Proust graphs

I recently finished reading the 2002 English translations of the seven volumes of Marcel Proust's In Search Of Lost Time.  My pattern was generally to interleave another book or two between the readings of the Proust volumes, to avoid burnout and allow some time for thought.  The overall book is immense, with something like 1.3 million words.  Depending on the printing and the translation, that works out to about 4000 pages.  In addition to its length, I found it not to be a book that I could read much more than twenty or so pages of at one sitting.  The writing is dense and Proust tends to dwell on ideas (about art, emotions, memory, whether his girlfriend is a secret lesbian, and many other things) for lengthy sections.  It would get my mind going.  When my daughter was young and many nights were spent reading to her, I developed the strange ability to read while paying absolutely no attention to what I was reading.  I could read a kid's book aloud, with proper inflections and everything, while thinking of something completely different, leaving with no memory of what I had read.  I didn't read Proust aloud, but I did find myself occasionally reading a paragraph, then drifting into thought about what that all meant, but unfortunately continuing to read the next paragraph without attention.  Then I'd realize what had happened and have to retrace and reread.  Further, Proust rather famously wrote very long sentences, with many dependent clauses. The plot, to the extent that there is one, moves very slowly.  All of that meant that my reading pace was much slower than for most other books I read.

That doesn't look much of a sales job.  To make it sound even less appealing, most of the characters are not very good, likable people, with the first person narrator no exception.  There are many romantic and sexual relationships described, and not one of them is healthy and loving.  Proust was himself gay, but the depiction of homosexuality is not one a 21st century tolerant liberal would produce.

Despite all of that, the book is profound and moving.  I won't say life-changing, but it's a book that I'll think about and be influenced by for a long time.

The narrative flow of the many characters and their interrelationships have an intricate structure in the novel.  The only one who is present throughout is the narrator (called Marcel a couple of times but mostly nameless).  Early on, Charles Swann is a main focus.  There's a section in the first volume, Swann's Way, in which the narration departs from the first person for the only time, to relate the story of the romance of Swann and Odette, a relationship whose obsessiveness and jealousy are later mirrored in several of the narrator's own relationships.  Swann then retreats in importance, and dies halfway through the greater novel, though what happens to his memory and reputation is a key theme.  Another main character, Baron de Charlus, is barely present early on, then dominates for awhile, then retreats again.  The great romance of the narrator is with Albertine, who does not really show up until the second volume.  Side note: the two main volumes dealing with the Albertine relationship, The Prisoner and The Fugitive, are widely considered the least pleasant to get through.  That was the case for me.  It's such a deranged relationship.  Almost all that Marcel cares about is keeping Albertine away from lesbian affairs, which he does very unsuccessfully.  It ends up being very repetitive.  One wishes he would get on with leaving Albertine, as he threatens to do innumerable times.  These two volumes and the final Time Regained were published posthumously.  It is very likely that Proust would have done some major editing work on them had he lived.  Complicating things further, Proust based Albertine on his chauffeur Alfred Agostinelli, with whom he had a long affair, and who also had relationships with women.  There's a prominent literary theory that other women (Gilberte, Andrée, Lea) in Lost Time are actually based on men also.

To visualize the comings, goings, and relationships in Lost Time, I turned to programming and graphing.  The entire novel is freely available in plain text format from a variety of sources.  The available translation is the original Moncrieff rather than the recent one I read, but I think the methods I use would not show much difference.  The first step was to strip all punctuation out of the text and leave one word on each line.  The next was to identify all the ways in which a character is named in the novel.  For instance, Swann is identified as Swann, M. Swann, Charles, and the possessives of all three.  But the word Swann can also mean his wife or daughter, so Mme Swann, Mlle Swann, Odette Swann, Gilberte Swann must be taken out of his column.  Further, there are a few other Charleses mentioned (Charles Morel and a few kings), which must also be removed.  Finally, Charles Swann would be double counted (Charles and Swann), and such double counts must be accounted for.  I did this for all the major characters, and ended up with a list of every location (word number) in the novel where each character is named.  The giant exception to this is the narrator himself, who is constantly there except for the Swann In Love section.  I actually did count all locations of I, me, my, mine, etc., but there wasn't any good way of separating the personal pronouns from instances when other characters used them about themselves.  And in any case, it wouldn't have told me much except that it's a first person novel.  I decided to do a running count of the number of hits on a name per thousand words, as a way of smoothing the results a bit.  Here is what comes out for the character of Swann (click to enlarge):

