Zap! Perfect vision.
That’s what I’d thought would happen. Instead, I’m biding my time in recovery for 11 weeks since my PRK (photorefractive keratectomy) laser eye surgery.
Up until college I had “okay” vision. Then, all of a sudden, I couldn’t read the overheads. (Overheads – now I’m dating myself!) Since then, and for a couple of decades, I’ve been a 20-40 near-sighted fellow.
What My PRK Procedure Was Like
The procedure itself is pretty quick and pain-free. It took no more than 2 or 3 minutes per eye. Most of that time was ablating the surface to prepare for the laser. Everything is numbed up quite well.
Then the laser itself is a mere 2-3 seconds. Granted, if your vision is -5 to -10, the laser could take up to 10 seconds! Still, all you’re looking at is a blurry green halo, all the while.
I noticed the faint smell of burning tissue but it was no worse than that smell when you get a cavity filled at the dentist. If you can get past this and the sensation (albeit numb) of the surface of your eye being scraped off, you’re good to go…
I was pretty amazed at how well I could see coming out of the “operating” room. From that point until about day 6 or 7, the main discomfort was the sensation of having a grain of sand or eyelash stuck in my eye.
I could even drive if I had to. But you need someone to accompany you and drive you home after the procedure.
My PRK Recovery Timeline, Part 1
The first 24-48 hours after the procedure weren’t that rough, truth be told. I could see 20/20 from both eyes. The reason? Very little of my ablated cornea had grown back in yet.
When it does, the new epithelial layer grows back in a crystalline pattern to protect the cornea. After five or six days this process should be complete.
The grueling part is the latter half of day 2 and all of day 3 when your eyelids don’t want to stay open.
Day 3 sucked eggs. This is when the brunt of the procedure hit me. I couldn’t keep my eyelids open, so I stayed in bed much of the day, listening to a symphony of pounding as the roofers went to town nailing down new shingles above me.
Funny, since Day 3 was the day my eye doc said I’d be ready to return to work. Ha!
At least the contact lens bandages came off as planned by day 6. (Don’t worry – they’re completely transparent. These bandages won’t affect your vision. The re-growing epithelial layer WILL.)
My advice? Give yourself the day of the procedure off. Try to work a half-day the first half of day 2, keep day 3 blocked on your work calendar, and attempt a half day again on day 4. Granted, everyone’s experience is somewhat unique.
Just be sure to plan with your boss and have a back-up host manage your Airbnb for a few days. You’ll need to rest your eyes a decent amount on days 2, 3, and 4. By day 5, you are functioning pretty much back to normal.
Why I Chose PRK Over LASIK
When it comes to refractive surgeries, PRK is similar to LASIK. With the latter, a flap is made on the surface of your eye, pulled back, and the laser does its magic. You generally have your corrected vision fully within 24-48 hours.
PRK is different. The surface of the eye is ablated (scraped away, in medical terms), then the laser zaps the eye, then you get a big clear contact lens bandage applied. In anywhere from a month to six months, you get your perfect vision.
So why in the world would anyone want to subject themselves to such a long recovery, and a semi-grueling 3-5 days of post-operative suffering? There are a couple of things I learned in my research comparing PRK (ablate and suffer) with LASIK (flap and done!):
- PRK does not create a flap. The flap created with LASIK can come loose if knocked by an elbow of a small child or MMA fighter. Or a twig recoiled by the inconsiderate hiker in front of you. Sadly, with LASIK that flap never fully heals. So you need to be mindful of that if you’re an active sort, or like me, paranoid.
- PRK does not cause dry eyes to nearly the same degree as LASIK. I have mild dry eyes in wintertime. No need to make that problem worse.
- PRK is the procedure of choice by the U.S. Air Force. Top Gun. Tom Cruise. You know the outfit. Wait – whoops, that’s the Navy. Still, when pilots are opting to go with PRK for the two reasons above, plus anecdotal evidence of the reduced long-term need for further correction vs. LASIK, I will sign up for THAT.
Of course, the downsides of PRK vs. LASIK are the crappy first few days of post-op recovery (it’s just uncomfortable, not painful at all) and having to wait up to six months (in some cases) for the eyes to stabilize.
Compare it like this: PRK recovery is a long, up and down, cross-country train ride.
While LASIK recovery is a quick non-stop flight. Well, all-aboard the long-haul PRK express for me!
Laser Eye Correction Is a Good Investment
The return on that investment is limited only by your age. The older you get, the less viable the procedure is, particularly if you expect to have cataract surgery in your 70s or 80s. In that case, voila – new lenses!
Bear in mind, that I didn’t go through with this procedure to save money. If the opportunity cost were flipped, I’d still go through with it.
Why? I hate eyeglasses. Just not a big fan. Fumbling between regular glasses and sunglasses is a pain in the butt. Keeping lenses clean is a pain in the butt. Biking in cold, winter weather when you want a muffler over your face? Can’t do it – fogs up your glasses.
Shall I keep going? Okay. Driving. Ever go on a long road trip and find that the bridge of your nose is sore? Yeah. Wearing annoying eyeglasses too long. Want to go for a quick run and see well, without wearing dorky glasses? Check.
