My Epi-Lasek Experience....

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My Epi-Lasek Experience....

Postby rgonyer » Tue Jan 23, 2007 4:32 am

Pre –Surgery thoughts and comments:

I have been considering refractive surgery for a couple of years. Last year (2006) I decided that if I was going to do it, 2007 was going to be the year. I started to do some research on the subject on line. Several of my co-workers had already had it done. One had Lasik at one particular clinic, and was very happy (one year post-op). One had Lasik at a different clinic (several years post op, very happy), and 2 had Epi-Lasek at the 2nd place, both about a year post op and very happy. I scheduled an appointment with a place local to me (a 3rd place) for a free screening.

It became apparent to me that my dry eye problem was going to be an issue. I have been unable to wear contacts because of this, for basically my whole life. It is interesting that the very thing that drove me away from contacts will potentially also keep me from getting refractive surgery.

The place I got my inital screening from did a tear test (Let's call them "A"). I was well below the threshold that they would consider doing lasik on. Not until I talked to the surgeon and myself suggested epi-lasek or PRK, did he say "yes, that may be a better option than Lasik since you have dry eyes, but it is painful and we do not recommend it". I did not get an inital warm fuzzy from this place in the first place, so I basically ruled them out. They did help treat my dry eye by putting me on Restasis.

After remaining on Restasis for several weeks, I decided to schedule screenings at the 2 places that my co-workers had recommended.

The second place I visited (Let's call them "B") was by far the most “professional”, clean, and compelling of the 3 that I had visited. They too, mentioned my dry eye as an issue, but said I was an excellent candidate otherwise. He mentioned that they would recommend doing Lasik, but not until later in the year, when it wasn’t so cold an dry. Made sense I thought. When I asked about PRK/Epi, he basically said it was an old technology, and they really didn’t recommend it. I was disappointed with the response, but I also appreciated the fact that he wasn’t trying to rush me into surgery as the first place was.

At my prescreening at the third place ("C"), my dry eye was never mentioned as an issue, in fact it wasn’t even tested. When I questioned about this, they said since we perform epi-lasek, it’s just not really an issue. You may be dry, but you won’t be any “drier” a couple of months after the surgery. I knew this wasn’t a great response, but I could see where they were coming from as well. I also appreciated that Epi was their default surgical choice – they only went with Lasik in cases where it was beneficial – high refractive error cases. It has to be a tough decision for a clinic to choose a more painful procedure as their default. At this point I was excited, and mentall wrote off the dry eye issue – Because I wanted to have the surgery so badly, I bought into their line of reasoning, that Dry eye would not be an issue with Epi, even though I had read otherwise and probably knew better. The coordinator scheduled me for my pre-op exam for the following week, and surgery for one week later.

More to come later…..
rgonyer
 
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Your daily progress-

Postby mike r » Tue Jan 23, 2007 5:52 am

In a nutshell or the readers digest version. How was your day today?
Just wondering clarity?bad, improved, good, pain? or uncomfortableness? bad, good, improved, none, or any other latest regressions or progressions haloes, double vision, haze ? or is the curtain drawn until the bandages come off. I guess your not making judgement because of these bandage contact things?

I hope never to get popped in the eye because of the flap thing now but this ordeal that your detailing makes me feel grateful that I had basic lasik. Open my eyes and wham sharp clarity.

All the numbers would be really worthwhile to interject in the narrative. As mentioned by previous poster. Also did you get monovision? I would like to hear your adaptation to that. Its been ineresting for me.

I hope the wait turns out being worth the reward.

<mike r>
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Pre-op appointment, Friday, January 12th, 2007.

Postby rgonyer » Tue Jan 23, 2007 3:35 pm

This went well overall. I tried to make mental notes of all the tests that they did.

- He checked my pupil size in a dimly lit room.
- They did a wavefront diagnotic of my higher order abberations.
- Checked my manifest and cyclopegic refractive error.
- Corneal thickness test.
- Checked my pupil size artificially dialated.
- Measured my prescription automatically (the test where you focus on the hot air balloon)
- They also did a test on the actualy laser machine itself, he said that was if I decided to go with conventional rather than wavefront guided treatment.

Other Notes:
- They use a LadarVision 4000.
- He recommended WaveFront guided ablation for me for a couple of reasons - Potentially better visual results, I had a fair amount of HOA, and my dialated pupil size was on the large size.
- I was *not* able to see the surgeon, as he was out of town unexpectedly. All these tests were done by other staff members. This was a little un-nerving to me, however I let the appointment for the surgery intact, and figured I could back out if necessary after some thought over the weekend. Surgery scheduled for Thursday, January 18th.

