In July of 2011, I had PRK laser eye surgery done. Shortly before, I wrote up a Primer on PRK vs Lasik that the reader may find interesting (TL;DR: Lasik is a dodgy quick-fix, avoid it, stick with PRK). Before I went into the surgery, I did a great deal of research and found a dizzying array of variables that the prospective patient should take into account before choosing whether to have the surgery and where to have it performed. Resulting from this research I detailed the critically important questions that need to be asked before going under the laser: My Laser Eye Surgery, Part I: PRK Pre-Op Preparation. In this article, I describe the PRK procedure itself and the subsequent recovery period.
It has been about three years since my PRK surgery, and I still couldn’t be happier. I reached better than 20/20 vision three weeks after surgery, and have had practically no side-effects with my 20/15 vision since around the four-week mark. I have not tested my vision for quite a while, but I don’t feel as if I’ve had much if any fall-off (your eyes will naturally get worse whether you have surgery or not). I still have better vision than I ever had before, and regularly am able to ‘show-off’ when discussing my PRK by reading things at distances others cannot. Before the surgery, I was about -4 in each eye with an astigmatism of around 1.00. I see much better now than I did with glasses or contacts before and my eyes are actually less dry and less red than they were before surgery. I have had zero regrets about the procedure.
While I have been on the ‘best case you can hope for’ end of the bell-curve of results. *knock wood*, I think perhaps that my efforts to assist in my healing provided at least some benefit to that experience. Along with my account of surgery and recovery, this article will also detail the steps I took to give myself the best possible chance to recover optimally, in the hopes that readers may benefit by it.
Day 0: Operation Scorched Orbs
Pre-Op: Peak Anticipation
The procedure was crazy fast. The time between arrival at the clinic and departure for home was about 45 min, and that’s including filling out the necessary paperwork, waiting 5-10 min for the pre-operative anesthetic drops to take effect, post-operative exam, etc. The actual procedure took about 5 to 10 minutes, maximum.
After I was signed in and waivered, I was brought into an examination room for one last look at my eyes, to ensure that nothing had changed and that I was still Go for Surgery. With the green-light, I was led to a bed in a quiet pre-op prep room and given some anesthetic drops for my eyes. I was then left alone for ten minutes, just outside the operating room, so that
I could obsess once more over the risks of the coming procedure the anesthetic drops could take effect.
At length I was ready. A nurse fetched me and brought me into a medium-sized room that was dominated by the sight and sound of a large, droning machine. The machine itself was a desk-sized cabinet with a manhole-sized robotic surgery on an arm overhanging an attached bed. The contraption, made for a single purpose, sprouted a host of digital and optical display instrumentation, control knobs, and ventilation tubes. The sound it emitted was somewhat lower on the tonal register and decibel scale than a vacuum cleaner, but above in volume and pitch the buzzing of a wasp nest. It was a blanketing white noise, loud enough to soothe jangled nerves, and loud enough to isolate the room from sounds coming from without (coming from within too, for that matter). The machine would not have looked out of place on a Star Trek sickbay set. Come to think of it, it would not have looked out of place on the set of a Borg Cube assimilation chamber.
My heart-rate was at its highest at this point of Peak Anticipation.
The surgeon introduced himself and laid me on the bed. He proceeded to give a quick overview of the procedure, what I would experience, what it would feel like, and what was needed of me. The surgeon’s description of the process had no surprises for me, I knew the procedure fairly well, even having gone so far as to watch videos of the surgery online, and when he asked if I had any questions, I replied that I hadn’t.
Prior to this, I had been prepped by both technicians and ophthalmologists, they had given me the necessary information on the procedure, it’s risks, and it’s post-operative care, but this was the first time I’d been told the ‘nuts and bolts’ of using a high-powered laser to burn a new shape into my cornea. Based on my prior research, I was likely more informed than the vast majority who had laid on the bed before me. As I’ve mentioned previously, my one criticism of all the laser eye surgery providers is that they are not overly forthcoming with details on risk, complication, and actual procedure. They were all quite helpful when I asked for greater detail, or had specific questions (if they’re not, run the other way!), but none were forthcoming with more than the minimum required. I suppose this is necessary, as most truly don’t want to know more than the very high-level picture of risk and reward. The reader would be forewarned to do their own research before going under the laser, though I suppose that message is preaching to the choir in this account.