The thick vertical lines are the breaks in the volumes of the novel.  The thinner lines are section breaks within each volume.  So one can see that Swann appears early on in the first section of the first volume.  This is the Combray section, and Swann is invited to dinner with the narrator's parents, which leads to the narrator's mother not coming up to kiss him good night.  He then leaves for awhile, and comes back to dominate the Swann In Love section.  In Shadow of Young Girls, he is present in the first section, in which the narrator is attempting to gain admittance into his house so as to pursue a friendship with Odette and a relationship with Gilberte.  Swann is then only mostly referred to occasionally, reappearing dramatically at the end of Guermantes Way, in which he shows up at the house of his friends the Duc and Duchesse de Guermantes to inform them that he is dying.  (They don't really care, being concerned about getting dressed for a party.  This is Proust skewering the vestigial nobility of Third Republic France.)    Swann is later said to have died.  This report comes from an offhand remark by another character, which shows the way in which Swann is already fading in the memory of society, having failed to achieve any immortality, because he threw away his artistic gifts.  Afterward he is only occasionally referred to, mostly through his still living wife and daughter, who abandon the Swann name and legacy, leaving him forgotten.  As Swann is one of the more admirable characters, this is all pretty bleak.

Next I wanted to see how interrelated some of the characters were, through the simple method of determining how close the mentions of two characters tended to be.  For each pair of characters A and B, for each mention of that character the closest mention of the other character is found (forward or backward).  The average distance can then be computed.  This can be done in each direction--the average distance of a B mention for each A mention, and vice versa.  For instance if A is mentioned consistently throughout the book and B only one time, from B's perspective A is close (the one mention of B is close to one of the many mentions of A), but from A's perspective B is not close (most mentions of A are nowhere near the sole mention of B).  So I made both calculations and decided the overall distance between the two is the average of the two numbers.  I had to do it this way if I wanted to map the distances for more than two characters.

To make a 2-D map, I reached for some optimization techniques.  I used a multidimensional scaling method.  Basically this method takes the desired distance between each pair of points, and attempts to place those points on a 2-D surface such that each is the proper distance from the other.  Most times, it is impossible to get them all exactly right.  As a trivial example, if you have three points A, B, and C, and AB is 10, BC is 10, and AC is 30, it's physically impossible to place them that way.  If you get AB and BC right, the maximum mapped AC (putting ABC on a straight line) is 20.  Another trivial example is that you can not place four points equidistant to one another on a plane.  (You can in 3-D: make a tetrahedron.)  So the method attempts to do the best possible job, moving points around until the tension (a measure of how close the mapped distances are to the desired distances) is minimized.  That will generally mean accepting small errors on each distance.  If tension is below 0.15, that is generally considered good enough.  All the maps I will present here have tensions below that.  The basic method places the points at random on the map, then nudges them a small amount.  If the nudging improves the tension score, repeat, if not, nudge them a different direction.  I added the twist that if the method stalls out with an unacceptable tension score, blow it up and place the points in a different random location, then start again.  In evolutionary terms, this allows saltation as a solution to leap from one dead end local best solution to a higher peak farther away.  Eventually it settles on a best solution, though the actual map can vary each time I run it, as the initial random guess will be different.

Here is a sample of how the method works, showing all the women to whom Marcel is attracted. Mlle Stermaria is a very minor character, and the other four are recurrent throughout the novel, with Albertine getting a bit more ink than the Odette, Gilberte, and the Duchesse de Guermantes.  Mlle Stermaria's few mentions are mostly in volumes where Albertine is also present.  She appears in the beach town of Balbec, where Marcel meets Albertine and her friends in Shadow of Young Girls.  In Sodom and Gomorrah, Marcel is planning a dinner with and seduction of Mlle Stermaria.  Meanwhile Albertine shows up and Marcel attempts to be rid of her so he can make his date.  So Mlle Stermaria is fairly far away from everyone but closest to Albertine.  Albertine herself generally dominates the two volumes about her so is a little distant from the other three.  The relationships among Odette, Gilberte, and the Duchesse change as the novel progresses.  Early on, Gilberte is a child and is therefore near her mother, Odette.  The Duchesse is Swann's friend and will receive him, but not his wife Odette, who has a scandalous past as a courtesan.  Nor will she receive Gilberte as she grows up, until she inherits a great deal of money and marries the Duchesse's nephew, Robert de Saint-Loup.  At that point (late in The Fugitive), we see Gilberte and the Duchesse get mentions in close proximity to one another.

 

Here is the distance map which results.  The size of the circle is proportional to the number of mentions of each character.

 Gilberte's closeness to the Duchesse relative to her own mother could be seen as a sort of triumph for Swann, who wished his daughter to be accepted in the highest of society, represented by the Duchesse early on.  However, Gilberte only manages this after Swann's death, and by taking the name of his rival, the Baron de Forcheville, after he marries Odette.  Swann himself is forgotten and renounced, but his daughter ,and in the final volume, his granddaughter, achieve social success.