Squinting to death while trying to follow the action at an over-priced sports event? Sigh…
Maybe the reason I enjoyed getting to the movie theater so much as it was the first time I’d seen a flick without glasses. There have been a few times I’d forgotten my specs at a restaurant or even had them broken in a polka mosh-pit (long story).
You get the idea. Glasses suck. And to think I had a pair of fake glasses in high school to look cool. Sigh…
What Is the Cost of PRK?
The upfront cost of the procedure in my case was almost $4,000. Gulp.
That includes the procedure and the bevy of prescription eye drops you need to use for three months of recovery after the procedure. I paid with my new Chase Ink Business Preferred card. Those 35,000 airline bonus miles take away some of the wallet pain.
I then reimbursed myself with the good old HSA. All said and done, that $4,000 came out to $2,330 (reduced 33% for HSA as it’s pre-tax, and $350 for the cash value of the miles).
The question is, does that $2,330 help me avoid paying for new glasses every four years or so? In the past, I’d sometimes just swap out lenses if the frames weren’t too out of fashion. Let’s make the argument that every five years I have to fork over about $700 for new eyeglasses and sunglasses (after taking into account HSA savings).
PRK one-time true cost: $2,330
Ongoing: Readers and Cheap Sunglasses every 5 years: $200 ($40 per year) – not using HSA for these nominal costs.
Rx Transition Lenses and Rx Sunglasses every 5 years: $700 – factoring in HSA “discount”
Plus, let’s not forget Rx Contact Lenses (disposable) for misc. armchair athletics: $300 – Reduced by HSA as well
In summary, I could fork over a big chunk now and only have to worry about nominal eye-wear costs going forward, or, continue to have to reload on corrective eyeglasses roughly every five years.
Here’s what I give up in a 20-year index fund investing at 7% inflation-adjusted returns, by investing instead in PRK:
PRK plus ongoing eyeglasses / contacts: $10,771
Continue with full Rx eyeglasses / contacts: $12,643
I chose a 20-year cut-off since I might need lens replacement by then if cataracts strike. It’s a win-win situation at that point since you get perfect vision with those new lenses implanted. Or, maybe I’ll luck out and never have to worry about it. I do like being in the sun though…
Will I Need Reading Glasses?
Every month I go back to the eye doc to see how things are shaping up. The left eye continues to be the winner in the race, giving me 20/20 distance clarity. The right eye has improved from month 1 where I had a correction of -2.0, to month 2, where I improved to -1.0. Things get doubled/blurry after about 10 feet of distance.
There’s a concept called “monovision” that I’m experiencing at this stage. I can read up close just fine, thanks to my still myopic right eye, and I can take in distances pretty well too, thanks to a strong left eye.
Some folks opt to correct just one eye so they can avoid readers, while still maintaining distance vision. This assumes you can put off the inevitability of presbyopia in that nearsighted eye.
And that brings us to a downside of corrective laser eye surgery in general, PRK or LASIK, doesn’t matter: You’ll need to start wearing those lovely readers years sooner than you would otherwise.
That’s right. Bring on those readers! Wahhhhh!!! My eye doc says in general, you might need readers a good 5-10 years sooner than you otherwise would have, because you’ve made your eyes so strongly far-sight biased. This is the main reason I held off on getting corrective eye surgery back in my late 30s.
So now we’ll see how long it’ll be before I have to pick up those cheap reader specs at Walgreen’s just to read a book. I’m hoping to squeeze another four or five years out of these eyeballs before that’s needed.
Does Corrective Eye Surgery Cause Inflammation?
I had the advantage of being familiar with my surgeon prior to pursuing corrective vision. As an ophthalmologist, he provided care with my recurring bouts of iritis (anterior uveitis).
I have had a couple of mild flares since my PRK procedure, but each time after a few weeks of Durezol steroid drops, I’m back to near-perfect vision. I’ve observed that gluten (and stress) contribute to my flare-ups… I wonder if Mila Kunis has gone gluten-free?
Other Out of Pocket Expenses With PRK
Make sure you have decent Rx coverage because certain newer drops like Lotemax (another steroid that is required for all patients after a procedure) ain’t cheap. Fortunately, my eye doc keeps a stash of coupons which lowered my out-of-pocket cost to $60 a bottle.
Want to know how many little bottles of eye drops you go through, post-recovery? At least 5. The procedure was $3,700, and drops alone were $300. HSA dollars help a LOT.
My PRK Recovery Timeline, Part 2
For the past four-plus months since the procedure in late April, my left eye has carried the load with 20/20 clarity.
But my right eye has been a laggard, taking its sweet time to heal from 20/30 to barely 20/20 four months on. Here’s the rest of the saga…
Many of the accounts I’ve read online are similar to my experience. PRK recovery duration varies a LOT, person to person. My wife had PRK done last fall with a -10 correction. And yet it only took about 8 weeks for her to reach 20/15 in both eyes. I’m nowhere near that recovery speed.
Some patients take up to six months, or even longer, to reach 20/15. And sometimes it’s not gradual at all. You just wake up and suddenly your eyesight is perfect. I’m hoping to experience some perfection soon since my right eye is still stuck at 20/30.
