My PRK experience. Surgery date 11/30/07.

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My PRK experience. Surgery date 11/30/07.

Postby P.E.T.R.O.L. » Wed Dec 05, 2007 11:29 pm

Hi,

I read a lot of comments on this site prior to surgery, so now that I've had it I thought that it would be good to give back to the community and share my experiences. I will provide my whole experience, including how I decided which procedure to have and where to get it done, and then how I progress. So, this first posting is a long one! I’ve split it into three parts so you can skip to the bit that interests you most if you don’t want to read the full account…

Part 1 – How I chose PRK and the surgeon

First off, I decided to get PRK because I feel that it is marginally safer due to the lack of flap complications and can result in (even more marginally) better results. I'm switching jobs at present and was able to engineer my new start date to allow two weeks recovery before needing to work and drive an hour each way to my new job. I am confident (so far!) that PRK was the right choice for me, but if I was unable to have two weeks at home then I think that LASIK would probably have been the better choice.

I live in Boulder, CO, and had a few choices of where to go within an hour drive of home. I initially narrowed my search to two based on reading the company web sites to get a background on the surgeons (both of whom are very experienced), and from the local paper's customer awards. I visited both twice and first met with the pre/post-op doctors. I requested a visit with the surgeon (choosing the most senior at each), which both were happy to grant. I asked the "50 Tough Questions" (as provided on this site) to each, and got almost identical answers. Each were very satisfactory and complied with the expected answers. This made choosing between the two tough!

I asked for references from both doctors, which each provided within 1-2 weeks. I was surprised that they didn’t have them on hand, but waiting was better than nothing. I spoke to the references, and all gave glowing reports. The decision was not made any easier!

So, faced with such similar surgeons I turned my research onto the equipment each uses. Doctor 'A' uses a VISX S4 laser, and Doctor ‘B’ uses a LADARVision laser. Both are respected systems, but the main difference for me was that the VISX laser has a maximum optic treatment zone of 6.5mm whereas the LADARVision has an 8.0mm zone (these are the flat non-blended zones). Since my pupil size is a slightly larger than average 7.0mm, I considered the LADARVision a better choice to minimize the risk of halos at night. The LADARVision also has a faster tracker (4000Hz vs. 60Hz). So, I opted for Doctor ‘B’. If you are interested in a specific recommendation, the please post your email address (using SPAM resistant format, “name at address.com”) and I will reply with the details.

I discussed my initial preference for Custom PRK with both surgeons and both agreed that for me there was a slightly better advantage of using PRK over LASIK, especially given that I was able to make use of two weeks recovery time before returning to work. My pre-surgery prescription was -2.00/-3.25 so I had a free choice of either type of surgery.


Part 2 – The Surgery

My surgery was on Friday 11/30/07 at 2pm. I arrived and was given the option to have an At1van, which I accepted, and was given a Neurontin for pain relief in advance of the surgery. I had also been taking Acular LS four times a day for four days prior to surgery. I was left to chill out for a while in the pre/post-op area on a soft reclining chair with relaxing music playing in the background. I was given a stress ball to squeeze, which did help relieve the small amount of anxiety that I still had. There were five other chairs, and some were occupied with patients, both pre- and post-op. After a number of pre-op vision checks (including the LADARWave CustomCornea measurement), a couple of doses of numbing drops, and after my eyes were dilated, I entered the treatment room and got comfortable on the laser bed.

The doctor talked me through each step of the procedure as he did it, which was both comforting and interesting (I am scientifically minded!). A patch was put over my right eye. I felt no pain as the device to hold open my eyelids was inserted. This is probably due to the doctor numbing my eyelids directly beforehand. The surgeon began work on my left. My epithelium was then removed with a device that looks like an electric toothbrush. Although not painful, this is what I received most sensation from during the procedure. It felt like a rough tickling of my eye. Not pleasant, but not too uncomfortable either. I was glad that I had accepted the invitation to watch a surgery when I was comparing surgeons, as I knew that this procedure was over with very quickly.