After the run-down of the surgery, and after one last chance to ask questions or back out, we began the
PRK Surgery: Blink and You’ll Miss It
A nurse inserted Clockwork Orange eye-priers, and dabbed a few drops of lubricant drops. Then, the bed I was on was swung under and into the machine. From above, the large, round robotic surgeon looked mostly benign, but from beneath, the beast’s many-eyed, many-fanged face felt uncomfortably close. That said, as a lover of all things novel, technological, and physiological, the dozen different lights and probes and nozzles of this technological terror were at once intimidating and fascinating. My heart-rate was at its highest at this point of Peak Anticipation.
I had an unparalleled view of the operation, best seats in the house.
As the procedure commenced, I was a little surprised when the very first part of the purportedly “no-touch” procedure was the doctor placing a ring-like device on my eye (to be filled with an alcohol solution for effectively ‘delaminating’ my epithelial from the cornea), then using a scalpel to score the epithelial around it. I’d known that some procedures use laser, others scalpel for removal of the skin-layer. This isn’t a critical part of the procedure (unlike the cutting of the Lasik cornea-flap, in which the laser is much safer than the scalpel, but you shouldn’t even consider Lasik and its cornea-flap anyway, so never mind). I wasn’t overly concerned about this, but I did have a brief, wry thought involving “no-touch” and “my ass”.
I wasn’t too nervous once things got started. I’d imagine it’s like bungie-jumping or sky-diving, the nerves peak, then fall away when you step into oblivion. I suppose there’s no evolutionary advantage in nervousness past the point of no return, instead the body goes into a “let’s do this” mode, though the message is probably less verbal and more atavistic.
The surgery was quick, and fascinating. I had an unparalleled view of the operation, best seats in the house. While fully manageable sober (I declined the happy-pill), the procedure was a bit unpleasant for a few different reasons. Readers will have to decide for themselves whether they’d rather have the sedative.
For three days, every time I disturbed my beard I’d get a fresh waft of Charnel No. 5.
The first unpleasantness was that, despite the knowledge that they had milisecond 3D tracking of the outside of my iris (the best available at the time, see Part I), I was more than a little nervous that I’d screw myself up by losing track of the orange target light that I had to stare at. In practice, this isn’t really an issue, the laser is supposed to detect any movement off-axis and halt the procedure within a millisecond or so. Even armed with that knowledge, I was still apprehensive before starting. And this worry raised itself during the procedure itself, as I kept wondering, “Hey did I just move my eye?” It was difficult to tell with all the activity, water, implements, and flashing lights going on in your eye, and it left room for groundless doubt to creep in. In the end, there were no issues of course.
The second less-than-pleasant aspect of the surgery was the smell. Awful. Ever had your tooth drilled at the dentist? That’s the smell. Worse for me, I have a beard. And because you can’t wash your face for a while (don’t want to risk bacteria getting flushed into your eyes), for three days, every time I disturbed my beard I’d get a fresh waft of Charnel No. 5.
The third, and most unpleasant aspect of the surgery is the fact that there is an awful lot going on to your poor eye. While the eye itself is completely numbed, three parts of the procedure were uncomfortable: the Clockwork Orange eyelid clamp; the epithelial removal ring, which had to press fairly hard onto your eye (stick your knuckle into your eye pretty good for an idea); and the ice-cold water bath immediately after the laser had done its work (instant, terrible ice-cream headache, centred in your eye, thankfully lasting only a few moments).
