Laser Eye Surgery, A Retrospective

After years of thinking about having laser eye surgery done, I finally decided that now was the time. In early May I went in for a consult at Mattax Neu Prater in Springfield, MO, and they ran a battery of tests on my eyes. The end result was that Dr. Mattax though I was an excellent candidate for either Lasik or PRK. I scheduled surgery for the end of May and went away to think about whether I wanted PRK or Lasik.

Pre-surgery selfie taken at the doctor’s office

There are plenty of places online that will go into more detail on each type of surgery, but here’s the summary:

Lasik: the doctor uses a laser to cut a flap in your cornea, the flap is peeled back, and the cornea beneath the flap is shaped with a laser to correct your vision.

PRK: the top of layer of cells on the cornea are removed via some chemical and a delicate squegee, and the cornea is shaped with a laser.

Lasik provides a quick recovery time, and most people have good vision within a few days. The downside is that the cornea isn’t like your knee. Once that flap is cut, it never truly heals. Dr. Mattox explained that there’s always a small risk of the flap getting ripped open or torn away. I still regularly play soccer, and I do occasionally catch elbows and hands to the face, so this was a concern.

PRK provides a much slower recovery time, and the first few days after surgery can be downright painful for people as the cells on the eye heal. It does not require a flap to be cut, so there is no concern about it being re-opened or torn. Dr. Mattox mentioned that police officers, firefighters, soldiers, and professional athletes typically go with PRK.

After considering the options for two weeks, I decided that I was willing to deal with short-term pain and a few months of blurry vision in order to not worry about the flap and future complications.

It’s now been three months. My vision is at least 20/20 in both eyes, possibly better. Dryness is largely gone, with the exception of a few days in the last month where I spent 12+ hours staring at a screen. (Computer job + writing hobby = too much screen time.)

What follows is my journal of the surgery and post-surgery days.

Day 0
I went in to the doctor alternating between excitement and trepidation. A nurse took blood pressure and gave me a valium. I was already fairly relaxed as laser surgery was something I had wanted to do for years. Even if I was kidding myself, the valium made sure I wasn’t. The nurse gave me a hairnet and booties for my shoes. She swabbed around my eyes with an iodine solution and I waited a while for the valium to take effect.

In surgery they laid me back on a padded bed. The doctor explained what he was going to do, and proceeded to tape my eyelids open and put a ring over them. He gave me numbing drops and let me rest a moment, then dabbed some solution over my eye and wiped it carefully. It took a few wipes, but I couldn’t feel anything. My only job was then to stare at an orange light. The laser thumped a few times, and the light gradually turned blurry. A fain smell of burning, not quite hair, but certainly not charcoal, reached my nose. The doctor pulled the laser away, warned me that he was going to squirt cold liquid in my eye, and gave me a squirt. It felt good. I cracked a joke about when was the procedure going to start? No one laughed. I explained that it was a joke because it was so quick and painless.

They repeated for the second eye, and it was much the same. No pain, and over in under 10 minutes. The time under the laser was about 35 seconds each. Someone was in the background counting backwards in 5 second increments, which made the time under the laser seem even easier.

Afterward I felt some pain as the numbing drops wore off. My vision was shockingly clear, but then the pain grew. It wasn’t horrible. Not even to the level of jalapeno juice, but more like sweat on a too-dry contact. If I kept my eyes closed, I didn’t feel it at all, so I made my way to the car by holding onto my daughter’s shoulders while my wife and a nurse guided my arms.

Once I was home I put on some doctor-provided goggles (to prevent unconscious eye scratching), went to bed, and napped for a couple hours. Light sensitivity wasn’t too bad–I wanted a dim room, but was able to move around otherwise. I applied steroid and antibiotic drops regularly as directed, and didn’t experience much discomfort. I spent most of the day resting in a dark room listening to Neil Gaiman’s “Norse Mythology.”

Post-surgery goggles. There may have been strong, prescription drugs involved in the taking of this photo

Day 1
Woke up at 7:00 AM with an appointment at 8:00. Eyes were a little dry, but not terrible. Did another round of steroids and antibiotics. Wore sunglasses and a big, floppy hat (my yard work hat) to the doctor’s office. They said I was at 20% regrowth and to keep with the medical drops 4 times a day. They also instructed me to use plenty of moistening drops, too.

Pain was minimal. Hard to even call it pain, really. Felt like I was wearing contacts at the computer and not blinking enough. Which, come to think of it, was literally the case. In the first 36 hours I used three small tubes of “single-use” preservative free eye drops. Single use really meant quadruple use–I could douse each eye twice before the container was empty.

At this point my vision was blurry. I’d have moments of clarity, but mostly it felt like i was reading with my glasses off and the book was just a little too far away. With text blown up to 200% I could use my computer, but the characters were still fuzzy. From what the doctor told me and what I read online, this was to be expected.

