There is a lot of information on the web about what PRK surgery is, so I won't repeat it here. Here's a good place to start. (I did not get my surgery done at this institution.)
My experiences have so far turned out to be very negative. As you read, you'll see that I seem reasonably happy and excited at first, but slowly become more negative as I realize that I'm going to have to live with what I've got. If you are considering the surgery, you absolutely must check out this site. It's too late for me. I wish this site had been available before I did what I did.
I had my right eye done on Friday, January 17, 1997, and my left eye done a week later. Prior to the surgery, I wore contact lenses with power -5.75 in each eye. I believe I was approximately 20/600 in each eye. I had been wearing contact lens for about 11 years.
Here is a journal of things that happened.
My appointment was at 2:30 PM. I got there a bit early -- around 2:15 PM. One of the first things they had me do was pay. I gave them a credit card, and they punched up two credit slips -- $700 for the facility fee and $1115 for the doctor's fee. I filled out what seemed to be endless waiver after waiver. There were probably four in all. I don't remember too much about them. One was a waiver that was in the package that was mailed to me; it seemed to be somewhat boilerplate. Another was specific to Dr. Kawesch, and seemed to have most of it culled from the boilerplate waiver. Then there was another one that said I consent to the surgery -- again. When I asked why that one was necessary, the lady said that the first one was informed consent for the surgery, and the other was informed consent so "Dr. Kawesch could do the surgery". So I suppose I agreed to the surgery generally, and then to the surgery for Dr. Kawesch. Even though I was only getting one eye done this day, I filled out the forms for both eyes.
Another form had some check boxes on it. The lady looked at my chart, and checked off the entry that had something to do with my understanding that the FDA recommends 3 months between eyes, and I was ignoring that recommendation and getting them done within a week. The lady said that the FDA was getting their data from people like Dr. Kawesch, so not to worry, bla bla bla. Some of the other boxes, which didn't apply to me (and thus weren't checked) included warnings about being under 18 (the FDA suggests you be at least 18) and attempting to correct over a particular level of astigmatism.
Then I went to the big wooden desk in the open waiting room, and another lady gave me a fanny pack with many medications. The lady there went through them with me: "this one you take right away, four times a day. When you get up, lunch, dinner, when you go to bed. One drop." It was Ciloxan, an antibiotic. "This one, you don't take until the doctor tells you." It was Vexol. It's supposed to help prevent the cornea from clouding when it grows back (although she didn't mention that).
I also got some unsigned prescriptions which were attached to my chart to be signed by Dr. Kawesch.
I went into the waiting room, where I was given 5 mg of Valium -- "people seem to follow instructions better" said the lady. I didn't really want any, but I suspect I would have gotten 10 mg if I hadn't said anything. I didn't really feel an effect, at least not right away. She put a silly hairnet shower-cap contraption on my head with an "R" sticker to indicate right eye. The waiting room lady was very chipper, and put drops in my eye at least four times. I only felt the first set; my eye was totally numb after that. By the fourth set, I could taste the drops in my mouth. The tip of my tongue and the roof of my mouth was starting to get numb.
I waited my turn. I saw about three people go into the room and come out. One guy came out looking like a zombie (in fact, another patient made a comment to that effect).
Finally it was my turn. I was very nervous, and the technician who guided me to the room took my glasses, so I couldn't see a thing as I was going into the room to make matters worse.
I got in the chair, which seemed very similar to a dentist's, and after scooting to the correct position, reclined and rotated under the laser. They gave me what looked like half a pair of swimming goggles that wrapped around my head vertically to go over my left eye. They let in light, but I couldn't really see through it. I was told to keep both eyes open and look at the light, which was essentially straight up. I did.
I briefly entertained the notion of jumping up and saying, "Wait, I've decided not to do it." It suddenly seemed so real. But realistically, there really wasn't anything I could do.
The doctor put a device on my eye to keep me from blinking, and the torture began.
The first time the laser machine made a sound, it sound like a big zap and squeak, and I jumped. "Try not to flinch," the doctor offered kindly. I sure wasn't expecting that.
The whole thing lasted for a minute, but it seemed like much, much longer. I knew that the first step was to remove the epithelium with a "spatula-like instrument", but I didn't realize how this would be done. My eye was zapped a bit, and it seemed strange and unpleasant. It went on for a bit. Then the doctor said, "Things may move a bit now," and I saw a metal instrument come down and shake around on my eye. I remember the bright white light I saw nearly directly in front of me (which was not the flashing red light I was supposed to stare at) move back and forth really really far. It was very scary.