I was told to focus on the red dot. I wasn’t really able to focus on it as it was a blur, but I fixed my sight on the center of it. “Aquired” I heard the computer say as the tracking system locked onto my cornea. As the laser ablated my cornea, I was aware of some blue light at the periphery of my vision. I felt a slight sharp tingling, but not pain, and I could smell a scent similar to burning hair. The computer gave spoken updates every few seconds on how much it had completed as a percentage. This was great to concentrate my thoughts on, and the time (less than a minute) seemed to pass very quickly.

The surgeon then placed a chilled piece of wet paper/fabric onto the cornea for a few seconds which he said would help reduce swelling. A bandage contact lens was then placed on the eye and the bubbles pushed out. The same procedure was the carried out on the other eye.

I was helped off the table and then left the treatment room and was seated in the dimmed recovery room. I was told to keep my eyes closed. They went to get my wife from the waiting area who sat next to me and we talked for about five minutes until the post-op doctor came over to see how I was doing. He asked me to open my eyes and everything was blurry and watery looking but I could make him and other objects around me out. He gave me a bag containing my drugs and three pars of glasses/goggles, and explained what I needed to do/take over the coming days. I put on the dark goggles and wife then drove me home. The whole experience was a lot easier than I thought that it would be.


Part 3 – My Recovery/Progress

Day 1 (day of surgery) – I had a burning scratchy pain in both eyes within an hour or so after surgery, but nothing too bad. I got home and kept my dark glasses on all night. I took another Neurontin four hours after surgery. I chose not to go straight to bed, as I knew that it would make it hard for me to sleep through the night if I did. I used numbing drops (Tetracaine) shortly after getting home and before going to bed. I also continued to use the Acular LS that I had been using prior to surgery. I used the supplied dark goggles to sleep in to protect my eyes, which stayed on just fine. I woke up twice during the night with scratchy eyes, so first wetted them with Systane (the preservative-free vials). That helped but they continued to be scratchy, so I put a drop of Tetracaine into each eye, which stings as it goes in but works within seconds.

Day 2 – My eyes were very watery and I had trouble keeping them open for more than a few seconds. So, I spent most of the day listening to an audio book with my eyes shut and sunglasses on. I used Tetracaine and Neurontin every four hours (and needed them). I was now also using antibiotic drops (Vigamox) and steroid drops (Econopred) four times a day, My vision was not too bad, if I could see past the tears and keep my eyes open long enough to look at something (which I couldn’t). I had an eye exam at 10am and the doctor said that everything looked fine. My combined vision was around 20/20 in the exam (with numbed eyes, so I could keep me eyes open just long enough), which I was very pleased with! I noticed large concentric halos and starbursts in both eyes while looking at the lights on our Christmas tree, which I hoped would pass with time.

Day 3 – I woke up again twice during the night. This time the pain was more sharp than scratchy, and quite severe. Again, wetting drops and Tetracaine soothed them enough to get back to sleep. I joked to my wife that I wanted shots of Morphine directly into my eyeballs, so I guess I was in quite a lot of pain! My vision was more blurry than the day before, but my eyes were less watery and I was able to open them for longer periods, so overall I was more mobile. Once again, I spent most of the day with them closed, listening to audio books. I noticed that the halos around the Christmas tree lights were smaller and not evenly shaped, and figured that it was probably being caused by the epithelium growing back from the outside-in.

Day 4 – Again, I woke up twice during the night and used Tetracaine and Systane to ease the discomfort. My vision was quite blurry and now also hazier. I noticed that the halos had gone from my right eye but were still small but present in my left eye. I had an appointment to remove my contact lenses in the morning. By the time that I arrived, my left eye had a sharp scratchy pain, so the doctor numbed it. Everything looked good with the slit lamp exam (the epithelium had grown back in both eyes), so he removed my contacts by first flooding them with artificial tears. They came out without any problems. My vision afterwards was noticeably worse, which was a bit disappointing but not unexpected. The doctor said that most of my pain that day would have been due to the contact lenses, and sure enough, I was a lot more comfortable for the rest of the day. I was asked not to use Tetracaine anymore, but upon my request was given a prescription for three more days supply of Neurontin in case I needed it. My vision was 20/40 in my left eye and 20/30 in my right. I was told that my right eye was recovering ahead of schedule and my left eye was on schedule. I’m taking 1000mg of vitamin C each day, which I’m hoping is going to speed up the recovery (I had talked this over with the doctor before surgery, and he said that although it wasn’t absolutely necessary it had been reported by some to help). I was now technically legal to drive without glasses! (Although there was no way that I was going to try it just yet as I felt that my vision was far too poor). I was just about able to use a PC by dropping the resolution to 800x600, and could watch TV for a few minutes at a time. I continued to use Systane every 40 minutes or so.

