My PRK Diary

The following is the diary I started of my journey the Friday before Thanksgiving:

I Did a bunch of research, and narrowed it down to customvue bladeless lasik. Customvue is a computer topomapping that is done of your eye to make the programmed laser sculpt the cornea as well as possible. All these procedures use some sort of mapping, but customvue adds a layer of precision to the mapping. You can read more about it here:

http://www.allaboutvision.com/

Unfortunately for me, despite what I *wanted* to do, I ended up with PRK instead of LASIK. I have slightly thinner corneas (about 15% of us do), and this affects our choices. With LASIK, a cut is made on the side of the cornea, and thhat part of the cornea is folded back, like a flap. Then, the programmed laser does its thing. Bladeless LASIK use a knife but makes the cut using a laser, so depth and edging is more uniform. This can lead to less complications and quicker healing.Typically 3 to 5 days with less pain and more "WOW!" factor.

In PRK, after anesthetic drops are applied, the clear cells that protect the cornea (called epithelials) are first loosened with a solution of alcohol applied for a period of a few seconds, and then gently wiped off, exposing all of the cornea. Then the laser does it's thing, and a clear contact lens is applied to protect the cornea while the first layer of epithelials regrow. Then the contact is taken away and healing continues. For those of us with thinner corneas, it's the "safer" alternative. Ironically, it can have a slightly better outcome than LASIK, because with LASIK part of the corneal depth/width is not corrected (the layer that is the flap, if you will) but in PRK, the entire corneal depth/width is available for sculpting. Downside is that healing is typically 6 to 8 WEEKS and there is more discomfort that lasts longer.

This is your eyesight. Spend the money and time and do it right. Conservative, even if it's "harder" or has a longer recovery, or delives 20/40 versus 20/15, is much much MUCH better than the alternative (both short and long term).

As I just said, LASIK nowadays typically heals in 3 to 5 days. PRK, is longer, just shy of two months usually, though you can read and watch TV the first day (as I'm doing) while wearing sunglasses at night. Eyes are photosensitive for a while after plus mild haloing etc.

Pain is no joke. Not screaming agony, but annoying, like when your eyes are burning from being tired and you want to rub them. Imagine that ALL the time. Ask at least for a mild sedative or decent painkiller (they will give you eye drops to help but vicodin just helps overall as well). After surgery the best thing you can do is to get the room as dark as you can, put on the eye shields they give you and maybe a sleeping mask, and nap for a good 3-4 hours. You need to rest the eyes and give them time to recover.

Valium. They prescribe it for everyone. 1 pill if your slightly nervous, as I was (of course you're nervous) or two if you need extra calming.

The actual procedure is you go over with the doc the day of the surgery everything that's being done and sign final consent. and arrange payment. They give you a kit with wrap around sunglasses and various eye drops. Then you take the Valium. About 40mins later, after watching a film on post op care, and having you put on a paper hair net, they'll bring you into the surgical theater.

They bring you into a room with three or four people in surgical gear (scrubs and booties and head wraps and masks) and you sit in a reclining chair that is and integrated part of this big unit. The chair reclines and they swivel a metal box (that reminded me of HAL from 2001 Space Odyssey) a few feet over your head and they ask you to look at the blinking light. The doctor will be performing quick checks with the technicians as to who you are and verifying correct info is entered into the laser system. I don't know about LASIK, but for PRK, they'll put a few drops in to numb the eye, then they'll ask you to keep looking at the blinking light. They put a hard shield over the eye not being done. and tape open (with paper tape) the eye being sculpted. The doc will place what they call a lollipop over the eye being done. It looks like a ring on a stick like we used to blow soap bubble with as a kid. This allows him to gently hold the cornea in place. All you see at this point is a blurry blinking light that you're trying to focus on / keep watching.

As above they use alcohol to loosen the cells then wipe them away, and they will call out the time the drops have been applied before they start wiping. Once they're satisfied the cornea is clear, they'll proceed on. So now, you're ready for the laser. This is NOT the blinking light (that is simply a target light for you to look at long with a tracking camera). They will slide in from the side what looks like a large straw tube. It makes a whirring noise like a small fan on high speed, then you hear a "tack!tack!tack!tack!tack!" sound for about 15-30 seconds (this is the laser firing in micro-burst) and you will see the orange blinky light become very clear, like adjusting the focus on a camera. You may notice a faint acrid smell (very faint).