Then the real zapping began. I could tell that something was going on, and thing got messier and messier. I could see less and less as the machine chirped, and I could smell the smoke coming from my eye. It was utterly horrifying. The doctor did his best with "That's it... keep going" or whatever. I distinctly remember "You're doing great" and "Almost done".
When it finally stopped, I was so relieved. The torture had finally completed. I pretty much couldn't see a thing in my right eye.
The doctor put a drop in my eye and said, "We're going to numb this eye so it doesn't bother you when we do the other," and I was a bit surprised since there were no arrangements to do the other. But the technician quickly corrected him, saying that they were just doing one eye, and it was the other guy who was having both done. I was a bit alarmed to say the least, but I was extremely pleased that most of the fog went away when the drop was administered. Then he put the bandage contact lens on.
I remember saying to the doctor, "You know what I forgot to do? I forgot to keep both eyes open." He just said, "You did fine." That made me feel a bit better. He handed me the signed prescriptions.
I got up from the chair and left the operating room. Michele, my ride, had arrived so I said hi to her. I put my left contact in so I could see a bit, and we went to the drug store.
I'd never actually had a prescription filled by a drug store since I was a kid, so this was the first time for me. I gave the lady the three prescriptions and she asked if generic substitutes were okay. I said yes, and she said it would be about 15 minutes.
I came back in 15 minutes and picked up the prescriptions. One was for pain: Vicodin (500 mg Acetaldehyde, AKA Tylenol with 5 mg Hydrocodone Bitartrate) for pain; the generic substitute cost $7.39. Another, Dalmane (30 mg Flurazepam Hydrochloride) was for sleep, in case the pain was unbearable; the generic substitute cost $6.95. The third was another optional set of drops, Voltaren; there was no generic substitute, so it cost $41.95.
I could feel the numbing drops wearing off. Over the next few hours, I used the Voltaren and Ciloxan drops. My eye was very irritated, but not too painful. It didn't much feel like the "eyelash in your eye" feeling that I was expecting. I was just plain beat, and went to bed around 9:30, to some Vicodin. I wasn't experiencing pain; I just wanted to head it off at the pass.
I had a 9:15 AM appointment at the Santa Clara office. The fellow who came out of the PRK procedure looking like a zombie was there. I overheard him tell the lady that he had used all the Vicodin, and wanted to know if he could get more. The receptionist told him that it was up to the doctor, but "probably not". I couldn't believe it -- I had only taken one! I decided that so far I had been pretty lucky in terms of pain.
The doctor called me in, and put in the numbing drops, which was a big relief. Although my eye didn't hurt much, it sure made it feel better. Then he gave me a quick eye test, in which I scored 20/50. I didn't really feel like I could see very well, but he said that 20/50 was "excellent for the first day". So I felt that it was a good sign.
It was a very short appointment. After my name was called, I was in and out within four minutes -- literally.
I took advantage of the short period of time that the numbing drops afforded me feeling normal to get my hair cut. Then I went home and rested.
Today my vision seemed okay, but certainly much worse than it was before with contacts. The good news is that the pain, mild as it was, was pretty much absent now. I had the "it-feels-like-there's-an-eyelash-in-my-eye" feeling a bit, but it wasn't too bad.
I was starting to feel a bit depressed about it though. I wondered how much sense it made to do this risky (although only slightly risky) procedure; I was, in effect, taking bad vision that was correctable to essentially perfect with contacts, and mucking with it. I found myself wondering aloud if I should having the other eye done.
I've been using the Ciloxan antibiotic drops four times a day and occasionally the anti-inflammatory Voltaren, as suggested.
Another early morning appointment -- this one at 8:15 AM. I got the numbing drops even though I didn't feel like I needed them. A technician look at my eye with these white and blue lights from various angles, and gave me a vision exam. I scored 20/30, although I was squinting, which I later found out is considered cheating.
The technician left, and the doctor looked at my eyes with the same lamps. He said that my eye was healing nicely with no cloudiness, and took out the bandage contact lens. It didn't make as much difference to the vision as I thought it might, but it was nice to get it out of there.
The doc told me to continue with the antibiotics for the day (probably just to keep things simple), and then starting tomorrow, take the Vexol steroid drops. I would take four drops a day for a week, then reduce the dose by a drop a week for four weeks. He wrote the schedule on a sheet of paper for me.
I asked him if I could drive in this condition, and he said that 20/40 was the legal limit, and I already exceed that. I don't know if you need that in one eye or both.
The Vexol drops were described as (possibly incorrectly) "anti-inflammatory drops" on the post-operative sheet that I received with my fanny pack. My understanding is that they help prevent the eye from regenerating a cornea that's too thick or cloudy, although I'm not sure what the mechanics are.
