My PRK Experience - Newport Beach, CA

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My PRK Experience – March 2014 Hello everybody...

My PRK Experience – March 2014

Hello everybody.

I thought that I’d write a commentary with subsequent updates to help others with their process in deciding upon PRK or LASIK surgery given that I found other commentaries rather helpful in my process. The only struggle that I had was finding recent commentary on the experience as the latest blog was from 2012. In addition, most commentaries spoke to the experience post-surgery. I am hoping to provide some views on my process before the decision to move forward, insight to the day of surgery and my experience thereafter. By no means am I a medical expert so if there are those that are medical experts out there, please feel free to offer amended comments to anything I mention.
First, a little about me. I’m now 39 years old and I’ve been a user of contact lenses and glasses since I was 18. I have long considered LASIK surgery but it was just one of those things that I could put off and it wouldn’t bother me too much (One being the cost issue. It can run up to $2500 or more per eye). Plus, I lived overseas for a number of years and was never comfortable having the surgery done in a country other than the good ole U.S.A. I was comfortable in contacts but like many who use contacts, I was one of those that would fall asleep in them from time to time (leading to sticky eyes) and would struggle with contacts during allergy season (as a result of hayfever). I have astigmatism (can be described as having slightly curved corneas – like an oval or a football – versus a rounded cornea in both eyes. So even with contact lenses, I wouldn’t have perfect focus. I hated wearing glasses. For some reason, it would give me a headache if I wore them too long…… in February of 2014, I decided to move forward with the procedure.

I’ll write a little about the journey. I do think it’s important that you have been seeing an optometrist on a regular basis for several years. He or she will be able to track the health of your eyes. If you haven’t seen an optometrist on a regular basis, I highly recommend that you don’t make decisions on a whim. These are your eyes and you need to take proper steps in determining that this is right for you…..anyway, you should let your doctor know of your interest and he’ll likely tell you that your eye prescription should be stable for a year or two. My doctor actually worked for the Laser Eye Center at one point in his career and had asked me if I had ever considered LASIK but as I wrote above, there were always reasons to put it off. It was great having an optometrist who was very familiar with LASIK (although most optometrist will be familiar whether they worked in a LASIK center or not) because he would always give me updates on the evolution of the process…..When I returned to the States, I decided to take steps in exploring the process to have my eyes corrected. I had probably been 5 years since I had my last change in prescription. I was -5.75 in my left eye and -4.75 in my right eye. Basically, I would only read something clearly that was 6 inches in front of my face. I’ll note too, that I has picked up doing triathlons over the last few years and grew frustrated with contacts falling out during my training (particularly if water was in my goggles during swims, I had the potential for contacts to wash out).

CHOOSING THE RIGHT DOCTOR for your LASIK/PRK procedure. Your optometrist will recommend laser centers but it is incumbent upon you to feel comfortable with the doctor and the practice. Somebody actually suggested I review a Groupon to save on costs. I highly recommend against this. These are your eyes and you only want to see a doctor that is well-established and has a VERY long track record in performing the procedure. Since my optometrist had worked in a well-established center before, he recommended a couple of places where doctors in that practice had branched off and started their own practice. Ultimately, I chose to go to NVISION (Dr. Tooma) in Newport Beach for a consultation. Prior to going in to any office, I would recommend people to do some searches on the practice. If possible, try to find comments from people online who have had good and bad experiences. You may find some disgruntled opinions but it is important to understand the basis for the opinion. Also, you have to understand that while the surgery has a very high success rate (often times expressed as having greater than 99%) there is always the probability of a procedure going bad. My own opinion is that in the medical practice, even if there is .01% chance of something going wrong, medical practitioners have to state these long list of disclaimers to cover their liability.