I'll do several other groupings of characters in posts to come.

PRK Journal, Three Months

The last month has brought some significant improvement.  The right eye (distance) has gotten much better.  There is still some residual ghosting, which is mainly noticeable in low light when the pupil is larger.  The left eye (reading) is still lagging, though it has improved some in the last week.  I don't know where it's heading for its final stable value.  It still has some ghosting as well,  more than the right.  

I've noticed that looking at fine print or a computer screen leads to a couple of minutes of less than great distance vision after I stop.  Maybe the distance eye is still trying too hard in those situations when it has to learn to let the reading eye do the work.  Hopefully that improves as well.  

I'm now on just one steroid drop treatment per day.  (For internet memesters, the name of the steroid is actually FML.  It doesn't actually affect ML negatively at all.)

Again the bottom line is that my vision is completely functional, though still a bit short of where I was with glasses.  Driving is fine, though the increased ghosting at night interferes with long distance sign reading a bit.  Improvement continues and will probably do so for several more months before it reaches stability.

PRK Journal, Week 10

There's not much new to say.  If there's been improvement it's been very slight and sporadic.  The astigmatic ghosting is still present, maybe slightly reduced.  I'm still hoping for much better vision than I currently have, and there's still reason to think that the coming months will bring that improvement.

Again, I'm totally functional without glasses.  I'm just not where I was with glasses.
 

Book review, Northanger Abbey

This was the last Austen novel I hadn't read, so I thought it was time.  It's definitely my least favorite, but that only puts it last among greats.  The characters are just not as vibrant as her later creations.  The heroine, Catherine Morland, is something of a mouse with no notable traits other than an overactive imagination due to her reading of gothic novels.  Henry Tilney is amusing, in one sense a typical Austen male lead in that he is of the highest character and sees the virtue in our heroine.  He's also got a bit of Mr. Bennet about him, in that he is more of a bemused observer of the human foibles around him than he is a manly actor like Mr. Darcy or Mr. Knightley.  Partly this befits his status as a country parson rather than master of a large estate.

The villains, the Thorp siblings, are less convincing than their equivalents in the other novels, e.g., Wickham and the Crawford siblings of Mansfield Park.  Austen is more subtle when we meet them in conveying the bad character of those than she is here with the Thorps.  Isabella and John are fairly transparently awful from the get-go, despite Catherine's failure to see so immediately.  Just about the only character with much depth is General Tilney, whose nature is something of a mystery until the end.

The writing is as always very good, and the social observations keen.  There are some fourth wall breaks which strike the modern reader as unusual or postmodern, though it wasn't actually that uncommon at the time for authors to take asides to talk directly to the reader.  Austen for instance at one point notes that the reader will have seen that there are just a few pages left so clearly she had better wrap things up.  At another she notes that the time she has allotted for one character to relate a large amount of information to another isn't really sufficient given the distance she has given them to walk and talk.  She brushes the concern aside, saying something like, well let's just assume he wrote some of it to her in a letter at some other time.  It's a striking nod to the artifice of the fictional construct. The entire ending is the purest deus ex machina, which is partly due to the nature of Northanger Abbey as a parody of the Gothic novel.

Image chosen for general hilarity.  The bad girl in the middle is the exact opposite of Catherine Morland.  The right cover is from a 1960s paperback, trying to sell Northanger Abbey as an actual Gothic horror novel instead of a parody of one

PRK Journal, Week 7

There hasn't been much change in the last couple of weeks.  Each eye still has some ghosting, a second faint image above and to the right of the main image.  This is the result of astigmatism, which is an asphericity of the cornea which prevents it from focusing a single image precisely on the retina.  In the Day 6 report I mentioned a test at the doctor's office which involved looking through a pinhole and seeing a clear image, in contrast to what was still very blurry vision sans pinhole.  That's an astigmatism test.  The pinhole takes away any ghost images because only a small part of the cornea is getting an image in the first place.  

At any rate, the astigmatism and resulting ghosting should go away as the cornea continues to heal.  In other PRK recovery accounts I've read, ghosting starts to go away in week 5 or 6.   However a factor in my case may be the use of steroid drops, whose purpose is to slow healing down.  Others report that they see noticeable improvement in vision when the steroid drops are discontinued.  Frequently that's a month or two after surgery.  For whatever reason, my doc has me continuing the drops for four months after surgery.  Four drops per day the first month, three the second (where I am now), etc.  So my improvement may be correspondingly slower.  There's no reason yet to worry that it won't arrive at the right place eventually.

