Those with PRK experience.

How impressed are you all that have had PRK with your vision quality post PRK (after several months of stabilzation and improvement)? How noticeable and annoying are the visual aberrations that come with PRK?

I just want to get some qualititive observations from those that have had PRK. Maybe they will get me off the fence regarding PRK. I still would consider pretty hard to convince. Here's why:

Despite what many claim they experience, you cannot have better vision post PRK than you would have pre-PRK with correction. All types of refractive surgery induce higher order aberrations. Even customized wavefront ablations. The aberrations that wavefront guided ablations induce are just not as severe.

From the Bausch and Lomb website regarding their Zypotix vision correction systems which couples their Zywave aberrometer and their orbscan topographer with their Technolas 217z laser:

Although the ZyWave® Wavefront System measures the refractive error and wavefront aberrations of the human eyes, including myopia, hyperopia, astigmatism, coma, spherical aberration, trefoil, and other higher order aberrations through fifth order, in the clinical study for this PMA, the average higher order aberration did not decrease after Zyoptix Personalized Vision Correction.

The aberrations induced by wavefront PRK are simply not as bad as those induced by traditional PRK. What does this mean?: All refractive surgeries induce aberrations, which can lead to decreased contrast sensitivity (among other things such as haloes, double vision, starbursts), and it is impossible, at least with todays technology, to have better vision with PRK than what you would be able to get with contacts. This is especially true with RGPs, which can decrease higher order aberrations by around 70% (much better than you would get with PRK, which at best is no net gain in aberrations).

You definetely get a reduction in the quality of your vision with PRK. However I can see why the military has been such an enthusiastic adopter of PRK once it was proven as medically safe: It's good enough vision to get the job done (pilots included) and a much preferred alternative to glasses and contacts which can problematic in a combat zone. It's the issue between quantity (Snellen acuity) and quality (how good is you vision, even if it is 20/20).

All these folks who tout how great their vision was after PRK, I think don't remember how good their vision was corrected before PRK, especially with contacts. Especially with bilateral PRK, which is most common right now, you have no reference point to judge you post PRK vision with. With me, for example, if I go without glasses or contacts for a few days, I will oftentimes say to myself, "Hey, my vision isn't so bad...". However the minute I put my contacts in, it's "WOW! What a difference!"

I am hoping that the Coast Guard will adopt the Navy's new SNA contact lens policy. Granted, it usually takes the Coast Guard a few years before they will adopt Navy policy, so I probably shouldn't be too optomistic that the Coast Guard will have this policy in the books in time for my second tour about 3-3 1/2 years from now.

To all those who have had PRK, how happy are you with your vision?

On the results of clinical studies which show that PRK, whether traditional or wavefront, induces higher order aberrations. The laser isn't perfect. Go to any laser manufacturer's website and you will see a similar statement in the fine print. Remember that 20/15 isn't neccesarily better than 20/20, and that having 20/20 isn't neccesarily good vision. There are many who claim that despite having 20/20 or better Snellen acuity after PRK, their vision is not as sharp and crisp as it was with corrective lenses, particularly contacts.

To those who have been under the laser: How is your night vision. And how pleasant is your vision in low contrast situations. Don't give me this Snellen 20/x stuff, which really tells you little about your vision. Has anybody taken a contrast sensitivity test?

Its sounds like you have made your decision already Royal.

I had PRK and am glad I did. I can do anything I want to without worrying about losing a damn contact or messing with glasses. I am very pleased with the results.

I had PRK about 2 years ago. I'm perfectly happy with my vision as it is. I was 20/400 NOT correctable to 20/20 with glasses/contacts (only 20/30). However, I am now 20/20 2 years after I had the procedure.

My night vision is virtually perfect... more defined than with glasses. Depth perception, perfect. I can actually distinguish dark blues and black better than I could pre-PRK. Overall, I am more than happy with my PRK results. My vision is sharper and clearer than when I wore glasses.

The worst problem I have is a little bit of dry eye every now and then, but with a life-time supply of refresh drops, its not a problem, and itusually goes away on its own after a minute or two. So no big deal there.

Most of my classmates wo recieved PRK are extremely happy with it. I say most because there was 1 person who's vision did not get better. In fact, it stayed pretty much the same. But inany medical procedure, there's the risk for an adverse result.. its the nature of the science.

After 3 years post PRK, I really couldn't be happier. I'm not entirely sure I understand the talk about higher order aberitions and crisp vision with contacts. Before the surgery I was extremely close to the limit where the Navy will not even attempt to operate on you (some sort of addition of your refractive error and your astigmatism). Afterwards my vision was 20/18 and 20/16. I'm not really sure I remember how "crisp" my vision was before hand. I did wear the RGP lens (Rigid Gas Permiable, the "new" hard contact, for those that don't know) before my surgery. Although my vision may have been more crisp it was far and away less comfortable. Even my dry eye has gone away with PRK, but with the contact lens, even after wearing them for years to "get my eyes used to them" I still had a limited amount of time before I wanted to rip my eyes out instead of keeping the gas perm contacts in.

