A couple years ago, I told you about a procedure I had done called conductive keratoplasty. The first round of surgery worked wonders. I saw in the distance perfectly and needed only simple readers. But I was still frustrated. I hate to reach for my glasses every time I need to read something. So my ophthalmologist, Dr. Kondrot, thought a second round could help me read without glasses. Unfortunately, I developed astigmatism, which cant be corrected with readers. You need prescription glasses. I was really frustrated.
My sister, Sheri Rowen, MD, a gifted ophthalmologist in Baltimore, told me about two procedures that could correct most astigmatism and even farsightedness. One is Lasik, which is a popular in-and-out procedure. Despite the incredible safety record, I did not like the idea of having my cornea cut. Many people have had great results with Lasik, but I wanted to see what else was available.
Sheri told me about another procedure, photorefractive keratectomy (PRK), that does not cut the cornea. However, it does have a much longer healing time.
I was okay with the healing time as long as I was convinced the procedure was safe.
Sheri introduced me to Mickey Gordon, MD of San Diego. He did some non-invasive tests. Based on those tests, he thought that the PRK procedure would work.
There are some differences between PRK and Lasik. The cornea does the majority of the light refracting, so minuscule reshaping yields a huge effect on how it functions. It can even overcome the functional aging loss of your lens. Both procedures reshape your cornea. The difference is how they operate on it.
Your cornea has three layers: an outer epithelial cell surface, an inner epithelial cell surface, and a much thicker middle layer of tough collagen. Though its perfectly clear, this collagen is exceptionally strong and protects your eye. If it were not , even small bumps to your eye could be disastrous.
With Lasik, your eye gets anesthetized. A cut is made around your cornea into the middle layer. Your cornea is lifted back, creating a flap. Then laser beams reshape the middle collagen layer by vaporizing collagen. Your doctor lays back the top layer, and you have new vision. There is insignificant healing time since the outer epithelial layer, where the pain nerves are, is largely undisturbed. The middle layer adheres quickly and tightly when put back together. The result is nearly instant eye correction.
When I expressed concern about the incision, Dr. Gordon admitted that once its cut, the cornea is slightly weaker. A bump to the eye could cause a wrinkle in the flap. Its quite uncommon and your doctor can repair it easily. But I worried because I lead a very active lifestyle, mountain biking and backpacking. I could easily imagine a bad bump to my eye far away from Dr. Gordon.
And there is some risk of problems. For Lasik, its less than 1%. Problems include dry eye, halo, starburst, glare, and vision fluctuation, most likely resulting from imperfect healing of the flap. But that was more risk than I wanted to take on. (Now you know why they say doctors make the worst patients.)
Instead of reshaping the cornea from the inner layers, PRK does so from the outside. That means that there will be significant healing time to the outer epithelial layer. This creates some discomfort and it has an increased risk of infection. That worried me. But the overall risk of complication is even lower than Lasik. And I would not have to worry about bumping my eyes. So I decided to give it a try.
Dr. Gordon decided I would benefit from modified monocular vision, meaning he would just slightly under-correct my dominant eye for distance and just slightly over-correct my non-dominant eye for reading. I would be able to read most print without glasses.
I could not believe how fast the procedure was. I went into the operating suite, where Dr. Gordon programmed his equipment for the precise reshaping of my corneas middle layer. He anesthetized my eyes. Then he put in drops that removed the outer epithelial layer of my right cornea. After cleaning off the debris, he asked me to hold my eye perfectly still staring into the center of a ring of bright lights. In seconds, these laser lights did their job. He put some drops into my eye. Then he repeated the procedure on my left eye.
The procedure was painless. However, when the anesthesia wore off, my eyes felt quite irritated, like fine grit was in them. I wore protective sunglasses and a night shield and used antibiotic and anti-inflammatory eye drops. I did not need to fill a prescription for a painkiller he provided in case I experienced significant discomfort. After about four days, my cornea regained the outer epithelial layer, and I was able to stop the antibiotic drops. I continued the anti-inflammatory drops for about two weeks. My eyes felt somewhat irritated for over three weeks.
My vision fluctuated quite a bit for weeks. One day I would see perfectly. The next, it would be just as bad as when I started. Dr. Gordon told me to be patient since we would not know the final result until the outer epithelial layer fully recovered. This layer regenerates very quickly. Within three days my eyes felt dramatically better. How-ever, the young cells were not mature or densely packed. As they mature and fill in, it causes your vision to fluctuate.
Before the surgery, I was moderately farsighted and had moderate astigmatism. The astigmatism caused me to see ghost-like double shadows.
Before PRK, my right eye could see a poor 20/60 (minus two letters on the 60 line). And my left eye was 20/30 (minus one letter on the 30 line). My right eye could not pass a driving test and the left would barely pass.
Six months later, the results were incredible. My acuity had improved to 20/20 without corrective lenses in both eyes! The awful astigmatism was virtually gone. I corrected to within one-half diopter of Dr. Gordons target. I could read outdoors on a bright day and operate my computer without glasses. One eye sees distance better and the other sees close up better. With both eyes open, I cant tell the difference. And, just as importantly, I did not have any long-term side effects. I am thrilled with the results!
PRK is a great treatment if you have a thin cornea since it does not require incision and affects only the very outer collagen. Its also good for highly active people at risk for bumping their eyes or for people who do not want their cornea cut. It does have its downside, mainly the lengthy time required to heal. And no one can guarantee that your outcome with either procedure will be perfect. But PRK is worth looking into if you do not want to have Lasik.
The long-term improvement of each procedure is similar. And both of them can help you read without glasses and also help nearsightedness.
Good visual acuity is a treasure. If you are interested in either of these procedures, you can contact Sheri Rowen, MD at 410-821-5333 in Baltimore or Dr. Gordon at 858-455-6800 in San Diego. Either office can help you find a skilled ophthalmologist closer to you.