I am curious also to hear Mr. Temple’s input if he has had any experience with this.

I finally had my consultation and have decided to go with PRK. I am a candidate for LASIK, but when I asked about my corneal thickness after the surgery and ecstasia, even the doctor said that he would recommend PRK over LASIK to alleviate any concerns I had. I still have to check if I can get the appropriate time off work as it’ll be difficult for me to get there without driving.

Two last questions for you: I’m over 40 and will likely have to wear readers after the surgery (I don’t right now). If you wear readers, do you have to wear them while using a computer and/or using your cell phone? I’m trying to determine if it’s worth swapping one kind of prescription for another. Finally, would you say your vision is crisp now? Would you do it all over again? Thanks again for all the info! It’s been hugely useful!

http://www.isthisyourhomework.com/my-laser-eye-surgery-part-iii-prk-post-op-recovery/

In it I describe how I probably could have driven at the two-week mark (perhaps even earlier), but wasn’t fully comfortable even then.

I started driving after 2.5 weeks.

If recovery time is a factor, I would choose no-surgery over PRK. Lasik is not worth the permanent long-term risks.

Investigate Lasek (note the e) and Epi-Lasik. I understand that both do an epithelial/skin-layer flap (NOT the dangerous corneal flap that Lasik features), and both have significantly reduced recovery times (at slight added risk of relatively non-serious side effects. Very much unlike Lasik).

Many clinics today are advertising Lasik, but performing Lasek (that e again), Epi-Lasik, or PRK due to the significant reduction in risks of the no-corneal-flap procedures.

Don’t do lasik. Certainly not to trade two weeks of hassle for a lifetime of serious risk to your eyesight.

I’m also going to post my comments about haloing in their own post, because I’m sure others would like to know.

Also… Consider your doctor’s bias. There is good money in Lasik. I wouldn’t touch Lasik with a ten foot pole. That said, I’ve seen some clinics advertise Lasik, but never perform it (doing Lasek or Epi-Lasik or PRK instead). Lasik is a powerful brand that gets people in the door. Though a lot of docs recently are eschewing its (in my opinion) wholly unnecessary risks for the safer no-cornea-flap alternatives.

I’ve already been for a pre-evaluation (assuming Lasik but knowing PRK was also a possibility), but I have to go back because one eye was too borderline dry on one of the tests. If he doesn’t already recommend PRK for me, I’m definitely going to suggest it rather than Lasik, unless he suggests Lasek or Epi-Lasik for me.

Thanks again, so much!

The first three days were painful and light-sensitive.

Days 4 and 5 were very uncomfortable (felt like I’d had my contacts in for way too long, which is exactly what was happening), but I was able to commute on transit to the clinic on Day 5, where the bandage contact lens was removed, the discomfort subsided immensely. I’d wished I’d known about the preservative-free drops, as that would have helped a fair bit.

For the next two weeks my vision was good, but ‘blurred over’. It seemed like I was wearing glasses where somebody had smeared a tiny bit of oil over the lenses. Clear vision, with a bit of blur overlaid as the epithelium was growing back. Whether looking 10 feet away or 10 miles away, the vision was the same quality. Not great to begin with, but improved over time. The first week post bandage contact removal the world felt small, as I couldn’t see well (though well enough to function. It’s hard to describe because it was unlike pre-surgery myopia where details get worse the further away. Details were universally poor from tip of nose to infinity. This improved each day. By two weeks, I could see well, but I still had ‘ghosting’.

Ghosting is a faint double-image which occurs because the epithelium is swollen as it grows back and heals fully. It’s offset a tiny bit from the actual main image. Problem is, each eye had its ghosts offset in a different direction, so you’re really seeing triple. The main image crystal clear, but two a faint, slightly-blurry double images offset half a degree from the main. My ghosting got worse as my eyes got dryer (those no-preservative drops were a godsend). Typically later in the day, they’d be worse than in the morning. Never was it so bad that I couldn’t function easily. But it was highly distracting at first.

Immediately after gettitng the bandage lens out, I could use the computer, but I had to crank the zoom to max. I’d say it was about 12-14 days before I felt like I was using my monitor at normal levels, and probably three weeks before I set it back to Max-Resolution Tiny Type.

17 days after my surgery, I played in an all-day all-weekend frisbee tournament. My world still seemed a bit small, but I was able to see well enough to throw and catch a fast moving frisbee coming/going downfield. I took two frisbees off the face, which is very atypical for me. Little hard to catch the middle of the three discs, but those conditions were very tough (keeping eyes open without blinking on a long throw, etc). I’d say I was at 95% capacity, even if my vision still had noticeable ghosting that would come and go (sometimes there’d be none at all, other times it would be bad).

By three, three-and-a-half weeks I was pretty much fine. Every so often I’d see ghosting, but only when I was tired and my eyes were dried out. By my 5 week follow-up, I hadn’t had any visual artifacts in ages and I was extremely happy with my vision. I was tested at 20/15 (I saw at 20′ what others saw at 15′), but I felt my visual acuity even improved a bit over the next month or so.

Eye Dryness

As for eye-dryness. I’d largely stopped wearing my contacts, because my eyes were getting sensitive to them. I used to wear them all day and night, taking them out only for bed. In the couple years previous, I wore glasses when I was home, and only put contacts in to go out and play sports. Even when I’d not worn glasses in a day, I’d wake with my eyes a bit dried out (eye-crunchies). I didn’t think I had any dry eye issues, I thought that was normal.

