Highly Recommended, with a Prolonged Path to Healing - South Africa

**1. Why did you decide to have corrective eye...

**1. Why did you decide to have corrective eye surgery?**

I was was tired of my glasses.

**2. What was the evaluation like?**

I chose a doctor who super-specialized in corrective eye surgery. He has done thousands of procedures and is experienced. I went through a whole host of tests. The work-up cost about $350 and took several hours. I was subjected to multiple eye testing machines. At the end of the day I had a long consultation with him. I requested SMILE surgery. However, he told me that my corneas are too thin for both SMILE and LASIK, and thus my only option would be PRK. He would perform PRK on my one eye, and the second one two weeks later. He told me that two eyes were possible but that it is severely disabling and you cannot function for days, and maybe longer. I waited 12 weeks for my procedure.

**3. How did you prepare for the procedure?**

I did some reading on PRK and noticed that it was a painful procedure. However, after reading some articles I discovered that the use of omega-3 before the procedure, and possibly cortisone helped healing. I started taking omega-3 (1g daily) a week before and I took 80mg of prednisone on the day of the procedure. I also take 1g of Vitamin C a day as this *may* help with eye recovery too. I was told to eat a good breakfast on the day, wear no deodorant or aftershave, and arrive in normal clothes for my 8:00 appointment.

**4. Describe the procedure**

After paying my right eye's visual acuity was tested again. I was then taken to the operating theater where I lay in a recliner chair with a warm blanket. I was given 10mg of valium to swallow and that made me mellow within minutes. The nurse then added local anesthetic drops to my eye. They burned like hell but after a few times my eye was completely numb and it even spread down to my nose and eyelids. She also cleaned my eye and upper face with iodine. I was given a prescription for eye drops and a packet with some OTC analgesics.

I was taken into the operating suite and I lay on a table. The table swung round and I was under the lazer. The doctor then added an eye retractor and my forehead was draped with adhesive plastic. He told me to focus on the red dot in the middle of the screen, which was surrounded by a halo of white dots. If you suffer from severe anxiety or claustrophobia I think you should mention this. I'm neither but this environment induced both in me. You're basically put right under a massive machine and then covered in plastic. I felt like Darth Vader, and not in a good way.

He then added a small circular device onto my cornea and dropped a cold solution onto it. He then used what looked like an electric toothbrush on my cornea. It felt unpleasant but not painful. I then had to stare at the red dot carefully for about 20 seconds while it zapped my cornea. I smelled a burning smell immediately. Afterwards he washed out my eye with a freezing cold solution. This was the worst part as it spread backwards and gave me severe brain freeze. My pain threshold is high but this was close to unbearable both times. He added a contact lens and eye shield and I went back to the recliner chair. While there I was given an intramuscular codeine injection, and five minutes later I was on my way home. The waiting time was about 90 minutes but the whole procedure took 5 minutes at the most. At home I drank the second valium they gave me, and when the codeine kicked in I fell asleep watching TV and woke up hours later. The eye shield must be removed about that time to start with the constant eye drops.

**5. How was the pain?**

Since I had done so much research on the procedure, I knew that cheap OTC analgesics weren't going to cut it, so I prepared well and dosed myself adequately. I took Arcoxia (a strong anti-inflammatory), Tramadol pills, Pregabalin pills and ketorolac eyedrops. I also had local anaesthetic drops for breakthrough pain. I had to take antibiotic eye drops 4-hourly to prevent the most dangerous complications: infection. Both ketorolac eye drops and local anesthetic eye drops delay healing so I stopped using those on day 4.

The pain started two hours after the procedure when the local drops wore off. It varied between the two procedures and the experiences were different, but at one time I had pain that I would describe as severe. It felt like I had onions in my eyes. I tried to put drops in but I couldn't even open my eyes to do so. I then had to wait for the pain pills to work which took about two hours. The pain lasts 3 days after the day of surgery, and at most times it feels like you have an eyelash in your eye or a grain of sand. At more severe times it feels like a burning pain or a deep eyeball discomfort. My eyes teared a lot. On day 4 you have occasional light pain, and on day 5 there is no pain.