(Mike R, I'll get there shortly. I'm going to get this all up to date today)
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Monday, January 15th

Postby rgonyer » Tue Jan 23, 2007 3:51 pm

Today I called the refractive surgery coordinator at the clinic. I told her I would like to email a list of questions to the surgeon since I didn't get a chance to see him on Friday. She calls me back, and says he would actually really like to see me before the surgery, and would Wednesday afternoon work? It would, but that doesn't leave me much time before the surgery to think it over. I asked if he was available today, and he was- If I could get there ASAP. So I talked to my boss, took off from work, and broke a few laws to get up there (about a 40 minute drive from work).

After speaking with him, my confidence was boosted greatly. I probably wouldn't have gotten this far had it not been for the fact that I have 3 co-workers that all had theirs done by this surgeon, and all were happy as could be. All my questions were answered easily and confidently. When I asked about glare and contrast tests, he said they are a helpful thing, but he didn't see anything in any of my other tests that would bring these as a cause for concern. If I wanted to push back my surgery, he would arrange for me to have these tests. He said in his several thousand procedures with eyes very similar to mine, it's not been a problem.... so against my better judgement, I let the surgery date stand.
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Thursday, January 18th

Postby rgonyer » Tue Jan 23, 2007 4:40 pm

The big day. I need to be at the clinic at 1:15 in the afternoon. Surgery is set for 2:30. My wife came home from work at 11:15, and we hopped in the car (about a 1.5 hour drive).

Upon arrival, I filled out my consent forms and made the payment.

While waiting for my "turn", we were able to watch the surgeries in progress on the TV in the waiting room. I was able to watch 2 eyes being operated on before I was called in. I also signed a consent form allowing my surgery to be shown on the TV, so my wife could watch. It is amazing how "routine" this whole deal is. Typically, on a Thursday, this place does 4 people in the morning, and 4 in the afternoon.

After I get called in the back, they repeat several of the tests that had already been done, including the wavefront diagnostic. This makes me feel good, that they are doing "one last check" to make sure all the numbers match.

I go through the drop routine with one of the employees. He gives me a bucket full of drops to take over the course of the next couple of months.

Into the surgery room we go, and it really went without a hitch. No pain at all, and the laser maybe lasted 10 to 20 seconds per eye. Before you know it, I was done. I did choose to have the wavefront guided ablation. No monovision, epi-lasek. I am a 34 year old male. I will still try to get the majority of those pre-op numbers and report that later.

In the post-op waiting area, the left eye feels okay, and the right one feels like there is an eyelash or something under my contact. Very painful. I mention it to the doctor, and she looks very closely in my eyes with a slit lamp, and says there is nothing. She said I will get those feelings on and off in both eyes over the next couple of days. Sounds like fun!

Everything checks out fine, I put on my "ski goggles" as my wife likes to call them, and we hop in the car. Luckily, I brought a towel to drape over my head on the way home. It was a long hour and a half ride!
The snow on the ground was BRIGHT, and my eyes began to hurt quite a bit.

When we got home, I did my first round of drops as instructed, took a pain pill, and crawled into bed around 5:30 in the fetal position.... haha. Luckily, I can sleep through about anything. I have had kidney stones before, which are incredibly painful. This wasn't QUITE that bad.

My wife woke me up around 9 for my second round of drops. The pain had decreased significantly. Took my drops, wandered around a bit, and we both went to bed.
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Friday, January 19th 2007

Postby rgonyer » Tue Jan 23, 2007 4:51 pm

Friday morning I got up when my wife left for work. I was happy that I slept through the night with no trouble. My eyes were VERY bloodshot (no surprise), but what was a surprise is that I could actually, see, surprisingly well. Not great, but much better than I expected to be able to. In fact, I had written the day off as a "lay in bed" day, when in actuality I got a lot done around the house. Did some touch up painting that needed to be done (we are in process of re-doing a rec room in our lower level), and actually did quite a bit of work on the computer.

Towards the end of the day, it became apparent that I was going to have to call it quits for the day. I could no longer read a computer screen without squinting very hard. Double vision in both eyes, halos everywhere, and really nasty light sensitivity. In addition, the pain was moderate in both eyes, on and off throughout the day. They did give me some drops to numb my eyes, the problem with them is they only work for an hour at a shot, and they recommend using them no more than once every four hours. So once every 4 hours or so, I got an hour of relief :) I knew if I used it more, it would only delay my recovery, so I didn't.