In short, if you can handle the few days of pain associated with PRK, the benifits far outweigh the negatives.

You can, for example, have double vision but still have 20/20. You can also have 20/20 (or better) but have scattering of light in your on you retina from HOAs leading to less perceived contrast. Remember the Snellen (or the logMAR, which is what they use nowdays to get Snellen equivalents) is a high contrast test. It gives no indication of how you see in low contrast situations nor is it a test of the qualitative aspects of vision.

This is all compared to your BCVA with glasses and contacts, or course. PRK has the advantage that you're not a disabled human being without glasses or contacts.

So far I've been only hearing good things about the surgery from people who have had it. You all are slowly pushing me off the fence little by little. I am going to continue playing devil's advocate though until the day I possibly get the surgery.

PRK hurt like hell. I went from 20/30 to 20/15, but it took months to stabilize at that. I have no aberrations--I'd never know I had PRK except that I can see a little better, but not that noticeably...I didn't wear glasses or contacts before.

The only reason I got it was so I could be a pilot, and then they came back and said "Just kidding about that whole pilot thing. We need FOs too badly to switch you back to a pilot contract." (I tried to switch 3 times and didn't get anywhere...I'll try again when I hit the fleet.)

Knowing what I know now, I wouldn't have spent the money (not to mention the suffering), but it's cool I guess being able to see really well instead of "ok". I don't notice a big difference in day to day stuff, and I haven't experienced any negative effects since the rather lengthy healing process finished.

Does PRK cause your near-sightedness to go away with age?

A bit dry, but that's about it.

I went from really bad (-3.75 / -3.25) to no correction (20/15 both eyes) and it's been almost exactly a year since the procedure. I occasionally notice that my eyes are dry, especially after a long day in my humidity controlled (very low humidity) lab. Also, a short night of sleep is brutal and I find myself putting a drop of eye lube in as soon as I open them in the morning.

The problem is that when my eyes are really dry, the abberations are a bit more clear, and although I can still see clearly, a bit of a starburst is noticible around bright lights at night.

For those of you who are unsure of what abberations look like go here: http://www.visionsimulations.com/

it's an interesting site to play around with, especially pre and post surgery as you can simulate what you see and more clearly describe it to a doctor by printing a picture of what you're actually seeing.

The funny part though is that until you get it done, you dont realize how much of a disability it is to have to wear glasses / contacts. I couldnt see $hit without my glasses or contacts before, now I wake up and still get a kick out of being able to read the labels on the shampoo bottles in the morning.

PM me if you have any other questions you'd like to ask off the post.

-Texan

I had PRK in July. Went from 20/400 to 20/15, which was my best corrected vision with contacts. I can tell no difference in my vision now compared to when I used to wear contacts, except it's a hell of a lot more convenient.

Echo what bubba said about the dry eye, I do get a touch of it from time to time, and it does tend to go away on its own pretty quickly. All in all the surgery is definitely worth it, and being free made it cost effective as well.

Cheers/
Paul

I had PRK done last March and it was by far one of the best investments I've made. I wore contacts for 8 years prior, and I am very happy with the fact that I do not need to take the time to put on, remove, clean, purchase, etc contact lenses. And glasses, I could never stand to wear glasses. I hated the fact that my peripherial vision was blurry while wearing glasses.

I've found that my vision is roughly the same as when I wore contacts, but I do also get the occasional dry-eye. As everyone else has stated before, an eye drop or two quickly takes care of the problem.

As for differences in clarity, both of my eyes are 20/20 but I can distinguish the slightest difference in sharpness between each eye. If my left eye were a 10, then my right eye would be a 9.5. It seems rather odd, but when I think back to my days in contacts I can remember having the same issue with different prescriptions in each eye.

Should you get the surgery? Take a look at what we've said and decide for yourself. Would I recommend PRK? In a heartbeat....

Remember: No Risk, No Rewards....

I had PRK done a little over a year ago. My contact prescription was -1.25 and -1.75 before the surgery. Now my eyes are 20/15. The only down side is that I am a broke college student and I am still paying off the surgery.

Nope. You may need glasses later on in life.

I had PRK done end of February this year. I was -2.0 diopters in my right eye, and -1.25 with -.75 of astigmatism in my left. Give or take ~20/150 uncorrected, corrected to 20/15 or better. Now I test 20/15 on both eyes, and combined I can almost make out the 20/10 line, but my left eye is noticeably stronger than my right. The testing has been stable and consistent from 60 days post-op til now. As far as higher-order aberations, I can't say much about it. They put me in the machine to scan me for them, and the doc said my eye surface was almost completely free of any aberations, and I'd be throwing away a grand if I opted for customized.

While the Bouch & Lomb site is probably a pretty decent reference, its just one source of information, and its the internet. Alot of things listed on fact sheets are misleading (example, 0.1% experience "vision loss", which scares people, even though their definition of "vision loss" is a change by 1 line on the eye chart). Talk to a surgeon, preferably a good one. If you ask around, you might even be able to find one that participated in those clinical trials (University of Rochester/Strong Hospital in Rochester, NY, has a few such surgeons).

