PRK vs. Lasik (Follow-up)

Well, I am way overdue for an update to my blog, as well as a follow-up to my earlier PRK vs. Lasik post. I have received several requests for an update, so . . . here it goes:

It has been over eight months since my surgery, and I am happy to report, that my eyeball-modification experience has resulted in two healthy eyeballs. At this point (and I am alternating eyes right now to be sure) I cannot tell any difference between to the two surgeries. Right now my vision is at least 20/20 in each eye. (They have both tested better than that on occasion. I don’t know if my vision is quite as good as it was with glasses before, but it is very close.)

PRK Recovery
Certainly the PRK eye took longer to recover. My theory is I would grow a new layer of cells over my eye at a rate of .333 eyeballs per day. In other words, I would have funky, fuzzy vision for a couple days while a layer of cells was partially covering my eye, distorting everything. Then on the third day angels would trumpet, stars would align (literally), and I would have perfect vision out of that eye. Then the process would start all over the next day.
It seems like after 4 or 5 months I stopped noticing. From that point (and for the remainder of this blog,) my eye experiences were identical.

Typical Complaints

As far as the well-known, long-term complications go:

Eye drops: At this point the doctor has instructed me to use eyedrops when my eyes feel like they need it. Right now I have a whole box of eyedrops in my medicine cabinet. Once a week or so (usually right when I wake up), my eyes feel dry. One drop is all it takes and my eyes feel instantly better. Not too bad. You get used applying them, but I am still not to the point where I can flip a drop up and catch it in my eye. Maybe someday. However, that will probably be more worthy of YouTube than Blogger.

Halos at night: Certainly, street lights at night do have a bit of a halo around them. I have to be looking for them to notice. It’s usually not too bad, and tends to go away when I wash the car’s windshield. (Maybe I should wash the car more often ;^)

Tired eyes: I will periodically get together with the guys and we will play games until sunrise or wifetext, whichever happens first. The next day my eyes will be sore. Once I even had some funky throbbing migraine-like sensation that had me a bit freaked out. (Headaches of any sort, especially migraines are pretty foreign to me.) Usually an eyedrop and a nap is all I need.

My personal reservations

Of course, beyond the well know complications, I had my own set of neurotic phobias:

Not being able to cry: Believe it or not, I was really nervous that my ability to cry would be damaged. I had heard horror stories of extreme dry eyes. Fortunately, that is not me. It was at my daughter’s baptism that I realized my eyes could still produce moisture at appropriate moments. Of course, that realization made me cry. Oh, and the baptism was nice too ;^)

Accidentally ripping my corneas off: I have always been something of an eyeball rubber. (By that I mean someone who rubs their eyes, not protection from pornography-based STD’s). I was really nervous that within a few weeks of my surgery I would reenact some Greek tragedy; I’d find myself blind and screaming holding my corneas in clenched fists. Good news: I am still an eyeball rubber. (Stop laughing, you sicko.) I would certainly recommend taking your doctor’s advice in this area, but I have found it is possible to scratch an itch without filing for disability.

Surprise Complications

There is bad news too. There are a few problems that I did not expect. Anyone considering eye surgery should become aware these less known complications:

Looking less intelligent: I was asking my oldest who the smartest kid in his class was. Then I asked how he knew. “Well, he wears glasses.” Of course, when he saw my expression he back-pedaled: “Don’t worry dad, I know you are smart because you used to wear glasses.” Of course Kristin is more subtle, but the point is clear: “I think without glasses you look tough.” Too me “Tough” = “Brawny” = “Thug” = “Barbarian” = “Caveman” = “Barely comprehensible missing link.” Maybe that is a bit of a slippery slope, but the sentiment is there.

Destroying Sunglasses: One thing Lasik give you is a new appreciation for the exciting world of sunglasses. Of course, the problem with sunglasses is that you take them on an off constantly. Glasses you put on in the morning and take them off at night. You put on sunglasses and sip cool beverages, then pull them off for dramatic CSI moments. Your kids try them on, you set them next to the sink, they flip out of your pocket every time you reach for your cell, or fall out of your coat when you get out of the car. Suffice it to say, destroying sunglasses is an expensive hobby. I have gone through at least 3 pair in the last 8 months. Perhaps I should just take up Kefi -- better return on investment.

