[techs]

So I've decided to have PRK surgery done on my eyes, and like others have done before me I think it may be a good idea to keep a rolling log of the results. That way if I go blind or my eyes fall out or whatever, at least other people might find this and know to avoid getting this surgery done on their eyes. For anyone interested, the difference between PRK and LASIK is that in PRK, they don't cut into your cornea and then fold back the flap at the beginning of the surgery. Instead, they just take off the epithelial cells, and then use the laser to reshape the surface of the cornea. This results in more initial pain, and a longer healing period, but the long-term results are the same as with LASIK, and you're not left with a permanent corneal flap that may come dislocated at any point after the surgery. It was because of that last bit that I decided that I'd rather have PRK.

Anyways, I went in for a consultation at the Pacific Vision Institute on March 3rd after my pair of glasses broke in half one morning when I was putting them on, and after seeing the extremely positive reviews that Dr. Faktorovich had gotten on Yelp while looking for a place that could replace my glasses on short notice. I basically decided "well there's no point in spending hundreds of dollars on a new pair of glasses that might just break again in the future if I can have my eyes be fixed permanently" (and also, in the ~2 hours it took for the krazy glue to set well enough that I could wear my glasses again, I realized that having poor eyesight was a really severe liability as I suddenly could no longer use a computer, see the TV, or even play GTA4 effectively anymore), and I liked that PVI has a strict screening process to ensure that they only take you if you're a good candidate for the surgery, So I decided to go for my free consultation to see if they would even take me.

Well actually, I had only gone down there to schedule a consultation, but apparently things are slow for them right now (not surprising given their prices coupled with the state of the economy) and they offered to take me right away. The first thing I did was talk to Brooke, who is their "patient counselor" or some such thing. Really though she's just a salesperson. It's her job to figure out if you can even afford the procedure (I can forgive her skepticism, it's not like I walk around looking like I have money), and how you're going to pay (they offer 12 and 24 month interest free loans for people who qualify). She's also the one you negotiate the price with. I didn't like Brooke. Not because of anything personal, I just don't like salespeople. She was pretty aggressive, taking my information to see if I qualified for the loans, and trying to get me to commit to have the surgery done before I had even had the consultation, which as she told me "20-30% of people fail". And she also tried to blame the obvious slowness on it being "lunchtime right now", despite the fact that it was after 3:00 pm in the afternoon.

At any rate, once Brooke is satisfied that you can afford the treatment, and that you're not just wasting everyone's time, you get to go back for your actual consultation. They scan you with 3 different machines, one of which does a CT scan of your eyes, and two others that print out surface maps and take various measurements. They'll show you all the output, and explain what it means. They said that my corneas were about 520 micrometers thick, which is a little thicker than what they typically see (though according to Google, it's pretty average), but that's okay because thicker is generally better as far as laser eye surgery is concerned.

After they measure you, they'll leave you in a room and eventually the doctor will come to talk to you. She looks at your scan results, and then makes her recommendation (or flat out rejects you if you fail, I assume). She said that she would have recommended me for PRK even if I hadn't come in asking for it, because the surface of my cornea is a little bumpy, and apparently with PRK she'll be able to compensate for that. I liked Dr. Faktorovich, she came across as very intelligent and friendly, and most importantly, like someone who I could trust to operate on my eyes.

Finally, it's back to chat with Brooke some more. She told me that I had been approved for the interest-free loan, and that she had scheduled me for surgery the very next week (like I said, she's pretty aggressive). I declined the loan, telling her that I'd prefer to just pay the cost up front, and had her push the surgery date back a week (to the 18th), and then I walked out of the office $6000 poorer. They gave me a bag with some eye drops and some vitamins (apparently they're special vitamins that are designed to help prevent the dry eyes people typically get after eye surgery), and instructions to start them both one week before my surgery date. I don't think the drops have any therapeutic value, they probably just want to get me into the habit of using them. I'm going to do them anyways, because getting into the habit seems like a good idea. Otherwise I'm liable to forget to take some of the drops when it's actually important.

I felt very apprehensive about everything for a couple days after signing up, mostly because of how quickly I had gone from just going in to schedule a consultation to actually signing up for the procedure, and because I found some postings online by people who had complications during the healing process after getting PRK. I feel better about it now however, and am pretty much resigned to my fate at this point. I'm not concerned about the negative reports I've read, because the people posting them don't seem to have used the same doctor I'm using, and because they all seem to be much older than me (the people who report healing problems tend to be in their late-30's and mid-40's). Younger people seem to have better experiences.

