well, i'm back from Dr. Nordan's in Sunny Carlsbad, California.

as i type this, my vision is somewhat blurry and unreliable, but i'm only 5 days out of a hyperopic PRK.

let's see, what would post-RK's want to know about PRK?

1) PRK ain't no joke - it removed 48 microns from my left eye and about 18 from my right in order to induce myopia in my post-RK "flat" eyes.

2) oh yeah, did i mention the part where your epithelium is SCRAPED off your eye prior to surgery? yeah - that was fun.

3) Percoset constipates you.

4) the bandage contacts placed over your PRK eyes are subject to fogging, which is a fun way of thinking your have developed "haze" after PRK. when the contacts come off, so does your "haze".

5) it can take months for the PRK to stabilize (in the form of refractible vision), and i'm only past my first week, so there will be alot of fumbling with readers and other glasses to help get me by. i cannot drive a car during the day right now due to my right eye still being "off".

6) did i mention the pain? yes, there's pain, and the extra fun thing is just when you think it's over - BAM - you get hit with the REAL HARD pain. i thought i was done the end of the 2nd night and stopped the Percoset - only to end up curled in a fetal position clutching my head and groaning...ahhh, thank God for Percoset.

7) surprisingly, given all this, i'm still glad i went through with the PRK, as i can read up-close in my left eye now and expect "normal" post-RK vision to return within several weeks.

despite the cost of the trip (in dollars and pain), i will most likely return to Carlsbad and see Dr. Nordan about my right eye about a year from now if it fails to improve much.

keep i mind that i sought out PRK as a way to 1) reduce my ever-increasing post-RK aberrations and 2) possibly improve my BCVA.

so far, only a tiny amount of post-RK aberration has been reduced, with BVA favoring my left eye instead of my right (which is crazy and mixed-up considering my right was my "good" eye for 12 years after RK...)

anyway, i'm back.

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Muddy, thanks for describing your experience. I hope that your vision turns out to be much better than before. Since you had both eyes done did you take some extra time off work?

Can you please tell more about the epi being scraped off?

Muddy,

Best wishes for a speedy and full recovery!

Moose

Fast healing Muddy. Thanks for keeping us informed.

wow, what a restful night.

unfortunately, my vision's somewhat messy this morning, so forgive any typos i don't catch.

Sandy,

yes, the epithelium was "scraped" off wuth what appeared to be a tiny razor or metal implement. my understanding is that PRK cannot reliably "shoot" through epithelial layer, so it has to be removed before the PRK is performed - almost sounds like LASIK without cutting a flap. the epithelium is what grows back in over the following months and fills in the area, including any irregularities left from the RK.

and yes, i took some time off from work - about 2 weeks plus some if i don't feel i can go back after that - just in case.

right now, i'm not having very sharp vision, but the left eye tends to progress during the day and the right is still off in la-la land somewhere.

i think the strangest thing is getting used to how my left eye now sees better than my right, and the disorientation that comes with that feeling.

oh, i should mention that i only spent about 30 seconds under the laser with both eyes - it took longer for the anesthetic to work than the actual ablation to take place.

Ron,

i think i know why you don't care to undergo any more surgeries. not only are they painful and fairly unpredictable over an existing RK, but you may have a better RK than i do, in that there are no long vertical incisions in your eye.

the inferior RK incisions in my eyes are the signature of an egotistic RK surgeon - 4 cuts, make them long, and pray that the cornea doesn't buckle. i feel that RK's with 6 incisions that "fan" out to the left and right of the pupil may be in better shape than me after RK.

what do you say?

--

Muddy:

I have followed your journey towards better vision for 4 years now and am awed by your resilence and courage. It was not an easy decision for you to have more surgery. I hope you heal quickly and completely.

FYI..Percoset gives me auditory hallucinations while relieving my pain. Strange drug, but good....very very good!

I'll be looking for your updates.

"let's see, what would post-RK's want to know about PRK?" - Muddy

Muddy,

Glad you are back and share your PRK experience with us. I still have a few more questions regarding your prk and hopefully you can shed some lights on them.

1. Did your surgeon use MMC on your eyes to prevent haze?

2. Are you using steroid drops after PRK and for how long?

3. What do you think of the idea of taking Vitamin C before and after surgery and avoid UV light to prevent haze?

Speedy recovery!

1. Did your surgeon use MMC on your eyes to prevent haze?

no. there is no haze, during or after surgery. it was Dr. Nordan's opinion that haze _might_ be a factor in a myopic PRK, but since the central portion of my corneas were left intact during the hyperopic PRK, there was no real risk of haze.

2. Are you using steroid drops after PRK and for how long?

yes. FML - for about 5 days. the bottle is very small so it has started running out after about a week. i am also on the end of the eyedrop antibiotics.

3. What do you think of the idea of taking Vitamin C before and after surgery and avoid UV light to prevent haze?

this one is tough - mostly opinion. i went ahead and took 500mg of C daily in the week before the surgery and then 1000mg daily in the week after surgery (up to about tomorrow). as far as UV light, Nordan didn't believe that exposure to UV light (e.g., sunshine) after PRK had any bearing on forming haze or not. the mild haze i still see is from the RK incisions - nothing more, nothing less (a very familiar sight, trust me)

i went for a 3 mile run this afternoon, and noticed a tiny change in my right eye - i'm sure things will be getting better from here on out, but i'm nowhere near "perfect" after PRK, so please don't misinterpret my results and run out and get a PRK.

i had Nordan take some topos 1-week post op just for kicks and they look VERY different from my post-RK topos. i might share those with SE when he mails them next week, but they are mostly for illustrative purposes, not analytical.

oh, by the way, my eyes stopped being "scratchy" today - must be a sign the epithelium is growing back fast as expected.