Power tools: Glasses give you a bold sense of invulnerability when it comes to power tools. Where others stop and timidly put on protective goggles, the glassed (like blessed, but for those with glasses) power up and jump in. (Note: Even the glassed really ought to be wearing eye protection.) There have been many times when something will bounce off my glasses, and I would just smile. Prepare to feel naked all the time. I am seriously considering getting a welding helmet for the next time we light sparklers.

Art: Surprisingly, corrected vision has made art more complicated--but for entirely different reasons. To me, art (like statistics) is an act of information reduction. You are looking for patterns and picking out what is important. In the past, I would tend to take my glasses off when I started a project, so I could focus on big shapes without being distracted by details. I don’t have that luxury any more. In order to compensate, I find myself squinting more, to reduce the information I am trying to recreate. Squinting for any length of time not only leads to wrinkles and headaches, but awkward conversations with passersby who feel compelled to state “You ought to get your vision checked.” I even tried wearing my old glasses to over correct my vision, but that didn’t work nearly as well as it sounds like it should. Still, someone should invent “uncorrective lenses.”

Overall, I think the investment was well worth it. Now I can start thinking about what genetic flaw I will be outwitting with corrective surgery next. Hmmm, hair-transplant surgery, liposuction, adamantine skeletal reinforcement, Bluetooth dentures: the possibilities are endless.

PRK vs. Lasik

Four weeks ago I participated in the modern miracle that is laser eye-correction surgery. My perspective is somewhat unusual however, "seeing" (HAH!) as how I participated in a research study conducted at local medical school. My left eye received PRK treatment, and my right Custom Lasik. This gives me the ability---nay, the solemn responsibility---to educate inquisitive eyeball-modification aspirants in their choice.

The Choices

PRK stands for Post-Rectal Knitting. The "post-rectal" area--the area exactly opposite your bum, is, of course, your eye. The term original comes from the concept of getting to your eyeball via your back-pocket (i.e., wallet.) Even at a dramatic guinea pig discount, the surgery isn't cheap. "Knitting" refers to the size of the needle they stick in your eye to hold your eyelid open. More about that later . . .

Lasik is just a friendlier term for "Set your phasers on disintegrate." If they called it Laser, you would immediately think about all those warnings they have on those little Laser-pointers that very clearly say "DON'T SHINE THIS IN YOUR EYE!!!". You might at that point have second thoughts when you see the surgical table with the gigantic James-Bond-Villain-style laser pointed at one end. You see, this isn't a Laser, per se, it's a Lasik--it's like a cute, fuzzy Pokémon character, only the "Poké" is in your eye.

Pre-surgery

I had two evaluations before the surgery. Each one consisted of long explanations of what was going to happen, plenty of 70's sci-fi props, the ritualistic reading of letters from across the room, and opportunities to back out. If you look closely in the eyes of your nurses, you can sometimes catch a glimpse of their panicked and pleading fear--their desperate yearning to scream "Run! Now! Before it is too late! Never look back!", at the same time knowing that their paychecks depend on you not finding out . . .

The Surgery

There is a certain kind of energy that only comes in anticipation of elective surgery. It is kind of like getting to the top of the line of a water slide, but one where you searched the whole water park and couldn't see exactly where the slide emptied into a splash pool, so somewhere deep inside you wonder if it actually does, or if the slide is just slowly filling up with a blockage of dead bodies . . . kind of like that.

As I entered the surgery room, they were testing the laser, which happens to sound exactly like a taser. That was not a soothing sound. ("Don't Lase me bro!") I was laid down on the surgery table, given a teddy bear to hold, and placed under a suspiciously warm blanket. I snickered to myself at the thought of needing a teddy bear, until I noticed the bare spots where fur had been pulled out by the handful. Nice.

For a moment I reflected on that disturbing scene in Flash Gordon where a Lasik surgery gone awry reduces the doctor to a pre-zygotic vegetable. (I find it very help to reflect on movies during surgery--it helps lighten the mood. For example, during your wife's C-Section, it is helpful to discuss the disemboweling scene from Braveheart, or perhaps the "birth"-scene from the movie Alien. She'll think you're hilarious, I promise.)

