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DPChallenge Forums >> General Discussion >> Lasik or PRK surgery?
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12/27/2007 10:05:06 AM · #1
I have been told I am a better candidate for PRK rather than straight Lasik and was wondering if anyone else has had this done and what their experience/outcome was.
My surgery is scheduled for Jan. 22. Wanted to know the pain levels, and overall healing experience for the first week post-op.
12/27/2007 11:00:24 AM · #2
I'm act as the LASIK/PRK coordinator for a large ophthalmology group in SC. Been doin' it for nearly 10 years. Feel free to PM me with specific questions, but overall...

LASIK:
2-step procedure with creation of corneal "flap" of tissue with laser applied to underlying tissue.

Pros: Very rapid visual recovery, little or no pain, great results.

Cons: More corneal tissue is required. Patients with thin corneas may not be candidates. More risk associated with potential "flap" complications (they are rare, but happen)

PRK:
Epithelium is removed and laser treatment is applied to front surface of cornea. Also can be known as "surface treatment".

Pros: Less corneal tissue is required so patients with thin corneas or possible underlying subclinical corneal disease may have this instead of LASIK. Since there is no "flap", there is no possibility of a flap complication. Little discomfort, great results.

Cons: Longer visual recovery than LASIK and more discomfort. New advances in bandage contact lens technology have greatly reduced the discomfort issue and most patients report slight scratchy or burning sensation after surgery, but nothing serious enough to impair their ability to do normal every day activities.

This was a quick overview as I'm about to go into surgery and assist on several LASIK and PRK procedures. I'll be happy to discuss any specific issues/questions you may have later this evening when I finish up. Hope this helps.

Message edited by author 2007-12-27 11:00:50.
12/27/2007 11:26:22 AM · #3
Lee,

Thanks for those great highlights. I was told I have adequate corneal thickness, but I also have alot of corneal erosion from long term hard lens wear/oxygen deprivation. My topography showed alot of 'red' spots which I am assuming is where the damage is. I have a few dry spots in those areas also, so I am guessing this is why PRK was suggested to me as the best option. About how long till the vision is determined to be 'at its full best'?
12/27/2007 11:39:50 AM · #4
Yep... sounds like PRK is the way to go. Sometimes people with subclinical dystrophies, erosion, and/or scarring are NOT good candidates for LASIK for a number of reasons. In the case of dystrophy and or erosion, when you create flap, sometimes the epithelium will just "fall off" anyway and you'll experience longer recovery than even PRK because you have to heal the flap AND the missing epithelium. In the case of scarring, the corneal surface is irregular (as shown by the "red spots" on your topography). Since you're not working with a smooth surface, the chance of having a flap complication goes up pretty dramatically. Trust me, you do NOT want a flap complication, they can be tricky to treat during post-operative management and in some cases can have permanent visual consequences (depending on the type of complication). Sounds like PRK is a good recommendation for you and you should trust your surgeon (assuming you have a good one). Visual recovery varies from patient to patient. Males under the age of 30 heal the fastest, Females over the age of 40-50 heal the slowest. This is mainly a factor of the eyes diminishing ability to produce natural tears as you age and it affects women more so than men. Post menopausal women have the toughest time with it. With that said, you're still looking at anywhere from 3 days to a couple of weeks for full visual recovery. Typically you'll have functional vision within a few days after your surgery (some patients even the next day). You'll probably have to wear a bandage contact for several days after your surgery to assist with the healing process as well as keep your eye comfortable. It typically takes the epithelium 2 or 3 days to regenerate and after that, vision is fairly stable.
12/27/2007 12:44:30 PM · #5
Thanks for sharing your wisdom with me. I feel better about the PRK after hearing what you have said. I am 42, but have already noticed some dry eye which is what led me to come out of my Gas Perms recently. They have me on Optive eye drops 3x a day right now. Not sure if it is helping though.
12/27/2007 06:52:11 PM · #6
Originally posted by CalliopeKel:

Thanks for sharing your wisdom with me. I feel better about the PRK after hearing what you have said. I am 42, but have already noticed some dry eye which is what led me to come out of my Gas Perms recently. They have me on Optive eye drops 3x a day right now. Not sure if it is helping though.