PRK Journal, Week 5

It has felt like I've hit a vision plateau over the last two weeks, with little or no improvement.  Just some minor ups and downs.  I am fully functional, but not at my pre-surgery level with glasses.  I have begun to notice some ghosting, a fainter secondary image slightly off of the primary image.  That leads to blurring when reading at distance.  When I stare at a difficult target for a few seconds, I'm able to differentiate the two and finally read it, but it's quite different than normal sharp vision.  As I've said in previous posts, this surgery has emphasized to me that vision is a complicated eye/brain process, the subtleties of which are not nearly encompassed by a single acuity measurement.

Today I had my last followup appointment until six months from now when both eyes should be settled at their final level.  The bottom line is that my right (distance) eye is somewhere between 20/25 and 20/30, and my left (reading) eye is at 20/50.  Something of interest I probably should have put in the first post is that pre-surgery the right eye was at -4.00 diopters and the left eye was at -6.50.  Today the doctor said it generally takes on the order of one month per diopter to fully stabilize, so there are still a couple of months of improvement to come (recall that the left eye is purposely being left about a diopter short for reading purposes).  The scan revealed a small remaining astigmatism on the right eye which should smooth out with time.  He's still confident that that eye is on target for 20/20.  The left eye has a larger remaining astigmatism, and still a prominent epithelial ridge.  This is where the regrowing cells collide and form a sort of temporary epithelial Himalayas over the center of the pupil.  He was surprised that I'm able to read as well as I can with that eye right now.  When the ridge is beaten down by a few more weeks of blinking action, he said the reading should get much sharper.

If anyone is carefully reading these, they'll have noticed that my system of estimating acuity is, charitably, way off.  Neither eye is at 20/20 in reality, and the left eye isn't even close.  Perhaps I've been unconsciously biasing the results by convincing myself I can see the legs of the m in "Brahm's Lullaby" at distances where I can't quite.   And maybe my daughter was being more strict with herself when she claimed she could only make it out at 150 inches when using my standard she'd be more like 180 or something.  At any rate, I've altered the scale of the measurements so that today I'm at 20/27.5 on the right eye.  Unfortunately that adjustment leaves the left eye at 20/29, which again is way off what the pros measured today.  Perhaps another possibility is that the improvement will consist more in the time it takes to resolve the m at distance (currently several seconds) than in changing the distance itself.  Regardless, the exercise has been valuable in determining whether things are getting better, worse, or staying the same.

Other notes: the doctor saw a small amount of corneal haze today, which again is normal and should clear up.  He reiterated the need for sunglasses through the summer, which I've been following.  He also gave me a DVD of my surgery, which I'll watch at some point and maybe post here.

Steroid drops continue for the next three months, tapering off as we go.  Currently I'm to continue it three times a day, losing a drop per day per month.  The drops are $42 a bottle which lasts about two weeks at the current rate.  That's $8/gram, which is only about a sixth the price of gold, so what am I complaining about.

PRK Journal, Day 28

It's now been nearly a month since the surgery.  The last week has been pretty steady, with actually a small decline, especially in the left (reading) eye.  It's nothing that has kept me from from doing any normal activities, just a little loss in sharpness.  There's still supposed to be some fluctuations in the course toward the final corrected vision, so I'm not too concerned.  Hope it improves though.

Reading and computer work is all fine and normal now.

PRK Journal, Day 21

The past week has been one of continued gradual progress, and maybe a plateau for now.  The target test numbers have leveled off right around the 20/20 level for each eye, with the right eye always a little better as planned.  It is the distance eye and got the full Custom Vue treatment.  The left eye did not as there's no point in the ultra fine tuning since it was to be left short of full distance correction anyway, as the reading eye.

I'm hoping that this isn't the final level though.  Things are still not as sharp as they were with glasses, plus they take just a little longer to come into focus.  It feels like I have to be closer than before to street signs and license plates, for example, to be able to read them.

I am now working with my computer at the high resolution setting I used pre-surgery.  Need for the artificial tears has fallen off drastically.  I now use them only a couple of times a day, and it's not a strong need.  The eyes do continue to dry out somewhat at night.  I usually wake up one or two times and decide to reach for the drops.  This also continues to get better.

One sort of gross note:  I'm still taking the steroid drops, now three times a day, and I find I can taste them in the back of the throat right afterward.  Makes you think there's a system leak back there somewhere, like radiator coolant finding its way into the fuel lines.  But we are not cars, and tasting eye drops is apparently common and harmless.

