Laser eye surgery – My PRK experience

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Laser eye surgery – My PRK experience

Revised 2016/9/13

Timeline

· 2008/4/7: Eye exam at Dr Alexandra Chebil's office in Irvine, California. I chose this practice because you get to discuss your case with your surgeon at each visit. Marsha Rossen did the measurements and Dr Chebil examined my eyes. I am a good candidate for PRK, and Dr Chebil agrees that it is the better choice over Intralase Lasik. Like other surgeons (Dr Nepple), Dr Chebil has returned to PRK as their procedure of choice over Lasik. More info on choosing a laser eye surgery.

o My correction (in diopters) measured today:

§ Right: -8.44

§ Left: -6.69

o My max pupil size as measured with infrared device:

§ Right: 6.50

§ Left: 6.25

o Size of treatment zone: 9 mm.

o Type of laser system: VISX Star S4 with CustomView and iris registration (follows rotation of pupil).

o Decision to get monovision, with -1.00 to remain in right eye.

o Expectations:

§ Eye irritation pain for first 48 hours.

§ Temporary contacts removed after 4 days.

§ Vision will take 1 to 3 month to achieve best result.

· Thursday 2008/4/10 (day 0): Got PRK surgery at 12:30pm. No problem with the surgery itself. Thanks to Jim for being my driver. I took this medicine over the rest of the day:

o 2 pills: Ambien CR 6.25 mg

o 3 pills: Hydrocodone-Apap 7.5-750 (Vicodin).

Later in the day I am feeling: As if I am dreaming while aware, dizzy, nauseous, weak-legged, irritation in my eyes and lots of tearing.

· 2008/4/11 (day 1): I called Dr Chebil about feeling weak and nauseous. She says it is the drugs (now discontinued as it was a one-day thing). In the afternoon those feelings go away. Now I start getting abdominal pains, probably from lying in bed all the time (or Vicodin slowing down my bowel movements). Eye irritation is same as yesterday, and with lots of tearing.

· 2008/4/12 (day 2): Abdominal pain goes away as I pass gas. At 10am (45 hours since surgery) I can keep my eyes open without feeling significant irritation for the first time. My eyes stop tearing. I am on track with the expectation of 48-hour eye irritation. Vision blurry at this time (as expected). With the pain now behind me, I look forward to a gradual improvement of my vision over the next couple of months. Moral is good as I start enjoying the positives of this surgery.

· 2008/4/13 (day 3): I can keep my eyes open for a few hours without having significant irritation. Slight vision improvement over yesterday.

· Monday 2008/4/14 (day 4): back at work (using a computer all day). I can now keep my eyes open all the time without significant discomfort. Got the temporary contacts removed. In the left eye I had some irritation at times, and it could have been from the contact lens because I felt better after it got removed. With some effort, I scored a 20/20 on the eye chart. I was cleared for driving as of now (got a card to go along with my driver's license to say I don't need corrective lenses), and given the OK for paragliding in a week from now. My vision for working at the computer is blurry, so I increase fonts size to help.

· 2008/4/15 (day 5): No eye irritation at work or anywhere. Difficult to focus on my computer monitor. Right eye provides my best vision at any distance, but vision improves slightly in left eye. My left eye exhibits ghosting. When straining to see better, the direction and amplitude of the ghosting changes, sometimes almost disappears. I am told that this is a normal temporary side effect which should disappear in a few weeks.

Excerpt from here:

Dry eyes will almost always exacerbate ghosting, and can be the sole cause of the ghosting.

Probably the most common cause of temporary surgery-induced ghosting is edema. All types of refractive surgery are an insult to the eye and swelling of the cornea is a common response. As the eye heals, edema is reduced and the corneal irregularity is resolved. With the resolution of the edema, the ghosting disappears. Edema seems to be most pronounced with PRK and All-Laser Lasik, although all eye surgery can cause edema.

· 2008/4/16 (day 6): I am told not to worry about the ghosting in my left eye, that it is a normal temporary side-effect that can last a few weeks. When I but artificial tears in my eyes, I can sometimes see quite clearly (as good as with my glasses before the surgery).

· 2008/4/17 (day 7): Drove a car during the day: No problem.

· 2008/4/18 (day 8): Working at my computer all day long seems to be getting more comfortable. Creation of this web page.

