Went in for my three-week (post bandage lens removal) follow-up visit this morning. I was excited to hear how things are going and to test my vision. Subjectively, I feel like I'm not yet where I want to be and not yet seeing as clearly as I did with contact lenses prior to surgery, but I also know that the full process takes time, so I'm patient.
The first order of business was to do a quick vision test with the wall chart. The optometrist (the same one who worked with my on the day of my surgery) asked me to cover one eye with one hand and read what I could with the other. I chose to test my right eye first, as it's been noticeably more blurry than the left. I could make out the top line (20/40), and almost make out the bottom line (20/25 – I think I got 4 out of 5 letters), but they were both a bit fuzzy. The left eye was a breeze at 20/20, although while the letters are clear I wouldn't say they're completely sharp. This is exciting stuff, because prior to PRK I was somewhere in the 20/400 or worse range!
After the vision test, the doctor had a look at my eyes with the slit lamp, and did a pressure test. Apparently, everything is looking good in terms of healing. The blurriness and/or ghosting with my right eye is being caused by a bit of swelling as the cornea continues to heal and the seam where my corneal epithelium grew back together. In the left eye, ongoing healing means that things aren't completely clear yet, but they should become so over the next two months, which is when I'll have my next followup. The pressure test is mainly to see if the steroid used to regulate healing and inflamation – Lotemax, in my case – is causing any problems. In some patients, the steroid causes increased interocular pressure, which can have serious long-term effects. Since my pressure was well within the expected normal range, I get to continue with the treatment regimen as planned. From 4 drops in each eye everyday for the first three weeks, I now reduce it to 3 drops for the next three weeks, then 2 drops, then one, then done.
Overall, I'm very happy with my progress so far. The one lingering annoyance is the blurry vision in my right eye, and as long as that resolves I'll be a totally satisfied customer. I'll be extra happy if my vision in each eye is 20/20 or better, which is a very good possibility. Speaking of that blurry vision, the doctor explained that using a sodium chloride ointment at night – which reduces swelling and maintains eye moisture – should result in pretty much instant improvement. Apparently, sodium chloride ointment is commonly recommended as post-PRK treatment for patients who had much higher corrections and thus more swelling due to an increased wound response. Reducing that swelling contributes to a quicker return of good vision. My surgeon recommended this ointment to deal with dryness because I'll be traveling to Kenya for seven weeks, and he told me I could start on it once my bandage lenses were out. I held out because of the cost (a tiny tube of Muro-128 is pretty pricey) and because things were going reasonably well. Talking with the optometrist today, she explained a little more about what the ointment does, how it works, and why to use it, and I'm going to start on it tonight. She expects that after using it nightly for the next week or so, I should be able to reduce to a couple times a week, depending on how dry my eyes feel. She also explained that because some of the blurriness in my right eye is caused by inflammation due to the healing process, this ointment should alleviate that.
Barring unexpected regressions or complications, I expect to add updates here after my next few followup appointments. In the meantime, and if you're interested, here's some more on how things have changed since my last update nearly three weeks ago:
Day nine (January 14) I was in Vermont, skiing for the first time in probably twenty years (I'm a snowboarder, what can I say?). Eye-wise, I had been experiencing really dry eyes the day before and was constantly using lubricating eye drops. Up on the hill, things were impressively clear and comfortable, without having to put any drops in throughout the day. I figure this is because of the cool (okay, honestly, icy cold... it was freezing that weekend!) air moving through my worn out goggles, which kept my eyes watering. I was worried that I'd have to be extra cautious because I wouldn't be able to see the snow as well as I normally would have, but it was all good. The next day was even better, back on my snowboard for the first time in over two years (life's been busy, and I promise myself I'll be a more dedicated rider next season!), I was able to really fly over some gorgeous cruisers at Sugarbush and took advantage of powder on a freshly opened section to get in some great face shots.
Back at the house in the evenings, my eyes were incredibly dry again, probably because we were keeping warm with a woodburning stove... some of my clothes still have that rustic woodsmoke aroma. Using eye drops to wet my eyes, I finally got back to reading printed books (and managed to finish off the last 130 pages of the Girl with the Dragon Tattoo on a lazy holiday Monday before heading in to Burlington to fly back to NYC).
Back at the house in the evenings, my eyes were incredibly dry again, probably because we were keeping warm with a woodburning stove... some of my clothes still have that rustic woodsmoke aroma. Using eye drops to wet my eyes, I finally got back to reading printed books (and managed to finish off the last 130 pages of the Girl with the Dragon Tattoo on a lazy holiday Monday before heading in to Burlington to fly back to NYC).
After the January long weekend, I was able to get back to work pretty much full time. My vision was still blurry and I was using lots of drops, and over the course of the week I didn't adjust the font size or screen resolution on my computer. Things seemed pretty stable, and still pretty dry.
The beginning of last week, a little more than two weeks post-PRK, I noticed that my vision was more clear and my eyes were less dry. I was able to start reducing the size of the letters on my computer screen and read comfortably. As I mentioned above, I noticed a distinct difference between my left and right eyes, with the right being blurry enough that reading with my left eye closed was uncomfortable, and at times the blurriness of my right eye made reading with both eyes a bit challenging. By the end of the week though, things had continued to improve and become more comfortable. And that's where I'm at now.
Strangely enough, over the last couple of days, as I've gotten ready to go to bed I've thought about taking out my contact lenses as I walked into the bathroom. Years of following the same routine is apparently very habit-forming. I've read about people unconsciously reaching for their glasses in the mornings for a while after having PRK, so I shouldn't be surprised about this. What seems strange to me is that it took three weeks before my old habits started to reassert themselves. My guess is that this is either a) because it took three weeks for the experience of PRK to work its way deeper into my memory and out of my conscious mind, b) because my vision is now about as good as it was when I wore contacts, c) because I've been using lubricating drops less frequently and the air feels drier, reminding me of how my eyes usually felt at the end of a day wearing lenses, or d) some combination of all of the above. My money's on d.