After the surgery, (and after the bandage contact lenses were removed), my eyes already felt less dry. This is rare but not uncommon. Some people get SEVERE dry eye from laser surgery. This is much more frequent with Lasik, as it cuts much deeper into the cornea and has greater chance of severing the nerve which transmits the signal to the tear ducts. It is not unheard of with PRK though. I didn’t know what was meant by ‘dry eye’ as a side-effect to laser surgery until that first five days when I was recovering. It is incredibly painful. Unlike any symptom that I’d have called dry eyes previous. It felt like my eyes were dessicated and could not be rehydrated. The drops helped (but the preservative-filled ones started to make it more frequent). When I switched to the preservative-free drops (which are nice and gloopy), this problem went away (it also coincided with the day 3-4 recovery of the epithelium, so it was a combination of both).

Halos

The only other side effect I’ve suffered (and still ‘suffer’) is haloing. I knew going in that my absolute widest pupil diameter was about 8-8.5mm. I measured my own in a *completely* dark room using a camera with a flash that would bounce off the ceiling and capture the pupils at the instant before they reacted to the flash. The laser doc measured my pupils in a semi-dark room and got about 6.5mm.

I knew that the system’s true correction zone (ignore any taper zone, that’s worthless) was about 6-6.5mm, so I knew that I was going to be susceptible to haloing under very dark conditions. And I am, and will be unless I get my eyes done again in later years after my vision naturally deteriorates (and assuming these future machines have wider treatment zones).

Haloing is an effect where your pupil opens wider than your corrected zone on your cornea (effectively carving a lens into the cornea itself). In such a case, I have say 6-6.5mm of great corrected vision, but a donut-shape of another 2mm of uncorrected vision. So–and only in *very* dark situations–I will get 70-80% of the light entering my eye and hitting my retina being corrected perfectly, but overlapping that, 20-30% of the light will be blurry, virtually the same blurriness as it was before my surgery.

This results in excellent vision of objects, with a faint after-image. In practice, I only notice it when there is a very bright object in a very dark setting. When setting is dark (driving at night in the country), but the object is not bright enough (pretty much everything except headlights and retroreflector cat-eyes on signs/road/etc), the halo is below my visual acuity. And when the setting is bright enough (driving in the city), the ambient light from orange streetlights is more than enough to contract my pupil to 6-6.5mm (still quite wide!), and all the light hitting my retina is corrected, so there are no halos.

I really only notice it in the countryside. Very bright stars have halos, but fainter ones do not (their halo is too faint). Cat-eyes on the side of the road and reflective signs in the distance (small size) have halos, but large size signs or the moon do not. And I can make all the halos go away if I turn the map-light in my car on. That’s just enough ambient light to contract my pupils. I can actually play with it. A distant road sign will have a halo, and when I increase/decrease the brightness in the car just enough, I can watch the halo shrink/increase as my pupil contracts/dilates.

Anyway, it’s interesting. But not really disturbing. I’d prefer not to have it, but I haven’t actually changed my behaviour any way. I don’t drive with any lights on in the car cabin (even though the light is still quite faint, just enough to have my pupils go from Extremely Wide to Very Wide). It simply never bothers me enough to bother about it. It’s kind of interesting though.

Of course, if you think about it, how your pupils react will have a big effect on your haloing. If your pupils go Extremely Wide (beyond the treatment zone, ignoring taper, etc) under relatively lighter ambient lighting situations (say driving at night in the city), then you’re going to experience haloing much more frequently. If I saw halos on every bright object (remember only the bright objects have enough light for their 20-30% halo to even register) in the city, then I may not be happy about that.

That’s one of the reasons I think they measure my pupil in a ‘mostly dark’ room. That more closely simulates the environments you’d be most annoyed if you had haloing. It’s not often that we are in extremely dark settings that have very bright lights. Driving at night in the dark countryside is one of them.

Summary (at long last)

I know this is a lot to process, but hopefully the straight dope helps you make your decision. I think the ‘you only need a week off work’ for PRK is a bit optimistic (depending on the work you do). I also know (and it’s good to reiterate) that my PRK experience was pretty much optimal. I had a decently thick cornea, not a huge correction, and tried to do *everything* I could to maximize my body’s healing capacity (lots of rest, lots to drink, vitamins, keep bacteria out, use as few of the medicated drops as possible, etc). That said, one might do the same thing and have a different result. Though, as I understand, that’s fairly rare with PRK.

And above all, I’d never, ever consider Lasik. That’s just stupidity in my opinion. Save two weeks of discomfort/inconvenience by sacrificing your long-term eye-health. No thanks.

For me, if the choice was down to Lasik or no surgery, I’d STRONGLY urge all to go with no surgery.

Of course, since I’ve done my surgery in 2011, there have been advances in Lasek (note the e) and Epi-Lasik. Both involve an epithelial (eye skin) flap, but no cornea flap (which makes Lasik so dodgy), but both seem to quicken the recovery process. Each have slight complications (though not the corneal flap complications that Lasik has), but as I understand (I’m not super-well informed here), when there is a complication with the epithelial flap in Lasek (that e again) or Epi-Lasik, that epithelial flap is simply removed, turning the process into a de-facto PRK.

If I was going under the laser again, I’d definitely look into either Lasek (always going to point out that e) or Epi-Lasik. Seems the *only* nice aspect of Lasik, but without the dodgy-as-hell aspect of cutting a cornea flap.

Oh look, it turns out I made that post after all! :) Good luck, and keep me posted!

I have been considering LASIK over PRK because of the shorter recovery period. I’ve read so much online about long, awful PRK recoveries, but even for those it seems most people are happy in the end. I will have to give PRK a serious consideration over LASIK after reading through your site.

Thanks!