--- From this point on, I will only report unusual or significant events ---

· 2008/4/24 (day 14): Eye exam. I score 20/20 with both eyes, but with some effort (20/30 easy). My best vision is 10 minutes after I wake up in the morning, then fluctuates and gets worse during the rest of the day. Easy to drive my car, day or night. Ghosting in my left eye is slightly reduced since I first noticed it, most often at 2 o-clock position, but shift to 10 o-clock position at times. Some ghosting in my right eye at 6 o-clock position. All symptoms are normal according to Dr Chebil at this point in my recovery. The eye drops I have been taking to slow down my recovery (Omnipred), which is to prevent hazing, is now reduced from 3x/day to 2x/day. I am told that during PRK recovery, one of the reason vision fluctuates is that the epithelium does not re-grow evenly at first, and only establishes a constant thickness layer over time. For analogy: Think of a new lawn grown from seeding, it is uneven at first.

· 2008/4/27 (day 17): Today is the 2^nd day of the weekend, and my vision seems better than during a work day. Maybe not being at my job and working on a computer (dry eyes because not blinking enough?) is helping. From a patient's point of view, I now see getting PRK laser eye surgery as a 2-part process: First you deal with discomfort for the first few days, and then you worry that your vision may not improve beyond its current state.

· 2008/5/3 (day 23): 4.1 hours of paragliding from Marshall, California. The Oakley Flak Jacket (with XLJ lens) I used were good to keep my eyes protected from wind (no dry eye feeling), and the pink/red tint helped accentuate contrast from the sky and vegetation.

Flight data:

o Flight #1: 1 hour 23 min. A 22 km XC. Info on Leonardo.

o Flight #2: 2 hour 42 min. Thermalling. Info on Leonardo.

· 2008/5/13 (day 33): I entered the 1 to 3 month vision recovery timeframe. Vision still fluctuates, with mornings offering the best. My right eye is doing very well, with objects in focus most of the time and at any distance. My left eye has been making progress these last few days, as objects are starting to get in focus a times, and ghosting is diminishing.

· 2008/5/21 (day 41): Eye exam. In summary, I am doing well. Without much straining, I score 20/20 minus 2 (missed 2 letters) with both eyes. The output from a machine determining precise eye quality measurements indicates a significant progress (more in left eye, which is "catching up" to my right eye with better vision) since the last visit. The Omnipred eye drops are now reduced from 2x/day to 1x/day, and only for the next 2 weeks (until June 4). I will keep using lubricating eye drops 2x/day until the next visit.

· 2008/6/12 (day 63): Distance vision in left eye has improved and is now as good as right eye, so they are both good. For near vision, right eye has been good for a while, and left eye has been improving weekly (minor variable ghosting remains).

· 2008/7/10 (day 91): Eye exam. I score 20/20 with both eyes individually and 20/15 with eyes used together. Although I don't feel it, dryness is observed. I will keep using lubricating eye drops 2x/day until the next visit.

· 2008/9/30 (day 173): Eye exam. I score 20/20 with both eyes individually and 20/15 with eyes used together. Left eye has better (perfect) distance vision (as anticipated from the monovision procedure). Dryness is observed in right eye. I will keep using lubricating eye drops 2x/day until the next visit.

· 2008/10/21 (day 194): Expressing concern for my right eye, I get an eye exam. I score 20/20 with the left eye and 20/40 with the right. Right eye exhibits hazing (10% chance for large-correction patients), so back on the Omnipred for 3 weeks. The hazing would have eventually corrected itself, but the Omnipred will accelerate the recovery.

· 2008/11/11 (day 215): Eye exam. I score 20/15 (fantastic) with the left eye and 20/30 with the right. Right eye hazing is nearly gone but I have dryness that makes my vision get worse during the day. Medication: Omnipred eye drops in right eye 2x/day for a month and then 1x/day for 2 weeks, Lubrication 4x/day in both eyes with Systane Ultra.

· 2008/12/22 (day 256): Eye exam. I score 20/15 with the left eye and 20/30 with the right. So same thing as previous exam. Right eye hazing is nearly gone but what remains is in a crescent shape in the lower part of my eye, which explains why I get vertical ghosting and why I had better vision in September, when hazing was more axisymmetrical. Medication: Omnipred eye drops in right eye 1x per 2 days for 2 weeks and then 1x per 3 days for 2 weeks, lubrication as needed with Systane Ultra.

· 2009/1/20 (day 285): Eye exam. I score 20/15 with the left eye and 20/25 with the right. So my right eye has improved and expected to continue. Medication: Omnipred eye drops in right eye 1x per 3 days, lubrication as needed with Systane Ultra.