So my appointment was set to have the initial consultation. My doctor told me to set aside about 1 hour 30 minutes so if you’re a working person (as most of us are) make sure you plan your day accordingly. This appointment is used to conduct various tests on your eyes, none of which are uncomfortable. In fact most of the test are similar to what your own optometrist will conduct. They’ll do their own distance test, evaluate the general health of your eyes and evaluate the cornea. The main difference from a normal routine eye exam is that they’ll measure the landscape of your eye (kind of like how we measure the landscape of the earth in geological examinations). This also will give you an indication of whether or not your cornea is thick enough for the surgery. I will say that the folks at NVISION were very thorough. The nurse who conducted most of the tests answered the host of questions I came prepared with…..what is the success rate in your practice? Describe to me the corrective procedure for those that didn’t go as executed? Who is actually performing the surgery (i.e. is the famous doctor doing it or one of the associated doctors)? What can I expect during the surgery, leading up to, on the days of and the time following the procedure? Make sure that you come with ALL of your questions. THE MORE COMFORTABLE YOU ARE WITH THE DECISION, THE LESS ANXIETY YOU WILL HAVE THE DAY OF YOUR PROCEDURE.

ARE YOU A CANDIDATE FOR SURGERY? So I was told that you need between 500 – 800 microns of corneal thickness to have LASIK procedure with a preference for more, obviously. At the end of the surgery, you’ll want to have at least 300 microns or more to ensure stability of your cornea. (If there are any medical professionals out there, please add any amendments or thoughts on what I’ve written). In combination with your eye prescription, it will be determined if you are a candidate or not. So, I WAS NOT A CANDIDATE FOR LASIK BUT I WAS A CANDIDATE FOR PRK. Both of my eyes were around 500 microns, plus I had some issues with the shape of my cornea. So how was it determined that LASIK was not right for me? Well for those who don’t know about LASIK, the procedure involves creating a flap in your eye that is created by a laser (look this up on YOUTUBE). This flap is pulled back by the doctor and then the laser will zap your eyes with the pre-determined measurements to correct for vision. The flap is then placed back over the eye and you’re done. In LASIK, the procedure for creating the skin flap compromises about 100 micron. For each diopter of correction, the laser is removing an additional 12 microns. So recall for my left eye I had -5.75 and for my right I had -4.75. 12 x 5.75 = 69 and 12 x 4.75 = 57. So if I were to do LASIK, I would have been left with a little over 300 microns of corneal thickness in each eye (500 starting point – 100 for flap – 69 = 331 for correction as an example of my left eye). The doctors felt that this was too close to the minimum standard. For those that were set on LASIK, this may sound like a disappointment but the other option is PRK.
The PRK procedure differs in that you don’t have a flap that is created. Instead, you have a layer of the top skin tissue (epithelial tissue) that is removed. I cannot recall how many microns this involves but it isn’t much. The key is that you save many microns versus the ~100 microns through LASIK. That said, once the skin tissue is removed, patients have the exact laser correction done as they would have with LASIK. As with other areas where we have skin tissue removed, the skin grows back in the eye. One of the other key benefits is that PRK is safer than LASIK. You won’t have the same potential complications with LASIK with the flap healing incorrectly. The downside is that there is a longer recovery process involved in PRK that could have an emotional impact on patients expecting immediate results.

OK, so HOW DID I COME TO MY DECISION? It’s pretty simple. All of my questions were answered by the staff at NVISION very thoroughly. I had done my due diligence to a point where I felt comfortable. I was happy that one of the doctors doing the pre-examination (including Dr. Tooma), said his eye stats were similar (he had PRK as well). I was comfortable in feeling that they would turn down patients that were not good candidates. While I “thought” I wanted LASIK, I was comfortable in knowing that PRK would have the same outcome but knew my recovery time would be longer. I thoroughly understood the risks but was very comfortable with this. So that same day, I booked my appointment for Feb 28th.
As an additional note, when you choose a practice, take a moment to understand the equipment that they are using, particularly, the laser that will be used on your eyes. NVISION had a review of the laser along with a pamphlet that described the technology. It was clear, they were using the latest and greatest technology which has very many benefits for the patient and increases the precision. Among the benefits is limiting some of the side effects that you may have read about from older types of lasers. I was impressed that this equipment will detect a slight movement in a patient’s eye and will stop and pick up again when the eye is still. This increases the accuracy of the correction.