Day 4 – I only woke up once during the night! And this time, all I needed was Systane. My vision had improved, and the halos around the Christmas tree lights had disappeared in both eyes. My eyes were noticeably less scratchy and I only felt the need to take Neurontin once during the day. I was able to watch some TV and use the PC, but tried to rest my eyes as much as possible by finishing off my audio book.

Day 5 – Again, I only woke up once and wetted my eyes with Systane. My vision had improved a little and I was even able to increase my PC resolution a bit. I still couldn’t use the PC for more than 20 minutes or so at a time as my eyes would get dry. However, no pain today at all! I had a slight feeling of dry scratchy eyes, as if I had left contact lenses in them. I didn’t feel the need to take Neurontin again, but did take Advil once which put an end to the scratchy feeling. I made the mistake of going for a walk outside while it was very windy and got grit blown into my eyes despite wearing sunglasses. I had to head back home to flush them out. They felt scratchy again for an hour or two. Stay indoors if it is windy!

Day 6 (today) – For the first time, I didn’t wake up at all during the night! I put some Systane drops in after getting up, but my eyes have felt less dry today. I have been wetting them every 90 minutes or so, which is a lot less than over the last few days. Again, slight but noticeable improvement in vision. Still blurry vision with some ghosting. I’ve been using the PC most of the day, which has been fine so long as I keep my eyes moist (I’ve had to use very large fonts though and the letters are still quite blurry). I haven’t felt the need to close my eyes for extended periods, but they still feel like a dry contact lens has been left in them.

Well, I’m sure that I’ve been using the PC for far too long today, and have probably bored everyone stupid, so I will end here and give you an update soon…
P.E.T.R.O.L.
 
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Postby P.E.T.R.O.L. » Thu Dec 06, 2007 2:28 am

Day 6 (still) - OK, I have definetly been using the PC too much today. I seem to be using Systane very 30 mins or so now to releive dryness. I will stop and rest immediately after this post!

Question - Can using lubricating drops too frequently cause problems with healing? I use a PC all day for work and if today is anything to go by I'll be using them a lot when I start work in just over a week...
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Postby houstonman » Thu Dec 06, 2007 3:45 am

P.E.T.R.O.L. wrote:Day 6 (still) - OK, I have definetly been using the PC too much today. I seem to be using Systane very 30 mins or so now to releive dryness. I will stop and rest immediately after this post!

Question - Can using lubricating drops too frequently cause problems with healing? I use a PC all day for work and if today is anything to go by I'll be using them a lot when I start work in just over a week...


hmmm I use the systain about every 4-5 hrs. Yeah I noticed if I use the wet drops they have this strange dry feeling. I read someone on this site that too much drops can do something to the eye however its nothing that cant go back to normal. I just tend to use them when I absolutely have to. I found it interesting that you didnt mention anything about what im having to take dailly... I was informed that I must take "Omni Pred" drops every day 4 times a day for a week then 3 times a day for the following week then 2 times a day the next week and so forth. Do you have to do this? I love the systain... its feels so good when they hit your eye in the morning. I also had PRK on 11/15. Oh yeah I also found it interesting that I could only use the nevenac the day of surgery and was not allowed to use it after that. I think u said something about you were able to use it 2 or 3 days after.

You will begin to noticed some days you will see better out of one eye then they will switch. its weird but all normal. I also find it harder to see at night and indoors vs night. this was a big deal but slowly getting better. Its like watching hair grow, just have to be patient and take it one day at a time. Oh and make sure you get some Polarized glasses, my choice was Oakly's and they are pure awesomeness.

Feel free to ask me anything in this thread and I will be happy to compare and help you where ever I can.
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Postby P.E.T.R.O.L. » Thu Dec 06, 2007 4:34 am

houstonman, thanks for your reply.

