Bottom Line: My experience getting a kind of vision correction surgery called PRK, part 3.
Please read my disclaimer. Basically, none of this is intended as medical advice, just a description of my experience and the thought process behind my decisions. To find other posts in this series, scroll to the top and hit the PRK tag under the post title.
A quick note
One thing I wanted to mention was why I’m taking the time to blog about my experience with PRK. It’s not because I think it’s going to be the most interesting anecdote ever written. It’s because having eye surgery is a big deal. Although it’s statistically very safe, the thought that you could permanently mess up your vision is pretty scary. As much as your healthcare providers do their best to explain all the details of the process, sometimes the best thing is to hear what others have to say that have gone through it. As part of my preparation, I spent a minute to do some Googling and ran across several bloggers that had done something like this. Reading their day-by-day experiences gave me a much more detailed idea of what to expect, and little tips and challenges that I hadn’t anticipated. (Caveat emptor: Each patient and each surgery is unique, my experience will not be exactly like yours.) With this series of posts, I’m hoping to give other potential PRK patients something to read (before they go through their surgery) that will make them ask better questions of their doctors, understand more fully what they’re getting into, prepare more thoroughly for the procedure, and be more comfortable and satisfied with their decision, whether or not they get PRK.
In medicine, day 0 is the day that the event occurs by which you’ll measure the other days. In other words, if you’re admitted to the hospital, that day is “hospital day 0,” the following day is “hospital day 1” (HD1), and so on. Similarly, in surgery, post operative day (POD) 1 is the after the surgery, with day 0 being the day of the surgery.
On my day 0, I’d asked my roommate to drop me off across town at the eye surgeon’s office for my appointment at 10:30. He had class, so he couldn’t stay to take me home, so I made arrangements with another friend to pick me up. I made sure to get a good night’s rest and ate a light breakfast as instructed. I made sure to shower and shave, unsure of when I’d get my next chance.
At the office, I went through the initial paperwork, signed the consent, and was offered a Valium 5mg (which I accepted graciously). They went through the postoperative care instructions and explained the drops I would be given (a steroid, an antibiotic, and a lubricant). Without much time wasted, I was taken back, given a few eye drops including an anesthetic, and my eyelids and the surrounding areas were swabbed with iodine. I was given a little surgical cap and taken back to the operating room.
Once there, I was reclined, a few more drops in my right eye, and a protective mask type device was placed on the left eye (the one to be done second). The right eye was then given more drops. He asked me to look up, then down, and taped open my bottom and top eyelids, respectively. After taping, he inserted an eye speculum to keep the lids open for the procedure.
Then came the abrasion of the epithelium — quite unnerving! I’m glad I took that valium. My surgeon took some kind of instrument with a metal loop and pressed it into the cornea (which was totally numb), then came at it with what looked like a rotary electric toothbrush.
He then used this toothbrush-like instrument to do away with the epithelium covering the cornea. While this was painless, it was a bit anxiogenic. After that, he used what looked like a little swab to wipe away the bits and pieces, leaving me with a pretty clear view. Next, he instructed me to center my vision on a blinking orange light on the apparatus positioned over my head. It then made a series of popping noises, and there was a little bit of pressure and a light smell of something burning (… me ….). This went on for maybe 30 seconds or so. When it was done, I think I may have gotten an eyedrop… but then he placed a small disk on my eye (the MMC no doubt). After 15 seconds or so he removed the disk and rinsed the eye with some very cold water. Interestingly, as he washed out my eye, I had some of the clearest, sharpest vision I’ve ever had — a phenomenon a few people have mentioned in their experiences. After copious irrigation, he placed a bandage contact over the eye. Lastly, he removed the eye speculum and the tape and switched the mask from the left to the right eye.
The left eye proceeded identically, except the mechanical abrasion required a bit more pressure with the loop-type instrument I described above, which was a bit painful.
After the left eye was done, they stood me up and walked me back to the room. The whole ordeal must have taken 10 minutes. The surgeon took a look at my eye with the slit lamp to ensure that the contact was in the right place, gave me one more set of lubricant drops with a dilute anesthetic (tetracaine), a prescription for a pain medication, then basically said I was good to go! I put on my super-cool sunglasses and made my way to the lobby.
My friend arrived shortly thereafter. It was really difficult to open my eyes. They were a little painful and light sensitive, but it’s hard to explain why it was so hard to open them. It’s like they were made of lead, I just couldn’t open them for more than a split second at a time. When I could get them open, my vision was pretty good — definitely better than it would have been without my glasses a day ago (remember, -3.0 D OU).