· 2009/3/24 (day 348): Eye exam. I score 20/15 with the left eye and 20/20 with the right. So my right eye has improved. Medication: Right eye: Omnipred eye drops 1x per 3 days + Daily lubrication with Systane Ultra.

· 2009/6/18 (day 434): Eye exam. I score 20/15 with the left eye and 20/20 with the right. So my right eye is the same. Medication: Right eye: Daily lubrication with Systane Ultra.

· 2009/10/22 (day 560): Eye exam. I score 20/15 with the left eye and 20/20 with the right. But my right eye has improved: I can feel it and it is also obvious from the output of the evaluator machine. Medication: None.

· 2010/4/29 (day 749): Eye exam. My right eye has slightly improved: Astigmatism dropped from 1.00 to 0.75. Medication: None.

· 2010/10/28 (day 931): Eye exam. My right eye has slightly improved. Medication: None.

· 2011/4/28 (day 1113): Eye exam. I score 20/15 with the left eye and an easy 20/20 with the right. My right eye has slightly improved, only a shadow of haze remains. Medication: None.

· 2011/10/27 (day 1295): Eye exam. I score 20/15 with the left eye and 20/20 with the right. Doctor says my left eye has improved but right eye is the same. I feel the reverse (left eye is the same & fantastic and the right has improved). Medication: None.

· 2012/6/21 (day 1533): On 2012/6/13 a dirty stick pierced through my right top eyelid. CT scan at hospital indicated no eyeball damage and chemical test indicated no surface scratch. Very lucky. Swelling kept my eye shut many days but after this, vision is like before in the right eye.

· 2012/10/30 (day 1664): Eye exam. I score 20/15 with the left eye and 20/20 with the right. I complain about vertical line ghosting in right eye, while having achieved clear horizontal lines about a year ago. This minor imperfection in right eye is not worth a corrective surgery, which could be as likely to produce another similar imperfection, instead hope for continued improvement. Reading without glasses is good. Medication: Systane Gel Drops: 1 drop/day in right eye in morning.

· 2013/10/29 (day 0): Eye exam + Surgery. Same as last year: I score 20/15 with the left eye and about 20/20 with the right. I complain about fuzzy vertical lines in right eye. With the doctor we agree to do a corrective surgery in the right eye to resolve some astigmatism and set it for distance vision. The mid-afternoon surgery (around 3:30pm) went well, with a treatment time of 6 seconds. Medication to use: Antibiotic (Gentamicin) 1 eye drop 4x/day, Non-steroid anti-inflammatory (Durezol) 1 eye drop 2x/day, Artificial tears (Systane Ultra) 1 eye drop 4x/day. Must wear eye cover while sleeping. Worst thing was long 2.5 hour drive home in traffic and after sunset.

· 2013/10/31 (day 2). Recovery is less painful than when first done 5 years ago. Eye is comfortable at this point, with most of redness gone.

· 2013/11/2 (day 4): Post-operation Eye exam. Temporary contact lens removed. Recovery is normal. Medication to use: Non-steroid anti-inflammatory (Durezol) 1 eye drop 1x/day at bedtime for a few days, Artificial tears (Systane Ultra preservative-free. No "gel" before a month) 1 eye drop 4x/day. If I run out of Durezol, use Steroid (Pred Forte) as substitute with same dosage & time.

· 2013/11/11 (day 13): Eye exam. Recovery is normal. I score 20/15 with the left eye and 20/25 with the right (recently operated). Medication to use: Artificial tears (Systane Ultra preservative-free.) 1 eye drop 4x/day.

· 2013/12/16 (day 48): Eye exam. Recovery is normal. I score 20/15 with the left eye and near 20/20 with the right (recently operated). Medication to use: Artificial tears (Systane Ultra preservative-free.) 1 eye drop 4x/day.

· 2014/2/6 (day 100): Eye exam. I score 20/15 with the left eye and 20/19 with the right (recently operated). Medication to use: Artificial tears (Systane Ultra preservative-free.) 1 eye drop 2x/day.

· 2014/8/27 (day 302): Eye exam. I score 20/15 with the left eye and 20/18 with the right. Medication to use: None.

· 2015/9/1 (day 672): Eye exam. I score 20/16 with both eyes. Very happy. Over the last 2 months I did noticed my right eye improving. Medication to use: None.

· 2016/9/13 (day 1050): Eye exam ($50). I score 20/15 with both eyes. Healthy optical nerves and pressure. Very happy. Medication to use: None.