Going into the procedure, I see 20/10 in my right eye and 20/12 in my left eye with glasses. My prescription is something like -4.25 in my right eye, and -4.75 in the left, which falls well within the treatable range for laser eye surgery (which goes up to about -7.0). My biggest (realistic) concern is that after the surgery, my vision may never be quite as sharp as it currently is when I'm wearing glasses. Given the information I've seen, it seems likely that I'll get to at least 20/20, but at the same time 20/20 vision seems rather poor when you're used to seeing things at nearly 20/10 (seriously, the letters they use for the 20/20 line in the eye test charts are HUGE). If the doctor can get my vision to 20/15 or better, I'll be very happy.

Much ado about nothing so far, I know. Things should get more interesting in a couple of weeks.

This post has been edited by techsupp0rt: 09 March 2009 - 01:10 AM

[shakey_snake]

PBR day sounds more fun. :P

Anyways I'm interested to hear how everything goes for you, Techs.

[sttaffy]

good luck dude, that's a big leap of faith!

[Hugh]

She'll be apples. :up:

[ShyShy]

PRK is the preferred option over LASIK in the military, funny that. Good luck!

[techs]

So today is day 1 of the drops and the vitamins. I'm glad they gave me a week to practice, my aim is pretty bad right now. The drops don't seem to do anything other than sting slightly when they finally do go in. Makes sense since they're basically just saltwater.

Not minding the vitamins, apart from the really weird taste when I put them in my mouth. The trick is to swallow them as quickly as possible.

[Teews]

Good luck with the surgery :)

[techs]

Just went to my pre-op appointment with Dr. Lee. It was fairly uneventful, actually (although their office was very busy when I went in this time, so maybe their business isn't as slowed as I thought it was). He did a vision test and then dilated my pupils before repeating many of the same tests that were done as part of my consultation. He also took me into the laser room, and photographed my eyes using the laser (apparently, it's a laser *and* a camera). The laser has extremely bright lights on it that shine on your eye from all sides. I hope they don't leave those turned on during the procedure, otherwise the desire to blink/squint coupled with my inability to do so will be maddening.

In any event, Dr. Lee seemed intelligent and professional, and entirely likable. He explained the healing process to me, and took whatever questions I had. I confirmed with him that they were going to perform a wavefront-guided PRK procedure, which made me feel more optimistic about things (there are a handful of recent studies that suggest that wavefront-guided PRK typically produces very excellent results). I also asked him how they planned on removing the epithelial cells from my eyes as part of the procedure, and he told me that it was basically a mechanical scraping process, and that it would be "the most uncomfortable part". That part was quite disappointing/disconcerting. I had been hoping that they would just ablate the cells away with the laser. I'm not looking forward to having my eyes scraped, though I trust that they know what they're doing. Maybe I shouldn't have asked that question. But I guess it's better to know than to get surprised on surgery day. I've heard that they'll give me a Valium beforehand, so maybe I won't mind so much after that.

Dr. Lee also mentioned that he had his own eyes lasered about 5 years ago, and that he now sees a little better than 20/20. Even better, he said that I had a "90% or better" chance of reaching 20/20 vision, and about an 80% chance (the number he gave was actually 78%) of getting better than that, given his past experience with similar patients. Those seem like good odds, and I assume that they should be accurate, since there's no need for any exaggeration at this point (they already have my money, and my signed consent form). I asked him about how often people ended up with permanent visual artifacts (halos around lights, etc.) as a result of the surgery, and he said that 90% of people have no significant artifacts after about the 3 month mark, and that less than 1% of people have uncorrectable artifacts. Those numbers seem reasonable, if not stellar. As "correction" probably entails going through the whole process again, I hope to avoid falling in with the 9% of people who have correctable artifacts (and to especially avoid being in the 1% with permanent artifacts).

They also gave me a couple of prescriptions. One is for antibiotic eye drops, and the other is for Vicodin. They want me to fill those tonight, and also to pick up some "artificial tear" type drops (the same things they've had me practicing with for the past week) when I do. Additionally, I was given a consent form that I had to sign, and some documentation that described what would happen during the procedure, as well as instructions for how to take care of my eyes afterwards. I might scan them for the sake of completeness, though they're not all that interesting. At any rate, surgery day is tomorrow. Death and blindness await.

[Sandman2012]

Good luck.

[Hugh]

Yeah, good luck mate. :up:

Something I didn't think of when I had teeth extracted a few years ago, was how I would get home. Have you got a ride sorted out? I'm guessing you'll be unable to drive.. ;)

[techs]

Yep, that's one of the many benefits of being in a stable relationship. Allison will take care of the transportation. And afterwards, she'll also bring in dinner from Abacus to help kickstart the healing process. She'll probably do other things to help keep my mind off the searing eye pain, too...