The real differences between the procedures is in the preliminary work on our eyeball:

In Lasik a gigantic suction cup is attached to your eyeball. I am not sure of the details of this part because my conscious mind has not yet come to terms with the fact that it actually happened. My wife warned me going in that the procedure may trigger suppressed memories of alien abduction (as per "Fire in the Sky.") What I think is much more likely, however, is if I am ever abducted by aliens, it will trigger suppressed memories of Lasik surgery. I remember I had the uncontrollable urge to clamp my eye shut, as if I was hanging from a trapeze holding on with nothing but my eyelid. For all I know, they suctioned my eyeball out completely and were passing it around the room to be polished on someone's shirt sleeve.

PRK is a more subtle procedure. The doctor just splashes some kind of acid jelly in your eye, then after a few minutes of sizzling, uses a miniature garden hoe to scrap of the top layer of your cornea. This sounds painful, but feels like you are walking on the moon now that the suction cup is off the other eye . . .

Then comes the Tasering . . . I didn't feel a thing. I had been warned about the smell of boiling eyeball juice before, so I held my breath. It lasted eight seconds for each eye. By "eight seconds" I mean, eight 30-minute periods of intense trying to focus on an orange light that I couldn't see because the top of my eyeballs were missing, without moving. Somewhere deep down I was absolutely certain that Utah's way overdue earthquake was going to hit any second.

PRK has one additional step that you skip in Lasik---the Waterboarding. They wash the gel out of your eye using ice water. It sounds innocent enough, certainly not as bad as Acid gel, but trust me on this point--it is much, much worse. According to my memory (and let me remind you I think there are some things my memory may still be repressing), this is the worst part of the surgery. Imagine an ice-cream headache, but rather than it coming on gradually, you surrendered control of the spoon and have ice-cream injected intravenously directly to that spot on your forehead. On top of that, and very unexpectedly, I couldn't breathe. I completely sympathise with how horrifying Waterboarding must be, because for those 30 seconds cold water was being poured on my eye, I had to frantically persuade my body that I was not actually drowning. That is not a sensation I am anxious to repeat.

After the surgery, you are still flat on your back, clenching a couple handfuls of teddybear fur. Eyeballs still pried open. Doctors engaged in some casual conversation about local restaurants, while they wander the room taking turns dropping chemicals in your eyes. I think they just opened the doors and let anyone in the waiting room come in a drop anything they want into my eyes---there was an awful lot of chatting and dripping going on.

From there it is easy, just a few minutes of sitting with your eyes closed, while seductive-voiced females give you instructions for eye-care. (It was actually impossible to avoid sneaking a peek at the distinctive sound of unzipping---as she placed my eyedrops into a little zippered bag.)

The Recovery

Four weeks later, recovery has been fairly easy. A couple trips to the doctor, a couple of nights with ridiculous looking eye shields, that somehow find their way under the bed in the middle of the night, developing a knack for putting in eye-drops, nothing too exciting. It really wasn't nearly as difficult as I imagined to not rub your eyes. (Before surgery, just thinking about not being able to rub my eyes made them itch.)

My PRK eye is still pretty fuzzy, at my last check up it was 20/50. My Lasik eye is 20/15. Rumor has it that these next couple of weeks should be magic for that PRK eye however.

My Recommendation

Based on my experience, I think I would recommend Lasik to most people--it is hard to beat that almost instantaneous recovery time. It does have some worst-case scenario drawbacks, like the fact that your eyeballs might explode if you are in a plane that looses pressure, or a punch to the face might dislodge your eye flap. In either case, your probably have bigger problems to deal with anyway . . .

The recovery with PRK is slow enough that if both eyes received that treatment, I would be effectively incapacitated. I would have to be waited on hand and foot, I wouldn't be able to drive, or cook, or clean. I would just need someone to kowtow to my every whim . . . for weeks . . . hmmm.
PRK. Definitely. Go with PRK.

(Follow-up posted 2/6/09)