortunately it's inevitable. That means that if you have presbyopia and lasik is performed to correct both eyes for distance vision, you will notice blurred up close and potentially computer vision. You will most likely need reading glasses to read up close and potentially use the computer.
Despite presbyopia, lasik is still done to correct distance vision. Having nice and sharp distance vision is great for people that live an active outdoor lifestyle. Needing reading glasses is a trade-off to having crystal clear distance vision.
Contact lens wearers may already be used to this effects. Standard contact lenses work similar to how lasik works. Others used to wearing progressive glasses may take a little bit of time to adjust to these changes. The biggest change will come for those who are naturally nearsighted. If you are used to taking off your glasses to read and see the computer, correcting your vision completely for the distance and needing reading glasses will be a big big change for you (unless you are well prepared ahead of time).
With lasik, however, there is another way to correct vision in presbyopia. This is through a concept called mini-monovision. In mini-monovision, one eye is corrected for the distance while the other is corrected for computer and reading vision. Mini-monovision provides a great way to provide glasses independence with lasik for those with presbyopia. Many people with contact lenses already employ this solution to stay out of reading glasses. The drawback of mini-monovision is that it will take some time for you to adjust to having two different prescriptions. Patients with mini-monovision after lasik will also be more sensitive to fluctuation of vision from dryness (see last section). If their vision is fluctuating, it will make it more difficult to see the computer (since both eyes aren't working together anymore to compensate for one eye's fluctuation).
Prescription error
Lastly, if you have residual prescription error after lasik (typically residual astigmatism), it can make it more difficult to see the computer screen. As perfect as lasik seems, nothing in life is perfect and some patients may end up with some residual prescription following the procedure. Those that have very large prescriptions to start out with are at a little higher risk of having some residual prescription error; especially those patients with very large amounts of astigmatism.
Typically the blur from residual prescription error isn't terrible, it just doesn't feel as sharp as what it could be. You may notice that some of the finer details on the computer screen are a little harder to see.
If you do end up with residual prescription error following lasik, it can frequently be treated with an enhancement procedure to get rid of that remaining prescription. Typically the surgeon will wait a few months for everything to stabilize first. In addition other causes of blurry vision such as dry eye are also treated to exclude as a cause; dry eye and fluctuation of vision can lead to the measurement of prescription error that doesn't actually exist.
Summary
Having trouble seeing the computer following lasik can be stressful and annoying. Especially as many people use the computer every day for business. But fortunately, there are real reasons why your computer screen is blurry after lasik. By knowing the causes, you and your eye doctor can get you set on the right course to get everything corrected and get you seeing things great.
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