Late July 2018: Three months post-surgery update: My eyes seem to have regressed over the past week. At my check-up, I needed some powerful refraction to see the charts. I managed 20/30 in my “good” left eye, and 20/50 in my right!
This after being about 20/20 on the left and 20/30 on the right for the better part of the first couple of months post-op. My eye doc says that if you’re not “there” by month three, then a touch-up is usually in the cards. So I set up a time for November to get it done just before Thanksgiving. The question is, will I have both eyes touched up, or just the, right?
The good news is that my doc will cover the cost of the procedure (not unusual), but also the facility cost which is just north of $700. Nice!
Early September 2018: Four-plus months post-surgery update: Some minor improvements. I wonder if being in Colorado with higher elevations had anything to do with that last dip in clarity at month 3, or was it simply getting off the steroid drops at that same time? Regardless, my left eye is back to 20/20 and shockingly, my right is technically 20/20 as well.
It’s interesting to have both eyes at 20/20 since my right is still not quite as strong as the left at this point. I’m still hoping to eventually get to 20/15 in both eyes. If I can get there with the left, and improve the 20/20 on my right, I may just opt out of that touch-up procedure in November. Riding my bike, driving, and watching TV for an hour at night are just peachy. I can read the very fine print on the TV with the right eye which is nice.
At this point, the touch-up in November is up for grabs. My doc would like to avoid doing anything while my eyes are still changing. Makes sense. Overall, I’d say my vision is 50% improved from before the procedure. I went in at -1.5 and am now at -1.0 and -0.75. My up-close vision is holding on fine with computer work and reading, but I have some days where at least in the morning, it’s tough to focus. Readers could be on the horizon…
Late October 2018: Six months after the procedure: I had yet another check-in visit with my eye doc. Interestingly, I had a harder time this time reading the eye chart than I did in early September. But, the refraction test (when they correct your vision with the big fancy View-Master) was an improvement over early September. WTF??
Sure enough, my brain had begun to subconsciously memorize the eye chart. Even though I couldn’t make out the syntax to save my life on the 20-20 line, I had seen the sequence so many times before, that the pattern had stuck in my head. So I asked the tech to give me a new random set. And hence, I did worse this time: 20-25, vs. 20-20 (supposedly) the previous month.
The good news? The refraction part is the test that shows how powerful a prescription you need for 20-15 vision. I’m now -0.75 and -0.50, an improvement of 0.25 in both eyes! I guess for some of us, you need to be patient and give your eyes time to adjust and heal. Not everyone who gets PRK will get to 20-20 or 20-15 within three months. Some of us poor saps can take six months or even a full year!
I’m glad I’ve held off on getting a touch-up, and my eye doc agrees. I can see well enough now that I’ll hold off from getting a touch-up at least until early spring 2019, if at all. Let’s see how our check-in in mid-December goes. Fingers (and eyes?) crossed!
Early March 2019: Roughly ten months after the procedure: Good news and bad news this check-in. The bad news first – I had another iritis (uveitis) flare-up in my right eye. Not a huge deal and this is nothing related to the PRK procedure since I had this eye condition beforehand.
Even though I got the flare quickly under control with the drops, the drops themselves cause your vision to lose a touch of clarity.
So the right eye came in worse this time, at 20/30. The good news?? My left eye (unaffected by the iritis) scored 20/15 on the refraction test! Yippee!!! So, it took roughly 9 to 10 months for the PRK Train to finally reach its destination in that eye.
The other good news? A week after the eye doc check-in, about two weeks after the iritis abated and I was off the drops, my right eye has bounced back nicely. I think it’s 20/20! We’ll get the certified results after my next check-up in late April, exactly one-year post-procedure.
Late April 2019: The 12-Month Mark! And after a full year of PRK recovery, what do we get? 20/20 in BOTH eyes! I’m probably close to 20/15 in both eyes now. I never would’ve thought I’d get there after such a long journey. My right eye consistently lagged at 20/40, 20/30, 20/25, and finally, 20/20.
Only at month 11 did I start to recognize how clear my vision had become during drives home after work. We’ll see if there’s any future change, but assuming I’ve “locked in”, I’m very happy to have finally crossed the finish line.
August 2019: Good grief. Another bout of inflammation in the right eye in July. My vision is struggling to get back to 20/20 a good three weeks after getting off Durezol. Maybe 20/30? Time to visit the eye doc!
March 2020: After finding that gluten causes my iritis I’ve given up on craft beer. Ouch! But there are plenty of decent GF brews out there, and I’m okay with cocktails too, so I don’t miss the beer much at all.
As for my vision? I’d say things have stabilized to the point that I’m incredibly happy with my PRK outcome. I don’t even notice the superficial difference between my clear 20/20 left eye and fuzzy 20/20 in the right. How often do we go about life with one eye closed, anyhow??
2021-2022: 20/15 in both eyes! I think I got here without even realizing it. That’s how discrete the difference is between 20/20 and 20/15. The cool thing about writing a blog is I can share my experience and hopefully help others make informed decisions.
Seeing is believing!
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