That's one of the most common reasons we see patients interested in refractive surgery. You may want to ask if Restasis is an option for you. We prescribe to pretty much every female over 40 prior to and just after refractive surgery.
12/27/2007 07:24:20 PM · #7
I had PRK done two years ago. (Thank you to all of you for paying for it!)

The healing process is much worse than that of Lasik. However it was the Dr.'s recommendation to do PRK as opposed to Lasik, but they had technology that you probably don't have access to.

You hear ads for custom Lasik. This is th emost cutting edge Lasik out there. Instead of just taking your prescription and mapping your cornea to fix it, they actually bounce light rays inside of your eye and the machine measures the reflections off of the retina to map your cornea. This is the most accurate way of reshaping the cornea. With the Lasik they then cut the flap, reshape the cornea, put the flap back down and hope the flap heals. Now if you receive an injury to the eye, such as a ball hits it, or you get in a fight, or your dog jumps up and smacks you in the eye you can upset that flap (which is why they siad go with PRK).

Now since Uncle Sam has the money you all gave them the Laser Center at Wilford Hall Medical Center is the test bed for custom PRK. They did the same procedure as custom lasik up to cutting the flap. They measured the light rays off my retina, mapped my cornea and went from there.

Now here is where it got wierd.

The put me in my chair, and they got out a brush that reminded me of the electrric toothbrush that I used this morning. They scrubbed my eye with this brush to get rid of some of the epid*****, then they took a brush like we use to wipe off our camera lens to wipe away the cells that the first brush disrupted. Then the laser started shaping my cornea, and ebfore I knew it, it was done. They poured ice cold water on the eye which gave me the sensation that I was drowning. When you see the debate over waterboarding, trust me, it has the effect to make you think you are drowning. It is wicked. So then they moved to the other eye and repeated. Now, the worst part of the experience in my book was the contraption used to hold your eye lid open. I felt like I had four pins sitting in my eye.

Ok, so the lasers are done, I am done being waterboarded, and they tell me to sit up and look across the room and tell them what time it is. Wow, I can see!

Now as I walk out the door of the hospitol, my eyes are ultra sensitive to sunlight. Before you do this make sure you own a QUALITY pair of sunglasses. I don't mean the 50 dollar pairs and Sunglass Hut, get something with quality!

Healing. I spent a week total in San Antonio doing this. The day of the surgery I take my Systine capsules and put them in the fridge. This was important. I then put the steroid drops in my eyes and go to bed. I woke up a couple of hours later and used that cold Systine to make my eyes feel better. The first day was not bad. The second day I was in pain. It was very aggrevating. I couldn't see well and my eyes burned. This is why people love Lasik, you odn't have this sensation, you just wear bandage contacts. A day later i was in Houston watching a football game. I couldn't see perfectly but the eyes were doing better.

Another day and I was cleared to drive and so I drove 14 hours home to Missouri. Not the smartest thing I could have done. I had to continually put rewetting drops in my eyes because they were dry.

2 years later I have 20-15 vision in both eyes. I havne't had to wear glasses or contacts since and I am very happy about that. I stillprotect my eyes from sunlight with the sunglasses, and you should continue to do so. My first year I had a 'waiver' that entitled me to wear sunglasses even when I was in a formation (Most of the time we can't do this).

I wouldn't change a thing though.

Before you do this, check to see if Custom PRK is available.
01/04/2008 12:39:36 PM · #8
I had LASIK done 7 years ago and I'm still seeing 20/20 or better. My plan includes lifetime enhancements (no cost) but the doc said that he would do PRK on me if I needed an update because it's preferable to pulling up the original corneal flap.
01/04/2008 12:57:17 PM · #9
I've been curious about getting corneal work done.

How does LASIK or PRK affect ones ability to dive? In other words, are there any precautions to take due to the pressures experienced diving or snorkeling after getting corneal work done?

What are the costs of the procedures these days?

(ACK! So many questions want to come out all at once!)
01/07/2008 11:26:24 AM · #10
Originally posted by _eug:

I've been curious about getting corneal work done.

