(A personal view of PRK laser-eye surgery.)


Jeffrey S. Rosenthal

(Published in The Outreach Connection, Sept. 23, 1998, page 14.)

(Note: An expanded version of this article is also available.)

On July 31, 1997, at approximately 4:55 pm, I lay on my back, perfectly still, while a complete stranger fired a high-powered laser, first at my right eye and then at my left eye.

No, this was not a new form of high-tech torture. Rather, the laser was being fired at my request, and I had paid $4000 for the privilege.

I was one of over half a million patients worldwide to undergo photorefractive keratectomy (PRK), a procedure which uses an excimer laser to correct nearsightedness and astigmatism. My goal was a simple one: to achieve 20/20 vision without the need for glasses or contact lenses.

Undergoing PRK was not an easy decision to reach. I was skeptical of the PRK institutes with their misleading and over-simplistic brochures (e.g. saying that "getting rid of [your glasses] takes only minutes," without explaining how long the healing process actually takes). On the other hand, my dependence on glasses made me feel vulnerable and also interfered with certain activities such as sports and swimming, thus making PRK sound tempting.

Further reading convinced me that PRK had become quite safe and had a high success rate. After much procrastinating, I nervously made an appointment for the surgery. One week later, with my heart pounding, I lay on my back and was positioned under the laser. My eyes had been frozen with special anesthetic eye-drops and were held open by a small metal device. The surgeon sat down behind me, and I was told to stare at a blinking red light just above me.

The surgeon first had to scrape off my eye's epithelium, or thin protective coating of the cornea, using what was described as a miniature spatula (rather gruesome-sounding!). Since my eye was frozen, I felt nothing.

Next, the laser itself was used. I stared at the blinking red light, being extremely careful not to move my eye at all. I heard a "click, click, click" sound as the excimer laser delivered a series of precise pulses which "ablated" (i.e., removed) tiny portions of my eye's cornea, to reshape it so that it would focus light properly onto my retina.

In just a couple of minutes, the operation was complete. I had felt nothing, and had been awake and comfortable (if not calm) the entire time. Protective (non-refractive) contact lenses were then inserted into my eyes, to act as bandages for a few days while the eyes healed.

I noticed right away that I could see distant objects with greater clarity than before without my glasses. On the other hand, for all objects near and far, there was a strange blurriness rather unlike my previous nearsightedness. Reading -- either a nearby book or a distant sign -- was extremely difficult. I knew that this blurriness was supposed to go away as the eyes healed.

After the surgery, I was given a complicated array of eye-drops (five different kinds in total), plus some pain medication and a pair of oversized sunglasses to protect my eyes while outside. I was then sent home.

Beginning about twelve hours after surgery, and lasting about thirty-six hours, my eyes began to feel very sore and to sting. The pain was rather severe, and prevented sleep or relaxation. (Later, comments in the eye institute waiting room and from the staff convinced me that my pain was not unusual.)

Between my pain and the fact that I couldn't read instructions or labels, it was virtually impossible for me to deal with all of the eye drops and pain medication that I needed. Happily, my friend Margaret stayed with me and provided fabulous help in the form of good food, encouraging words, and assistance. I do not know how I could have gotten through those first few days without her.

My eyes were also very sensitive to light. I spent most of my time indoors, with the lights out. When I did venture outside, I wore the oversized sunglasses on top of my regular sunglasses. I found it ironic that, after having surgery to eliminated my dependence on corrective eyewear, I was currently wearing two pairs of glasses plus one pair of contact lenses.

Four days after the surgery, my eyes were examined and found to be healing properly, and the contact lenses were removed. I was anxious for my vision to return to normal as quickly as possible. I knew that final healing of my eyes would take up to six months. However, information in the institute's discharge instructions (e.g. "you may return to your normal activities of daily living after 3-4 days") had led me to believe that within a week or so, I would more or less be seeing normally.

My optimism proved to be unjustified. One week after the surgery, that strange blurriness in my vision was decreased but still very much present. I could not comfortably read or use a computer. I could get around well enough but could not do anything requiring visual concentration. I purchased some "talking book" audio cassettes and tried to be a patient patient.

By the tenth day post-surgery, there was some improvement. Reading for a short time was possible. Using my computer briefly was feasible. I even managed to do a little bit of office work.

Then, on my eleventh night after surgery, I awoke during the night with a searing pain in both eyes. They felt extremely dry and sore. Opening my eyes was very painful; turning on the light was even worse.

The next morning my eyes felt better, much to my relief. But as I looked around I discovered another disturbing fact: the vision in my right eye had become much more blurry! It was if the eye had been "smudged".

Around the same time, I happened to notice that the eye-drop I was using five times a day was a non-steroidal anti-inflammatory, whereas according to my earlier readings a steroidal drop was normally used. I enquired and was told that the institute was trying this new eye-drop as an "experiment". Now, I do understand the need for experimentation to improve techniques. But did they have to experiment on me? And without my knowledge or consent?

While I was worrying about my right eye, the vision in my left eye was finally sharpening up, to the point where it now had close to normal vision. It still didn't feel as strong as my old vision with glasses, but it was working reasonably well, for both near and distant work.

Finally, gradually, my right eye caught up to the left. By day eighteen, both eyes were approximately as good, and both were fairly close to 20/20. For the first time since childhood, I could see fairly well without corrective lenses, which was wonderful. However, my vision was still a bit blurry in the fine detail, and didn't "feel" quite right. Furthermore I was still over-sensitive to light, and still saw something of a "halo" effect when viewing bright lights. So I now really could return to my "daily activities", but I still could not work or read for very long periods of time.

Things continued in much the same fashion during the following months. Overall my vision continued to improve, but the "fuzziness" (depending on colour and lighting) did not completely disappear. My eyes often felt dry, especially in the middle of the night, causing mild pain and sometimes preventing sleep. At the end of the fifth month, I finished with the eye-drops, which was a relief. And my vision was mostly quite good. However, it was still not truly sharp like it had been with glasses before the operation, and this still worried me.

After six months, I had another eye examination at the institute. The surgeon indicated satisfaction with my progress. When I asked him about the fuzziness and halo effect, which I thought would be gone by this point, he assured me that they would go away but that "it takes about a year." A year?!? My vision has sharpened up somewhat since then; but after all this time, I am still in a position of waiting to see how my vision finally turns out.

Knowing what I know now, am I glad I undertook PRK laser eye surgery? Was it worth all the trouble I went through, just to achieve the convenience of life without corrective lenses? Probably it was, though it's hard to be sure. Sometimes even hindsight isn't 20/20.

Dr. Rosenthal is an Associate Professor in the Department of Statistics at the University of Toronto. To contact him click here.

See also the expanded version of this article.