PRK Enhancements after Lasik

[ms_firecracker]

This will seem like a typical story, but having looked over the forums, I haven't found the answer to my very specific questions.

In January, I had Lasik surgery to correct my -9.5 vision. At the time of the surgery, my Doctor told me that any enhancements would require PRK, as my corneas were too thin for a second Lasik procedure.

For the first two weeks after my Lasik procedure, my vision was fantastic. 20/20 in both eyes. Then, after my one month checkup, it seemed my left eye was regressing a bit (but it was too early to tell if it was due to healing or actual regression).

I noticed between my one month and my three month that my vision "deteriorated" a bit, to the point where I could no longer see clearly from about a meter away from me. This made driving and watching TV from a reasonable distance difficult.

At my three month post op exam, my optometrist revealed that my vision was now -1 1/4 in both eyes, with a mild astigmatism in the left. He suggested at this point that I look into enhancement surgery.

So, my questions are:

1) is it worth getting enhancement surgery for such a "minor" prescription? It does require me to wear glasses while driving and watching TV, but I can still do my office work without glasses and see generally well enough. I guess I'm afraid of being disatisfied with my current vision, and then going through all that trouble only to end up with similar vision in the end.

2) Are there different risks associated with getting Lasik first followed by PRK? All the articles I've read about PRK assume that it's my first surgery, so none of them really address my concerns about PRK as my second surgery.

3) How painful would PRK be for such a minor correction? I understand that it is the more "lengthy" of the healing times, but is there a difference between getting PRK for -9.5 and for -1 1/4?

4) I'm planning a big trip to New Zealand in December. If I were to get the PRK surgery in September, would that be enough time to heal? I've had excellent healing with the Lasik (my optometrist likes to oggle how well my eyes are doing in that sense, for some reason), and while I know it's a different procedure, I'm assuming that gives some indication as to how quickly my eyes heal in general. I could be horribly wrong though, of course.

Any help answering these questions would be greatly appreciated. Also, if anyone has seen articles or other threads that deal with these questions or the whole PKR after Lasik debacle, if you could point me in their direction, that would be great!

Thanks!

[LasikExpert]

1) is it worth getting enhancement surgery for such a "minor" prescription? It does require me to wear glasses while driving and watching TV, but I can still do my office work without glasses and see generally well enough. I guess I'm afraid of being disatisfied with my current vision, and then going through all that trouble only to end up with similar vision in the end.

The relative benefit is, well, relative. Only you can decide if you would be satisfied with what you have. There is always risk, but you will have a much smaller refractive change this time around. Discuss this with your doctor.

If you are at or near age 40, you may want to keep this small amount of myopic (nearsighted, shortsighted) vision, at least in one eye. See Lasik Monovision.

2) Are there different risks associated with getting Lasik first followed by PRK? All the articles I've read about PRK assume that it's my first surgery, so none of them really address my concerns about PRK as my second surgery.

There are peer reviewed medical journal articles regarding PRK after Lasik (PubMed.com). I just spent several days at a medical conference reviewing new reports.

The greatest concern with PRK on Lasik is corneal haze. In an informal poll at one of the sessions, 100% of the people who do PRK over Lasik use Mitomycin C intraoperatively to limit the probability of haze.

3) How painful would PRK be for such a minor correction? I understand that it is the more "lengthy" of the healing times, but is there a difference between getting PRK for -9.5 and for -1 1/4?

Unfortunately PRK will have about the same level of discomfort if the correction is small or if it is great. Patients here have described PRK as being abject misery to nothing at all. It is reasonable to assume that for the first 1-3 days you are going to have discomfort to outright pain. Whatever meds they offer - take them.

4) I'm planning a big trip to New Zealand in December. If I were to get the PRK surgery in September, would that be enough time to heal? I've had excellent healing with the Lasik (my optometrist likes to oggle how well my eyes are doing in that sense, for some reason), and while I know it's a different procedure, I'm assuming that gives some indication as to how quickly my eyes heal in general. I could be horribly wrong though, of course.

Normally this would be enough time for PRK on Lasik flap to resolve. There may be a minor issue such as dry eye or a bit of glare, but this should be enough time.

[ms_firecracker]

There are peer reviewed medical journal articles regarding PRK after Lasik (PubMed.com). I just spent several days at a medical conference reviewing new reports.

The greatest concern with PRK on Lasik is corneal haze. In an informal poll at one of the sessions, 100% of the people who do PRK over Lasik use Mitomycin C intraoperatively to limit the probability of haze.

I had a look on the website you recommended, and typed in "prk after lasik", and I have to be honest, a lot of it was Greek to me. Are there any other resources that you can think of that might be geared towards the everyday reader?

Thank you for your reply, by the way. It was very helpful.

[LasikExpert]

They will be written in medicalese. I do not know of any lay-articles other than what is written in this forum. The bottom line is that PRK on Lasik flap is virtually the same as virgin PRK for small corrections if Mitomycin C is used. Without Mitomycin C the flap will haze. All other issues are virtually the same.

[ms_firecracker]

The bottom line is that PRK on Lasik flap is virtually the same as virgin PRK for small corrections if Mitomycin C is used. Without Mitomycin C the flap will haze. All other issues are virtually the same.

That is exactly the information I was looking for! :) Thank you!