PRK Journal, Day 14

Tomorrow it will be two weeks since I had PRK surgery to correct my vision.  There has been great improvement in the past week.  Distance vision has improved almost every day and is now near (but not quite at) 20/20 in my distance eye.  There's still a hard to describe lack of sharpness that's not the same thing as acuity.  I don't know if this is a monovision effect or what, but it also gets better every day and isn't really that noticeable now unless I'm looking for it.  On about day eight the road signs finally started becoming legible.  Close up vision isn't quite as good, though also improving.  It tends to start out reasonably good in the morning and degrade somewhat over a day of computer use.  I've been able to bump up the screen resolution and bump down the font size, though it's not yet comfortable at the full resolution I had before.  But I can work without any major issues now.  I have much less need for the artificial tears--maybe 4 or 5 times a day I feel the need compared to 30 or more times a day last week.  Also I'm definitely reading with my left eye, as planned.

Overall I'm feeling much more encouraged than I was a week ago.  Other reports I've read have people still not experiencing good vision even after three or four weeks.  I think doing a quantitative test every day has been helpful.  It's really hard to decide how well you're seeing just using words.  And when your vision changes every day it's hard to remember exactly how it was a day, two days, three days ago.  The target test has forced me to see that there's been consistent improvement, even if slight. Seeing a target from five inches farther away than yesterday isn't a big difference, but cumulative improvements do add up.

The acuity graph shown is an estimate, based on an assumption that my daughter's contact-corrected vision is 20/20.  She can see the target at 12.5 feet.  I'm now at about 11 feet.  The graphs should be taken as having error bars on the order of a foot or so, since it's hard to exactly pinpoint where the target comes in to clear view.  Also I've been taking the measurement first thing in the morning, when things seem to be at their clearest.  I've been losing 6-12 inches by the end of the day, only to regain that loss and more after a night of sleep.  Hopefully that daily regression will stop as things settle in.

The graphs show what I reported earlier: with surgery on Wednesday, vision on Friday and especially Saturday went south very quickly, rebounding after that.  Days 6 to 9 showed a lull, with steady improvement thereafter.

I've had no issues with night driving, in contrast to some.  No halos.  Bright sunshine is still a little too intense without sunglasses, which I'm supposed to wear for a summer anyway for healing purposes.

PRK Journal, Day 7

A bit of a frustrating day working on the computer.  It was hard to read, though I managed.  I've read others reports from the 1-3 week range saying that the artificial tears gave a brief improvement in vision, and I've found the same.  I get one or two noticeably clearer minutes.  As a result I'm plowing through the tears at quite a rate, probably every twenty minutes while I'm at the computer.  Which the doc told me is just fine, in fact it helps the healing.  I'm using the rest of my preservative-free drops first.  They're fairly expensive but I'm happy to pay a few dollars for any acceleration of the timeline.  I've also got a bunch of cheaper drops with preservatives which I haven't tried yet.

I was out last night.  I could have driven.  I'll still try to avoid it for a bit if I can.  Sign reading is still a bit dicey.

I'll switch to weekly updates from here.  Apologies to any readers on the dullness of these reports.  Basically I'm forcing myself to keep a record so I can see what the progress has actually been.  Also I found that these types of running journals on other blogs to be very helpful, so maybe mine will be of similar use to others considering or recovering from PRK.

Comfort: Hitting the artificial tears as hard as ever.  Otherwise fine.
Photosensitivity: Only bright sun and direct glare (as off wet streets)
Target: Both eyes: 72 inches.  Right eye: 72 inches.  Left eye: 57 inches.
Closeup vision: not so great today.
Driving: OK, not night driving yet.
Working: Did it, but it was tough.

PRK Journal, Day 6

There were lots of milestones today.  I drove for the first time, I worked for the first time, and I had the bandage lenses removed.  Driving was basically fine, especially since I've driven the routes I drove a thousand times.  I can read most signs, but sometimes it takes a second for them to come into focus.  I reduced the resolution on my work computer monitor and blew up the fonts so I would have to strain as little as possible.  It's workable, but some improvement would definitely be nice.  There's still a blur surrounding all the letters.  I took frequent brief rest breaks as my eyes got tired.

The checkup appointment went well.  First they check the distance vision on each eye with a standard eye chart.  The instruction is to read the smallest line you can, but as I was reading one line, the next line would gradually sharpen enough to be read, so I ended up reading several lines.  They then tested the left eye for reading, and again smaller lines would come into focus as the seconds passed.  I ended up being able to read much smaller than I thought, but until the focus comes more quickly, reading itself will not be fully normal.  An interesting addition is that they also test the reading eye by having you look through a shield with pinholes in it.  The diffraction through a pinhole really, really reduces blur.  It was nice to (briefly) see sharp text again.