The vision in my right eye seemed okay, but it's my left eye, with contact, that's really been doing all the seeing. The vision in my right eye is, of course, much better than it was before the surgery, but I didn't really have the means to correct it now (nor is it clear that it could even BE corrected in its current state).
I browsed the web a bit tonight, looking for information about PRK. There are essentially three types of information: anecdotal, from patients; propaganda, from eye doctors or eye centers who perform these procedures; and scientific. There don't really seem to be a lot of studies. The FDA approval seems to be based upon one study in particular with early equipment.
A particularly interesting site is VISX's site (http://www.visx.com/). The company that makes the laser really seems to make it easy for doctors to set up a business. Not to be outdone in the $$ department, VISX gets a cut for each patient operated on (although "touch-ups" are done for 'free', in terms of royalties payable to VISX).
I read an excellent description about how your vision is in the days after the surgery: it's like looking at the world though glasses covered with "a thin coating of petroleum jelly". Very true.
I took out my contact tonight for the first time since putting it in Friday after the surgery. It was really quite stunning to me, having my right eye do most of the seeing. It really was an interesting experience, being able to see reasonably well with no correction. I remember thinking: "Wow!"
Not much to report today. I've still got some double vision in my right eye. It's not great, and my left eye is doing most of the seeing. However, I can now use the information my right eye provides to provide some three-dimensional context, and I've got at least a bit of stereo vision.
Today things are still doubled in the right eye. It's not just that things are "out of focus", but they're also doubled after a certain difference, and I have a lot of trouble making out detail.
I couldn't put my left contact in this morning, as I'm supposed to have them out 48 hours before the surgery, so I tried hacking up my glasses. I removed the right lens, since it would be serious overcorrection. But it didn't work. When I put them on, I could see clearly with my corrected left eye, and reasonably well with my uncorrected (but post-op) right eye. However, the eyes would not work together, and objects appeared to be different sizes in each eye.
So I covered the right side, and simply switched my glasses up a lot during the day.
Driving was very scary. I drove slowly and carefully, with my glasses on, so I could only see with my left eye. However, it became apparent that the right eye is my dominant eye. Fortunately, I only work about a mile from where I live.
I also figured out a situation with the Vexol steroid drops: the drops are very thick and milky, and when I was trying to put them in my eye, I would hold the tip of the dropper so close to my eye that the drop wouldn't drop off the tip, but rather would simply grow in size until it came in contact with my eye, then flow into the eye. So from now on, I'll hold the Vexol up higher.
My right eye was very nice this morning when I woke up. I drove to work without the glasses, using the right eye.
By the evening, things were a bit fuzzy, but there wasn't too much in the way of doubling.
I went to the Next Users' group meeting tonight and there was a presentation. It was a bit hard to see, but I think a big part of that was only having one good eye. My right eye seemed good for distance vision, as long as the distance wasn't too far. Indoor-type distances.
I woke up early this morning. We had work at an unusual offsite location, so I got a ride. I couldn't see too well today.
The surgery in my left eye was today, at 4:20 PM. It was a much better experience this time, in part, I suppose, because I knew what to expect, and in part, because I took the 10 mg of Valium rather than the 5 mg. However, it wasn't clear that the Valium had any effect until the surgery was over and I felt like a zombie.
I seemed to be able to focus on the flashing red light much better, and I was much less alarmed even during the eyeball scraping. I only had a couple involuntary eyeball spasms. I asked the doctor what the minor spasms would have, and he said that it probably corresponded to a few bursts of the laser, and it would not be a problem.
I didn't get a video tape this time. Fine.
There was a noticeable difference right after the surgery. I suspect it was noticeable after the first eye too, but this time I really noticed it.
On the way home, I got a prescription for Vexol because I would, as the doctor said, "run out". I was very woozy, very tired, and completely zoned out. I also got an ice pack. It seemed like I would need it.
After the numbing drops wore off, my eye hurt quite a lot. It didn't seem like the contact fit very well, and sometimes when I moved my eyeball, it seemed like it would slide and scratch the surface. Needless to say, this hurt a lot, since the cornea was already very raw.
I ate dinner with my eyes mostly closed, then took a pain killer and a sleeping pill and went to sleep. My eye hurt a lot more this time.
I had an early morning exam. I felt very very awful. When I was sitting in the doctor's office, I couldn't keep my head up because my eye hurt so much and it was tearing. I was kind of embarrassed because it probably looked like I was crying -- and I kind of felt like crying too.
