PRK Journey

My background

I am a 37 year old male who has worn glasses for nearsightedness since the 5th grade and my vision has gotten progressively worse over the years. As I have gotten into my 30s my vision has finally begun stabilizing and is currently at-5.25 diopters right eye and -5 diopters left eye. I have considered laser surgery for the past 10 years but decided to wait until my vision stabilized, the number of possible complications was reduced and the technology improved. Since my prescription is now stable, the procedure is much more common, complications have significantly reduced, and the customwave technology is now available I decided it was time for me to proceed. I also got a lot of encouragement from my wife.

My research

Prior to visiting any doctor, please do your research. You are dealing with your eyes and once surgery is done there is no going back. Also, try not to focus so much on cost as you’ll find even the so called cheap doctors are not so cheap once you go in and get your eyes examined. Often times you’ll see amazing offers starting at $495 per eye; however, once you take off a day from work and go into the doctor’s office to get your eyes examined and dilated, you’ll find that because of your prescription the cost will quickly go up. This is a common tactic similar to a bait and switch routine where they try to get you into the door. I didn’t feel comfortable having a doctor work on my eyes that was involved in this type of car sales routine.

I started my research in February of 2008 by looking at several doctor’s backgrounds, trying to determine how much experience they had, whether they had complaints, and the technology they used. To find whether each had complaints, I did a few simple google searches on the words “Dr. Anyone complaints” and also checked the Better Business Bureau. You’ll be surprised when you find complaints about various doctors.

As part of m y research I came up with a list of key questions to ask the chosen doctor(s). The list of questions was primarily focused on ensuring the doctor was right for me and that the best most effective technology was being used. As I researched at all the negatives and positives of laser surgery a recurring theme from people with bad experiences was they went to a bad doctor. Most of these bad doctors tend to focus on quantity and not quality. Everyone, including what I considered the bad doctors, used the latest and greatest technology which includes the customwave equipment (an effective means of mapping out the exact contours of the eye which guide the laser), S4 Visx laser, and intralase laser which makes the actual lasik flap.

Pre-screening and pre-op appointments (February 26th and March 13th 2008)

After I did all my research and was comfortable with the doctor I setup my pre-screening appointment to determine if I was a laser surgery candidate. After the pre-screening I was setup with a second pre-op appointment which consisted of dilating my eyes and going through all the same tests from the pre-screening. During both visits I got the opportunity to speak to the doctor who would be performing my surgery and I asked him my list of questions obtained from the previous research.

During the pre-screening I told the doctor that I was concerned with dry eye. Although my pre-screening tests did not show that I had dry eye the doctor stated he would do a more in depth test during my pre-op to determine whether I had dry eye. Also he stated I would be an excellent candidate for lasik or prk. He stated for patients with dry eye he would recommend prk; however, this would be further assessed during my pre-op tests. I then asked the doctor on a scale of 1-10 where he would place me as a laser surgery candidate and he stated I was a 9 or 10 and could go 50/50 for either lasik or prk.

At my pre-op appointment my doctor concluded that I did have a slight tendency for dry eyes as a tear breakup test indicated that my tears broke up quickly (A sign of dry eyes). At this time I asked my doctor which procedure he’d recommend and he stated 55% prk and 45% lasik.

I then went home and did more intense research on prk versus lasik and ultimately decided prk was a better choice for me for several reasons. During the Lasik flap creation corneal nerves are severed which never heal whereas prk does not have this complication. These nerves have a direct impact on the eye’s ability to produce tears so if you start off with dry eyes before the surgery they will worsen after the surgery. I didn’t want to be a person who was a slave to eye drops for the rest of my life. Also, after reading about lasik I found that the flap created during the process is more invasive than prk as a cut is made more deeply into the eye whereas prk takes off a small portion of the outer layer. What was somewhat shocking to me is the flap created during lasik never fully heals and you always run the risk of flap complications even years after the surgery.

I was told by staff after being very inquisitive in comparing the two that someone who had lasik surgery several years earlier had come into the office whose dog had hit her eye with his paw causing the flap to fold. Had she had prk this would have been impossible as they eye fully heals back to its original state. The only negatives on prk were possible starbursts, halos and the pain involved in the recovery process. With lasik you can also have starbursts and halos; however, the pain is much less severe and the recovery is much quicker. Lastly, since I was border line on going with either procedure the lab technician gave me forms for both prk and lasik to take home, sign and bring back on the day of the surgery. These forms contained a list of all the possible complications you may encounter as a result of the surgery. I immediately noticed that the prk consent form was a few pages shorter than the lasik consent form due to a lesser amount of possible complications.