One side note, I consulted my primary optometrist and he advised me to do additional research on the potential risks of the surgery. While he was an early advocate of having the procedure done, given that I was on the low range of acceptable limits, he became less of an advocate. To ensure I had a complete picture, he advised me to research all of the downside possibilities before the day of the surgery. My decision didn’t change after doing so, but I will say that having complete knowledge helps in the process.

So a quick summary of what I’ve written prior to the day of surgery.
1) Make sure that your eyes have had a stable prescription and that you’ve been seeing an optometrist on a regular basis for several years
2) Make sure that you do as much reading on LASIK/PRK so that you’re knowledgeable about the procedures and prepare as many questions as needed in order to establish a FIRM comfort level
3) Find the right doctor for the procedure
4) Make sure you’re 100% comfortable

I think if you have followed these steps, you’ll minimize the level of anxiety that you have during the day of the procedure.

WEEK LEADING UP TO THE PROCEDURE. They’ll tell you not to wear glasses for the week following up to the procedure. In addition, you’ll be on a schedule of various eye drops (which I think it’s best for you to hear from the doctor rather than me) to prep your eyes for surgery. You’ll also be told to take in pills with fish oil, vitamin C and some type of anti-inflammatory pill. I’ll note that PRK and LASIK will have a slightly different cocktail of drops. The key message here is to follow this to a “T”. As I’ve stated above, these are your eyes and you’ll want to minimize any downside.

DAY OF PROCEDURE (T). My procedure was done on a Friday morning. I would have done it on a Thursday morning or late afternoon (I’ll explain why below) but I had business conflicts that pushed me out one day. With PRK, they say that the recovery time is 3 – 5 days post-surgery. I was aiming to limit my days away from work so by having it on Friday, I was counting on 2 days away from work (Friday/Monday) and recovery time being 4 days (Friday – Monday). I was scheduled for two hours but most of that time was spent waiting around. I came to the office in very comfortable clothing. The staff performed all the same checks on the eye as they did in the pre-examination I described above. This is to ensure there are no material changes in the prescription. After the examination, I was given Zanax to help me further relax. In the pre-op waiting room, a nurse added drops in my eyes (either a cleanser or light anesthetic). I had a couple of other people around me at the time waiting outside the “operating room”. I will say that all along the way, the staff at NVISION speak with a tone that makes you feel very comfortable and always will ask if there are any questions. It was interesting to be in the waiting room because it’s like a factory. You see people walking in and you see people walking out. I could tell that one lady had LASIK because coming out of the room, she was jumping for joy. Nearly hysterical (because of the joy or the drugs) saying she has never seen so well before. I suppose that is the benefit of LASIK…you nearly have immediate results. So it was nearly my turn to go in and I was given a set of pills. I believe it was Motrin but it could have been more muscle relaxants. You certainly don’t want to move during the surgery.