My buddy drove me home, and my eyes slowly starting stinging and burning a little more during the ride, presumably as the anesthetic drops wore off. He dropped me off at home, and I went inside. It was just barely 11:30 — the whole ordeal has lasted less than an hour. The pain and burning increased steadily for about another hour, until it was pretty bad. I’d been instructed to use the dilute anesthetic drops only once every 30 minutes at most, as they could slow healing. Unfortunately, they seemed to do absolutely nothing for the pain — I could hardly tell the difference. I used them anyway, just hoping that they were working. I took a bunch of ibuprofen and waited — I was pretty miserable. The valium they’d given me was supposed to help me sleep, so I put on my protective eye goggles and tried to take a nap, but I was too uncomfortable. I tried listening to a podcast, but couldn’t concentrate because my eyes were stinging so badly. Probably the worst part is that you can’t rub them. It’s such a natural instinct to rub and press on your eyes when they hurt… it’s tough not to, but the fear that I’d permanently mess up my vision was a sufficient motivator.
Luckily, my girlfriend showed up when I was going through the worst of it (maybe 1.5 hours after getting home) and was able to get my prescription for pain medication filled at a nearby pharmacy. When she got back I took one greedily, and within 30 minutes I was far more comfortable, and nodded off for a brief nap. She was as loyal as anyone could ask for and sat by my side and studied all afternoon while I napped on and off. The pain started coming back a few hours later, so I re-dosed my ibuprofen and continued the rest of the evening like that, alternating ibuprofen and the other pain medication to make sure that I didn’t take either one too frequently. (NB: Please double check with your physician before you follow a similar strategy to make sure there aren’t any dangerous interactions between the medications.)
All the while, I would be putting in the lubricating eyedrops very frequently — anywhere from every hours to every five minutes — as they seemed to help the discomfort the most. I’d use the anesthetic drops anywhere from every 30 minutes to every couple of hours, but they didn’t seem to help. I used the steroid and antibiotic drops as prescribed, which seemed to have no effect on the discomfort.
During this time, I got comfortable enough to listen to some EMRAP (a phenomenal podcast for emergency medicine physicians) and mess around with VoiceOver on iOS so that I could return a few texts and navigate my phone with m eyes closed. It’s pretty cool that Apple integrates such excellent accessibility software… at no cost. I might have never known about it if not for this experience. My girlfriend made me some quiche (interesting choice, but delicious!) and asparagus for dinner, which I devoured voraciously in spite of the fact that I was feasting by a combination of braille and echolocation.
As before, I could open my eyes for a split second at a time and my vision was good enough to get my whereabouts, but it was too irritating to keep them open for much longer. Besides, I’d been told by my eye surgeon that laying low for a while was important for the healing process. I think a big part of this may be the moisture — that closed eyes don’t get so dry. If you’ve ever taken a microbiology class, you’ll probably remember that humidity it pretty important for getting your critters to grow. I think this is pretty true across biology: a good variety of cells often do well in moist, warm, dark places (cells depending on photosynthesis would be an obvious exception to the dark part). Using lots of eyedrops and keeping my eyes closed to keep them from drying out might help in a few ways. Also, check out the study on omega 3 supplementation that I posted in my preparation post — specifically, the part about tear break-up time.
Anyway, I held off on my last dose of the pain medication so that I could save it for before bedtime. I took it around 11:00 pm, with my last round of eyedrops. I put on my eye goggles, and believe it or not, I actually slept pretty well.
I woke up actually feeling pretty good. My eyes didn’t hurt much for the first 10 minutes or so, which was nice. I was able to get up, get my teeth brushed, and put in my first round of eyedrops. The stinging and burning started coming back pretty bad, though not quite as bad as the previous day. My girlfriend’s mom had graciously volunteered to take me to my followup appointment. Once there, I got a quick checkup and another once-over with the slit-lamp (again, I’m assuming to ensure the placement of the bandage contacts). I let my doctor know that I was pretty darn uncomfortable, and he gave me another set of eyedrops. At one point I told him that I was impressed at how good my vision seemed, and he told me that it would probably get worse before it got better as the epithelium regrew. This one was a topical NSAID (anti-inflammatory) that could be used once or twice per day. It was very viscous, and didn’t seem to help at first. On the ride back home, I was again very uncomfortable, to the point of having difficulty keeping up a conversation. However, within about an hour, it seemed like the NSAID drops kicked in (or it may have been pure coincidence), and I felt much better. I was able to once again kick back and listen to a few hours of podcasts, napping on and off.
My vision was not much different than the day before. It seemed pretty good, but my eyes were just so painful / tired / light sensitive that I couldn’t keep them open long enough to do much. My near vision was not great, and it gave me a headache to try to read even a paragraph. I tried to look at something on my computer by cranking up the zoom level (again, I’m so impressed by Apple’s implementation of accessibility features), but I could hardly get through more than a single sentence before my eyes just seemed to give up and go cross-eyed. It was really frustrating, they’d be okay for a couple of second, then everything would lose focus and give me a headache. I gave up pretty quickly and went back to podcasts.