So other than higher order aberations, PRK is a pretty stable route. Of course, the standard "the more f***ed up you are when you walk in, the more likely you'll still be a little f***ed up when you walk out" disclaimer applies. Keep in mind, while the docs are saying contacts are ok to fly, last I heard (if wink or someone else in the know can double check me on this) CNRC is not accepting people with contacts as SNA, so if you wanna fly, either try your luck with PRK or ask your recruiter for a copy of that NFO brochure


Oh yea, almost missed the "contrast test" thing. I'm not sure if this is the same thing, but the doc put up a "low contrast" eye chart for me before and after the op. I was able to identify almost all of the characters that I could pick out on the normal high contrast chart, with no change post-op (well, obviously the first 2 weeks or so were a bit shady, but once stabilized, its the same results). According to the doc, I had better contrast vision pre-op than most people ever would. Night vision is fine, no distortion, halos, or whatnot. I also took the "roommate" test, in which we drove down a suburban street at night and tried to find some godforsaken side road. My housemate, with natural born uncorrected "20/20" vision was unable to read any of the street signs until we were at least 20 feet closer to them than when I read the names to him. Street signs were read from both sides of the road, and covered in various levels of spraypaint

Yeah... but don't forget about the imaginary vice grip that's squeezing your temples...

But yes, very accurate description. Oh, the horrors!!!

Nope... not at all. It just makes your eye cold and painful as opposed to just painful.

Percoset (or whatever narcotic painkiller you are given) and the numbing eye drops are the only relief you get...

Caviot(s):
1. Numbing drops slow down the healing process.
2. Percoset doesn't so much kill the pain.. just makes you not care about it .

The pain over the first 3 days was definately the worst pain I've ever felt. Especially in the mornings when your first wake up, you have 20 minutes of agony until the next dose of painkillers kicks in and the drops actually start to re-lubricate your dry eyes. They say plan on being out of commission for a week, which is about right. I couldn't do anything (including watch tv) for the first 2 1/2 days. Sleep is your best friend.

They gave me two drugs, one of them was vicodin, which did WONDERS for the pain. I'd pop two of them at a time (I'm a big enough guy that two was an appropriate dose) and within a half hour the pain would be gone. It'd give me a headache if I tried to focus on anything though, so it just made it easier to sleep. However, you can't sleep for 3 days straight, which is why they gave me the second one. It was technically an anti-nauseant, because apparently some people get sick from the disorientation. I didn't ave that problem, but this drug had a "side effect" of being a major sleep aide. I napped during the day, and took one of those every evening, it worked out nicely. I crashed at a friends apartment during the 3 days, so even though I was sitting there with my eyes closed all day, I at least had people to chat with during the few hours I was awake.

After the first 3 days, you'll have dry eyes for a few months. With PRK just after day 3 or 4, your vision will cloud up big time as the outer cornea heals up and forms a seam, which smooths out over about 10 days. Even with that, I was cleared for driving (test 20/40 in both eyes) on day 10, and had been able to do most normal daily activity by day 4 or 5.

One occational thing that I'm really glad my doc warned me about. Your outer cornea is very delicate for the first few weeks. The new tissue occationally "sticks" to your inner eyelid, and a few cells will get torn off. The actual damage is negligible, and it doesn't affect your vision, but it hurts worse than anything else you'll have felt up to that point. It usually happens in the morning when you are jolted awake suddenly (alarm goes off, eyes shoot open), and goes away in ten minutes. But yea, all in all, the pain is part of the process. As the saying goes, "you don't have to get used to it, you just have to deal with it."

My recovery plan is books on tape.

My PRK 2c

Hey Royal,
I had PRK and am now blind...
:icon_cool
NO, just kidding. I had PRK done in April 2002 and went from 20/400 to 20/15. PRK was a better choice for me because I had (and still have) aspirations for the military AND since the correction is on the outside of the cornea the Doc can correct a larger area reducing chances of halo. He said I have large pupils and they might go outside the corrected area of the cornea at nighttime if I had LASIK- hence halo.
Dry eyes - yes, and still every once in awhile, and more sensitive to smoke/dust than before. Night vision and contrast are both great!
The other thing for me is my vision is WAY better than it was with contacts because after sooo many years of wearing them, my eyelids had become irritated and, even though I had daily disposables, they were rapidly depositing film on the lenses to protect themselves, and smearing my vision. I doubt you have the same problem, but it was a factor.
IF you do decide, the next most important thing to eval is your choice of doctor. DO NOT go to the one you heard about on the radio, just because; or the one your friend went to, just because. Any hack eye Doc can get a used laser and offer to do surgery. Study their approach (slow and attentive or "hurry, we got another one!!") and ask for patient results history. If you get a bad feeling at all, than get out!

See you soon. (or soonER, now that I'm 20/17) :icon_tong