How does LASIK or PRK affect ones ability to dive? In other words, are there any precautions to take due to the pressures experienced diving or snorkeling after getting corneal work done?

What are the costs of the procedures these days?

(ACK! So many questions want to come out all at once!)

I can't say from experience, but I can't imagine there would be any concerns about diving (aside from not going swimming in general for 6-8 weeks post-op in the case of LASIK, and PRK might be less since there's no flap).

My LASIK was $2200 for both eyes in 2001 after 5% insurance discount and including lifetime free enhancements if my vision falls below 20/40. It varies depending on your prescription, pupil size, and other factors -- mine was one of the more expensive options at the time. However, from hearing others talk about having it done more recently, it seems as though it has gotten more expensive rather than less (but again, I don't know the specifics about their eyes).
01/07/2008 11:36:22 AM · #11
i've been vaguely considering getting this done, but have always wondered about the longterm effects on my eyes. is colour perception affected? i'm mean - i'm a photographer and painter - should i mess with the eyes??? what about the inevitable changing of your eyes as you age? will one need stronger reading glasses (i notice i'm beginning to feel the book's a little close now...)? i too have basically stopped wearing contacts - 6 years in africa and eye infections seem to have made my eyes very sensitive indeed. the dr. said i was allergic to my own mucus. eeeewww.
01/07/2008 12:33:19 PM · #12
Originally posted by xianart:

i've been vaguely considering getting this done, but have always wondered about the longterm effects on my eyes. is colour perception affected? i'm mean - i'm a photographer and painter - should i mess with the eyes???

This was exactly my concern. I very seriously considered getting Lasik done. I went for the pre-surgery analysis and consultation, and then did more research. I decided against it for two reasons: 1. I asked the consultant, who had had the procedure, if I could expect problems with "haloes". He said it wouldn't necessarily be a problem because I'd "get used to it". He looked around at the lights in the clinic and said, "I can see haloes now, but I don't really notice them unless I look for them." I considered that an honest answer and it helped me a great deal. 2. The horror stories I read about were indeed horrible, even if negative results were very rare (only 3% of people report permanent complications, and only 0.5% report extremely serious complications). In the end, for myself, I decided even the minimal risk wasn't worth it for someone like me.
01/07/2008 01:00:05 PM · #13
I saw halos before my LASIK, especially with contacts in, so the minor amount of haloing that was there (new or remaining, I'm not sure) after my procedure was not an issue for me. Yes, 7 years later there is still haloing (I understand that it diminishes entirely in most people) but like the person Louis talked to, I don't typically notice them (and even then, only on bright points of light at night). Reasonable trade-off for me to have perfect vision without the hassles and on-going expense of glasses and/or contacts. I'm 38 and still have 20/20 vision and no reading glasses (although I know I'll need them eventually either way). No effect on color perception, no distortion, or anything like that -- in fact, I would think that'd be more a problem with glasses or contacts than with LASIK/PRK.
01/07/2008 01:46:54 PM · #14
Complications, glare, halo, loss of contrast sensitivity... all very good questions. The bottom line is that NO procedure can guarantee 100% satisfaction. [user]Louis[/user] gave a very good overview of the risk/benefit analysis that ALL patients should consider.

PRK has less occurrences of permanent long-term side-effects because most permanent complications are a result of a flap complication. PRK... no flap... no flap complication. There have been a few studies that cover loss of contrast sensitivity after LASIK. The result was that there was some slight measurable loss of contrast sensitivity in some patients who had LASIK. Customvue or Wavefront guided procedures greatly reduce this risk due to way the laser resculpts the cornea.

