Got PRK 1 wk ago => my extensive notes on the experience

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Got PRK 1 wk ago => my extensive notes on the experience

Postby Luke » Thu Apr 29, 2010 8:14 pm

I just got the PRK version of Lasik and made extensive notes about the experience in the hopes that somebody will find them useful. The article is posted here: http://www.metalev.org/2010/04/my-experience-with-laser-vision.html

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Somebody has suggested that I post the full text of my comments here. I converted the HTML posting at the above link to plain text using html2text.

It's easier to read it with the correct formatting, so I suggest reading it at the above link anyway, but here it is for reference.

UPDATE: I have already updated the copy of these notes on my blog, so go read the article there for the most up-to-date copy. I won't make further updates to this copy.

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My experience with laser vision correction (PRK)
http://www.metalev.org/2010/04/my-exper ... ision.html


**Just got PRK laser vision correction**


I decided to get Lasik/PRK after realizing that the amount I have spent on
glasses over the years added up to the cost of a Lasik operation. I also
owned a Canon 5D Mark II digital camera -- an awesome light-capturing machine
-- and I realized the camera was worth as much as a Lasik operation, but that
when I was focused on taking photos of beautiful scenery I totally missed the
moment. It is much more important to see with my eyes than through a camera
lens. So I sold the camera to pay for my laser vision correction operation.


I decided to write up my experiences in some detail so others have more
information in one place than I was able to find when I was investigating
getting this operation.


**What is PRK?**


PRK is like Lasik but rather than cutting, separating and peeling back a flap
on the front of the cornea and then ablating (removing tissue) underneath the
flap as with normal Lasik, with PRK they brush off the 6-cell-thick layer off
the front of the cornea and then directly laser the front of the corneal
protein. It's more painful and has a longer recovery time but is an older,
often more trusted technique and has numerous advantages.


**I chose PRK over flap-based Lasik for the following reasons:**

* There are fewer problems with dry eyes with PRK compared to Lasik in the 6
months to 1 year after the operation, because there is less nerve damage done
with PRK (there is supposedly less nerve damage with PRK than with flap-based
Lasik, though I don't know the details).

* There is less chance of dislodging the flap later in life with PRK,
because there is no flap -- with Lasik, the structural integrity of the cornea
is never again quite what it was, and even running into a tree branch can
sometimes dislodge it. It's not super-common for this to happen but if it
happens it can give you serious vision problems, so the cost of a problem is
high.

* There is less chance of infection with PRK (you can get an infection under
the flap with Lasik, which is relatively rare but can be pretty bad).

* They ablate/remove less of the cornea with PRK than with Lasik, so if you
need a touchup later on, you have more corneal tissue to work with. Touchup
operations are free within 6 months with my provider.

**The downsides to having any form of laser vision correction at all
include:**

* At about age 44 you start to experience presbyopia -- the inability of the
eye to focus outside of a limited range -- and by the early 50s this process
of deterioration in focusing ability is pretty much complete. Laser vision
correction corrects your vision to see to infinity with the eye's focusing
muscles completely relaxed, and you'll eventually need reading glasses to see
up close. I'm 34 though and although I don't need glasses when reading books,
I wear them 100% of the time anyway, and I do need them already when using a
computer screen. The way I figure it, I'll get 10 good years of use out of my
eyes without needing glasses for anything, and then I'll just need them when
reading a computer screen again (which I already do) or a book.

* The main downsides I see with presbyopia are that I will have to carry
around reading glasses with my cellphone, otherwise I won't be able to read
text on the cellphone screen (and that I won't be able to see my wife up
close!)

* Increased risk of chronic dry eye problems (I already had some issues with
this, PRK/Lasik would make this worse, especially non-PRK Lasik)

* Risk of haze / halos / starburst patterns around lights at night: your
pupil is more dilated at night so the chance of having light refracted from
both ablated and unablated regions of the cornea is higher, causing possible
halos and other artifacts. The chance of these side effects is higher with
strong prescriptions, -8 diopters or worse. My prescription is closer to -3
so I don't expect to have problems with this.

**The downsides to PRK vs. Lasik**

* Recovery time (both in terms of pain and quality of vision) is much longer
-- 2-6 weeks for PRK rather than 1 day for flap Lasik.

* **Important:** you need to take Vitamin C and wear good sunglasses when
outside for at least 6 months after the op, especially in the summertime
(**CONSIDER GETTING THE OPERATION IN THE LATE FALL**) -- the new cells that
regrow over the cornea are very susceptible to scarring in UV light.

**One big upside of getting laser vision correction**

* I can finally wear REAL SUNGLASSES and still see! Nobody that hasn't worn
glasses for years could appreciate how great this is :-) I bought polarized
prescription sunglasses before and they can be really expensive. First thing
I did after the operation when I could get out and about again was to go look
at sunglasses (since I'll need them anyway).