The tech then took the bandage contacts out.  They really stick on there, and it takes some manipulation to get them off, which hurts a little.  Overall a relief, though my eyes felt a little dry and scratchy afterwards.  The doctor then came in and examined each epithelium with a scope.  He initially though he saw a small defect in the right eye.  He had the tech put some dye in that eye and looked at again.  He declared it looked not completely healed ("a little ratty" was his exact term), but there were no defects requiring any action.  It ought to catch up in a day or two.  The left eye had healed very well.  With the lenses gone, I don't need the plastic eye shields to sleep any more, which is nice.  No more human fly look.

Unfortunately the removal of the lenses has led to a small drop in vision.  Not enough to restrict driving or working, though noticeable.  Gradual improvements with some fluctuation should be the rule from here on.  He advised holding off on night driving for a couple more days.

I had been on three medicated drops: a non-steroidal anti-inflammatory, an antibiotic, and a steroid (FML).  I'm now done with the first two.  I'll stay on the steroid for four more months, tapering down the dose each month.  I gather that the steroid slows how quickly the eye regrows.  You don't want it to happen too fast or some irregularities can develop.

Artificial tears now go from every thirty minutes to as I wish for comfort.  Right now I still find myself doing it every thirty minutes anyway.

Comfort: Eyes are a little tired from a day on the computer, and the removal of the lenses also led to some dryness.
Photosensitivity: as before, sunglasses outside, fine inside.
Target: Both eyes: 68 inches.  Right eye: 68 inches.  Left eye:56 inches.  This reading was taken at the end of the day, after the lenses came out.  Pretty sure it was a decent bit better this morning.
Closeup vision: Especially immediately after the lens removal, reading is a little strenuous.  Still lots of blur.
Driving: First day.  It's OK and seems safe enough.  Holding off on night driving for now.
Working: First day.  Reasonable success.

PRK Journal, Day 5

After a somewhat dispiriting Saturday, I woke up this morning to noticeably better vision.  There is not nearly as much smudge and blurriness surrounding everything.  While the target test numbers are better, they don't fully convey that difference.  That test is measuring acuity, but one can read a letter with lots of blur around it, or without.  I can read text in a normal book fairly comfortably at the moment.  I was able to reduce the font on the computer as well.  Testing individual eyes, it looks like I'm reading with the left eye, as is the plan.  The right eye has improved greatly over yesterday in its distance role.  On the whole things are still far from my previous glasses-corrected vision.

I'm sure things will continue to fluctuate and this marked improvement over yesterday is probably a local max rather than a permanent gain.  There are still weeks to months more until final stabilization.

I've been on three medicated drops: a non-steroid anti-inflammatory, an antibiotic, and a steroid.  The non-steroid course finished yesterday so I'm down to two, each of which is taken four times a day.  Plus the artificial tears, which I've been fairly disciplined about using every thirty minutes as directed.  I've read other reports where people have awoken in the morning to very dry eyes, some as far as having their lids stuck to the eye and needing to work artificial tears into the corner just to be able to open.  I haven't had anything like that.

Comfort: Pretty good, though I'm writing this in the morning.  I'm looking forward to getting the bandage lenses off tomorrow though.
Photosensitivity: Just fine indoors, still need sunglasses outdoors.
Target: Both eyes: 77 inches.  Right eye: 77 inches.  Left eye: 41 inches.
Driving: I feel like I could at the moment but will again take today off.  The plan is to drive to work tomorrow.
Working: Tomorrow.

PRK Journal, Day 4

This was definitely the worst day of vision so far.  I did the target test in the morning.  It doesn't really reflect how bad I could see today.  I tried it a couple of times after that without measuring and it was more in the 20 inch range.  The right eye was previously saving the left.  Now the left has moderately improved while the right went south.  Reading almost anything was difficult and blurry.  I went to a ballet performance and a play.  I could follow the action but could not really get the faces in focus.  This is sort of discouraging, even though the doctor told me this would probably happen.  Hope this is the bottom.  I couldn't really do much useful work like this.

Comfort: Tired eyes most of the day, especially evening.  No real pain.
Photosensitivity: A little more, not severe.  Sunglasses definitely necessary outside.  Felt more comfortable away from windows inside.
Target: Both eyes: 53 inches.  Right eye: 37 inches.  Left eye: 42 inches.
Closeup vision: Very blurry.  Reading was very hard and strenuous.
Driving; Would have been a bad idea, especially if I needed to read any signs.
Working: Not yet.

PRK Journal, Day 3

At 1AM I awoke and said ah, there's the pain I was promised.  The right eye had the feeling of a piece of dirt stuck on it.  It was very unpleasant and made it impossible to sleep.  I got up, detached the plastic eye shield and added some artificial tears. Looked at the computer for a couple of hours.  The pain subsided and I was able to get back to sleep.  This morning the left eye had some pain, not as bad.  In general, today isn't painful, but is less comfortable than yesterday.

