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