The P in PRK is for Parenting (and Patience)
“Where are your glasses, Mami?” Lucas asked as he peered into my face. “I see your eyes!”
It was my first few hours home after laser PRK surgery and both Lucas and I were marvelling at my face – without glasses. It was the first time in a decade that I’d been able to see my face in the mirror without glasses, and it was the first time in his life Lucas had ever seen it. Lucas is nearly three. When he was born, I had to ask the midwives to pass me my glasses so that I could see his face, even though I was holding my newborn in my arms. I was pretty much non-functional without my glasses.
Being non-functional without glasses was an annoyance before, but took on a new significance after having kids.
“What would happen if I were out alone with the kids and something happened to my glasses?” I started to wonder. “Who would take care of them when I couldn’t see?”
It was a scary thought.
So when I was finally in the position to have laser eye surgery – a stable prescription for at least a year, and neither pregnant nor breastfeeding – I decided to go for it.
Why PRK and not LASIK?
There are two main types of laser eye surgery LASIK (Laser-Assisted in situ Keratomileusis) and PRK (photorefractive keratectomy). In both procedures a high-precision laser is used to reshape the cornea and correct vision.
The difference lies in how the cornea is prepared for reshaping. In both procedures the outer most layer of the cornea (the corneal epithelium) is removed so that the laser can vaporize (ablate) cells from the corneal stroma layer below. In LASIK a laser is used to create a thin flap that is pulled back and then replaced after the surgery. In PRK the epithelium cells are removed completely and then have to heal. Therefore PRK has a longer recovery period than LASIK.
Despite the longer recovery period, I chose PRK for three main reasons:
(1) My prescription was quite high (nearly 7 diopters of myopia in each eye and 1.5 to 2 diopters of astigmatism on top of that). To correct a high prescription more corneal stroma needs to be removed, and to do this safely doctors must ensure enough corneal thickness is left to preserve the structural integrity of the eye. LASIK uses up more corneal thickness because the flap never really heals, so you lose an extra 100 microns to the flap.
(2) Because no flap is created in PRK there is no risk of flap complications. This was important for me since my kids have a tendency to accidently poke me the eyes.
(3) PRK is an older procedure, so there is more data on long term outcomes.
The day of the procedure I dropped the kids at daycare and looked at them for the last time through thick glasses.
At the clinic, I was given an ID tag with my name and my scheduled procedure. This reassured me that there would be no mixups (!!)
Then I signed my consent form, took the 5mg of Valium they offered me and waited my turn. I was surprised to see that the waiting room had a glass wall that looked directly into the procedure room. At first I didn’t want to watch the people ahead of me, but in the end it was reassuring to see how quick and easy it was.
When it was my turn, I lay down on the bed and they put the anesthetic drops into my eyes. They stung! But that sting served a purpose since I could tell the freezing was working as the stinging decreased.
“Do the drops still sting when we add them?” asked a nurse.
When I answered “No” it was time to begin.
For me, the worst part was the clamps used to keep my eyes open. Getting those in and out was uncomfortable, though not painful. The light on the laser apparatus was very bright and arranged in four brilliantly white squares with red dots within them, and a single green dot in the center. I focused on the green dot while the surgeon used the amoils brush (which looks very like an electric toothbrush) to remove the epithelium.
I had been most worried about this part, but it was over quickly. Then it was time for the laser. The surgeon held my head gently but firmly; I found this reassuring, and told me to focus on the green dot for 23 seconds. I saw some red and then the vision got brighter and blurrier. There was the slight smell of burning protein as the seconds counted down and I breathed deeply.
Then it was over.
They put a patch on my eye for a minute, bathed the eye in various drops and then told me I had done well. The second eye (the left) was exactly the same.
The whole thing took less than 5 minutes.