I walked into the surgery and was greeted by Dr. Tooma. He quickly walked over the chart and like his other associates, asked if I had any last questions. He then handed me over to his assistants. I can’t recall, but I either has additional drops prior to walking into the op room or after they initially laid me down. These drops effectively are an anesthetic to help relax your eyes during the surgery. As I laid there, I was very, very comfortable. The room was a bit on the cold side so wearing a sweat jacket was perfect. As the procedure started, Dr. Tooma explained to me every step. As I stared up, I was told to look at the green light. During that time, one eye is being prepped. This involved having the eyelids gently taped back. Then there is a device that insert that ensures the lid remains cranked open. You can hear the clicking of the cranks. So the real process begins. The doctor says he’s starting. He remove the top layer of the epithelium with a tool that looks like a miniature version of a plastic spackle. This was completely painless for me. Then you hear a countdown from 30 seconds, 20 seconds, 15 seconds, 10 seconds, 5 seconds and done. During the countdown, you see red lights flashing which I’ll presume are the lasers making the correction. I will note that you do smell some burning which is likely to be the laser burning the tissue. The doctor then says he’s washing the eye out with a cold saline solution. This was the only part of the surgery that I felt. It didn’t hurt but you could tell it was cold. Otherwise, everything is painless. It ends with the doctor placing a clear contact over the eye (since you don’t have a flap that is being re-covered as in LASIK, you need the clear contact to protect the eye as it is recovering). The doctor repeats the process for the other eye and you’re done. I get up, take a picture with the doctor and I’m escorted out of the room. I would say that this last no more than 10 minutes altogether. Admittedly, I didn’t have the same euphoria as the lady I say a few patients ahead of me, but I certainly did see drastic improvements. I had to wear plastic sunglasses that they provided to me for the journey home (note, you have to have somebody drive you and it’s recommended that at least for 3 – 5 days, you don’t drive). My wife drove me home and upon arriving, I went straight to bed. I think it was 11am on a Friday morning.

My wife woke me up around 6 pm to get food in my stomach. I was told not to watch TV or to strain my eyes too much for the first day. After eating – which took all of 30 minutes – I went back to bed (I believe I took the additional dose of Zanax) and slept til about 6 am Saturday morning. All in, I think I had 20ish hours of sleep. Note, you have to wear eye goggles to sleep the first week to ensure nothing bumps your eyes or that you don’t rub them too much. Oh, and the drops that you used leading up to the surgery are the same drops you’ll use post surgery for the next month.

Surgery day + 1 (T+1): I woke up before everybody else. Felt pretty good. Substantial improvement in vision but not 20/20. I can make out all the objects in the room 10-15 feet away but the details were less evident. For example, I could see my wedding photo (5 x 7) making out that it was me and my wife but could not make out the detail of the faces. It’s a bit uncomfortable keeping my eyes open too long and a bit uncomfortable keeping my eyes closed too long as well. So that is definitely frustrating. To help, I’m taking Motrin and using rewetting drops……remember, your skin layer was just removed so your body is trying to regenerate the skin. I’m pretty happy because there is a sense of freedom I’m experiencing w/out the need for contacts or glasses (even though my vision is not perfect).

Later that day, my wife drives me to see the doctor for my day after visit. He checks out my eyes and says everything is healing just perfect. All of my post op conditions are normal (dryness, light sensitive, irritation). My vision is around 20/30 to 20/40. I tell the doctor that its odd b/c at some points, I actually do see clearly but at other times, I’m back to struggling with the details.

For the rest of the afternoon and evening, I just relax.

T+2 (Sunday): Vision feels like its improving. The irritation has substantially been reduced and I’m finding less of a need for Motrin. I’m using the re-wetting drops every two hours which is helping. I’m still frustrated by seeing more clearly in some parts of the day versus others. But the doctor said to be patient since skin cells are constantly regenerating. As this occurs, it covers the part of the cornea in a pattern that is not smooth and then becomes smooth throughout the course of the day. I struggle a bit with the TV as my eyes are a bit overstimulated.

T+3 (Monday): Feels pretty amazing. I can see pretty clearly. I can certainly read thinks at a close range without any struggles. Even some of the longer distance items are becoming clear. As I drive around with my wife, I’m seeing signs fairly sharply and I feel quite comfortable with the long distance. I’m still light sensitive but other than that, my vision feels great. I’m pretty excited and then await my afternoon visit with the doctor. When it comes time for the visit, everything checks out with the healing process and he says its ok to remove the protective contacts. UH OH. As the contacts are removed, my vision takes a slight step back. I feel like I am back to T+2. The contacts, while clear, somehow help to manage the underlying growth of skin tissue. I’m good enough to drive (CA state law allows min 20/40) but I’m frustrated that I lost the definition that I had achieved.

