Undercorrection or normal vision fluctuation after PRK?

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Undercorrection or normal vision fluctuation after PRK?

Postby cate Harty » Thu Oct 26, 2006 9:14 pm

It was so great to find this site. It answers so many questions that we vision correction patients seemed doomed to never know the answers to due to overly busy and sometimes gruff surgeons.

I just underwent my second vision correction surgery. The first was Lasik and I was only corrected to a -2.0 and -1.25 (from -7.0 and -6.5). Since I developed somewhat dry eyes after the surgery, I was relegated to wearing glasses because contacts became too uncomfortable. I hate wearing glasses! I was of course disappointed and it took me over a year to work up the nerve to do a second "enhancement" surgery. My corneas were thick enough to have had Lasik again, but my doctor said PRK would be the way to go because it's more precise with lower prescriptions and I had had an issue with "sticky epitheleum" in my right eye during Lasik, which resulted in a scratched cornea during the initial surgery. He also said I would have less dryness with PRK.

It is now 6 days after my PRK and I can see pretty well in my right eye. I mean, I can tell that the vision will be crisp once the healing is finished. The left eye, however, is much blurrier (can't see well enough to drive with just that eye). I've read, and have been told by my doctor, that vision doesn't begin to stabilize after PRK until at least one week after the bandage contacts have been removed and then it continues to fluctuate for another few months. How can I tell whether my left eye is just slower to find its focus or if it is yet another undercorrection? My vision hasn't changed much in either eye since I was able to tolerate light and was able to see anything (about the third day) and it's hard to believe that I'm going to wake up one day and suddenly the vision in my left eye will be clear. I appreciate your thoughts.
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Postby LasikExpert » Fri Oct 27, 2006 2:02 am

Thank you for the kind words about our website.

You won't wake up one day and be able to see well. PRK recovery is often a long and very gradual process. It is not likely that you will suddenly have that crisp vision you desire. At about three months postop you will have a good idea about your final outcome, but it will probably be about six months postop when you know for sure.

I like your doctor's logic regarding your second surgery. The doctor was evaluating your new circumstances, rather than just going for the obvious.
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PRK - degree of improvement over several weeks/months

Postby cate Harty » Fri Oct 27, 2006 3:04 am

Thank you so much for your response. I guess my question, in a nutshell, is: Can I reasonably expect that the vision in my left eye, which is currently too blurry for comfort, can actually make the recovery all the way to 20/20 in some weeks or months after PRK, if I am patient? At my first Lasik surgery, the doctor just kept telling me to be patient, that vision takes awhile to come in. I was patient and got no results. I didn't regress, I was simply undercorrected. I don't want to waste my time either hoping for something that won't happen, or worrying about whether it will. Do you know of any cases with PRK that one eye does not have clear vision but eventually improves over weeks or months? Or does one pretty much have the general picture within the first week, give or take a diopter?
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Postby LasikExpert » Fri Oct 27, 2006 6:33 am

It is reasonable to expect changes in your vision over the next several weeks. It is always reasonable to hope and expect that the changes will be for the better!

The epithelium is the outermost layer of cells on the cornea and is removed during PRK. Although they are the fastest reproducing cells in the human body, it takes time for them to thicken and smooth. It is that smooth layer that will provide the final improvement. That and a good healthy tear film.

You do not get your final result in the first week after PRK. Far from it. PRK is relatively traumatic to the eye and there is a strong wound response that often includes a small amout of edema (swelling) and temporary irregularity while the epithelium thickens and smooths.

It is not unusual for one eye to heal at a different rate or to have a different final outcome.

You hear about all those "20-Minute Miracles" out there and it is easy to become distressed when recovery is slow. The truth is refractive surgery is more of a six month process...especially PRK.
Glenn Hagele
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Postby brownkc » Tue Nov 07, 2006 9:20 pm

I had PRK surgery about a week and a half ago and have had similar results. My left is progressing rapidly while I have serious questions about my right eye. It definitely impacts my ability to drive and see at night. It seems to be some mixture of blurriness and double vision.

I have a coworker that underwent PRK about 3 months ago and was having double vision in one eye. She said it is almost gone now. She was under the impression that her astigmatism pre-surgery may have played a part in it. I also had an astigmatism and thought it might have been that.

Sorry, I can't provide more insight but I know how you feel. I think it is just a matter of wait and see.
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Postby 2ndguessing » Tue Nov 07, 2006 11:10 pm

The topic starter mentioned having dry eyes bad enough to not be able to wear contacts comfortably, so my question is: wouldn't the bandage contacts that are worn after PRK be extremely uncomfortable and even want to "stick" to the eye causing more problems? I am asking this because my recent Lasik surgery has regression occuring and at this time I don't know whether the Dr. will want to do enhancement surgery with Lasik again or PRK and I had dry eye issues before surgery to where I couldn't wear contacts and that is why I opted for the surgery to begin with. Thanks
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Postby brownkc » Wed Nov 08, 2006 4:27 am

Not really.

The bandage contacts are only worn for the first 5 days or so until the epithelium (sp?) layer has covered all or the majority of the cornea. They took mine out with about 99% coverage 4 days after surgery. My doctor also had to remove one bandage contact the day after surgery to try to remove some lint they noticed. By the way, that was unsuccessful and it hurt like you know what when I blinked with the contact removed. Both times there was no problem removing the lens. The doctor did flush my eyes with tear drops prior to the removal each time.

Also, I had major dry eyes for the first week but it seems to be settling out (12 days post surgery). One of the doctors indicated dry eyes was more of a problem with LASIK than PRK. I got the impression they think there is some sensor/trigger in the eye and the deeper treatment of LASIK tends to affect that trigger more.

Hope this helps.
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Postby LasikExpert » Thu Nov 09, 2006 5:17 am

The bandage contact lens really is necessary until he epithelium has regenerated enough to protect the eye. It can be uncomfortable, but you would be using medication and artificial tear eye drops during those first few days. Also, surface ablation techniques like PRK, LASEK, and Epi-Lasik tend to be less likely to induce or exacerbate dry eye in the long term.
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It all worked out!

Postby cate Harty » Thu Dec 14, 2006 1:29 am

Hey Glenn!

Just wanted to let you know that my eyes are so great now! I waited about three weeks before my final vision came in and, true to your word, the vision in my left eye caught up with that of my right and now I'm 20/20. No starbursts, no double vision, no ghosting, very slight halos (like with contacts at night). I couldn't be happier. Everyone out there: keep the faith!
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Postby LasikExpert » Thu Dec 14, 2006 4:51 pm

Congratulations on your excellent glasses-free vision!

Thank you very much for returning to our forum and letting everyone know the ending to your tale. It is so very important for those in your situation or considering PRK to see the experiences of others...including the final outcome.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


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