I'm also photographer and do a lot of graphic design and felt the risk was minimal enough that I felt safe having the procedure done. Nearly 10 years later, I'm still 20/15 uncorrected but I do notice some halos around lights at night when driving. Was it worse before my surgery? I'm not sure, I did notice them before I had surgery. Do I notice it now? When I look for it, I do. The price has risen over the years because of new technology being introduced such as wavefront guided procedures and "no-touch" flap creation through the use of femtosecond lasers and other lasers that can be used to create flaps differently than microkeratomes. There has also been an increase in quality as a result in the rising prices. Many "fly by night" laser facilities are now out of business for a variety of reasons. When LASIK and PRK first hit the market, many places offered cut-rate prices and felt that sheer volume would offset the reduced rate. Some of these places were about 1/2 step above meat markets. When you sacrifice price, you must cut corners somewhere... it's simple business economics. Many of those "corners" were using substandard supplies and/or equipment and/or equipment maintenance. In healthcare this is dangerous to patients and in the end ultimately bit these facilities in the butt and they ended up going out of business. It's a safe bet that if you're using a trusted facility that has been doing LASIK and/or PRK for a number of years, there is a reason they are still in business and are still doing LASIK.

Really what it boils down to is you need to do your homework, research the facility, ask to get patient reviews (many facilities will have a list of patients that are willing to discuss their experience with other prospective patients). Ask the questions that have been outlined in this thread and if you think the risk is worth the benefit, go for it. If you want a guarantee that you 100% will not need any type of correction or that you 100% will not have a complication, stay in your glasses and/or contacts and forget about having surgery.
01/07/2008 05:53:44 PM · #15
thanks very much, that's a very useful bit of information there. the best place locally seems to offer PRK, so, hmmm......
01/15/2008 08:49:46 PM · #16
One more week till my procedure. My refraction shows I'm stable -750 and cornea is pretty dern smooth. I gotta admit I'm a little nervous, but going forward with it. I will let yall know how it went and what the pain levels were! LOL

As soon as I can see and type.

Kelly
01/24/2008 12:00:40 PM · #17
2 days post op. Things seem to be going as predicted. Eyes sore as heck, but tolerable. Had Custom PRK. Pretty scary event all things considered. It sure is a miracle though. I am told it will be atleast another 3-5 days till I can see worth a dern.

Weird not having glasses or contacts on!! I can't wait till the healing process is over and the vision starts settling in.

Will update in a few days as I can.

Kelly
01/24/2008 12:15:43 PM · #18
Thanks for the update. I really what to do this sometime this year. Hearing your process is helpful.
01/25/2008 05:42:36 PM · #19
Day 4....off the pain meds. Distance vision sucks right now, but I do have close vision. Optometrist said it will continue to change over the next week especially and probably by months end I will be in a pretty good place although not fully to where I will be in 3 months time. I really have zero pain today. Just sun-light sensitivity.

Will update in a few more days.
01/25/2008 06:10:38 PM · #20
You will have the sunlight senistivity for a while. Makes sure you protect your eyes with good sunglasses and keep up on your vitamin C and steroids. The more you take care of the eyes now the faster they will heal and your good vision will advance.

Originally posted by CalliopeKel:

Day 4....off the pain meds. Distance vision sucks right now, but I do have close vision. Optometrist said it will continue to change over the next week especially and probably by months end I will be in a pretty good place although not fully to where I will be in 3 months time. I really have zero pain today. Just sun-light sensitivity.

Will update in a few more days.

01/25/2008 08:18:59 PM · #21
eye eye sir~ Will do.
01/26/2008 10:27:29 AM · #22
In case anyone is interested, this is who did my surgery.
Woolfson Eye Institute
01/26/2008 07:07:30 PM · #23
Right bandage contact been buggin me all day. They sent me home with a fresh one, so I took the old one off and could feel the sensitivity right away on the cornea. Eek. I hope it aint raw come Monday when they remove them for good.
01/26/2008 08:14:23 PM · #24
Originally posted by CalliopeKel:

Right bandage contact been buggin me all day. They sent me home with a fresh one, so I took the old one off and could feel the sensitivity right away on the cornea. Eek. I hope it aint raw come Monday when they remove them for good.

You have to wear contacts postop? Eek. Not sure I'm gonna like that. How long is that needed?
01/26/2008 08:50:28 PM · #25
3-7 days. It's a soft lens, so after 23 years of hard lens wear it basically feels like a condomn in my eye.That or a roll of Saran Wrap take your pick. The contact is there to keep air off the newly shaped & very raw surgical site. It is needed, trust me.
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