T+4 (Tuesday and back to work): When I’m not traveling I am in front of a computer for 10 – 12 hours a day. Driving to work was fine; I’m only going 10 miles or so. I’m making out the street signs (although I’m not sure if my mind is fooling me on this since I’ve been passing the same streets for years or if it’s because I do have marginal improvements from the day before). I can certainly tell that my vision isn’t perfect. As I look out of the office window, I can read the BIG department store names but the focus is not sharp. However, it seems that as the day went on, the sharpness would return. In fact, it seemed that at night my vision was the best. I’m starting to really see signs in better definition by the end of the day. During the day though, I’d admit I’m struggling with staring at a computer screen all day. I have to remind myself to regularly lubricate the eyes and the look away from the computer every 5 to 10 minutes, for a few seconds.

T + 5 thru 7: Every day is quite similar to Tuesday. The exception is that every day, the starting point on vision (ie. Clarity and Focus) starts off better than the day before. My favorite time of day is the evening as my longer distance vision is much sharper. I think the key issue is that I’m in front of the computer all day and this is having an impact on my comfort levels as I am focusing on close vision at the computer versus long distance vision.

I’ll note that during the first week, I didn’t struggle with the halo effect and the ghosting at night that I’ve read in other blogs. The only side effect I’ve been dealing with thus far is dry eyes.
So overall, the first week was ok. Things aren’t perfect but I can certainly tell that I’m progressing. Had I had a chance to do it all over again, I might have taken a full week off so that I didn’t have to struggle at the computer for the first week (although I only worked for 4 days the following week). If I didn’t have to travel and wanted to save my vacation days, I would have elected the Thursday afternoon surgery, allowing for a full Friday, weekend and Monday to recover.

T + 8 & 9 (the second weekend): Things are good. Vision feels good although I can detect that one of my eyes is not perfect. I’m focused on keeping my eyes lubricated and sticking to the regime of the other eye drops. I’m down to just the antibiotic 3 x a day. My doctor says that it’s ok to swim for precaution, I’ll wait through the weekend just to be more conservative. I do take my daughter to the pool and have no real issues. I even get out on the golf range to see if I can track my golf shots. I can track the ball pretty well up to about 200 yards but it’s a windy day and it’s causing my eyes to dry out even more. But overall, I’m happy with the progress.

T+10: Work is great because instead of starting the day slightly less focused on those same store signs, they are in good focus to start the day. I have a doctor’s appointment at noon. The visit goes well. I’m 20/20 in the left eye and 20/25 in the right eye. Pretty good progress. Doctor explains that my eyes will continue to stabilize over the next 3 – 6 months and I have potential to improve to even better than 20/20. He expects that I’ll be 20/20 by my next visit in two weeks if not sooner. He noted that even LASIK has a long stabilization path. While LASIK may demonstrate immediate results, it will require a few months of stabilization as well. Further, he confirmed that because I had PRK, swimming is no problem. Since I have no skin flap issue (that I would have with LASIK) I don’t have that same risk of a flap being dislodged by water in the early days.

Pretty much, T+11 through T+14 are the same as T+10. I’m pretty comfortable with my vision and it appears that my right eye has caught up to my left eye (although I can’t confirm without the doctor testing it). I’ve gone swimming with no issues and driving certainly isn’t an issue. I do feel at points in the day that the skin cells are still regenerating, causing a temporary setback (although very, very minor). It’s probably in my head though. When I apply wetting drops, things seem to clear up pretty quick. I’m writing all of this on the morning of T+15. One thing that I didn’t mention about the vision is that because the procedure fixes the astigmatism, as my eyes heal, all things are much sharper. It’s like I was seeing the world in digital TV and now it’s HD!