The doctor called me in and put the numbing drops in. That was extremely helpful. I told the doctor that the contact didn't seem to fit. He looked at it, and said it didn't seem wrinkled or anything, so he just left it in place. I "refracted" around 20/100.
The day was a big painful blur (so to speak), and I spent most of it sleeping. I frequently used ice packs, and took lots of Vicodin, and did lots of sleeping.
This morning, in one of my frequent examinations of the bandage contact on my eye, I found it loose and hanging out of my eye, so I removed it. I called the office to make sure that it wouldn't be a problem, and after a short delay, they said it would be fine, and I should just continue using the drops.
The severe pain almost completely went away after that, except for minor irritation. I'm pretty much convinced the contact was causing a large amount of my pain this time.
I was still quite tired and coming down with a cold, so I slept most of the day again today.
I had an early morning appointment with the doctor (he seems to love mornings). He numbed my left eye again, and examined it. He gave me a quick refract. I scored around 20/50 in my left eye. After I expressed concern about my right eye, he gave me a quick test in that eye, and I scored better than 20/25. But it didn't seem much better than Friday.
I asked the doctor if the healing at this point was simply smoothing of the epithelium, and he said that that is exactly what is happening. He said that the new epithelium being of a different thickness than the old was the reason some people didn't achieve 20/20.
I drove today. It wasn't the greatest, but I could get by pretty well. It seemed safer than Thursday.
I woke up today, and things looked great! My left eye seemed sharper than my right eye in some ways.
I began the Vexol today in my right eye. The drops are kind of annoying because I can't see for a while after I put the drops in.
When I was in the dark, I discovered that lights would have the advertised sunbursts. Oh, great! Wonderful! I suppose that I was expecting it, but it will be nice if it goes away.
Things certainly seemed worse in my left eye today. My right was stronger. Maybe it just seemed that way since my left was weaker.
I was in the bathroom at work, and I had a strange experience. I saw out of the corner of my eye my pupils in the mirror, and they seemed to be different sizes! I stopped and looked at them carefully, but decided that if they were different sizes, it was only because one was in the shadows.
Things appeared doubled in my left eye, even at close range. It made reading very difficult. It's starting to get very frustrating.
Driving wasn't very difficult or even all that unnerving, but I had a lot of trouble reading the street signs and auto license plates. Fortunately, I knew where I was going.
I've decided that I'm a bit disappointed with how things are shaping up. There's clearly some more healing to go in my left eye, and I constantly get headaches and eyestrain because my eyes don't work together very well. I have a lot of trouble reading, particularly small text. I don't seem to have the resolution I used to -- small things are difficult to see in each eye, for seemingly different reasons. It changes throughout the day, but even in the morning when things are best, I still have trouble.
My left eye can see things clearly better at a distance, but my right eye is the dominant one, so it's still irritating looking at signs at a distance.
I hope this gets better, but I don't know how long it might take.
When a traffic light is distant, it appears tripled in my right eye, in an equilateral triangle centered with the clearest light being in the bottom right.
Well, things aren't as bad as they were. My eyes are working together reasonably well, but things are still a bit smeared when reading and a bit fuzzy at a distance.
I've decided that my left eye is a bit far-sighted and my right eye is a bit near-sighted. The reason I suspect this is that with my right eye, distant objects are always out of focus, at least a bit. With my left eye, distant objects are smeared (they're smeared cleanly thought, not fuzzy), but if I make an effort to "look closer", I can get the distant objects in focus.
I still have trouble reading though, and that's quite frustrating. It's especially bad at night, after a long day.
There's still a lot of variation. I kind of wish my eyes would just settle down and I could get new glasses appropriate for my new vision which I could put on when I choose to. In a sense, though, it almost seems like I'm worse off before. With my contacts in before the surgery, my vision seemed pretty much perfect.
Things have been looking better these past few days. I was walking around outside on Monday and decided that the vision in my left eye was near perfect. It really did seem pretty good. However, my right eye is still a bit near-sighted. This seems to me headaches from time to time, as my dominant eye is now the weaker eye. I feel a bit better about the results now.
I had an appointment with Dr. Kawesch today. I went in and had the whole slew of tests -- they made me look in the machine with the picture of the tractor in the field (which I assume they do to quickly measure the diopters). Then I had each eye "refracted" individually. Then the pressure in my left eye was measured (since I'm still using the Vexol), which involves the drops (my eyeball was very yellow for some time after that).