...And you're done.

Reverse the patch, the drops, the lollipop and do the other eye. Total time both eyes is less than fifteen minutes from the time you sit down till the time you stand up. The doctor will immediately check your eyes using one of the magnifiers that you place your chin in. If satisfied there's no immediate issues, they'll send you home with a kit that has a bunch of eye drops to help with pain and healing.

That was my experience. As I said before, do your research, and for goodness sakes, cost is NOT a factor. Do it right or don't do it!

Day 2:
discomfort in the AM, woke me around 5:40. Took some pain eye drops and started my four times a day drop treatment at 6am. Went and saw doc at 7:30am. So far left eye was 20/400 w heavy astigmatism down to 20/60 and improving (PRK takes a few weeks to reach best vision) right eye 20/100 down to 20/30 and improving. No signs of infection or issues, protective contact lens due out late afternoon tuesday. Though things are still a bit blurry at distance, near vision is very good and it's amazing walking around without glasses. I wear my sunglasses pretty much all the time right now, even indoors in a relative dark room on a cloudy day to let them rest as much as possible. Highly recommend doing so. Even with LASIK as opposed to PRK, don't push your eyes. Effectively they've been badly sunburned and need time in a cool dark environment (just like your skin) to recover.

Day 3:
Vision too blurry to do much besides squint and try and watch TV. Thing is, as your focus adjusts your eyes are fighting for dominance, which is tiring, frustrating and can be dangerous. No driving as your focus just might go for minutes at a time. Pain is much less, but itchiness and desire to rub eyes is increasing. Central blurriness is apparent since your eyes heal from the edge inward. Consequently it's always like you just stepped out of the pool with mild fogginess. Extreme sensitivity to light at times. Blurriness is apparent both near and far distance. Curiously, less apparent at far distance, but maybe that's normal. By example: Couldn't read instructions on back of frozen food yesterday.. amazingly frustrating.. finally worked it out after staring at it for a couple minutes and picking up on key words like "450" "bake" "16min" "flip halfway". If it had been more complicated than that I would have been ordering in. Could more or less follow Harry Potter movie on 51" HDTV though.

Day 4:
Vision improving, and getting much more steady, blurriness still present but decreasing, near focus much better today than yestreday. Less sensitivity to light. Went ahead and took today off as well (along with friday). I am not quite ready for prime time just yet. I can somewhat type, and somewhat watch tv, but would not recommend trying to drive long distances just yet. Pain is gone but I would like some fine grain sand paper to rub the itch out of my eyes. I know that's just the healing but it can be maddening at times! Grahhh!! You tend to try and be conscientious about actually rubbing the eyes so you rub all around them instead, or pull your eyelids off the eyes gently... Honestly if they make just plain numbing drops that would be helpful at this juncture. Can read more or less fine. Vision a bit watery at near and a bit blurry at far, but all in all much MUCH better than yesterday. The most significant thing is the lack of sensitivity to light/pain. Took off sunglasses (been wearing constantly since friday, even at night) late this afternoon and haven't put them on since. No pain really.

A reminder that I had PRK not LASIK, so some of this may be specific to my procedure. I know that healing time and time to best vision is longer with PRK and there is a greater chance I will need a second or third treatment. So far, sticking pretty religiously to eye drop schedule and staying with the "Jackie-O" eyeglasses look seems to be paying off. Keeping eyes moisturized with "refresh plus" teardrops also seems to help. At all costs avoid visine. It's bad for your eyes according to the docs.

I should be getting the protective contacts out late tomorrow afternoon.

Day 5:
Contacts out now. Some discomfort and light sensitivity after wards, but able to drive and function. Minimal night blindness and not too much haloing at this point. Increased blurriness as healing progresses. This is normal and the blurriness and fog.haze will dissipate as the cornea heals. The target is 75% healed in both eyes when the contacts come out. I'm at 80% and 90% left/right eye. Doc commented that keeping to the eye drops schedule pretty religiously (which I do) is a major determinant in the pace of healing and prevention of infection/issues. This means I'm up at around 6AM to do some eye drops about 20 mins apart (to make sure one doesn't simply wash the other out). Then again at 12pm at 6pm and at midnight before bed. Continuing to use the eye shields so I don't rub my eyes at night. Not a major hassle once you get used to them. Eye shades slip right over without issue.