**Surgeon vs. fellow -- save 50% with a fellow-in-training**


I elected to have the operation performed by a surgical fellow under the
direct supervision of a surgeon with 20+ years of experience, rather than
having an actual surgeon perform the operation. Receiving surgery from a
fellow reduced the cost of the surgery by 50%, from $6000 for both eyes to
$3000 for both (and I further talked them down to $2800 for both). A fellow
has completed an MD, a residency, and was on a fellowship, one step away from
becoming a full surgeon, and Lasik technology has become almost risk-free in
the last three years, so I figured risk was minimal and cost savings were
great.


I received the operation at Tufts New England Eye Center[1] in Boston, based
on the fact that they provide free or heavily discounted treatment services to
the disabled, first responders and the military (none of which I qualify for,
but on principle). They were very professional and knowledgeable, and did a
great job. Highly recommended.



The First Week of PRK


Day 0 -- Thurs -- PRK operation

* Given 15mg of Valium which made me completely uninhibited and incessantly
chatty -- I had the whole operating room laughing constantly :-)

* You sit under the machine and see a ring-shaped light with a dull red glow
in the middle, and a spotty interference pattern from another laser below.

* Received anesthetic drops, then they taped my eyelids open and then put in
a metal clamp to hold the lids open.

* The surgical fellow used a small brush like a dentist's drill to brush
away the cellular layer from the front of the cornea. Painless but a weird
sensation. The lights swirled as the brush moved the eyeball in fast circular
motions.

* The surgical fellow then used a scraper to create a clean edge at the
boundary of where the cells had been removed. The bigshot surgeon checked
through the scope a couple of times between scrapings and pointed out areas
where the fellow had missed a couple of small spots with groups of cells.

* They then started the actual laser surgery directly onto the cornea.
There were something like 239 laser pulses that ablated the surface in random
order (to avoid overheating). A camera looked for saccades (fast movements of
the eye) with a frequency of something like 1000Hz and used a pre-stored image
of the retina to register the ablation plan correctly to the eye (this is the
Allegretto Wavefront laser way of doing registration) -- your eyeballs
actually rotate a few degrees when you lie down, and it's almost impossible to
stare at one spot for a period of time without eye saccades around even
without you being aware of it.

* The laser zapping process all seemed to happen in about 10 seconds. Each
laser pulse made a clicking/sizzling sound. There was a vacuum tube by my eye
but I could still smell burning protein.

* They washed the surface of the eye with a lot of fluid then put in a
contact lens, then repeated the whole process for the other eye.

* Everything was pretty cloudy when I stood up but my vision seemed somewhat
sharp. The valium had kicked in with being horizontal for over half an hour,
so I was pretty dizzy and needed help walking at first.

* I had to get a ride home, they wouldn't let me even take a cab because of
liability. I went home, figured I could see relatively sharply in spite of
the haze, and the valium had mostly worn off, so I stubbornly drove the 5 mins
to the pharmacy to pick up my prescriptions for painkillers and eyedrops.
Took painkillers and slept off the rest of the day.

Day 1 -- Fri -- day after operation

* I had been given eye guards to tape over my eyes at night. I woke up
without them on -- found one guard strewn across the bed and the other one
nowhere in sight, I still haven't found it to this day so I had to get a
replacement :]

* When I woke up my eyes were sore but it wasn't too bad. Eyesight was hazy
all day, had to squint to do much, and had to scale up font size on computer
to huge.

* Had to visit the eye center for the day-after appointment. Vision tested
as 20/15 (better than 20/20) in one eye and about 20/20 in the other -- sharp
but very hazy.

* Ended up taking painkillers and resting, pretty unproductive day.

Day 2 -- Sat

* Probably the worst day for pain. Felt like someone had poked me in the
eye for most of the day. Wanted to avoid painkillers so I just endured it.
Vision still hazy but usable -- took care of some errands, was able to be out
and about for most of the day being productive.

Day 3 -- Sun

* Probably the worst day for vision. Also extreme light sensitivity,
couldn't get up for 2-3 hrs because I couldn't open my eyes, even with the
blinds shut. Apparently trauma to the cornea makes the iris muscles spasm in
reaction to light, "like getting a charlie horse in your eye".

* Vision very blurry, borderline dangerous to drive. Avoided people I knew
at Church because I knew I wouldn't be able to tell if they were looking at me
or not from more than a foot or so away.

* Looked like I was looking through a steamy window during daylight hours.

* Took painkillers and slept off most of the afternoon.

* Distinct-shaped halos around lights at night, the shape of the wavefront
of cells regrowing in towards the middle of my cornea.

Day 4 -- Mon

* Couldn't open eyes again for about 3 hours after waking up because of
light sensitivity.

* Very little pain left but couldn't be productive in front of a computer
screen.

* Vision good enough to bike in for a checkup in the afternoon, the doctor
wanted to make sure I had no infection.

Day 5 -- Tues -- contacts removed

* No real problem with light sensitivity this morning, could tell that cells
were almost totally regrown because everything was pretty sharp right when I
woke up.