I didn't have any trouble with the pressure. My diopters were -0.75 in my right eye, so it's a bit near-sighted. My left eye is +0.375 (+- 0.25) diopters, so, as I suspected, it is a bit far-sighted. It's also a bit astigmatic -- around +0.75, which surprised me. I believe my vision is worse today than it was on Monday, though.
The doc also said that if my right eye doesn't get much better, a touch-up is always possible. I mentioned to the doctor that I had seen some of his posts on sci.med.vision. He mentioned that there was an interesting "signal-to-noise" ratio.
My next appointment is in six weeks.
Things have certainly settled down quite a lot. I no longer think about how my vision is doing every day -- some days, I don't even think about my surgery. It helps being off the drops -- I took my last one on the 24th. My eyes seem to working together much better, and I finally feel like I can see reasonably well without struggling.
It's odd though; I don't feel like my right eye has gotten any better. I also don't feel like my left eye has gotten better. In fact, I would guess my left eye is worse. Hmm, maybe not. Perhaps the astigmatism has gone down in the left eye, as it seems to be a help rather than a hinderance when reading now. Anyway, it does seem as though my eyes have stabilized. That's good. I feel a bit better about my vision now that I don't think about it so much.
I think that the writings in this diary will also stabilize, since I don't think I'll have much to add. Therefore, from this point on, I'll only add to this upon visits to the eye doctor.
This morning on the radio I heard one of those Howard Stern commercials during his radio show -- you know, the ones he does himself that sound sort of half-improvised. It was for vision correction surgery with Dr. Kawesch.
I'm not really sure what this means.
Just a point of clarification I thought I'd make after a recent discussion with someone who's read these pages.
It may appear that I'm disappointed with my vision following the surgery. This is not quite true. For the most part, my eyes have stabilized, and I now see reasonably well without effort or constant thought about how my eyes are doing. All things considered, this is impressive.
For a while, it was alarming, frightening, and annoying, and I wrote a lot about it. Now, I don't think about it much. That's why I don't write about it too much. This might well be construed as a good thing.
Note that my right eye still doesn't see all too well at outdoor distance. This is most noticeable when I'm driving. However, I can see well with my left eye and my brain has gotten used to the inequity, and I can see quite well.
I feel as though I'm out of the woods. I kind of wish I had glasses for what is now a new prescription so I could, when necessary, see as well as I could when I wore contacts. But I feel that my vision really is quite good. I don't see perfectly, but I'm not disappointed. And there's always the possibility of a touch-up after six months. As time goes by, I believe I will feel less and less desire to have it done. We'll just have to see.
Well, I had another appointment with Dr. Kawesch. I got there around 4:15 PM, fifteen minutes early, but I didn't have to wait any longer than the usual few minutes.
A technician measured my diopters using what I call the "tractor machine". It's a machine where you put your chin in a chin rest and stare into a viewfinder with a photo of a tractor in a field. The technician makes some adjustments which brings the tractor in and out of focus, then does something that causes some "shik-zzzt, shik-zzzt" sound, which I guess is a reading being printed. Interestingly, the tractor is not at the best focus when he makes the sound (although it's close).
Then he took me into an office and sat me in the chair. He had me cover each eye and read the letters, as usual. In my right eye, I scored 20/20. In my left eye, I scored 20/15. The letters weren't clear, but I could make them out. I noticed that when covering one eye, I could actively focus my one eye to help me see. So perhaps there's still some getting used to coming. For some reason, he left the lights on in the room this time; in at least some previous refractions, the lights in the room were off, which I would imagine would detract from the vision, since my pupils would be more dilated.
My two eyes together also scored 20/15. Impressive! I guess I couldn't really ask for much more. I don't feel like I'm seeing as well as I was with my contacts, but it's a good score. Then the technician put those yellow numbing drops in my eyes, and shone the blue light into my eyes. Then he said the doctor would be by and left.
The doctor came in a few minutes later with a couple of visiting doctors. One was an older fellow and the other was Asian. I had the strange feeling that the older guy was European, but I'm not sure why. He asked me if it would be all right if the visiting doctors sat in, and I said sure.
Then the doctor shone the white light into each of my eyes at various angles. When he was done, he offered the other two doctors a look, and the old guy looked, but the Asian guy didn't bother. He did a couple of quick refractions using lenses to see if they helped my vision at all, and it didn't really seem to. I asked what the diopters were at, and he said that it was essentially, within the limits of uncertainty, zero. The tractor machine yielded +0.50 in my right eye and +0.375 in my left eye. However, it has a higher uncertainty than the lenses, and he said that it was essentially zero using the lenses.
I asked what he was looking for with the light, and he said he was looking for haze. My right eye is clear, and my left eye has a minor amount, so little that doesn't affect the vision. He said it generally clears up within six months, sometimes a year.