The pain of the procedure is severe - you need opiates and other medications. Simple OTC meds are not enough and it angers me that eye doctors often don't respect that. The nerve intensity and density in your cornea is really unbelievable. It's got to be on the same level as the gag reflex and the genitals. I'm an anesthesiologist and I'm going to write an academic article on this so that it can be addressed (locally at least).

**6. Follow-up and Medication**

On day 4 I returned and they removed the contact lens. It was sensitive and my vision immediately degraded without the lens. He took a picture of my eye and was kind enough to email it to me (see attached). See that line down the middle? Well your cornea grows back from all directions and it collides in the middle and makes a ridge. This ridge takes a few weeks to flatten and go away, but as light strikes it, splitting occurs and this is the origin of ghosting. The fact that it is right over the pupil explains the visual problems we experience. Of course, the new cornea is like a cobblestone street and you need to blink and use tears and over weeks/months it smoothens out and becomes like glass.

I was told to wear sunglasses whenever I went outside because UV makes the new keratinocytes into fibroblasts and this leads to the formation of scar tissue instead of healthy cornea. Also, not swimming or sweat in my eyes for at least 6-weeks. No make-up for women, or men who like make-up. No rubbing your eyes and constant use of natural tears to keep the eyes moist. I was given a petroleum jelly like substance that I had to put into my eyes every night for a week. It obviously makes your vision blurry so that is why you sleep with it. I was also given cortisone eye drops that I have to use for 6 months: 4-hourly for a month, 6-hourly for a month, 8-hourly for a month, 12-hourly for a month and finally once a day for a month. This prevents the formation of scar tissue. The drops run in your tear ducts and into your throat after about 20 minutes and are bitter, but you get used to it. It's a super diluted form of cortisone and apparently doesn't go deeper than the cornea, so there's no chance of side-effects.

**7. Vision**

Anyone who has PRK should not underestimate how disabling it is. I often felt demotivated and the recovery time is LONG. I'm actually really glad that I only had one eye done at a time. I found the eye severely useless for a week, moderately useless for two weeks and useful after about four weeks. The ghosting lasted about a week for me, but my visual acuity came back extremely slowly. You will experience functional blindness for at least a few days and your work will be frustrating for weeks afterwards. I really struggled to put up IV lines on kids, and I also couldn't read the small font on hospital stickers. You'll need to go up way with the font on your electronics. You'll also have light sensitivity for a while. At home I wore sunglasses while using my computer. Also be aware that your vision is heavily dependent on the ambient light. Excuse my French, but at night it really goes to shit. Night driving: avoid! The traffic lights are like stars, the lines are double and everything else is blurred. Daytime driving is okay if you take it easy, but I wouldn't drive for at least five days. You may notice that your visual acuity is not that bad but that the ghosting makes everything double up, and it makes you 'blind'. Also note that your vision is almost 100% on day 1 after the operation - as you have no cornea. This is the 'end result' but it's a glimpse that is quickly robbed from you, so don't get excited.

**8. Ultra-short summary**

PRK is quick, and is followed by a few days of significant pain. The visual recovery time varies between people but it is prolonged. I would have had SMILE if I could, but between LASIK and PRK it is a toss-up. The PRK recovery irritates me but I think I'm used to instant gratification and PRK is about patience and time. The end result is sensational and to never use glasses is a great treat. PRK also requires constant eye drops and medication, and that means 6-months of strict adherence to your doctor's orders. If you can't manage that you could get scarring, and maybe should think of other options.

Hope this helps some people out there. I also hope it doesn't come across as daunting or negative. I think one shouldn't forget how essential eyesight is to one's daily life, and how even mild impairment causes tremendous frustration. I would 100% advise anyone to go for it, but remember it's a long path to good vision after PRK.
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