One very surprising thing - by the time my wife got home, my eyes were so non-bloodshot it was amazing. Even more so than when I wear my glasses. They were as white as I have ever seen them. Must be all the artificial tears I have been using.

My wife came home, we had some dinner, relaxed for the evening, and went to bed. Not a bad first day, I thought, compared to what some of my coworkers had told me.
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Saturday, January 20th, 2007

Postby rgonyer » Tue Jan 23, 2007 4:59 pm

Slept through the night again, very happy about that. Eyes were starting to feel pretty comfortable. Using lots of refresh drops. When I woke up, I had blood shot eyes again, which quickly diminished again to very clear eyes. Couldn't see well at all today. Double vision in both eyes, halos, etc. I made the unfortunate decision to go with my wife shopping today, and we wound up running all around town. WOW was I sensitive to the light. Wish I had that towel with me again to put over my head while we were in the car. Overall, I felt like I probably delayed my recovery with all the stress I put on my eyes today. In the afternoon/evening, I couldn't watch TV at all - WAY too bright. So I laid on the couch and wandered around a bit, and again went to bed. Overall for the day, not very happy, and beginning to get a bit nervous/anxious. Wish I could look at the computer screen so I could do a bit of research. Don't get me wrong, they told me all this would happen - I just assumed they were giving me "Worst case scenario", and that I should be progressing faster. They told me I should be able to drive by Monday! Most certainly this wouldn't be the case the way I was going.
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Sunday, January 21st, 2007

Postby rgonyer » Tue Jan 23, 2007 5:02 pm

Woke up today feeling good. Eyes were barely blood shot at all, and I could actually see to do some stuff. Computer was still tough however. Ghosting in both eyes, halos around lights, etc, but starting to be able to focus better. My wife and I did a whirlwind clean up in our rec room downstairs so we could watch the playoff games down there. Had no trouble watching those. Couldn't read any scores or print on the screen, but had no problem following the games. Vision fluctuated most of the day, issues bounced back and forth between eyes, etc. Nothing major to report today, same old stuff. Starting to get very nervous that the ghosting will be permanent, after reading a few posts on here and other sites. Other than that, no pain issues at all, followed my drop instructions as always, etc.
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Monday, January 22nd, 2007

Postby rgonyer » Tue Jan 23, 2007 5:13 pm

My first followup today. Could I drive to it? I woke up feelnig good again, and able to see pretty well. Some ghosting still in both eyes, with my right eye being better than my left. My appointment was at 8, so I had to hit the road at 6:30, when it was still pitch dark. I was a little worried about that, but it turned out to not be an issue. I don't think I would have went out exploring unknown roads, but I had no trouble driving safely. I couldn't read signs, but I knew the roads/speed limits well, so that wasn't an issue. Serious ghosting/glaring/double vision of anything lit however, but I had no problem ignoring it.

At my appointment, I expressed my concerns to my doctor, and he said it was all normal. He took a look in my eyes, and said "wow". I thought, great, not good! On the contrary, he said that he had only seen one other person heal this fast since he had started doing this. Great news!

On the eye chart, I tested 20/40 using both eyes, 20/40 in my right, and not very good in my left. He did say that my epithelium was a little behind in my left eye compared to my right, so that made sense. He chose to leave the contacts in at this point. He said the right is very close, the left should be left in for a few more days.

I felt a lot better after the appointment. After getting to work, I was able to do my job (mostly on the computer), with not much problem. I did jack up the res on my monitor one level, which helped a lot. By the end of the day on Monday, my right eye vision was very crisp and clear, just a very small amount of ghosting on high contrast images on my PC screen. Overall my vision is getting better, and I'm getting more and more functional every day. At home, I was able to watch TV normally and read most of what was on the screen. A really good day, I thought. My eyes still look great with very little irritation, very surprising since I have had contacts in for nearly 5 days!
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Tuesday, January 23rd, 2007

Postby rgonyer » Tue Jan 23, 2007 5:19 pm

Woke up this morning with VERY dry eyes. Thought for sure my contacts were going to get displaced. Ran into the bathroom and doused my eyes in refresh drops (which by the way, if you need a on of these, you can get them at Sams Club, $20 for 100, much cheaper than buying the small boxes). That seeemed to take care of the problem. Hopefully I can remove these soon!

So far today is going okay. Nothing major to report. My right eye is very very good with only minor ghosting around high contrast areas or bright lights. Almost non-noticeable. I still hope it goes away, but it wouldn't be the end of my world if it remains.