After this, my mind was made up I was going to go with prk. I was willing to take a little more pain with prk in return for not having to worry about dry eyes and future flap complications. I was also given several prescriptions to fill prior to my surgery day.

Day of surgery (March 20, 2008)

My appointment was at 1:30pm. I took a prescribed pain pill at 1pm and at 2pm I was taken back to waiting room where I was given several eye drops and asked if I’d like a Xanax. As I was nervous I immediately jumped at the offer. About 20 minutes later I was taken to the operating room where I laid down at the VISX S4 laser and administered several more eye drops. As I lay down under the laser, my nerves became increasingly high and the doctor began placing tape on my right eye lids to hold them back then used a speculum to secure them. My left eye had an eye patch placed on it. The speculum placement was painless but strange as I could feel the doctor placing slight pressure on my eye ball as he secured the speculum. I squeezed my hands very tightly, took several deep breaths and prepared to have my epithelium cells removed before the laser started.

Shortly after securing my eyelids, I noticed a small spinning bristled brush (appeared similar to a battery powered toothbrush) which was placed directly on the eye and used to scrape off the top layer of epithelial cells. This process was done manually by the doctor as he held the brush and went over my eye several times. This process lasted about one minute and was painless but I felt a pressure on the eye and was my most nervous at this point. The nurse then stated that most patients commented that the brush process was more painful on the second eye than the first. She deduced that since the patient knew what to expect after the first eye the brain tricks the body into feeling more pain on the second eye.

After the brushing was complete on the 1st eye, I was then asked to stare at the orange light. I fixated my eye and held my breath as the laser began removing part of my cornea. During this time, a smell very similar to burning hair was detected. This was the least painful part of the process and took exactly 31 seconds for my -5.25 diopter (right eye). At the end a bandage contact was placed on the eye. Once done with the right eye I received the exact treatment on the left eye. I completely agree with all other patients that the brush on the left eye seems more painful than the right eye. Although the pain is very low, I felt a lot of pressure and my left eye and instinctively began looking down (to avoid pain) whenever the brush began and the doctor had to tell me to look straight up. My left eye took 30 seconds, which had -5 diopters. All in all the actual process took about 20 minutes. My lovely wife then drove me home where I lay on the couch and napped on and off the rest of the day. My day vision was very blurry. My night vision was extremely hard to see and I could not read anything. My pain level was at a 3 out of 10.

I was previously given several prescriptions which I filled and brought with me to the appointment. I was prescribed the following medications.
1. Zymar (antibiotic drops). Must take twice day of surgery and 4 times each day for 5 days or until bandage contacts are removed. Keep this in the fridge as the coolness feels great on the eyes.
2. FML (Fluoromethalone – cortisone/steroid drops) Must take twice day of surgery and then several time daily for the next 4 months. Keep this in the fridge as the coolness feels great on the eyes.
3. Toradol (Ketorolac – pill for acute pain). Only prescribed 3 pills. I had to take 1 pill at 1pm on day of the surgery and then for the next 2 days.
4. Vitamin C. My doctor prescribed and I also read when doing research that Vitamin C helps the healing process of the eye. My doctor recommends 500mg twice daily for 1 year.
5. Refresh plus – over the counter drops used to keep the eyes from drying out. I took this approximately every 3-4 hours daily. Also take at night every time you go to the bathroom as your eyes will tend to dry out the worst at night and do not turn on any fans as this will cause your eyes to completely dry out and your eyelids to stick to your eyes. Keep this in the fridge as the coolness feels great on the eyes.
6. I was also given several pain medications which I was only to take under extreme pain - Acular PF, Tetracaine, and Ultram. My understanding is these medications slowed down the healing process and therefore should only be taken if experiencing a high level of pain.

Day 1 after surgery (March 21, 2008)

Went to the doctor for a post-op checkup at 8am this morning and reported slight burning and tearing. Although my vision is extremely blurry I checked in at 20/40 in my left eye and 20/60 in my right. The doctor stated that my eyes appeared healthy and were progressing well.

Later that afternoon I took a nap and upon waking my eyes were strongly burning and tearing uncontrollably. I immediately decided to wait it out for about 4 minutes but the tearing and burning continued and I couldn’t keep my eyes open for more than about 10 seconds. I then decided to try regular refresh plus drops to moisten my eyes, waited 4 minutes and no luck. I then tried going to my daily routing of Zymar (antibiotic) waited 5 minutes then FML (steroid). My eyes seemed to improve slightly but still burned heavily. I then tried the Alcon (pain relief drops) and waited 4 minutes….still had pain. After about 30 minutes, pain began to subside. For most of the day, I had a slight burning sensation and I spent the day with my eyes closed listening to the TV. I am also more sensitive to light today.