That was about it. He said my next appointment should be in four months. Rather than make it then and there, I'm just getting them to send me a reminder in July to make it then, since it's not clear what my schedule will be.
I wasn't originally supposed to, but I went into the eye doctor's office today. I've been feeling as though my vision hasn't really been all that great. I've been having a bit of trouble reading off and on, and I complained a bit about it in an e-mail I wrote last Friday. Reading has been made more difficult by a persistent "floater" (a whispy, smoke-like string) in my right eye, larger than most others, and always jumping into my field of view. Since I noticed it, I'm pretty sure it's destined to drive me crazy.
Well, I did some searching on the web to see if there was some information about increased floaters and how it might relate to laser surgery, and I (finally!) found a web site that spoke of refractive surgery in a negative light. I recommend everyone who is considering refractive surgery of any kind plow your way through this site. I rather wish I had. If you have already had refractive surgery, you may wish to avoid it. It's depressed me a fair bit.
In particular, I've had several specific problems of late: more floaters, especially the one in my right eye (which may or may not be new, but I certainly notice it now); general decreased clarity in vision (difficult to pin down) as compared to with contacts prior to the surgery; a bit of difficulty reading; difficulty focussing close objects with my left eye; difficulty focussing distant objects with my right eye; and difficulty making out low contrast items. In particular, I have a VCR with a low-contrast LCD display that has a backlight when the VCR power is on. I have a great deal of difficulty reading the the time from distances that didn't used to foil me.
How many of these complaints actually fall into distinct categories is open for debate. I speculate that I notice the floaters more because I have more difficulty focussing on objects in which detail matters, if they are too near or too far, as the floaters are transient irritants.
My eyes also have seemed to be fairly dry lately. This may be due to a lack of sleep, but this combined with the frustration factor and general depression about my vision led me to make an unscheduled appointment with Dr. Kawesch. I called the office yesterday, and got in today for a 12:15 PM appointment.
The machine with a tractor photograph has been replaced by a similar photo of a balloon in the distance over a long road heading towards the parallax in the desert. "So you're probably seeing pretty well now," said the doctor.
The doctor himself did a bunch of tests. After the machine, I went through a much more sophisticated series of refractive tests. It seems that some of the equipment there has been upgraded. I did refractive tests with the lenses ("one or two"?), including a test with a circle of dots that appears on the left and right side of my field of vision. I assume this is supposed to help test for astigmatism.
I ended up refracting slightly nearsighted in my right eye and slightly farsighted in my left eye, about "a third" of a diopter either way. "Straddling perfection" is what he said. I think this might be causing me some strain, or other difficulty in focussing.
He also dilated my eyes because of my complaints about the floaters. I told him they weren't really as big as the ones in the pamphlet (it had big brown splotches obscuring an image of a university campus), but he said that that was just an artist's impression.
After waiting for the dilation to take effect, he put on a itty-bitty-booklight, and took out a magnifying lens, and looked into my at different angles. I guess everything was okay though. He said that floaters are quite common, and that he has them, and that they don't go away. So I guess I'll just learn to cope. That or go insane.
I got a prescription from him anyway, in case I decide to get glasses for when I'm feeling that it's too difficult to focus. My prescription is O.D. -0.50 sp, +0.25 cyl 25 degrees; and O.S. plano, +0.75 cyl, 120 degrees. So I suppose I'm mildly shortsighted in my right eye, and mildly astigmatic in my left. It may be worth it.
Then, after asking if I had work to do today, he put drops in my eyes to make the pupils go small again within two hours instead of four to six.
I'm doing this update late, so I'm note sure of the exact date, although I believe it was the 30th.
I went to the eye doctor again, unexpectedly. I've been having a lot of problems of late. In fact, I guess the past couple of months have been among the most difficult time in my life.
Since my last visit, I'm been absolutely obsessed with my eyes. I've found myself squinting to look at the floaters, continuously closing one eye to check the vision, and being horribly fascinated with the side effects and artifacts. At times I've been positively despondent and miserable, panicking and getting extremely mad at myself for making what I now consider to be a bad decision.
It all sounds pretty severe, I guess. I think it has more to do with the floaters than the surgery, which the doctor contends has no "known connection". However the floaters came about, they are horribly annoying and depressing.
Anyway, I went to hopefully get some relief. Here's a list of problems I've experienced:
The headaches were particularly bad over the past few days, so I thought that this would be a good time to go in. Unfortunately, everything was fine. According to the doctor, most people with my results would be "bouncing off the walls" (presumably with pleasure). Perhaps my standards were too high, but it's difficult to explain the floaters, since they are not generally seen as a real problem (unless they are associated with retinal tears).
