Notes on PRK eye surgery.

So, about 5 weeks ago, I went in for PRK eye surgery, and now that there has been some time to heal and see the results, I thought I'd write a blog post about it to let people know how it went. There seems to be a lot of interest about the procedure out there on the internet, so I'm hoping someone finds this useful, if not at least an interesting read.

First off, I have been wearing glasses since the fifth grade, contacts since seventh, and hard contacts since 9th grade (which was in 1990). My last eye glasses prescription was rated -5.25 in the right eye and -6.00 in the left, so I had a pretty high prescription. Anything farther than 5 inches away from my face was pretty blurry. I was switched to hard lenses because my eyes were very sensitive and put out a lot of protein when I had contacts in, and my soft lenses got deposits on them too fast. Hard lenses are way easier to keep clean. If disposable lenses had been cheaper back then, I probably could have switched to dailys, but they has just been introduced and were still pretty expensive. But, my eyesight was very good with the hard lenses in, about 20/15, so was mostly happy with them.

What prompted my decision to look into eye surgery was that I was just tired of dealing with the downsides of contact wear. Mostly things like that they made my eyes very sensitive to any kind of debris in the air, and even a stiff breeze has been known to knock the hard lenses out of my eyes if they hit me just right. And I work on a computer all day at work and spend a lot of my free time in front of a screen too, so the dryness and fatigue of wearing hard lenses were factors as well. I considered switching to soft disposable lenses again, but I figured I might as well check into the eye surgery just to see what my situation was first.

I chose Pacific Vision Institute here in San Francisco, mostly due to Dr. Faktorovich's reputation and the fact that they had all the most modern equipment available. As much as a good doctor is important, having the right equipment is almost as important (some people will tell you that it is more so), since the procedures themselves are mostly automated. That said, a good doctor is one who will give you an honest and thorough evaluation as well as proper pre and post operative care. I have been mostly satisfied with PVI so far.

After my evaluation was done, I was told that my retinas were too thin for lasik, and that PRK was my best option. After reading up more on it, I actually felt that I would prefer to get PRK anyway, since the chance of complications is less than with lasik, due to the lack of a flap being cut. That said, I was pretty concerned of the extended healing time. When I asked my doctors about how much time I should really expect the healing to take, they gave some good answers, some bad. They were always clear that my final result wouldn't known for months after the surgery, since your eyes take some time to fully heal. I understood that the surface of the eye needs to smooth out and that the membrane covering the eye needs to grow back, and that takes time. What I felt like I wasn't given a straight answer on was how long after the procedure I could expect to have reasonably good vision again, meaning that I could take care of myself and go back to work and such. Than answer I always got was "it depends on your comfort level", which I now understand to mean "it's different for everyone so you just need to wait and see".

I actually had a friend go in to PVI for the same procedure exactly a week before me, and being able to gauge his experience against mine, I would say that healing time is pretty different between people. He took almost twice as long as I did to get back to functional (good enough to get around) vision after the procedure.

So, let's skip ahead to the day of the procedure. I was very (very) nervous going in, since I was uncertain if I had taken enough time off of work and of course I was hoping that nothing went wrong and that I could fixate on the target well enough. They gave my a dosage of ativan to help calm me down beforehand (I never felt it kick in, to tell you the truth), and then I waited for my turn in. I was surprised at how busy the place was, there were about four other people in the pre-op waiting room, and I could tell they were being taken in one right after the other. It was very strange to see one person go in, spend about 10 minutes in the operating room, and then see them come out with the dark shades and protectors over their eyes. It seemed too fast. Soon enough, my time came and in I went.

They had me lie down and they started on the prep work (sanitize face, tape back eye lids). We waited for a bit while they set up the machine, and finally DR Faktorovich came in and they began. First thing they did was they push down on my eye with a metal ring and remove the epithelium. At this point, I kind of freaked out, since they didn't bother to tell me what they were doing. In all the prep work and pre-op briefing, they always mentioned that there would be no flap to cut, but they never mentioned having to remove this membrane layer manually. I figured it burned off with the laser, I didn't know to expect to have my eye scraped. If I could fault PVI for anything, it would be the lack of information given about this in particular. If you are interested and are not squeamish, you can watch this video on youtube to see what the procedure is like (note: that is not me in the video, just some random patient). I kind of wished I had looked it up before going in just so I could have known.

Anyway, they held me down and went to work fast, giving me directions on when to focus and how much longer it was going to take. They constantly irrigated my eye with a cold liquid, which was actually quite refreshing, and before I knew it, it was done. Each eye took less than two minutes a piece. They then toweled off my face, taped on the eye guards, handed me a pair of the coolest shades ever and a vicodin prescription and lead me to the waiting room. My brother came and picked me up and took me to his place where I would ride out the first few days of healing.