I had another checkup appointment this morning.  Surprisingly I am now legal to drive thanks to the right eye.  That's really sort of scary, to think that lots of people are driving around seeing as poorly as this.  I'm not planning on driving until Monday unless things get noticeably better before then.  

Epithelium on my left eye is regrowing faster than the right, though both are progressing normally.  Vision is supposed to degrade for the next couple of days before getting better again, thanks to the irregular regrowth of the epithelium.  It does seem worse today, and the vision target test reveals that.  The left eye is now quite poor.  They're constantly reassuring me that this is all normal.  I guess people tend to get discouraged or panicky. thinking the surgery was a bust.

There were five other patients in the waiting room who also had PRK on Wednesday.  We exchanged reports.  One guy has had a noticeably harder time.  He is extremely light sensitive, has to wear his sunglasses inside and can't look at a screen.  He also had serious pain on both days, with some relief this morning.  Makes me feel lucky.  I was able to take a walk (in sunglasses) in bright sunshine yesterday.  The doc did tell me that today (Friday) is usually the worst for pain, with improvement tomorrow.  Sunday is usually pain-free.  Again, we'll see.

Comfort: pain in the right eye last night for a couple of hours, a little in the left this morning.  Eyes generally feel very tired and need a lot of artificial tears.
Photosensitivity: not much.  Need sunglasses outside, inside is fine.
Target: Both eyes: 49 inches.  Right eye: 49 inches.  Left eye: 30 inches.  Considerably worse than yesterday.
Closeup vision: Still blurry, still using megafonts on the computer.
Driving: legal, but I'm not doing it yet.
Working: not yet.

PRK Journal, Day 2

There's no pain yet, and this is supposed to be the day when it shows up if it does.  Maybe I'm lucky.  I slept with the eye shields last night, and that went better than I expected.  It was a good night's sleep.  The Tylenol PM may have helped.

There was a quick checkup appointment this morning, at which it was clear that I'm not ready to drive yet.  I could read a few lines on the chart fuzzily with my right eye, and nothing with my left.  The appointment was basically to check that I wasn't in agony, the bandage contacts were still in place, and I was using my drops as prescribed.   

Computer use isn't completely comfortable either, even with big fonts and low resolution.  Long stretches of text are tiring.  

It's a bright sunny day so photosensitivity is a little noticeable, not bad.  I'm supposed to wear protective sunglasses outside anyway.

Distance vision is slightly improved, though my test is imprecise.  Whether I can distinguish all the letters in the title "Brahm's Lullaby" (sic, this book apparently thinks his name was Johannes Brahm) sort of fluctuates as I look at it.  But my best guess today is 61 inches.  I've noticed vision is better within a couple of minutes of application of the half-hourly artificial tears.

Comfort: same as yesterday.  Eyes feel tired and the artificial tears are necessary.  No pain.

Photosensitivity: a little in the bright sun, but ambient indoor light is perfectly comfortable.

Target: Both eyes: 61 inches.  Left eye only: 51 inches.  Right eye only: 81 inches.  Yes, the left eye is actually adding blur to the joint vision and I'm seeing better with the right eye only.  

Closeup vision: feels a little blurrier than yesterday.  I can make out the text in a normal print book but reading any significant amount is too strenuous.

Driving: not yet

Working: not yet

PRK Journal, Day 1

At my recent regular eye appointment, I finally received the bifocal diagnosis that I knew had been coming for a couple of years.  I'm 46, which is right in the age range when presbyopia kicks in for many people.  I didn't really want bifocals so it seemed like a good time to investigate the corrective surgery options.  My doctor recommended PRK over the more well-known LASIK.  LASIK creates a corneal flap which is unhinged to do the laser correction of the cornea, then reattached.  The flap can cause complications for some people--infection can form underneath it, or a small wrinkle can develop which can affect vision.  Or a later trauma to the eye from an injury can cause it to detach again.  Further, the flap never fully heals.  It also leads to dryer eyes, as nerve endings are cut.  The serious complications are rare, and most people end up just fine.  But for these and various other reasons, PRK was recommended to me.

PRK is an older procedure.  Rather than making a corneal flap, the surgeon removes the entire epithelium layer, does the laser correction, then applies a contact lens which stays on for five days while the epithelium heals and regrows.  The downside of PRK is that recovery is considerably longer.  LASIK patients achieve their stable corrected vision very quickly.  PRK patients can take months.  PRK also generally takes several days to achieve even acceptable vision for day-to-day activities.  The tech at the office I went to said some people are driving within a day or two, most within five days.  But I've also read some recovery stories where people really weren't comfortable driving for a week or even two.  Also, the first few days of recovery can be fairly uncomfortable, and some people report rather serious pain.  The standard line is that you'll regret getting PRK over LASIK for a couple of months, then be glad about your choice after that.

