8.7 Personal Experiences of Refractive Surgery
Description
This article is from the Vision and Eye Care FAQ, by grants@research.canon.com.au (Grant Sayer) with numerous contributions by others.
8.7 Personal Experiences of Refractive Surgery
The following information details the personal experiences that some
Internet readers have found having undergone some of the procedures
PRK (Barbara la Scala bfls@ee.mu.oz.au)
Prior to treatment:
Surgeons have become more experienced with correcting high degrees of
myopia over the past few years and so the chances of success for even
myopes with a high degree of correction have improved over the statistics
quoted above. My correction was -10 D in my right eye and -9.5 D in the
left. I was told I had a 95% chance of never needing glasses again, a 2-3%
chance of needing them for driving and a 2-3% chance of still needing
glasses all the time but far less strong ones.
I saw Dr Unger and discussed at length the operation, the side effects,
complications and success rate. My eyes were tested to determine my
current prescription and curvature of my corneas (I wasn't allowed to wear
contact lenses for a week beforehand). My eyes were topographically mapped
using a laser to produce a surface plot of my corneas. I also had to bring
in a old prescription so they could see how rapidly my correction was
changing. For corrections of over -10 dioptres they generally measure the
thickness of the cornea using ultrasound but since I was a borderline case
they decided not to.
The operation itself:
In the morning I went into Dr Unger's surgery and had all the tests I had
before repeated. I wasn't allowed to wear contact lenses for 2 weeks
beforehand to allow my corneas to revert to their natural shape. I also
had the degree of haze in my corneas measured using yet another laser.
This wasn't necessary for the surgery but for their research records.
I had the surgery itself that afternoon at the Royal Eye and Ear Hospital
in Melbourne as an outpatient. I had 4 lots of cocaine drops put in my
right eye to anaesthetise it over a period of about 1/2 an hour. I was
then taken into the surgery and a cap was put over my hair and my face
wiped with antiseptic. A cover was put over my left eye so I wouldn't be
distracted by the sight of anything on my left. I sat in a dentist-type
chair which was reclined and I was moved under the laser machine.
At this point I panicked :-) I didn't run screaming down the corridor but I
wanted to. Up until then I hadn't really thought about what the surgery
itself would involve - just the risks and benefits. Suddenly I realised I
was going to let someone mess around and *touch* my eye. I really didn't
expect such a strong emotional reaction. I believe some doctors will give
their patients a little Valium beforehand to reduce the stress but my
doctor doesn't. He found that if the patient was too relaxed it was hard
to convince them to stare a point and not let their gaze wander about as
the laser was doing it stuff. Terrified patients concentrated better on
getting it right :-).
An instrument was put in my eye to hold my eyelids open. It was rather
like the reverse of a pair of tongs - you had to squeeze the handles to
keep the ends together. Surprisingly I couldn't feel this at all -
probably due to the topical anaesthetic. A blow-up pillow, like those you
have for travelling in planes, was inflated around my neck so I couldn't
move my head from side to side. The doctor then laid a circular instrument
with cross hairs rather like a gun sight on my eye to mark out the
treatment area. He then used some sort of scalpel (I couldn't see what -
it was too close) to scrape off the outer layer of my eye and uncover the
cornea while I lay there trying very hard not to blink. I could see the
knife moving back and forward over my eye and the tissue coming off but
could only feel a little pressure. He would stop every once in a while to
rinse of dislodged tissue and give me a break. It took about 5 minutes
altogether and was the longest 5 minutes of my life.
Then came the laser surgery itself. The laser equipment consisted of a
small, bright red flashing light in a dark field with a ring of white light
around it to illuminate my eye. I had to stare fixedly at the red dot and
not move my eye or try to blink while the laser operated. The moment it
started to work I could no longer see clearly out of my eye - everything
disappeared into a bright white blur. I could still see a pulsating spot
in the middle though so I stared at it for all I was worth. The laser made
a clicking sound. Because my correction was so strong the laser was used
twice. The first time lasted for 1 minute and the second for 35 seconds.
The average time is more like 30-40 seconds.
After that it was all over. More drops were put in my eye - anaesthetic
ones I think but I forgot to ask. Then antibiotic ointment was put inside
my lower eyelid and they patched my eye closed. My left eye was uncovered
and I got to watch it all on video before being taken home.
They recommend going home and going to sleep immediately after the
procedure because if you move your eyes the ulcerated portion of the
treated eye rubs against the inside of the eyelid and is very painful. I
found that bright light hurt my untreated eye and I had to wear sunglasses
on the way home. When I got home I took one of the sleeping tablets they
gave me and went to bed. They also gave me Panadeine Forte tablets (these
are a mixture of paracetamol and codeine - the strongest mixture you can
get without a prescription in this country). I took one of these also but
I don't know if it made any difference. My eye had started to sting around
10 minutes after the procedure but wasn't too bad.
After the treatment:
The morning after the surgery my eye was painful but not so bad I couldn't
be distracted from it. It was extremely painful if I moved my eyes though.
My eye was checked and around 1/3 of the epithelial layer had grown back.
My eye became increasingly less painful over the next 2 days until it was
merely uncomfortable if I moved my eye. The epithelial layer completely
regrew in 3 days. Once it had regrown the pain was gone.
After 4 days I removed the eye patch and started using FML eye drops to
reduce inflammation. These are made by Allergan and contain the
corticosteriod fluorometholone. I was originally long-sighted but this
improved and after 10 days the vision in my treated eye was good enough
that I was able to rely on it alone and not bother using a contact lens in
my untreated eye. I did notice fine details becoming slightly fuzzy as
time wore on due to haze developing.
After 3 months the correction in my treated eye was -0.25 D which is
virtually perfect and I had little scarring or haze. However over the next
two months a great deal of scar tissue developed (level 2 I believe). One
month later (4 months after surgery) I had regressed to -5 D but the rate
slowed and I was only at -5.75 D one month later. After discussion with
several other eye specialists I was put on new stronger, steroidal eye
drops. (Maxidex by Alcon which contain a 0.1% solution of dexamethasone).
This was successful in reducing scarring significantly in another patient.
I'm only the 5th patient of my surgeon to get scarring sufficiently severe
to interfere with sight. The new drops had a noticeable effect after only
one week and my myopia reduced from -5.75 D to -1.75 D in 4 months.
An unfortunate side effect of the Maxidex drops is that it can make the
pressure in the eye increase causing a form of glaucoma. If untreated this
can eventually kill retinal cells and send you blind. After 4 months of
using the Maxidex drops two hourly my pressure started to increased. This
also caused my myopia to worsen. I was put on beta-blocker eye drops for a
month to reduce this pressure build up. These were Timoptol by Merck which
contain a 0.5% solution of timolol maleate. However they weren't effective
so the Maxidex was reduced from every two hours to twice a day. In the
following month the pressure did drop and my myopia improved.
Now, 15 months after the inital treatment the scar tissue has gone away and
my correction has stabilised to -1.75D due to regression. Ten days ago I
had my eye retreated with the new Summit Laser (the only one to gain FDA
approval so far). This operates twice as fast as the Visx laser I had
orignally been treated with. In addition, my doctor now uses the laser to
remove the epithelial layer as it leaves a smoother surface. This makes
the treatement faster and less unpleasant. He has also started using a
contact lens bandage in addition to an eye patch. This speeds up the
regrowth of the epithelium. About 70% had grown back in 24 hours and it
was completely healed in 48. This makes the recovery period shorter and
much less painful. My uncorrected visual accuity is 20/30 and there is no
sign of scarring.
(bfls@ee.mu.oz.au)
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