PRK: a diary for those with questions, concerns, interests, or comparison to LASIK

T minus 1 day:
I am going for PRK on my right eye tomorrow so I thought I would blog the experience for those who are interested. I figure I could offer a fairly unique background since I already underwent PRK on my left eye back in September with some success.

To start off with, you might be wondering what PRK is. The acronym stands for photorefractive keratectomy which means a laser is used to shave down your cornea, so that it will grow back in a contour that will allow for better eye sight.

How does this differ from LASIK which everyone has probably heard of, knows someone who has had it, or has had it themselves? LASIK stands for laser-assisted in situ keratomileusis. Once again, a laser is used, but this time a small flap is cut in your cornea and the laser makes minor corrections under this flap. The flap is then dropped back down which provides two of the biggest reasons why LASIK is so popular. You are able to see quite well within a day or two and there is little healing time.

PRK on the other hand can take a few days to have enough vision to perform basic tasks. They usually recommend waiting a week to drive. My ophthalmologist felt that I should be able to go back to work in under a week. Honestly, I didn’t feel comfortable in front of a computer for an extended period of time until 3 weeks out.

Now, you are probably wondering why I didn’t get LASIK. In fact, I already had LASIK on both my eyes 10 years ago with great success. Unfortunately, I was still in school at the time and my vision has regressed to a -3 to -4 spherical diopter with +2 cylinder (astigmatism) since then.

When I approached the ophthalmologist about further laser surgery, he noted that my corneas were thick enough to undergo LASIK again. My cornea was greater than 600 microns which scared the nurse a little. I’ve seen some numbers that ~500 microns is a threshold, but each surgeon has their criteria and different procedures that can be performed based upon how much residual cornea they wish to maintain. Thus, even with my thick corneas, the ophthalmologist was concerned about the integrity of my cornea with two flaps, thus we went with the safer route. Sure, I could’ve gone with the quick and easy LASIK, but I kept on having dreams of my eye collapsing on itself. I know that really can’t happen, but every one is allowed to have ridiculous medical thoughts at times, I’ve seen plenty.

In September 2009, I underwent PRK on my left eye since it had the worse astigmatism. This was also sort of a trial since my right eye was my dominant eye. I could still undergo LASIK if I was satisfied. As you may have noticed, I was undergoing one eye at a time because I could take off up to 3 weeks in case I was unable to work. I also have partial monocular vision, so I am able to look out of one eye mostly if need, thus another reason why this was suitable.

I arrived at the doctor’s office that morning and sat around for a while. I finally went back for the procedure which involved several numbing drops and lied down. A plastic stabilizer was next inserted around my eye to prevent blinking. I was now starting up at a multitude of red, white, green and yellow lights. The red was in the center and most important since the ophthalmologist kept on telling me to look at it. He then used a small instrument to take off the epithelial surface of my cornea. I could only feel the slightest pressure. If you’ve never worn contacts before or have some phobia of people sticking stuff in your eyes, you might need some valium before the procedure.

Next, he asked me to stare straight ahead at the red dot. It had not become slightly hazy, better with some lubricant drops. Then, the buzzing sound BEGAN. “Keep looking ahead,” I was reminded as the smell of burnt tissue entered the air. Since I’ve been on surgery rotations several years ago, this didn’t bother me in the least, but once again, if this makes you squeamish please tell your doctor so you can take some medication for anxiety before the procedure.

After about a minute, the procedure was over. Some mitomycin-c drops were applied which have been shown to reduce corneal hazing in people like me who are very near-sighted. A barrier contact lens was then placed on top. After spending 10 minutes total in the laser suite, I had received my bag of eye drops and was on my way out the door.

After having a friend drop me home, I stayed up several hours typing on the computer wearing the provided sunglasses. Nothing beats causing severe strain to my eye right after a stressful procedure. Also, like most patients I ignored my doctor’s orders of going to sleep for a few hours. My eye didn’t feel too irritated, just like there was a bit sand in there.

You will receive several drops to take. A steroid (prednisolone) drop which is used four times daily for the first week, three times daily for the second week, twice daily the third week, and once daily the final week. An antibiotic drop (Vigamox in my case) is also given to take several times a day for one week. A NSAID (Acular) eye drop was needed for one day. I also received some vicodin for pain and valium for anxiety and sleep, but I’m not a big fan of medication. I never opened the bottles, and they are still sitting in a medicine bag in case anyone gets any weird ideas. Artificial tears are highly recommended to use several times a day, especially if your eye is dry. I was also provided some thin goggles which you are supposed to sleep in for 3 nights.

The next day, my eye still felt great. I drove to my one day follow-up appointment (this is not recommended) and my check up went smooth. Words still looked slightly blurry, though I could make out objects at a distance. My cornea was already starting to heal well and I wasn’t in any pain. I have read horror stories where people are in pain continuously for five days and curled up in the fetal position unless they are taking pain meds or anesthetic eye drops. This reinforces why it is of the utmost importance to make sure your ophthalmologist is very experienced in this procedure. Cheaper surgeries may save you a few bucks, but issues with eyesight can affect you the rest of your life.

The second night I was about to sit down for dinner when my eye started watering. It had watered a little the first night, but stopped with a few dabs. This time my eye kept watering and felt irritated. I applied some of steroids eye drops which helped a little but the watering continued. I then went and laid down for about an hour in a dark room. Eureka! My eye had returned to normal lacrimation. At my one week follow-up, I was feeling more comfortable with driving though I still couldn’t stare at a computer screen or read text for a long period of time without the words starting to slightly blur. By three weeks, I felt like I could go about all of my daily work and home tasks comfortably. After 3 months, my left eye still only had about 20/40 vision, but my astigmatism was almost gone. I am wearing a slight corrective lens to lessen eye strain. Do I wish I had perfect vision out of my left eye right now? Sure, but 15% of the time, people will need touch-ups after laser procedures.

Now I sit on the precipice of PRK on my R eye, I will have an update tomorrow after the procedure.

Lastly, I would like to provide a quick disclaimer. While I do have a background in medicine, my knowledge of the eye is no where near what a trained ophthalmologist or optometrist has. My story serves to help those who might have some interest or questions before talking with their doctor. While I can provide advice or insight based upon what I’ve read or experienced, I will always defer to those who make a living in this field.