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Eye Surgery

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My PRK experience / recovery log

(this is a work in progress, I've just been trying to jot down the important bits.  I'll give it an editing pass and fill in the missing parts sometime soon)

I had PRK (Photo-Refractive Keratotomy) on my right eye on December 6th, 2002 and am planning to have the procedure on my left eye on December 16th.  This is a description of my experiences throughout the process.

Pre-game : The Desire to See

I've worn glasses since I was about five years old.  In the 90's, I began wearing contact lenses, and was pleased and amazed at the difference having peripheral vision (and not dealing with frames on your face) made.

...

Pre-game : Research

I've been almost ready to pull the trigger on laser eye surgery for about 5 years (ask any of my friends whose ears I've talked off about it).  But I've never quite felt ready to go through with it, until recently.

...

I decided on Dr. Jonathan Talamo, one of the more respected refractive surgeons in New England, and one of the first in the US to perform excimer laser surgery.

Unfortunately, my left eye in particular has a slight tendency towards keratoconus - I don't actually have it, but Dr. Talamo was concerned that if we went with LASIK, the reduced structural integrity caused by cutting the flap might cause latent forces in my eye to push my cornea into a steeper shape, which could cause later loss of visual acuity.  Not a very big chance this would occur, granted, but he recommended going with PRK over LASIK just in case.  Despite my misgivings about the longer healing time and the fact that we'd have to do one eye at a time, I decided erring on the side of conservatism wasn't a bad idea - I only have one set of eyes, and anything I could do to reduce risk was good, even if it meant a one-time annoyance for a couple of weeks.

...

Surgery Day : December 6th

The actual procedure was as follows:

First my eyelids were taped back with sticky stuff that kept my eyelashes out of the way.  I received a drop or two of topical anaesthetic.  Then they put in an "eyelid speculum" to hold my eyelids apart, which was actually much less uncomfortable than I was expecting it would be, although it did feel a little odd.  Then they swung my chair (I was reclining in something very much like a dentist's chair) undernearh the operating area, where there was a microscope and the laser target area itself.

I was staring up at a blinking red light surrounded by a white ring of light.  This was the thing I was going to be focusing on for the actual procedure.  The light was actually a little uncomfortably bright since I couldn't close my eye, so Doctor Talamo turned it down a bit.

They put a cylinder down on my eye to demarcate the area of epithelium which was going to be removed.  The cylinder was pressed down to acheive a good seal (this was the most uncomfortable part of the whole procedure - not because it hurt but because it felt *weird* to have your eyeball squished like that) and a few drops of alcohol solution were put into the resulting well.  The solution sat there for about 30 seconds while it "gelled" my epithelial cells, after which they swabbed it out and removed the cylinder.  Now I had an 8mm circle of gooey epithelial cells, which were gently scraped off with a little mini-spatula thing.  Subjectively, this was like a blur being wiped clear, resulting in vision that was strangely crisp (but still uncorrected).  Then we were ready for the actual laser treatment.  I was kind of concerned about moving my eye at this point, and was trying to breathe deeply and slowly to keep myself relaxed.  This was the one moment I almost regretted not taking the xanax, but I just kept breathing, and managed to stay calm despite the little voice saying "if you move your eye now your vision will be ruined forever!"

My friend Robin, who was going to give me a ride home, was watching this whole procedure on a TV just outside the laser room.  It's a pretty cool setup, they have a glass wall so your friend can see both the actual room where you're being lased, and a monitor which shows a "doctor's-eye view" of the operation.  She said my eye didn't appear to move at all, which was great news, and she really enjoyed watching the procedure and getting a play-by-play from Jenny, the very sweet lab tech who had prepped me for the operation.

After the laser was done, I was given a series of eyedrops (antibiotics, steroids) and the chair was swung back out from under the operating area.  This is the really cool part - there was a sign on the ceiling which said "Smile, you can see!"  Now, I couldn't even tell there *was* a sign before the operation, and now I could read it!

I was pretty excited on the way home, reading license plates aloud to Robin, and marvelling that I could see.

...

Day 2 : December 7th

My friend Adam picked me up at 8:30AM to take me to my post-op checkup.

I could read the 20/25 line on the eye chart!!  Granted it was a bit blurry, but I was able to get all the letters right, and this is just the first day after the procedure.  Doctor Talamo said that I was doing great, and that I should expect the vision to regress and then get better again as the epithelium healed over.  It's clear that the laser did a good job with the correction, though, and chances are quite good that I'll be seeing 20/20 by the time I'm done healing.

Adam and I went out to breakfast afterwards, and then went our separate ways for the afternoon.  I spent the day mostly napping and watching some TV.  I figured I'd decide later whether or not I was going to go to the chocothon that evening.

...