When I asked what I could do to stop worrying about my eyes, he didn't really have any suggestions besides "Stop thinking about it." When I asked about contacts, I was told that he had never prescribed a contact with such low power (+0.75 cylinder). It seems bizarre to me that people put up with such distorted vision during reading. Maybe I'll get used to it, but so far it's been difficult. He also suggested that he could correct the astigmatism with more surgery. However, it's too mild to use the laser, so he would have to do A.K. (astigmatic kerotactomy), a form of R.K. But the prospect of my cornea getting cut scares me too much to allow that, especially now. I'd really like to just get a contact lens first, to see how much difference it actually makes. It's hard to know what's bothering me in what proportion, with the astigmatism & the floaters.
Hopefully, I'll be able to cope. I didn't really get much satisfaction, but maybe I'll get better. I'm not really sure what the alternative is.
I had an appointment at UCSF with a corneal surgeon there -- a refractive surgeon named David Hwang.
They told me that since it's a teaching hospital, I would be seen by several people, and I was. A technician did a bunch of tests, including testing my eye pressure, a refraction, measuring my pupils with the lights on and the lights off. She also did a corneal topography, and I got to keep a copy of that. Then she put drops in my eyes to dilate my pupil, and she was off.
She told me that my pupils were quite large -- 7 mm with the lights on, and 8-9 mm with the lights off. Since this is outside the 6 mm ablation zone of the laser, this explains why I get halos around objects.
Then a fellow, which I guess means, "doctor in training" came in and examined me. His name was Dr. Churn (although I'm not sure of the spelling). He did a perkemotry, which measure the thickness of my cornea using ultrasound. It was about the same in each eye, which is good.
He looked in my eyes, and spotted the big floater in the right eye. He said it looked like a comet. He also said the left eye had some small floaters (I think he said that). Of course, I already knew this.
He also mentioned that I have posterior-vitreous detachment (PVD) in my right eye, which is the cause of my big floater. He said the PRK was smooth and well done, although I still have a slight haze in my left eye. I guess I can look forward to this going away within the next couple years, although I'm not sure that it affects anything. Hopefully.
He said that the PVD isn't all that unusual. I asked him what causes it, and he said that age, and sometimes inflammation can facilitate it. So I said, "What about the PRK? That caused inflammation." He said that more inflammation than just PRK would be necessary. It didn't make much sense to me. Sounds like he's towing some party line to me.
Then the big-shot corneal doctor examined me, although not for too long. He said that the left eye was treated off center by 1 mm, although "that's within tolerance". Great. I asked him about getting retreated with a larger laser, and he said he had just come back from a conference, and this type of treatment didn't produce good result. They need a laser that cuts just a crescent (a circle minus a circle displaced a bit south) in real-time, which just isn't done. I guess there's not much of a market in retreatments.
He suggested rigid or rigid/soft combo contacts (rigid in the center, soft on the outside) to help flatten my cornea.
I also asked him about AK to remove the astigmatism. He started getting kind of coy here, saying that it was a "relatively safe procedure", but he was concerned that it may cause more effects that I would notice. I kind of got the feeling that he thought I was being too picky.
He also suggested pilocerts or pilogel, which would constrict my pupils, which would help reduce the glare. However, I'm more for the rigid contacts, I think, since that might help with other problems like the astigmatism, which really bothers me. I'm not sure how anyone could consider it acceptable.
I also asked him about potential treatments for floaters, and although he's not a vitreal specialist, he still had some opinions, but they sounded more sort of off-the-cuff, so I won't bother writing them here.
UCSF is apparently in a clinical trial for a 7 mm laser, so if you want PRK in the US, you might want to consider UCSF (although if you're still considering it after reading this whole thing, you're crazy).
I found it interesting how the big-shot refractive surgeon guy wore large, wire-framed glasses. Who would know better than him.
Thanks to Michele for helping me by typing up a list of my symptoms, making a list of questions to ask, driving to the exam with me, and asking her questions. She really helped me a lot. So thanks Michele.
I rue the day I decided I would have this done to my eyes. I really really hate it.
It's been quite some time since I've put an update here. Once in a while, I get an e-mail asking me how things are with my eyes. Not much has changed; I still am bothered, pretty much every day, by the unsharp, uneasy vision, the doubling (which is very bothersome when reading), and the floaters. I have been coping a little better though, I guess; sometimes I feel pretty normal.