I would advise those going through the process to manage your expectations. Understand the process so that you’re not let down (too much). I have found it a bit of a teasing process. You get glimpses of what the vision is supposed to be but because of the process of the epithelial layer of your eyes healing, you’re in and out of good vision to slightly less good vision. That can be frustrating.
I have another doctor’s appointment in two weeks and I’ll aim to provide updates until my eyes stabilize. Until then I hope then you have found this helpful. If you have any questions, please feel free to reply to the post.

Weeks 3 - 5

Weeks 3 - 4: Both of these weeks were rather similar. I can feel that I have lost a little bit of focus on long term vision but everything within 15ish feet is quite clear. One of the things that was quite different is that my eyes are more dry than the previous two weeks. I'm powering through the eye drops during the day. Particularly when I'm at work in front of a computer. I find myself looking away from the computer very often and increasing font sizes on the computer screen to help my eyes relax. Another side effect starts to creep its way in. There is a ghosting effect on certain lighting. Stop lights, in particular, show up as overlapping lights (known as ghosting) from afar and merge into one singular light by the time I reach the stop light. Less noticeable during the day versus the evening. The odd thing is that I don't see the ghosting effect with oncoming traffic (white lights)... just colored lights. Also interesting is the fact that I don't have the halo effect.

At the end of week 4, I go back to my normal optometrist. He says that both eyes are 20/30 (recall that in my last exam I was 20/20 in my left and 20/25 in my right. This is certainly frustrating to hear. He also says that I have a slight astigmatism in one eye and about 0.25 prescription in my right eye. As you can imagine, this is pretty frustrating but I'm trying to be patient with the process (kind of like Tiger Woods and his swing change). However, given that my optometrist used to work in a laser eye center, I trust him when he says to expect stabilization over a 3 - 6 month period. At the end of the exam, he prescribes me Restasin. They are drops that help stimulate tears. My doctor tells me that the procedure removes nerve endings that typically signal when you need tears. I don't recall ever having this discussed with me in the early part of the process. Not that it would have made a difference to me in the first place (b/c men don't cry anyhow, right?) but it is quite frustrating to feel the need for lubrication every hour or so. The positive thing is that with these drops, I can last longer without the re-wetting drops.

Week 5 - I've been doing better since using the Restasin. I do feel like my eyes are stabilizing a bit but I won't get my hopes up given how my expectations have been set for a 3 - 6 month stabilizing timeframe. The ghosting effects seems to be subsiding so already this is a plus. I'm able to stay in front of a computer for 10 -12 hours a day with no problem but mainly b/c the new drops really help. I look forward to the weekends because of the break away from the computer. Sports are great because I'm able to see things in higher definition than before. It's a real subtle difference but enough to make me happy that I did PRK. I have another eye exam in two weeks so I'm crossing my fingers that I'm 20/20 and on my way to 20/15.

Oh, my colleague had LASIK two weeks after me. I'm jealous of how easy the vision process has been for him. That said, he's on a regimen of eye drops for several months to ensure no scar tissue builds up where the flap was created on the eye. I guess that is one of the key benefits of PRK. While the recovery process is longer, the skin that is removed in the PRK process grows back.

I'll write again after my next exam. Bottom line, I'm really happy despite some of the side effects and set backs. Freedom from glasses and contacts is a victory in itself.

3 Month Check up

Well folks, sorry it's taken awhile to do an update. My appointment was rescheduled a few times. That said, I had my eyes looked at over the weekend and I'm officially 20/20. Woohoo! 20/20 certainly came sometime in between visits but at least it's official.

I have a slight prescription in one eye but funny enough, it's helping me with my reading. In other words, I was corrected for long distance but I do not struggle with my reading focus (some people choose the monovision correction).

No ghosting, no halos.......the only thing that I put in my eyes is restasis (2 x per day).

So while I'm 3 1/2 months out, I'm hoping that my vision will continue to improve even more. If it does, I'll be sure to write more.

For those that recently had the surgery, be patient. It'll get better!
Dr. Tooma

Great experience with NVISION from start to finish.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
4 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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