I took a shower around 7:30PM, and then put in my eyedrop regimen.  Decided to take the last analgesic drop just in case.  Soon thereafter my vision got noticeably worse and I started experiencing some scratchiness.  It was actually kind of disturbing, because I didn't know whether I'd gotten a little shampoo or soap from the shower into my eye, and whether that might be the cause of the deterioration.  Of course that made me all paranoid about ruining my healing process, but then I thought about it some more.  My epithelium is growing back, and Dr. Talamo explicitly told me a few times that my vision would get worse, and then improve again.

Over the course of the party things fluctuated some, and by the end of the evening I was back to fairly blurry in the right eye.  Getting home, doing the eyedrop thing, and going to bed was quite a relief.

Day 3 : December 8th

Woke up this morning and things seemed a bit clearer, but then they rapidly deteriorated back to about where they were last night.  There seem to be clear areas and blurry areas in my visual field, and I'm getting some "ghosting" (double images).  There's also some pain, but it's not bad enough to take anything for.

Saw Solaris this afternoon - liked it, though it was even slower and more atmospheric than I was expecting.  Well done, but not spectacular.  In any case, my vision was good enough to enjoy the film, but was still blurry when we got out at 3.  Ate a late lunch with Joachim, and then headed home.

Vision continuing to fluctuate, right now (6:15PM) it's the worst it's been, can't read at all with my right eye. I hope this clears up by morning, and I'm considering just going to bed in the very near future.  Go epithelium, go!  Again, I'm trying not to flip out, and have read some stuff on the web about how PRK patients often have great vision at first which deteriorates as you heal, and then comes back.  I just hope it comes back soon, as I was hoping to work tomorrow and I'm not sure I could really do that comfortably as it is now.

Day 4 : December 9th

No discomfort today, but the blurring is as bad as yesterday. :(  I'm still trying to control my paranoia about this - although I'm now wondering if the TheraTears eyedrops I got on Saturday might be contributing to the problem.  The blurring started a few hours after I began using them.  Probably just coincidence, but I'm thinking of calling Dr. K or Dr. T to ask.

Couldn't go to work today - hope this improves soon.

Day 5 : December 10th

Woke up at 7:15AM, looked over at the clock, and noticed I was seeing it crisply and clearly with just the right eye.  Yes!  As I write this, I notice there is definitely still a bit of "haziness" to my vision in that eye, but it is much better than yesterday, and I can easily read the computer screen.  Apparently my fears, although natural, were unnecessary - I simply wasn't prepared for just how blurry things were going to get during the healing process, especially after such great results on the first day.  My worries about the remaining slight hazy look to my right eye vision have pretty much evaporated, since I now have every expectation for the healing process to do its magic.

I'm headed to work today, and have an appointment with Dr. Kolnik at 5PM to check how I'm healing, and hopefully remove the bandage contact lens.

Update - 12:10PM : Just saw Dr. Kolnik, who did in fact remove the bandage lens.  I hadn't really been aware of how protective that thing was - I'm now experiencing a scratchy feeling every time I blink, a lot like a really dry contact lens feels.  Also, my vision has deteriorated a bit again.  While this is a bummer in the short term, Dr. K said that I'm coming along great in the healing process, and both the vision problems and the scratchiness should disappear in the next 24 hours or so.

I think I'm going to leave work a bit early, as I don't really want to deal with driving in traffic and in the dark with my eye like this.  I expect I'll wake up tomorrow morning in much better shape.

Day 6 : December 11th

9AM : I woke up in better shape, but only "somewhat" better.  Eye is still a little scratchy, but definitely less so than yesterday.  My vision is better, but fluctuates mostly depending on moistness.  When my eye tears or when I put in a drop of saline, it becomes crystal-clear, but then blurs out a bit when it gets dry again.  I'm not particularly concerned since the scratchiness indicates the epithelium is still healing over.  I am a bit jealous of all those LASIK people with their quick healing times at this point. :)

Day 7 : December 12th

Still fluctuating, but also continuing to improve the baseline.  It seems to be good early in the day - when I woke up this morning, it was the best yet - I could read a pricetag on a package across the room from me (something I'm not sure I'd have been able to do with my glases!), and everything was crisp.  After an hour or so it got kind of wonky again.  I'm not quite sure how to decribe the visual quality of the blurriness - it's interesting, almost like looking through a greasy lens...  Still not overly worried, as things are now pretty good.

Day 8 : December 13th

Happy Friday the 13th!  As luck would have it, the one-week anniversary of my right eye surgery marks the first really solidly good day.  Had no "general" blurriness today, though I did still have to rest my eyes every once in a while.  Everything is quite sharp, and the weird artifacts that remain are getting significantly smaller.  For instance, I'm still seeing some haloing/starbursts around lights at night, but it's much better - I had no problem at all driving home tonight, reading license plates on the way.  There's still some way to go in terms of having that real crispness that I still get for a while when I put in eyedrops, but there continues to be progress progress progress.  I'm looking forward to the left eye on Monday!