I didn't write this entry until January, so it won't be too detailed or accurate. But there are event here that need to be mentioned since they put a context on the January entry.
I went to Vancouver for a vacation, and stopped in at the Gimbel Eye Institute. Dr. Gimbel is a Calgary-based ophthalmologist who is well-respected, and has several institutes in Canadian cities.
I had a morning appointment, but there was no doctor -- instead I spent some time with a technician who did a corneal topography. He was very patient, and listened carefully to what I said. It was unusually refreshing.
After collecting a bunch of data and listening to my stories (and printing out my web site), he said that he would have the local doctor and Dr. Gimbel in Calgary look at the information and come up with an opinion.
About a month later, he left a message saying Dr. Gimbel recommended a topography with "OrbScan and Technomed (preferably the new one with ray tracing, but not essential)" before an opinion could be given. He said that these were different types of corneal topography machines; they were not at the Vancouver location, but they were in the Calgary location. So I may look into this more (possibly try to find something a bit closer to where I live).
The practice seems to be a bit bigger. There seem to be more people milling about, and an O.D. works there now.
I signed in for the 11 AM appointment, and moped in the waiting room for a while. They called me back, and sat me at the "balloon" machine to get a rough read on my refractive error. I forgot to look at the results.
I talked with the technician a bit to see what's new. Apparently, new technology is available in the US now. The doctor now has the old VISX, and a new Nikon. The Autonomous is also approved in the US now. There are a lot of rules from the FDA and the manufacturer, and it seems like they're still waiting for some software (Nikon isn't for astigmatism, for example). I asked how much was technological and how much was bureaucratic, and she said it was about 60% for the bureaucrats.
Then they moved me to another room, where I sat in the chair. The technician asked "How's your vision?"
"Terrible."
I got refracted with the eye chart. I forgot to see what I scored; I would guess at least 20/30 in each eye, maybe better. However, even the larger letters were not clear, and were doubled. After a bit of the "better or worse" game, she flipped a couple switches on the wall, I guess to indicate that the doctor should see me, and she left.
The doctor came in pretty shortly thereafter. I told him that I had doubling, glare, starburst and just plain unclear vision (I intentionally didn't mention the floaters since he had previously said that "they don't go away"). I showed him how I could adjust my vision clearer by pushing on my eye sockets in just the right way. I don't think he thought much of that. ("I have no idea why touching your forehead would help.")
We talked for a little bit. He said I had mild astigmatism, but no irregular astigmatism. He said that my prescription had changed enough that my glasses weren't really working anymore. I was surprised to see that my prescription had changed to O.D. -0.75 +0.75 31 deg, O.S. -0.75 +1.00 140 deg -- much worse than before. It may be worth me getting glasses again.
He said my pupils were large (I wonder why he didn't mention that before the surgery... hmm...), and that I was one of the 3% who experienced glare two years post-op. I also mentioned the doubling was particularly noticeable and nasty with the red LEDs he had in the room. He gave me pinprick glasses and asked me if the doubling went away. It did.
I asked why they couldn't increase the ablation zone, decreasing the glare and starburst. He said they did do that, but at this time, only increasing the zone size from 5 mm from the crappy Summit to 6 mm with the VISX. So I asked him about the Autonomous (http://www.autonomous.com/), a new tracking laser, and he said that it could do it in theory, but the software isn't available yet, and when it becomes available, it'll be for people with severe problems, like keratoconus and very off-centre laser treatments, first.
He also suggested the "gold standard" used to check corneal aberrations was a diagnostic rigid contact lens. I mentioned that I had been fitted with rigid lenses, and they made my vision very clear, but I didn't like wearing them because they were uncomfortable, and didn't stay centred very well. He offered to fit a diagnostic lens, but for some reason I didn't follow up.
I asked him if he knew Dr. Gimbel, and he said that he did, and that he is very good. He said that I was welcome to a second opinion, but that he had the same lasers and software, I suppose suggesting it there wouldn't be all that much new to be gained by going to him. I said that he had suggested I get mapped with OrbScan and Technomed, and asked if there was anywhere around here I could get that. He said he knew a doctor in San Diego -- Dr. Nordon -- who had one, and suggested I check with UCSF. He also gave me the name of a doctor in Houston who does work with corneal topographic mapping (or something... I don't remember exactly what he said, but I believe it was while we were talking about the Autonomous and cornea sculpting).
He said I was welcome to a second opinion from Dr. Gimbel, but that they have the same software and the same equipment. So now I'm not so sure what to do -- I guess I'll get the glasses.
I said that maybe I should come back in a year to see how technology has progressed. So now I go back in another miserable year.