It's interesting to hear that Systane may actually be causing the dry feeling. I will speak to my doctor and see if he recommends something else. Agreed, it does feel good upon application. Have you tried any of the gel-based drops? I feel that they might be better for me overnight.

As far as Omipred goes, I'm using a different steriod, Vexol four times a day. I've been told to continue this until instructed otherwise and that this will be for "a while". As is standard with my surgeon (it's on the post-op instruction booklet I was given), I was put on Econopred Plus (steriod) until the contact lenses were taken out and then switched to Vexol. I'm not sure what the difference is.

With regard to Navanac, I was prescribed Acular LS instead. Both are topical NSAIDs. I was asked to use it four times a day for four days prior to surgery and then for up to three days afterwards if needed. The other surgeon that I evaluated was going to do the same. In the end, I didn't need to use Acular LS after surgery, although they did put a drop of Acular LS in just prior to surgery. I found that Neurontin and Tetracaine were enough. Tetracaine was a life saver! If Acular LS is to Advil for toothache, then Tetracaine is to Novocaine... Instant relief! It can delay healing, so I was asked to use it only when needed and no more than every 4 hours. I did need it almost every 4 hours during the first 3 days, and twice used it in under that time when waking up at night (when the pain was at its worst). I stopped using it after the contact lenses were taken out.

As far as sunglasses... I also have polarized Oakley's! I had prescription lenses in them and ordered non-prescription replacements before surgery. However, my vision is currently slightly worse with them on. I'm sure that will change as my vision becomes less blurry. I swear by polarized lenses, and am looking forward to using the polarized reactalite ski goggles that I just bought! It's great to finally have the freedom to buy regular sunglasses and goggles!
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dry eyes

Postby agent99bm » Thu Dec 06, 2007 8:33 am

I, too, had my laser surgery recently (11/29/07). I had SupraLase which is similar to PRK. It's a procedure that has been patented by my surgeon and is all laser. My surgeon put punctal plugs in my lower tear ducts about two weeks before the surgery because my eyes were dry and he also prescribed Restasis which he said I would use for a year. On the day of my surgery, he put the plugs in my upper tear ducts just after the surgery. I'm on day 7 now and my eyes are great as far as wetness. I use my drops 4 times a day as directed. I use Refresh Plus, Zymar, and Pred Forte (4xday) in addition to the Restasis (2xday). I had a post op visit Tuesday and my doctor said I was doing great. My eyes are very 'wet' which probably accounts for not needing the drops more often. He said he will leave the punctal plugs in at least until my next visit in a month.

My vision has fluctuated on a daily basis, which I expected after reading many posts on this message board. I know there's a healing process and everyone heals at a different rate, so I'm being patient. I can see well enough to drive during the day, but night driving is challenging. I work on the computer a lot and I can tell it's straining my eyes. I've purchased a pair of 1.50 readers for close work but I can get by with distance vision pretty well.

I purchased a pair of polarized Maui Jim sunglasses from the clinic I went to and they are awesome. I couldn't believe the difference in those and the over-the-counter cheap sunglasses.

I wish you continued healing success. Keep us updated.
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Postby P.E.T.R.O.L. » Sat Dec 08, 2007 12:54 am

A quick update...

Day 7 - I had very dry eyes when I woke up and it felt like I ripped a layer of cells from the cornea of my right eye when I opened it! I shall definately try some of that gel to keep them wet all night... It felt fine within 30 minutes of putting in some lubracating drops though. Overall, my vision was less blurry than the day before. I didn't need to use lubricating drops as much either. I noticed starbursts at night and more pronounced ghosting around lights, but not halos thankfully.