[shakey_snake]

Got JAWS up and running yet? :P

[techs]

So the procedure just completed about 4 hours ago. I can already see better without my glasses than I ever could in the past, though everything it still quite blurry. It tends to fade in and out a bit, and my left eye is definitely blurrier than my right eye. They told me that things like this can be expected and are normal. The interesting thing is that the blurriness doesn’t really depend upon the size or distance of the thing I am looking at. It’s more like there’s a filter right in front of my eye that is blurring all the light as it comes in. The difference in clarity between my right and left eyes behaves the same way. It’s not that far away objects are blurrier in my left eye, it’s that everything is blurrier with that eye. I suspect that all if this is normal, and will resolve itself in due time.

At any rate, the procedure itself really wasn’t that bad. When I showed up at the office, they gave me an Ativan to help keep me calm, and then Dr. Lee took me back and put several different drops in my eyes (antibiotic, anesthesia. anti-inflammatory, etc.), and dilated my pupils again. He used a marker to draw two black dots on each of my eyes, to give the laser some points of reference to track against. The dots were kind of cool, as the drawing of them confirmed that the anesthesia was working, and because I got to look at them in a mirror afterwards. He then took me to the machine that would generate the wavefront map, which did so by taking several scans of each eye. When he was satisfied with his wavefront map, he gave me more anesthetic drops and let me sit for a bit while my eyes dilated fully.

Eventually, they called me in to the laser room and had me lie down on the laser table. After a few minutes, Dr. Faktorovich came in and started the procedure. The first step involved taping back the eyelids on the eye that was going to be worked on (she did my right eye first), and was really not uncomfortable at all. The next step, however, it the worst part of the whole procedure. I’m not exactly sure what is being done, but Dr. Faktorovich places something over your eye that completely distorts your field of view. She then starts irrigating it with some sort of solution from what appears to be all sides at once. This continues for several seconds (perhaps as many as 10-15), and causes a burning and a pulling sensation (I think maybe there was some sort of suction involved…in fact there almost certainly would have had to be as otherwise my face should have ended up completely soaked by the solution, which it didn’t) that starts out mild but which gradually increases in intensity to the point of moderate to severe discomfort until suddenly she stops.

After that weird and extremely unpleasant step is completed, she comes in with the scraper to remove the epithelial cells. This part was not nearly as bad as I had thought it would be. Compared to the previous step, the scraping is downright pleasant. You don’t feel anything at all during this process, except for maybe some very slight pressure from time to time. If you look closely, you can see the cells coming off of your eye (looks sort of like a thin translucent film that starts sloughing off in chunks).

Once the scraping is done, in comes the laser. You don’t feel a thing when it fires. But it does make a loud crackling/popping noise when it is operating. There’s a blinking light that you’re supposed to stay focused on during the process, and I kept watching it hoping that I’d be able to see it gradually getting clearer as the laser worked. That didn’t happen, however. If anything, the blinking light just got blurrier and blurrier. If you watch closely, however, then what you can occasionally see are little track marks where the laser is currently striking. At any rate the laser is entirely painless, and doesn’t take very long to operate. It also talks. When it starts working on an eye, you can hear it announce things like “Patient XXXX YYYY”, “Right Eye”, “###########” (a string of numbers that I assume has some bearing on how it attempts to correct your vision in that eye). It’ll also say “Acquired” when it locks on to your eye for the first time, and then periodically it will announce things like “Program is 15% completed” as it is zapping your eye.

Regardless, after they finished with my right eye (once the laser has completed its program, they untape your eyelids and pop in a “band-aid” contact lens before instructing you to keep your eye closed), the process repeated on my left. They gave me some extra anesthetic drops, and then it was on to the horrible burning/pulling part (the anesthetic doesn’t seem like it really helps with that part), followed by the completely tolerable scraping, and then the entirely painless laser. I did notice that they lasered my left eye for a lot longer than they lasered my right (seemed like it took as much as 2-3 times as long). It could be because that’s always been my weaker eye, and that might also be the reason why my left eye currently has blurrier vision than my right.

After both eyes are done, they take you back to an examining room to counsel you on the post-op care. I popped my eyes open on the way over, and after the strange colored blobs that appeared when I first opened my eyes went away, I noticed that I was able to see fairly clearly (albeit with the same general all-over blurriness I’m currently experiencing). They instructed me to keep my eyes closed for a full two hours (which I mostly did), and then to start using the antibiotic and steroid drops every two hours after that, while using the artificial tear drops every single hour. I’ve noticed that when I put in some of the artificial tear drops, my vision becomes extremely sharp (like about as sharp as it was when I had my glasses on) in both eyes, though only for a few seconds at a time (usually it goes away after I blink a few times). If that is an indication of my final result after surgery, then I will be quite pleased.