Once it was all over (I’d say in a blink of an eye, it was so quick, but of course blinking was prevented by surgical clamp), I took a breath, gave a brave thumbs-up to the surgery team, and we started all over again on eye two. The second go-round was easier, as I knew what was coming, but I found myself dreading the ice-water bath more than all the other ocular indignities. It wasn’t that bad, but like licking a nine-volt, your body remembers its first time jangling raw nerves and is naturally hesitant the subsequent times.
Recovery: Into the Heart of Darkness
Immediately post-op, I could see fairly well. But hazy. 100x better than not wearing contacts. I could tell my vision was corrected significantly, but it was like looking through dense fog. Within about 10 minutes, on the way home, the light sensitivity kicked in. Even with eyes shut tightly, sunglasses on, my head down low in the car, and a hat pulled low over, it still felt super bright. And I mean painfully bright. I just wanted to go home and get in the darkness, fast.
Once home, my wife commenced Operation Grow Op, by tinfoiling all the windows. I’d heard some found this necessary, and I figured I’d hold off. I regret the decision, especially in eye-scorching sunny mid-July. My advice is to do this in advance, you won’t regret it. It was bad until it got dark inside. Even the tiniest slit in the corner of the window was crazy bright to me, even while wearing sunglasses. Be prepared to be a mushroom for 5 days.
Overall, aside from the light sensitivity, there was almost no pain. My eyes were definitely sensitive, they were abused pretty good, but the pain drops they give you pre-op lasted a while, and I was thinking I’d take a T3 that night, but didn’t have to. I took half of one of the sleeping pills they gave me and slept well all night. I didn’t use an eye-shield at all, just to help avoid bacteria. I’ve slept with one before and my face was a sweaty steamy mess.
Note: My surgery clinic gave me a little green bag that had all my drops (antibiotic, steroid, pain, lubrication) each well labeled with giant numbers on them listing their dosage intervals. Also in the bag were enough sleeping pills to last a week, and a load of T3s. You’ll be dipping into the bag for drops at least every 4h for the next 5 days, so you will grow to love/hate your Little Green Bag.
This is an important one to ask about too, check to make sure how much of the above your clinic will give you on the day, and how much you’ll have to get yourself. If they don’t provide it, I strongly recommend you getting all of your drops and drugs in advance. You literally will not be making any trips to the store for the next few days.
Extra Important Note: Standard eye drops that come in the medium size (30ml) bottle *all* have preservatives in them. The non-preservative ones don’t come in sizes that are greater than 1ml (to avoid infection). You’ll be using a ton of these drops to keep your eyes lubricated, and I realized way too late that using the standard drops that much just dries your eyes more. On Day 2 I started to notice that my eyes felt drier shortly *after* using the drops than they had been before, and on Day 3 I confirmed it. That’s the preservatives. Late on day three I had my wife pick up some of the non-preservative ones (available at your local drug store) and it helped immensely. Check with your doc first, but if I had to do it over again, I’d only have used them. The best ones I found after researching online were Refresh brand, specifically the “Celluvisic” variety (they’re about $0.50 per three dosages). They’re fairly thick and goopy, but they actually have less in them than the standard drops, and they were miraculously more comforting.
Stay Tuned for my PRK Post-Op report. I’ll be posting it shortly. In it will be an account of my experience throughout the recovery phase.
In the mean time, feel free to join the discussion below!
In July of 2011, I had PRK laser eye surgery done. Shortly before, I wrote up a Primer on PRK vs Lasik that the reader may find interesting (TL;DR: Lasik is a dodgy quick-fix, avoid it). Long before signing up for the surgery, long before going under the laser, I did a ton of research. I had been interested in having it done since 1998, and only got it done
I'm going in for PRK Laser Eye Surgery in a few days, and true to character I've done more than my share of research. I've learned quite a bit, and I'd like to share some of it with you. [Edit: Be sure to check out my follow-up account of the surgery: My Laser Eye Surgery, Part I: PRK Pre-Op Preparation and the forthcoming Part II] Unfortunately I don't have the