At this point, my vision was pretty blurry still, but I could definitely see better than I ever could without glasses or contacts. I was very light sensitive, and kind of in shock about how fast and seemingly rough the surgery itself was. I had my brother drive by a pharmacy first thing so I could fill the prescription for the vicodin, because even though they said that I should fill it only if I felt I needed it, I knew from the research I did that I was definitely going to need it. Actually, come to think of it, that is another thing that the doctors could have been clearer about. I'd hate to think that someone would come out of that surgery and not immediately fill that prescription, because although it only mildly stings at first, it grows to be a serious throbbing pain soon enough. If you didn't have pain killers on hand to help out with it quickly, you'd be very sorry.

So, the first 24 hours were actually mild. I could kind of see well, despite the light sensitivity. I could actually watch TV. I was doing my artificial tears and steroid drops every two hours and felt ok. I went in for my check up appointment the next morning feeling great. They just did a quick check up to see that everything looked ok and then made me another appointment for Monday (it was Friday then). I ate lunch and went back to my brother's place. That was when I started to get VERY light sensitive, and my eyes started stinging a lot. I hit the vicodin and waited. That 45 minutes of waiting for the pain killers seemed like forever, as my eyes were tearing up something fierce. The next two days I was pretty much immobile. My vision got very blurry and I couldn't stand any kind of direct light. I stayed doped up and found that I needed to take my next dose about an hour before my last dose would wear off (four hour effectiveness, so every three hours I'd take a pill), because any gap between would be miserable. All I could really do was lay in a dark room and listen to the radio. I got very bored. Saturday night was the worst of it, as I had to double up on the paid medication just to fall asleep.

The following morning, things started to get better. The stinging was less, and I could stand a little bit of light. As the day went on, it got better. My nightfall I was good enough so that I could actually hop on a bus and ride it home, but still with my shades on at night. I could see well enough to move around on my own, and the pain was gone. My eyesight was such that things didn't get blurrier the farther away they were, everything was just blurry to an extent. But, I could at least function.

So, as I said before, the doctors at PVI had said that I could go back to work whenever I felt I was comfortable enough, giving a minimum of four days of healing. Having the procedure done Thursday morning, I was definitely not ready to go back to work the following Monday. I took two additional days off and went back in the following Wednesday, a day after I had my contact bandages taken out. At that point, my eyes started to heal a little faster. I could sit in front of my monitor and do work, but I had the font size on my web browser and text editor turned way up. I would take breaks every couple of hours to let my eyes rest, but my eyes were showing good progress daily.

At my follow up appointment approximately 11 days after the procedure, my right eye was doing very well, at about 20/20. Left eye was taking longer to heal, and still had some blurriness. Still doing the artificial tears hourly and on slightly more dilute steroid drops four times a day at this point.

After my most recent one month checkup, my right eye now tests at 20/15, and my left is 20/20. I am using steorid drops twice a day and artificial tears as I feel I need them. My eye are dry, but I consider them to be about as dry as they used to be when I wore hard contacts all day, and I still have the hope of them getting better as time goes along. I've been taking omega-3, 6 and 9 supplements as well as multi-vitamins containing vitamin C and lutien to help healing and tear production. My night vision seems to be fine, no halos around lights.

All in all, my vision is fantastic and I still look around on occasion and remark at how clear things are. I am still not used to waking up in the morning and being able to see right away, and sometimes I still automatically reach for my glasses on the night stand. Am I glad I did it? Absolutely. Would I recommend it to everyone automatically? Not really. I suggest you go get evaluated and have a good long talk with your doctor first, maybe with several doctors in order to find the right one and to see if you are comfortable with everything that is involved. I personally am very happy, despite my fears and apprehensions about it beforehand. If you have any questions, please feel free to ask away in the comments.

UPDATE

So, it's been almost exactly two years since I originally had the procedure done, so I thought I'd write up an update for you guys. Eyesight wise, my vision is still very good. Last time I had it checked, it was 20/20 in both eyes. For a while afterwards, I did have some dry eye issues, but nothing that some good drops couldn't fix (I use Systane Ultra). I usually only had to put in drops first thing in the morning and when I got home from work at night. The dryness has mellowed as time went on, and now I usually only need them first thing in the morning. As for night vision, I do notice that in low light, my vision does get a little blurry. No halos to speak of, but just a little degraded. It is not terrible, and I really only notice it if I am trying to watch a movie in a dark room or something, in which case, I just move closer to the screen. In bright light, however, I notice no vision degradation. All in all, I am still very happy with my results. I do wonder if my vision will continue to degrade over time, though. But, considering how bad my vision was previously, having to eventually wear weak glasses for some things like movies or driving does not seem like such a bad trade off, I just hope that time doesn't come for quite some time.