My left eye is still fuzzy with some ghosting. About where my right eye was yesterday at this time, so I'm hoping by tonight I'll be in pretty good shape with the left eye. The drive in the dark this morning was a bit better, not quite as much double vision around headlights. It's definately improving.

I have another followup scheduled for Wednesday evening. I'll attempt to get the numbers that some of you are asking for. I do know that my contact prescription was -3 left, -2.75 right, and I also know that I had low astigmatism.

---- Evening Update
No major updates - Main issue today has been the cold weather, and having to have our forced air heat in the house and cars turned way up. Drying my contacts out for sure! When my eyes are well lubricated, I have nearly no ghosting in the right eye, very crisp vision. When we went out to lunch today, I noticed I could read signs very easily that I could not read with my glasses (and I had 20/15 with those). Still have some ghosting and glaring with the left eye. I would say a slight improvement over this morning. I have a feeling I will wake up very dry again tomorrow..... Refresh is making a killing off of me right now. Even at Sams prices, they are 20 cents / dose, and I must be going through 10 of them a day! I know that will taper off. All in all, things are going great, as far as I can tell. I have another followup appointment tomorrow afternoon.
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Wednesday, January 24th, 2007

Postby rgonyer » Wed Jan 24, 2007 3:43 pm

This morning my eyes weren't quite as dry as yesterday.

Vision in right eye is great, I would say nearly perfect. Set my computer monitor resolution back up to where it belongs.

Vision in left eye is still fairly crummy... maybe even worse than yesterday. Some ghosting, and definately blurry. Maybe due to dry eye, maybe not. I kind of expected some improvement last night or this morning based on my right eye experience, but no luck so far.

I'll give a quick update after my followup tonight.

What do you think Glenn, is it normal for one eye to recover so quickly, and the other one to lag days behind?
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Postby GodsClay » Wed Jan 24, 2007 3:58 pm

Was glad to see your post this morning :) and I too will be anxious to see Glenn's reply.... but even more so your MD report this evening. I wonder if they remove the contacts OR change your left contact will show significant improvement.

Hang in there
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Postby LasikExpert » Wed Jan 24, 2007 6:31 pm

It is very normal for eyes to recover at a different rate.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Wednesday, January 24th, 2007 Evening

Postby rgonyer » Thu Jan 25, 2007 4:30 am

Evening update ;)

Let me begin with a quote-

"Epi-lasek is not unlike a roller coaster ride. I only hope that I am glad that I got on when it is all over".

My followup didn't go all that well today. Nothing major, but I had horrible vision. (20/100, and fuzzy at that, astigmatism, both eyes). This was after my right eye was near perfect all day! I could tell when I walked into the place and sat down that my eyes were drying up. I should have bought some stock in Refresh before having this procedure done. ;)

All in all, he assured me it was perfectly normal to have some regression at this stage. Upon checking my eyes, he said both epitheliums have basically 100% regenerated, so my contacts came out. It's actually a bit more uncomfortable without them in, if you can believe it! I'm glad they are out though - it has gotten so cold and dry here the last couple of days, that is not helping anything. He also noted how clear and haze free my stroma looked. The doctor I saw today was a doc local to my work that has agreed to co-manage me with the refractive surgery doc. To be honest, he did a much more complete exam, so I am very comfortable with this guy (this is the first time I have seen him). He has never done a follow up with Epi before, only PRK. He said of all the PRK followups he did, my eyes were as clear or clearer than any others. A bit of good news. I have never struggled so hard to read an eye chart! The best he could do, with correction, was get me to 20/60.

He did notice that my left epithelium had a strange spot in it, he said it almost looks like something got under my contact and caused it to heal around it. This would explain why originally my left eye was doing the better of the two, and suddenly this shifted to my right eye being the better one, with major ghosting in the left. He felt once we got the contact off, it would heal without a problem.

Here's hoping for a better day tomorrow! As I sit and type this, it almost seems that my vision is improving ;) Wishful thinking? I guess we'll find out soon......
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thought about your earlier posting-

Postby mike r » Thu Jan 25, 2007 5:26 am

Didnt you say you were painting and doing all this stuff around the house right after the surgery. That rung a bell to me!!! or warning they say you can do all this normal activity...hhhmmm... I didnt I vegetated for xmas about a week no exertion mine was done dec 21...I thought it wise to rest my eyes closed and limited tv computer or generally relax. I dont know if this did anything just some input.

I ll say a short one for you<mike r>
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