Day 8 (today) - My vision is, once again, a bit better than the day before. My right eye is still a bit ahead of the left. Dryness is quite a bit better now, and I'm only using drops every 2-3 hours unless I'm using the PC or watching TV. Watching TV is fine, but does give me a bit of eye strain after an hour or so. I've noticed some people writing about seeing double when looking at green traffic lights and I'm doing the same... Well, actually triple in my right eye and quadruple in my left! It's definately worse with green traffic lights. Perhaps something to do with it being a higher frequency than red and refracting more through the cornea? I drove my car for a short distance today during daylight. I definately would not like to drive more than 10 minutes at the moment, and not at all at night. This is pretty much what I expect for one week in. Hopefully driving will be easier next week. I'm going skiing over the weekend, so it will be interesting to see how that goes!
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Similar experience

Postby Blindbat2007 » Sat Dec 08, 2007 5:54 pm

I underwent custom Vue Lasek 12/6. I am having very simliar results as you describe in your thread. I am having a particular problem in my left eye. There is a severe scratchiness and pain. I feels as if a foreign object is scratching the surface of my cornea. When I initially wake up in the morning it seems fine but the scratchiness and pain begins within about 30minutes of waking. Did you experience anything similar? If so how often did you apply the tetracaine drops? I was told to use only if absolutely necessary as the application was supposed to slow down the rate of the healing process. I've already had to use them twice this morning. The pain was so severe in my left eye that when I tried to open my right eye the facial muscles involved in trying to keep my left eye closed caused even more pain.

The visual acuity in my right eye seems to be improving on a daily basis. I would feel more comfortable if the results were more similar in both eyes versus no pain in one and severe pain in the other.

Any words of wisdom?
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Postby P.E.T.R.O.L. » Sun Dec 09, 2007 2:52 am

Sorry to hear about the pain, but you are nearly through the worst of it, so hang on in there!

I was told that I could use the Tetracaine drops for the first three days after surgery (so, day 4 in my thread). I was getting the same kind of pain that you describe, and did use the drops pretty much every four hours. I was also told to use it only as needed, but not more than every four hours. Since I needed it pretty much all the time for the first 3 days, that's just what I did! I would first see if lubricating drops helped. If after 5 minutes I was still in severe discomfort then I would use the Tetracaine. I was also given a prescription for Neurontin, which I used three times a day. My eyes were on schedule (one was slightly ahead) on day four, so I don't think that the Tetracaine delayed my healing.

Of course, if you think that your dicomfort is worse than expected then you should discuss it with your doctor, and follow his instructions about Tetracaine.

The feeling that there is something in your eye continues for at least the first week in my experience. After the more severe discomfort of the first 3-4 days, it then settles down and feels similar to having a dry contact lens in your eye. I'm now on day 9, and barely notice it.

I believe that it is common to have one eye heal faster than the other. Also to have that reverse throughout the healing. My left eye is now catching up with my right, but my right is still ahead.

My advice to you is to keep your eyes closed for as much of the day as possible this weekend. I found listening to audio books good, as they are several hours long. Check out Audible.com.

A quick update onb my progress:

Day 9 - I went skiing this morning! My vision was not perfect, but easily good enough to ski. I wore goggles all the time to protect my eyes from the snow, wind, cold, and UV. I had no problems at all with dryness. The wind in my face even caused them to water a little more, which meant no need to use lubricating drops. Altogether, much more comfortable than sitting at home using the PC or watching TV. The vision, once again, is slightly better than yesterday. I'm still seing ghosting, but slightly less, and my left eye is starting to catch up with my right. Although dryness hasn't been a problem today, I'm going to try using Refresh PM tonight and see if it keeps my eyes lubricated all night. Last night I did use Systane once, when I woke in the middle of the night, and my eyes were quite dry when I got up this morning.
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You're right on

Postby Blindbat2007 » Sun Dec 09, 2007 4:28 pm

The pain in my left eye has subsided somewhat. It's about a 5 or 6 on a scale of 1-10 with 10 being just shoot me now. My right eye is feeling a 0 since the day after the surgery. I made a homemade Snellan chart by calculating the size the letters need to be at 10 feet. I am seeing about 20/60 in my right eye.Still too blurry and hazy in the left to test.
I also have an engineering mind as I use mathematics on a daily basis at work. I am a mechanical engineer for DRS Technologies. My job is to represent engineered systems mathematically for analysis and performance. I don't believe I will be going in tomorrow if my visual status is as it is today.

Thanks for your daily status reports. They helped out a lot. I have been keeping track of my progrss also, but don't really have the vision to post it right now. In fact, please excuse any misspelled words or grammer errors. I'll have my girlfriend type from now on. She's been very supportive and patient with me.
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