So far there has been no pain (apart from the burning/pulling sensation that I mentioned during the procedure), although my eyes did sting for a bit during the two hours after the procedure. As Dr. Lee described, the feeling was very similar to what happens if you chop a few too many onions. It wasn’t too bad, and it faded away on its own after about an hour and a half. I have a slight headache now, but that could be anything from stress to simple blunt trauma from when they clamped my eyelids open. So far there hasn’t been anything to really encourage me to sample any of the Vicodin. I’m much more interested in experimenting with the artificial tear drops at the moment, to see if I can find a way to get the clear vision to stick for more than just a few seconds. Or at the very least to measure my visual acuity during one of those brief moments.

That’s about all for now, more information after my follow-up exam tomorrow. Maybe they’ll be able to tell me how to get the clear vision to stick.

P.S. I typed this in MS word at 200% zoom, because the font on the forums is too small for me to really make out right now. Hopefully that will change soon.

Edit: And I do seem to have some artifacting. I see starbursts/halos around lights, and I also get some ghosting around high-contrast light/dark things (for example, white text on a solid black background). I assume this is all normal considering that the procedure was done just a few hours ago, and that it also may be related to the fact that my pupils are still *very* dilated.

Also, I can read the text on the forums just fine as long as I keep enough drops in my eyes. I can read it from several feet away actually, which is promising. I could never do that without wearing glasses before.

This post has been edited by techsupp0rt: 19 March 2009 - 04:33 AM

[Hugh]

Sounds like success to me, fingers crossed it all comes good for you soon enough.

[ShyShy]

I'm jealous. :flowers:

[techs]

5:00 am update. My vision is awesome! The artifacts have all disappeared already (must have been related to the dilation). The light-sensitivity may be starting up now, I felt a very sharp stabbing when I caught the glow of a streetlight through the window, although it has disappeared for the time being.

Time for some drops and then back to sleep. So far still no pain except for the one instance.

[Teews]

It must be really exciting to think that you won't need glasses any more. :)

Can't believe you typed that mammoth post 4 hours after an eye op...

[techs]

Quote

Can't believe you typed that mammoth post 4 hours after an eye op...

I was a bit surprised too, though the procedure was really mild. I felt perfectly fine afterwards, and apart from the blurriness, using a computer is just as comfortable now as it was before the procedure.

But anyways, I went in for my 24-hour followup visit today. My vision is still quite blurry (probably even more blurry than yesterday), although the drops still allow for a few moments of full clarity. My left eye is much blurrier than my right, and almost has double-vision sometimes. However, with the drops in, they both reach the same level of clarity. The artifacts are also back, though not quite as severely as yesterday, and those disappear as well when the drops go in. I have no pain or light-sensitivity right now, which is something I'm a little confused about. Everything I've read suggests I should be extremely light sensitive and/or in a moderate amount of pain right now. Dr. Lee says that too. For the time being, however, I feel fine. I even walked around outside in broad daylight for awhile, and didn't notice anything unusual (in fact, the extra light seemed to greatly *reduce* the blurriness in my right eye). Maybe tomorrow the bad things will start.

During my office visit, Dr. Lee said that it looked like my eyes were healing normally, and that my vision will continue to get blurrier through Saturday, at which point it should start clearing up. He also said that once the healing is completed, I should expect to see a little bit better than I currently do in those brief moments immediately after I put my drops in. That is excellent news, if true. I also asked him about what they did during the PRK procedure immediately before the scraping part. Apparently what they do is place a well over your eye, and then flush it with an alcohol solution to weaken the epithelial layers prior to scraping. I told him that that was the worst part of the entire procedure, and he said that "a lot of people" feel the same way. Lastly, he told me that the artifacts I currently see are normal, due to the fact that light is either directly impacting my cornea or being scattered by healing epithelial cells, neither of which is good for seeing things correctly. The reason why the drops make things clearer for a brief time is that the thin layer of liquid roughly approximates the function of the missing epithelial cells.

So it looks like it's mostly a waiting game at this point. At some point the pain and light-sensitivity should kick in. I'm supposed to go back to the office on Monday to have them take the band-aid lenses out. From what I've read, after that is when things should really start clearing up.

This post has been edited by techsupp0rt: 19 March 2009 - 09:41 PM

[sttaffy]

hell yeah! very glad to hear everything went well!

congrats!

[shakey_snake]

techsupp0rt, on Mar 19 2009, 05:39 PM, said:

I have no pain or light-sensitivity right now, which is something I'm a little confused about. Everything I've read suggests I should be extremely light sensitive and/or in a moderate amount of pain right now. Dr. Lee says that too. For the time being, however, I feel fine.

Awesome. You must be lucky.