I'm currently wearing a prescription contact lens in my left eye, but I know I'm supposed to take that out before the surgery.  A lot of sources say a few days is good, but I asked Dr. Talamo about it and he said as long as I'm careful (don't sleep in the lens, etc) I should be OK wearing it up to Sunday evening.  I'm starting the left eye on the antibiotic drops this evening as well, for which I need to remove the lens too - I think I'll try to just keep the lens out as much as possible over the weekend (except while driving, etc).

Day 12 / 2 : December 17th

OK, status update time.  I ended up spending most of the weekend without a contact in the left eye, which worked out fine since my right eye is so dominant - it was a little weird, but not much.

I had my left eye done yesterday morning, the 16th.  This time we did LASEK (where they put the epithelial cells back on top of your cornea instead of disposing of them) because the epithelium came off in a really nice sheet and I was curious to see the difference in healing comfort/time between that and regular PRK.  Before I start in with the left eye, I'd like to note that my right eye tested at 20/15 on Monday, and is feeling perfectly fine.  Woo!!

Now, the left eye.  Things are not going as well as they did with the right eye, both in terms of vision and comfort level.  The vision part was expected due to the epithelial sheet being on the eye, but theoretically LASEK is supposed to provide greater comfort while healing, and that has not been my experience thus far, alas.

I had the surgery done at 10AM on Monday.  Starting some time Monday afternoon, I began experiencing some distinct discomfort in the eye.  My eyelid was swollen and somewhat red, it was hard to open my eye due to light sensitivity, and there was a painful "scratchy" feeling like something was in my eye.

...

Anyway, vision is somewhat better today, but the eyelid is still swollen and I've been continuing to take the pain meds to manage the discomfort.  I'd been hoping to go to work tomorrow, but I'm not sure I'll be able to.  I'm not particularly concerned, since I know from last time that recovery takes a while and I've confirmed that the experience I'm having isn't particularly unusual, it's just a lot more annoying than last time is all.

Having just taken another pain pill (it's about 10PM), I'm going to head to bed early and hope that more sleep will accellerate the healing process.  Good night!

Day 13 / 3 : December 18th

Indeed, I stayed home from work again today, but have been taking sporadic runs at the computer, which have been going alright, although they are a bit brief.  My eyelid doesn't look normal yet, but the swelling has come down a lot.  I'm still fairly light-sensitive in the left eye, which makes it somewhat hard to keep the right eye open all the way, but I'm getting by OK.

Took some advil earlier in hopes that it would help reduce the inflammation in the eye/eyelid, but I haven't needed any pain meds today, which is a good thing.  Vision in the left eye is still extremely blurry.

I have an appointment with Dr. Kolnik tomorrow to check things out and see if the bandage lens can come off.  Dr. Talamo said that he doubted it would be ready, but he (Dr. T) is going away for the holidays on Friday, so Dr. K is going to call him while I'm there and they'll plot out the course of the next few days together.

December 30th

24 days since the right eye was done, and two weeks since the left.  Haven't updated in a while, so I'll quickly summarize the past week or so.

The left eye definitely took a while to heal.  I didn't get the lens off until Monday the 23rd, a week after the surgery, and it was still sub-optimal for a few days after that.  However, by the 26th, it was doing quite well, and continued to improve after that.  Had I a do-over, I'd have opted for straight PRK over LASEK, but you live and learn.  Besides, there's no real way of knowing if the procedure was the problem or if my left eye was just more sensitive to the surgery in general.

So today was another appointment with Dr. K.  I was very excited because I was seeing super-well with my left eye last night, but then this morning I woke up and had a quick searing pain in that eye.  I applied some lubricating drops, which helped, but then I noticed my vision had regressed a bit afterwards.  Dr Kolnik and I theorized the same thing - my eye had gotten dried out overnight (I should drag out that humidifier) and got "stuck" to my eyelid, so when I opened my eye I caused a little abrasion, which was apparent when Dr. K looked at the eye with the microscope.  Anyway, I'm seeing 20/30 with some difficulty in that eye now, and should expect some increased clarity once the new abrasion heals a bit.  Dr. K gave me some more viscous eye drops to try at night to help avoid a repeat of this morning.  I'm hoping I'll end up with a fair-to-good 20/20 in that eye, which is about what I was corrected to with glasses.  Oh, also, the astigmatism is indeed just about gone in that eye!

The great news is that my right eye is back to a solid 20/15, and I could even read the first few letters of the 20/13 line on the eye chart!

All in all, despite the various worries and the healing time, I am pretty ecstatic about the results.  Went skiing for the first time on the 26th + 27th, and it was amazing to be able to see without the hassle of contacts drying out, scratching, or flying off my eyes.  Waking up every morning is a total treat, and I still find reading street signs a whole lot more fun than it used to be. :)

Will update again when there's a significant change, or after my next appointment on January 13th.

 



© Copyright 2003 Glen Daniels.
Last update: 4/24/2003; 6:43:59 PM.

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