Day 6:
Mild light sensitivity but nothing major. Blurriness as well. Can at times see definite real improvement when for a few minutes the haze/blur will go away and I have clear focused vision. Oh hurry up and heal eyes! This improvement will continue for the next six weeks so I'll just post updates after visits with the docs unless something dramatic happens.

Day 13:
Had my second simple follow up yesterday. Epithelial growth is 100% primary layers in both eyes, Doc was very pleased, no hazing or scarring to speak of, no pain or light sensitivity to speak of either and only very very minor haloing. I had astigmatism so I've always had some haloing.. if anything it seems to be less than it was, so far. I have a tiny bit of dry eye and discomfort in the morning. I have always had that, since I have large pupils, so it's not much of a difference, I just gently wash around my eyes with a warm washcloth and then pop on sunglasses for a few minutes until my eyes get over the "bright light!" effect.

My vision continues to slowly improve, using only the Prednisone steroid (to assist in healing) 4 times a day now. Also use Refresh Plus eye drops for up to hourly use to prevent dry eye / burning / itching. Yesterday I was also given a bottle of Systane Free to try out as it's closer to a light gel and will stay in place longer. As always I try to not do too much caffeine as it will slow healing. Stay on the eye drops schedule and you will be okay. One thing I will say about the drops is that they drain through your sinuses down the back of your throat, so you will get a kinda nasty chemical taste in the very back of your throat (remember that one time you chewed aspirin? Yeah, like that) about 10 minutes after you apply them. Just have some handy drink (even water will do) to wash it away and you'll not notice it much.

As above, when I put in eye drops I'll get what I call "the light at the end of the tunnel" effect. What actually happens is the eye drops will bond for a few moments in the space where the epithelials have yet to fully regrow to appropriate thickness. In effect, it acts like a liquid lens and replicates what my vision will be like in a few more weeks when the epithelials have regrown to normal depth. And for those few moments, I have perfectly clear 20/20 vision. It makes me giddy like a kid when it happens. I talked to my Doc about this and he explained that it's perfectly normal, most patients will have this occur, and it basically represents what my final vision will be. I think I'll go get a job as a sniper, or maybe a fighter pilot or something, because I am going to have bionic vision. N-n-n-n-n-n-n-nahhh!

Day 21
Another visit to the Doc. Visiion is continuing to improve. At this point, there's not much blurriness, but astigmatism (double vision) is quite apparent. I've been informed that I'm right in the groove for how things should be going. The double vision takes longer to heal, but over the next two to four weeks I should notice significant improvement in that area. In the meantime I can squint and lean close and can see well enough to type, though I get "squint muscle aches" after a while. Small price to pay, and they'll go away as the eye improves. Steroid eye drops down to three times a day now, next week they drop to two a day, then one a day then taper off completely. Minimal haloing, minimal light sensitivity in the morning no night vision issues so far.

As always, to anyone still following my little journey and considering the surgery I want to say a word or two. My results seem to be fairly normal middle of the road in terms of recovery length etc. I will ALWAYS recommend you do plenty of research and get the best you can afford. In terms of payment, I was considering just paying cash, but I ended up getting a medical credit account and paying it off over 18 months with 0% interest. Why not? Auto deduct from my checking account and when the tax rebate comes back this year I'll probably just pay it off completely. Be advised, of course they are deferring interest so if you take this path make sure you pay a few dollars more than your payment. I plan on setting up a auto pay of an amount that will pay off the cost in 17 months so no matter what I'll never be in arrears. If you go into arrears they will hit you with ALL of the back interest so make sure you pay it off on or ahead of time. The cost of the surgery is tax deductible as a medical expense, though it may not be more than your standard deduction so you will have to do the math and see if it's worth it to you.

Regards,
-Bouncer-
ps: Yes, thar is my eye. :)