I spent the vast majority of day 1 napping and listening on and off to EMRAP. I was going through the lubricant drops like crazy, so I had my girlfriend go get me more preservative-free drops from the store (actually, I think this may have happened Day 0 when she got me the Rx). The preservative-free drops come in funny little individual packets, but I was told that it was important to use preservative-free ones. For dinner, my girlfriend took me to get some Thai take-out at our favorite local place, and we spent the evening similarly to the previous one: me listening to podcasts, her studying.
I only needed my pain medication once on Day 1, and I otherwise got by with some ibuprofen in the morning. The NSAID eyedrops seemed to have helped considerably; I used them again before bed, and slept okay but not great (probably because of all the napping during the day). I quit using the ibuprofen at this point, because it’s another NSAID. I figured the eyedrops were probably doing the job well enough, no need to use two meds with the same MOA.
Day 2 was a big step forward. I used the NSAID drops in the morning, continued the steroid drops and antibiotic drops as prescribed, and the lubricant drops constantly. I was comfortable enough to make my first solo mission: to walk across the street to Walgreens (with a hat and sunglasses, since I was still pretty light sensitive) and get a few things. Among other things, I went ahead and picked up some cod liver oil (high in Vitamin A) and some fish oil. Even though the protocols in the studies I posted started weeks before surgery, I figure there’s probably little risk in taking them. I’ve taken both of these safely before, in my years as a nutrition major that thought supplements were a good use of money, but now I’m more skeptical. Again, please talk with your doctor before trying anything new, every situation is unique, etc.
I still spent the majority of the day lazing about and listening to podcasts, but I was a little more active. The pain and burning was substantially decreased, and now felt more like dryness. I was still light sensitive enough that I preferred to wear my sunglasses even indoors, but if the lights were off I didn’t need them. I was well taken care of, with a delicious breakfast omelette and some fancy macaroni and cheese of lunch, both cooked up by my girlfriend, and her mom brought me some take-out from one of our favorite Mexican restaurants for dinner. I should get eye surgery more often!
By the evening, I was able to do a few basic things on my computer, like write those two posts from yesterday. I had to crank the zoom and the font way up or else it gave me a horrible headache, and every few minutes I’d have to look away, rest my eyes, and put in some more lubricant drops.
I think one of the dangerous of looking at a screen in the situation is that I don’t think I blink as much as I would otherwise. With that in mind, i’m trying to make a conscious effort to blink a lot and put in lots of eyedrops, to make sure that epithelium heals as quickly as possible.
I wanted to mention, on Day 2, by the afternoon, things started to look a bit blurrier than before. Not the kind of blurry where you squint and it gets better, like when I’d take my glasses off, but more like foggy. My eye surgeon described the healing process of PRK like “somebody smeared vaseline all over your glasses” — I think this might have been what he was describing, though it didn’t seem that bad. Hopefully this new blurriness is a good sign, a sign that the healing process is ongoing.
I didn’t need any ibuprofen or pain medication at all on Day 2, just lots of lubricant drops and the NSAID drops in the morning. I’m starting to feel much more comfortable and looking forward to getting these bandage contacts out (hopefully on Tuesday 4/23/13). I took some melatonin and slept pretty well, with the exception of a few nightmares (which I consistently get when I take melatonin, and it seems to be pretty common for others as well).
That brings us all the way up to today. As I said, I slept pretty well last night, and got up feeling pretty darn good. It’s about 1 pm, and I haven’t needed any kind of analgesic at all — no ibuprofen, none of my pain medication, none of the anesthetic drops, and not even the NSAID drops. My eyes feel slightly dry, but otherwise really good, at least in comparison to the last few days. I can keep them open more or less normally, though I’m blinking more frequently than I otherwise would, and still using lubricant drops frequently. Things are still a touch blurry, and I still have the font size cranked up to 24 as I write this, but I can browse my Facebook feed and scan Google results without much difficulty. Outside still seems pretty bright, but I’m good to go with a set of sunglasses. I would probably feel comfortable driving to a nearby store, though I’ll wait until I get the official physician sign-off for that.
For my fellow data-lovers out there, I figured something more objective might be helpful. I tried a few different sites that claim to have free online eye exams, but so far they pretty much all just end up saying “pass” or “fail” then try to sell you a product. I did find this one by the VA, which suggests I’m somewhere near 20/40 in my left eye, which is apparently the standard required for driving (20/40 in one eye). My right eye is lagging a bit behind. It’s interesting, though, it’s not like normal refractive error blurriness, where the large letters are clear and small ones blurry — they’re all kind of blurry. Which fits with the mechanism, I guess.
Okay, well I think that’s all for now. POD3 and I’m feeling pretty good about things. Hopefully my vision will continue to sharpen as things heal — I know it can take up to 6 months or even a year to get full results from PRK, but I’d be okay with it happening sooner than that. :)