What is it Like to Have PRK Surgery?

I got PRK done on each eye, one at a time. Both eyes have been healing on slightly different timelines, but here’s the general experience:

Day 0: The surgery itself is relatively painless. I would compare it to going to the dentist for a cleaning, where you have to lie still for a certain amount of time and endure a bit of discomfort, but there is no real pain. The major difference is that since they are working on your eye, everything is right up in your face and you can’t really zone out. In fact, they pry your eye open like that scene in Clockwork Orange.

Probably the creepiest part of the procedure was when the doctor removed the corneal epithelium. It turns out that “removing the corneal epithelium” is an eye doctor euphemism for literally skinning your eyeball with a toothbrush. I could see the tiny brush moving back and forth as it scraped the top layers of cells of my cornea, but I couldn’t feel anything. This is a major difference between PRK and Lasek and essentially what makes the recovery time so different between the two procedures.

After all of this, the actual laser is a bit anti-climactic. You stare at a green light for about ten seconds while a bunch of other lights flash around it. It’s sort of like watching that scene at the end of Space Odyssey.*

Day 1: The day after the surgery, I woke up with some mild scratchiness in my eye but that quickly went away. I could see pretty well! My “new” eye was at about 80% of the sharpness of my other eye with a contact lens. I got pretty cocky and spent the whole day working on the computer. “Maybe I’ll be able to go right back to work tomorrow,” I thought, like a stupid person.

During the day, I went in for a standard post-op checkup. The doctor, after confirming that I didn’t have any oozing infections, advised me to fill out a prescription for Vicodin and valium. He said not to be shy about taking them, even before I felt I needed them because “typically days 2-4 are the most uncomfortable.” I was skeptical, since I felt great.

Days 2-4: It turns out that the doctor who has done 20,000 of these procedures actually knew what he was talking about. This was the least pleasant part of the recovery process and it’s what most people complain about when they get this procedure.

It started during the night, between days one and two. I woke up several times with pain or dryness in my eye. I could only sleep for a couple hours at a time without having to get up, pace around, and put in lots of eye drops.

This sensation lasted for the next few days. I’ve heard people describe it as akin to having sand in your eyes and I felt that to be pretty accurate. But there would also be occasional periods when the pain became much sharper and acute. At times it felt like someone was slowly poking me in the eye with a sewing needle.

The pain was unpleasant but not terrible. It wasn’t as bad as having a migraine and it never got so bad that I took the Vicodin. But it certainly made it impossible to go to work or function in any meaningful way. This was compounded by the fact that my eye was extremely sensitive to light. For about three solid days, I did nothing but listen to podcasts and audiobooks and pace around a dark apartment punching mirrors like Martin Sheen at the beginning of Apocalypse Now.

Days 5-14: Once the acute pain subsided, there were two major parts to the recovery. First, was light sensitivity. Over the next couple weeks, I would have intense bouts of tearing whenever I went outside, even in the Robocop sunglasses they issued me after the procedure.** This made it impractical to drive and generally hard to do any outdoor activities. It was also hard to look at bright computer screens for about the first week. In fact, for almost two weeks, I basically had to keep my sunglasses on all day, even when I was indoors at the office.

The other issue at this point, besides being bullied at work for wearing sunglasses, was my vision. After the first day, the vision in my affected eye actually got worse as it healed and then only slowly improved over time. This persisted for about four weeks (see below). In my case, since I got my eyes done one at a time, I had a huge mismatch between my old eye (which still had a contact lens) and my new eye (which was blurry). I experimented with eye patches but ended up just closing my “new” eye all day when I worked, which isn’t ideal.

Despite all of these inconveniences, I still felt really lucky that I could drive. I had been prepared to be grounded for the first few weeks, but this wasn’t the case. In particular, the doctor warned me about night driving, since many people experience optical effects that can make it hard to see in those conditions. But ironically, because of my light sensitivity, I found it much easier to drive at night than during the day.

It’s also worth mentioning that during much of this period you are still on a regimen of eye drops. There are both antibiotic and anti-steroid drops that you take multiple times per day. This was so trivial compared to the other inconveniences of the recovery that I hardly remembered it months later.

2-5 weeks: After the light sensitivity died down, I fell into a more steady state of recovery. At this point, my eyes felt pretty normal. There would be sporadic attacks of dryness, but I generally felt the same as I did before the surgery.

The main issue during this phase was how slowly my vision improved. I knew intellectually that it was getting better. But I never felt that way. Every day, it seemed just as bad as the day before. The biggest effect I experienced was “ghosting,” where I saw two versions of everything superimposed, but offset. This is confusing to explain, so I just drew what it looks like:

To be clear, this effect was most pronounced with things like traffic lights or words on a computer screen. But it was a constant and it made my vision very blurry.

“Ghosting” is very common in PRK recovery and, according to my doctor, it’s caused by a temporary ridge on your corneal epithelium as it heals unevenly across the surface. During my standard post-op checkups the doctor would measure my vision. About three weeks in, he was pretty confident that I was on my way to a full recovery and the only thing obscuring that was this ghosting effect. But to me, my vision just seemed blurry.

For what it’s worth, I’ve read a lot of online journals from PRK patients and this actually seems to be the most psychologically difficult part of the recovery. It can feel like your vision just isn’t getting better. And after several weeks, it’s hard not to worry that it simply won’t. I recommend reading some of the journals I link below. For me, just knowing that this was coming helped me prepare for it. I tried to keep an “eyes on the prize” mentality. The hard part (pain, wearing sunglasses indoors) was over. Now it was just about waiting.

6 months later: Six months later, my vision is slightly better than 20/20 and I don’t have any noticeable issues with dry eyes. Generally, I’ve been really happy that I had this surgery. The only effect I still notice is a bit of a halo effect around lights when I am driving at night. But it’s not much worse than the optical effects my contact lenses used to have with night driving, and it seems to be improving with time.

Some good PRK recovery journals

My PRK Adventure

My PRK Recovery Timeline – Alex Tran

My PRK Journal

*Takeaway- the surgery was essentially a Kubrick film marathon. It also kind of reminded me of that scene from RoboCop where they are operating on Murphy and turning him into RoboCop. None of these movies are comedies.

**No one makes action movies these days like Verhoeven did in the 80’s and 90’s. Also they were good movies. Starship Troopers is a classic.

More questions:

  • Eye Surgery: Is it a good time to have LASIK surgery? What new technologies are upcoming in vision correction?
  • Prescription Glasses: What are the problems people who wear glasses face that others don’t?
  • Contact Lenses: How is it like to switch to contact lenses after using glasses for years?

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