When I sat up I was amazed to see! Things were not clear, but they were sharper than I expected, more smeary than blurry. I spent about half an hour in recovery, where I was supposed to lie with my eyes closed, but I kept opening them to sneak looks at my hands. I could see my hands clearly – even at arms length – miraculous!
I left the clinic less than an hour after the procedure, armed with my post-op kit containing protective sunglasses, pain pills, and bottles of eye drops including antibiotics to prevent infection, and anti-inflammatory steroids to prevent premature healing and scarring. I felt ready for the long recovery.
Before the procedure, as well as during my recovery, I read many people’s personal accounts of their experience ( here and here.) This helped me to gauge what I could expect. My own recovery was relatively easy and pain free during the first week. I had no light sensitivity at all and the worst discomfort I felt was like having hard contacts in my eyes (I tried those for about a year in my early twenties.)
My first day I walked myself to the optometrist for my first post-op check-up and even ran some errands after. I was amazed at how much I could already see on the eye chart. At first the letters were a big blur, but if I concentrated they swam into focus.
By Day 2 I was spending time in the park with the kids and by Day 3 my eyes had healed enough to remove the contact lenses. Non-prescription contacts are used as ‘bandages’ after PRK to protect the eye until the first layer of epithelial cells has grown over the cornea. This usually takes 3-5 days. The main discomfort happened on the evening of Day 3, just after the contacts were removed. My left eye felt like it had an eyelash in it and both eyes has pretty severe “ghosting”.
In fact my vision was far worse than it had been with the contacts. However, by the morning of Day 4 I was feeling fine and already seeing better. In fact I was seeing well enough to go with the family to the museum! I enjoyed the rest of my recovery week. I even had a chance to visit the Toronto Islands – by myself – decadent! I also enjoyed much unhurried time with the kids and I marveled at seeing them better and better everyday. I also marveled at seeing my toes in the shower – even toenails! I hadn’t seen my toes in the shower since my late teens.
At the end of the first week I was seeing well enough to drive and I’d been back on my bicycle (my main mode of transportation) since Day 5. It was time to go back to work.
Back to work
My job is mainly reading and writing. These are two of my favorite things, but boy was it hard on my recovering eyes! During my week off I had spent no more than half an hour at a time in front of a computer screen, and rather than reading I’d listened to audiobooks. Work required much more time using close focus. Even though I took frequent breaks and lowered my screen resolution to make all text was twice are large as normal, by the end of the day my eyes were extremely tired. I looked forward to my cycle home because focusing into the distance was such a relief!
It did not help that my right eye was healing much faster than the left or that my left eye was slightly farsighted (with astigmatism) during my first two weeks back at work. In fact I would describe my first week back at work (the second week after the procedure) as the most painful of my recovery. By the end of the workday, all the muscles around my left eye would be aching. During that time my patience failed me.
“What if I am never be able to read comfortably again?” I wondered during that time. “What if getting this procedure was a mistake?”
Both my optometrist and my surgeon reassured me that my eyes were healing normally and reminded me that the “P” in PRK should stand for “patience”. I gritted my teeth and squinted through it. My vision was better some days and worse others, but it was improving, almost imperceptibly. One evening towards the end of Week 3, I realized that I was able to read a book without straining. The text was still ghosted in the left eye, but I could read comfortably.
The P in PRK is also for Parenting
Now, at the one-month mark, I’ve been able to put my screen resolution back to normal – hallelujah! My right eye is seeing 20/20 and my left is almost there. The left eye has about 0.75 diopters of astigmatism, but my optometrist can see that it is still healing so she is confident that I’ll get 20/20 in that eye too.
It is really quite incredible. A laser fixed my eyesight!
“Your eyes are hazel Mami,” said Ray looking into my eyes. “Just like mine.”
Now my kids can see my eyes.
Now I can use my eyes to parent them; we can go swimming, canoeing, maybe one day even scuba diving, without me worrying about losing or breaking my glasses.
Deborah Buehler is an ecologist, editor and writer in Toronto.