--

Hey Muddy!

Thanks for the updates on your PRK experience.
Good thoughts and prayers are being sent your way so that you don't have to have any more surgery. May your vision and comfort continue to steadily improve!!!!

Take care,

Cathy

Muddy and post RK's.....

I am one of the original post RK hyperopes that have been seeking help since 1982 and one of the original SE members.

I've have consulted several of the top refractive surgeons in Southern California and decided to pay Dr. Nordan a visit in mid January. The trip was easy for me since I live in Huntington Beach and his office is in Carlsbad about 50 miles away. I way prompted by the recent results for the post RK'ers who have sought the services of Dr. Nordan and have posted their results on this BB.

By the way, I saw Dr. Nordan about six years ago prior to PRK laser approval and we discussed the Lasso technique to steepen the corner. I did not opt for this surgery at that time.

He has had a great deal of experience with post RK fixes. And as you know,for those that have visited him, he was very confident he could help. On my first consultation, having not worn my RGP's for three weeks, he and his staff examined my eyes and found that I was +5 to +8 farsighted with 2 to 3 diopters astigmatism each eye. He said he was confident he could help me, but it would take 2 surgeries each eye 60 days apart.

I agreed to have PRK since I have become contact lens intolerant over the past 20 years, notwithstanding the fact that most practioners find it very difficult to fit post RK eyes. Believe me, I have visited and have been fitted with the special plateau lenses fitted by the "best" optometrists in Southern California. I owe them a great deal of gratitude for their patience and understanding. One of the OD's is a consultant to SE.

I had my first PRK operation mid January from Dr. Nordan. What a tough few days for the pain to subside. My right eye of +8, -3 was lasered for almost 2 minutes. My left eye of +5, -2 was lasered about one minute. This left eye is the difficult eye because of mixed astigmatism.

It has been one month since my first surgery. Every day since the surgery my eyes have changed. I was not able to see well enough to drive the first week. Since then I have seen improvements in both eyes. After a visit to my local lenscrafters for glasses to assistance in the interim, I find that the right eye is about 20/30 and the left eye is still farsighted with a need of +3.75, but the astigmatism has been reduced in both eyes to about 1 to 1.5 diopters.

I am today fully functional during the day and night without glasses or contacts. Although things really sharpen with glasses if needed.

Hang in there and things will improve, somedays better and somedays worse. Over the next few weeks you will see improvement as I have. My starbursts from RK have dramatically improved, colors are more vivid, contrast between black and white continue to improve. No haze, no dry eye...

I cannot wait for the next operation in mid March. Despite the pain and hassles, I think I am finally free of the visual burden that all post RK's experience in one way or another.

Please e-mail me privately if any of you have questions. I will update after my next surgery.

Muddy:

I am glad to hear you made it through your surgeries. Having had hyperopic PRK you should heal a bit faster than having had myopic PRK. Haze will not be an issue for you. It takes the epithelium a full two months to regenerate, not the 3-5 day stuff most people talk about - so please try to be patient. You can expect improvements in quality of vision over the next several months. What you will have at nine months will be different from what you will have at 90 days. I know you will be seeing better.

You have my home phone number and can always call and speak with me at any time. It took a lot of courage to have both eyes done at the same time.

Richard Esser

hey DT, thanks for the reply.

i've been a little worried over the past 24 hours about not being able to drive during the day, fearing (as we most often do) the worst.

i suspect i will see Nordan again for my right eye sometime later this year, but for now i will sit tight.

interesting that despite the troubles i've had after RK, Nordan mentioned that i am about a "2 on a scale of 10" for post-RK vision difficulty.

either this says i am a wimp, or Nordan really does see alot of messed up post-RK's!

--

You're anything but a wimp, Muddy. I hope you recover quickly.

Tron

UNLESS someone like you cares a whole awful lot, nothing is going to get better. It's not. -Dr. Seuss

I'm glad that the surgery is helping.

Unfortunately, IMHO, there are lots of problems that could be fixed or the vision greatly improved with additional surgeries. I understand, however, why one would not choose to do so.

Keep us posted on your progress.

"Nothing works as good as the original equipment."

Muddy,

Do you happen to know your pachymetry reading before and after the operation? You said they removed 48 microns. What did you start out with?

Comment: Although my PRK operation which removed 90 microns left me massively overcorrected, the one thing my surgeon did that seemed to help is keep my cornea moist during the procedure. According to him, this technique precludes pain after the operation. Sure enough, I had no painful after effects. I would be curious if any doctors know whether this technique is used anywhere else to prevent pain from occurring with a PRK operation.

Also, from my own experience changes in your cornea can continue for a very long time after the operation, so don't be discouraged if you don't notice instant improvement in your vision.
Good luck!

Blake,

my corneal thickness has always been better the average eye, but nearer the periphery it was something insane, like over 600 microns or something (i'm not sure if that's the reading BECAUSE of the RK steepening or what, but it's pretty hefty)

not sure if they're very accurate, but you can still check out some of my older topos on http://home.satx.rr.com/rksa

just look under the section titled "Content" for my older topos.

pachymetry readings pre-PRK should be on some of those.

--

says:

"anyway, i'm back."

We are all glad you're back Muddy. We know your eyes are going to be ok this time. The bb is just very plain without you around. Now, you can not only be SE's poster guy, but PRK's poster guy. That way you can post two pix of you flexing and the bb will be twice as bright.