Day 1.5
Pain picked up as I approached 36 hours post-surgery. Even with wetting drops, felt like sandpaper in my eyes. Or old, crusty contacts. And it persisted when not blinking. Research said that the 36 to 48 hour mark was often the most painful. This was probably a 6 on a scale of 10. Rough, but not curl up in a ball and cry rough. I took half a hydrocodone and went to bed. That didn’t help immediately, so I covered my eyes with a cold, damp wash cloth. Finally, the drugs kicked in, and I replaced the cloth with the goggles and went to sleep. I woke up around 5 am with scratchy eyes, so I added some drops and took the other half of the hydrocodone. The doctor was clear about staying ahead of the pain. By the time I finally got up for the day around 7:30, my eyes were scratchy again, but not really hurting.

Day 2
My vision in the left eye was better than the right, but was lousy in both. Where I was able to get by with 200% text size on day 1, I couldn’t read anything on day 2. I had some moderate burning in the morning, but countered it with a hydrocodone. Pain eased off later in the day, though I applied eye drops regularly to help with scratchiness. By the end of the day my vision had shifted to where the right eye was more clear than the left, but still, both were bad. I was able to read at 200% magnification, but only with difficulty.

Day 3
I woke up with no burning, just dryness. Treated with the preservative-free drops, waited a few minutes, and started the first course of antibiotics and steroid drops. Blurriness persisted throughout the day. It was impossible to read more than a few words at a time without frustration. I listened to more Norse Mythology.

It felt like I wore my contacts in for too long. As if they’ve gone blurry from protein buildup. I kept thinking that I should put on my glasses and I’d be able to see. Or take out the old contacts and my vision would clear right up. The brain does funny things when it’s trying to adapt to a new situation. I did some reading and saw something saying that vision declines when the protective lenses are removed. It was not reassuring.

By the end of the day my vision almost felt decent. I could read text at 125% with only a little blurring. I could see well enough to butter toast. And then I put the drops in again, and everything went back to blurry.

Day 4
With halfway decent vision, I decided to cut a bagel for breakfast. I didn’t get my finger out of the way and laid it open with a quarter inch slice. Thirty minutes later, I went in for the 3 day (4 day, really) checkup. The bandage contact lenses came out, and any thoughts of “almost decent” vision were soon gone. The doctor said everything was recovering well and looked good.

Unfortunately, blurry vision persisted throughout the day, making reading difficult. I had intended to work at least part of the day, but my to-do list involved a fair amount of writing, and I couldn’t read well enough to do it. I ended up taking a couple conference calls and using PTO for the rest of the day.

Day 5
Woke up to continued blurry vision with little improvement over day 4.

Day 6
More of the same, but a little more clear. Still far from 20/20. I couldn’t read a book with normal text size, and even blowing up the text in an ebook it was still blurry.

Day 7
Woke up feeling like things were more clear, but after putting medication drops in, vision felt blurry again. About like day 6.

One week in, I was not disappointed, but I was not ecstatic, either. From what I read, I was right on track with where most people are. I wished my vision were a little more clear than it was, but I felt safe driving in the afternoon. And for the record had no accidents.

Month 1
Vision has been steady the last few weeks. At the last checkup, two weeks ago, my left eye was around 20/30 and the right was 20/50. Acuity comes and goes, but it was still in the same general area. The doctor reduced me from four to two prednisone drops a day. I could see reasonably well at a distance. When driving, I could see the other vehicles fine, but license plates were blurry. Most of the time my vision felt acceptable, but when I had to read or pay attention to fine details, it was frustrating. It should improve, so I didn’t let myself worry too much about it.

On the plus side, my vision wasn’t actually bad. It was like wearing glasses that are smudged. I could navigate the house and do normal activities with no problems. I still started to reach to take off my glasses before washing my face each night. Then I realized that I didn’t have them anymore, and it made me smile.

Month 2
Vision was pretty solid. For most of each day it was around 20/20. No noticeable blurriness, no haziness, no concerns. My use of the eye drops tapered off over the previous two weeks, so the giant box I bought back in June could last a few more months. After trying a few brands, my favorite has been the Systane Ultra drops. They are every so gooey, and my eyes relax after they go in.

Month 3
We’re now at Month 3 at the time of this post. As far as I can tell, everything is perfect. Maybe even better than perfect. I have had a few days in the last month where my eyes felt dry late in the day, but it wasn’t bad enough to outweigh my inertial laziness and unwillingness to go find the drops.

Summary
The surgery itself was easy. The recovery wasn’t as bad as I feared, though day two had some moments that would have been miserable without good drugs. After about two weeks I could see tolerably well, and after about six weeks things were mostly back to normal. The good news is that PRK patients often end up with 20/20 or slightly better vision, though it takes three to six months.

My total cost was right around $4k for both eyes. This included the pre-op appointment, surgery, follow-ups, goggles, cheap sunglasses, and medical eye drops. It didn’t include the hydrocodone prescription or the additional lubricating eye drops.

I am under doctor’s orders to wear sunglasses when outdoors in order to prevent possible hazing in my eyes. The irony of giving up eye glasses to wear sunglasses is not lost on me, but when it was pouring down rain at Notting Hill Carnival, I could see just fine, which was heavenly. It is also amazing to wake up at night and be able to see across the room. Every evening when I go to wash my face before bed, I still reach for eye glasses that are no longer there.

Would I do surgery again? Yes.
Would I choose PRK over Lasik again? Yes.
Have I already been smashed in the face with an errant soccer ball? Also yes.
Do I have any regrets? NONE