* Got contacts out in the afternoon. Cells had completely regrown over the
cornea (with the characteristic ridge or pileup of cells in the middle that
was still scattering light) and looked really good according to the surgeon.

* Vision tested as pretty good, but not quite 20/20 before removing the
lens, but was worse afterwards. The newly exposed cornea surface was not as
smooth as the contact lens surface, because there was a (normal) ridge/pileup
of cells where the regrowth coming in from both sides joined in the middle.

* Eyes were pretty uncomfortable after the lens came out, but only for about
10 minutes, as the new cells were exposed directly to the air and eyelids for
the first time.

* Tried getting computer work done after getting lenses out, but needed
eyedrops for dryness every 10 minutes or less, eventually ran out of drops and
had to go home. Still had to scale up text font size to huge. Squinting
constantly to see better gave me a pretty bad headache.

Day 6 -- Wed

* Eyes were really sensitive to light again after getting lenses out, had to
spend whole morning in bed again. Couldn't do much productive. Vision was
not bad early in the day but got worse. Had to drive somewhere anyway.

* Had moments of near-perfect vision after putting in drops -- amazing to
see clearly again after everything being blurry for a week. However things
were still a little fuzzy.

* The extra dryness experienced yesterday was mostly gone, was able to be
relatively productive, only needed drops every 30 mins or so.

Day 7 -- Thurs

* Woke up with very dry eyes almost stuck to eyelids. Light sensitivity
first thing in the morning only lasted for a few mins once I put drops in.

* Vision was very clear the instant I put drops in but got fuzzy within a
few minutes of each set of drops.

* I can finally be productive on my computer again at normal font size,
albeit with fuziness, but without squinting.

* I have been informed I'm totally on-track for having perfect vision
restored within 2-6 weeks of the operation, so it will in theory only get
better from here. Vision will usually be best in the morning and dry eye
problems will be worse when working at a computer (which I do all day).

* I expect the log will be boring from this point on so this will be the
last entry :-)


Overall experience


This all sounds bad, but it's worth it if I never have to worry about wearing
glasses again!


Post-op considerations

* Important: Need to take Vitamin C and wear good sunglasses when outside
for at least 6 months after the op to prevent scar tissue forming on the
cornea.

* You're given painkiller drops right after the operation but you're told
not to use them after day 2 as they will slow down the healing process.

* You have to wear eye shields to bed every night for 2 weeks.

* No shampooing hair for 3 days to prevent infection; wearing swimming
goggles for showering for 2 weeks after the operation, or at least have to
wash hair/face outside of shower to keep water and soap out of eyes.

* No eye makeup for 2 weeks for the ladies, no swimming for 3 weeks, only
light exercise and no weightlifting for 3 days, sweatband should be worn
during exercise for 2 weeks.

* Antibiotic drops have to be used for a week or more, steroid drops for 3
weeks, preservative-free artificial tears every hour while awake (as much as
every 10 minutes as needed).

* Taking fish oil and flaxseed oil can alleviate dry eye problems.


Final thoughts

**WORTH THE PAIN/BLURRINESS:** Overall I can tell my vision is going to be
great and I would recommend PRK due to reduced risk of complications with PRK,
and because of the ability to get a touchup operation as needed.


**LASIK HAS COME A LONG WAY:** Lasik is far safer today than it was even three
years ago, with fewer chances of side-effects. I wasn't comfortable with
getting it until recently.


**CHEAP GLASSES FOR THE LASER-AVERSE:** For those that are not ready to take
the plunge to get laser vision correction, I recommend Zenni Optical[2] --
prescription glasses for $8 (both lenses and frames)! It's a company that
operates out of Hong Kong but has an office in California, and brings Asian
glasses prices to the US market (finally).


**DONATE YOUR OLD GLASSES:** One last comment, I learned the best thing to do
with used glasses is to donate them[3], where they can be taken to clinics
in the developing world. Most eye clinics have a donation bin or you can
easily find places online.


I donated four pairs of used glasses, and the realization that there were
millions of kids in developing countries who are hindered in their learning
and life progress simply because they can't see actually made me feel rather
bad about getting PRK. I had a "wow the gap between rich and poor is huge"
moment when I realized these kids can't afford even basic glasses and yet I
just had my cornea perfectly reshaped with a laser!!

[1]: http://www.mylasikdoc.com/

[2]: http://www.zennioptical.com/

[3]: http://charityguide.org/volunteer/fifte ... nation.htm
Luke
 
Posts: 1
Joined: Thu Apr 29, 2010 6:48 pm

Re: Got PRK 1 wk ago => my extensive notes on the experience

Postby PRKorIntacs » Mon May 03, 2010 1:41 am

Thanks for sharing your detailed story. I have threads on me thinking about PRK myself.
PRKorIntacs
 
Posts: 90
Joined: Thu Feb 25, 2010 5:43 am


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