All of that naturally has me concerned.  I'd very much like to get back to work as soon as possible (my job consists entirely of work on a computer), and to be able to drive so as to relieve my wife of the burden of driving me and our daughter everywhere we have to go.  Nor am I more enthusiastic about pain than anyone else, of course.

I had the surgery about an hour and a half ago.  I'm getting what's called monovision, where my left eye is left about 1.5 diopters short of full correction, so it will be the reading eye.  My right eye will be fully corrected and take care of distance.  I've sort of been doing that anyway with my glasses prescription, though not by plan.  Apparently about 60% of patients are just fine with monovision.   Their brains unconsciously adapt to both needs.  It drives other people crazy however.  In a test before we decided on it, I adapted quickly and easily to it, so I'm hopeful that it will work out fine for me.

The procedure itself does not take long, no more than ten minutes from the time I first lay down on the chair.  There was some prep time first of course, where I got various eye drops which numb the eye, protect from infection, etc.  The reading eye gets a slightly different procedure than the distance eye, and requires the doctor to mark on the cornea to align the equipment.  This more or less involved him writing on my left eye with some sort of pen.  With the numbing drops, it didn't hurt at all, though it is of course something of a strange sensation.  Then I was told to lie down on the chair and was given a silly stuffed animal to hold on to with both hands.  I suppose it gives the patients something to do with their hands.  Squeezing an animal rather than flailing would produce much less movement of the head.

To start the procedure, the lids are propped open.  Alcohol is applied to the eye for twelve seconds, which they count down.  There's a slight burning sensation with that.  Next is by far the least pleasant part of PRK, the removal of the epithelium with some sort of scraping tool.  The right eye was done first, and it was just a strange pressure sensation, but not at all painful.   Psychologically it's a problem for some people.  I knew what was happening, and while I didn't enjoy it, I was OK.  It ends with a cold water wash, which is a bit startling.

Next is the laser correction itself.  You focus on a light, and the laser does its work with very short pulses.  It is removing some of the cornea and thereby altering the focusing properties of your eye.  You have about 0.5 millimeters of cornea (500 microns) and they don't want to make it any thinner than 300.  The worse your pre-surgery prescription, the more they have to remove.  I don't remember my exact numbers, but I started out with something like 530 microns and wasn't really going to approach any danger zone.  PRK also requires a bit less cornea removal than LASIK.  During the procedure, you just focus on a given light.  The laser has a tracker to account for any movements of your eye, so you don't have to paranoid about screwing it up.  If you accidentally track your focus off the light, the laser stops. I think overall this part took less than a minute.  The pulses are audible as very short little cracks.  Other people have reported a burning smell as a result of the laser vaporizing the corneal flesh, but I didn't notice it.  

Another cold water wash is performed, then the bandage contact lens is applied.  Then it's on to the next eye for a repeat performance.  My doctor says it's very common that people experience more pain on the second eye than the first.  Such was the case with me.  Both the alcohol and the epithelial scraping caused some pain.  Not excruciating, but noticeable.  I don't know if it's a psychological effect or just the numbing drops starting to wear off.  If it were the latter, you'd think there would be a way of applying the drops to the second eye a little later, but I'm just speculating.  

Afterward I was taken to a normal exam room where a tech checked the placement of the contact lenses.  They were fine and I was sent on my way.   My vision is currently well off my glasses prescription, but way better than I was uncorrected before.  I *could* have driven home, but it wouldn't really have been advisable.  I'm able to use the computer, though I have it on low resolution, it's a little blurry, and I can tell there's a bit of strain going on.  So after finishing this I'll rest for awhile.  

I have multiple drops to apply multiple times a day for awhile.  I also have plastic eye shields to wear when sleeping, to avoid any unintentional eye rubbing which could disrupt the lens.  Which I'm told, you really, really don't want to do, as the pain of an unhealed epithelium exposed to air is extreme.  

Hours 12-36 are supposed to be the painful hours for those people who have pain.  We will see.  I have checkup appointments tomorrow, Friday, and Monday when the lenses come off.  Some people report another small degradation of vision after that.

I have picked as a vision target a piece of sheet music on the piano.  Currently I can read the title of the music reasonably quickly and without squinting, at a distance of 4 feet, 6 inches.  

Comfort:  Eyes sting a bit, and the lenses give a small foreign-body feel.

Photosensitivity: not really

Target distance: 54 inches

Closeup vision: computer use on low resolution is possible but a bit tiring

Driving: not yet

Working: not yet