On a scale of 1 to 10, the pain got up to about a 7 or 8 then subsided to a 4. I couldn’t keep my eyes open for very long as they kept tearing up and I can compare the feeling to contacts gone bad that are severely irritating the eyes. The only problem is you cannot remove these contacts. As far as pain goes this was the most painful day of all and luckily once you go through this process you won’t have a pain this strong again. After I went through the pain I found that a cold bag of peas or corn would have made a tremendous difference.

Day 2 after surgery (March 22, 2008)

Eyes feel much better today, slight burning sensation, sensitivity to light, and slight tearing. Vision is fairly blurry and it’s difficult to see in the dark. Everything looks washed out as if though a light fog were in the air. Still can’t read and my eyes feel strained and begin tearing when I try. My left eye has slightly better vision than my right. I’m using drops approximately every 2 to 3 hours to relieve dryness. I’m also taking 1000 mg of Vitamin C daily. I’m looking forward to day 5, when I can take my contacts out. Doctor said day 3 or 4 would be the day of my worst vision. When I close my eyes, especially at night when sleeping, I have a feeling of slight pressure; like it’s hard to keep my eyes closed. Eyeballs seem to be swollen. I was able to watch some TV today; however, only a little at a time as my eyes would begin burning and tearing. Pain level is 3 out of 10 due to slight burning sensation and occasional tearing.

Day 3 after surgery (March 23, 2008)

Last night as I lay in bed trying to sleep, I became somewhat depressed. My thoughts centered around the past two days of lying on the couch with my eyes closed, incapacitated, I was afraid my vision was not going to improve and briefly contemplated my a life of what if my vision doesn’t improve . When I woke up on day 3; however, I immediately noticed that I could read small lettering with my left eye My right eye was still blurry when reading. Overall, I had a big improvement in vision, and it boosted my confidence considerably. My pain level is at 0 and I still have blurriness in both eyes, but it’s improving every day. I have slightly better vision in my left eye and expect my right eye to catch up soon. Nighttime vision is still not improved much, but should get better with time. I was able to go outside and enjoy my day, watch a few movies. I had a much better day today. As the day progressed I did notice that I began to feel the bandage contacts and although they were painless they were becoming a slight nuisance.

Day 4 after surgery (March 24, 2008)

No vision improvement from yesterday. In fact I’d say my reading vision is slightly decreased. I can read but it is somewhat difficult. My doctor did state that either day 3 or 4 after the surgery would be the day of my worst vision as the epithelial cells came together at the center of the eye, completing the healing process. My pain level is at 0 out of 10. I highly recommend taking off from work on day 4 and 5 to allow your eyes to fully rest before straining them at work. If your reading vision is as blurry as mine you won’t get much done. I’m looking forward to tomorrow to have the bandage contacts removed and will drive myself to and from the appointment which is 1 hour 45 minute drive each way. I spent most of the day watching TV. Also, the slight contacts irritation I mentioned yesterday was not noticeable in the morning but as the day goes on the irritation increases. Refresh drops alleviate the irritation slightly.

Day 5 after surgery (March 25, 2008)

Last night my lashes slightly stuck together. I placed drops into my eyes and they immediately opened. Reading vision is slightly improved; however, overall I don’t feel much of a change. Pain level is still a 0. My doctor’s appointment is at 11am today to get the contacts removed.

Day 11 after surgery (March 31, 2008)

There was significant improvement in my right eye, which overtook my left eye in having better vision. I can read 20/20 with my right eye; however, it’s somewhat blurry. My left eye can only read 30/30 and is slightly more blurry. I have not had any pain since the day after my surgery. Improvement is at a very slow rate now; it seems to be once a week that I notice improvement. Due to vision difference in each eye, it’s a little difficult to read.

While driving, I’m still having difficulty reading signs, unless I’m very close. At a distance of approximately 30 ft. they’re still blurry. I’m still on a regiment of 4 drops a day and refresh drops, when needed.
I find myself pushing up my “glasses”, which aren’t there anymore; it’s a habit. At times it can be a little frustrating because I still can’t see as well as I could with glasses. The blurriness is the most frustrating part.

Day 16 after surgery (April 5, 2008)

No significant vision change since day 11. I still have blurriness in both eyes; right eye has better vision than left. While at the clinic for my pre-op, I met Johnny (a 28 year old male) who had LASIK the same day as my PRK. I spoke to him 14 days after his surgery and he indicated that he was only at 90%. He also said that the blurriness was what was causing him the most grief and it’s not as crisp as he was used to seeing.

If you have any questions, please email me at chrisvnet@gmail.com