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Ask HN: PRK worth it and recovery time?

by ilovecaching on 12/30/22, 6:09 PM with 21 comments

I've been looking into Lasik and PRK at 30 now that my eyes have stabilized. I do Jiu Jitsu so the doctor recommended I get PRK instead of Lasik as Lasik leaves a permanent flap that can be damaged by contact sports.

My main worry is a bad outcome and the recovery time. I was told I could start working at a computer again 5 days after the surgery when the remove the protective contact. I have a nice job at FAANG and don't want to risk my career or take too much time off after the holidays break.

Anyone been in the same situation? What is vision like at 5 days, and can it take longer?

Also how is your light sensitivity? Is it harder to look at a screen after the surgery?

  • by silisili on 12/30/22, 6:53 PM

    I did PRK about 10 years ago.

    Recovery was interesting. They tell you vision is gonna be rough for a few days, but right after surgery vision is perfect and you think you got lucky. Nope.

    I basically laid in bed for about 24 to 36 hours straight, lights off, curtains closed. I remember waking, looking at the ceiling fan and how blurry it was, then falling back asleep.

    By day 2 I think it was I ventured out to watch TV and even at the lowest brightness it was blinding. I had to wear sunglasses.

    I started work day 4 or 5 and had to increase the size of everything. I specifically remember that - and = looked identical, which makes code very interesting to read.

    I guess by day 7 to 10 my vision was perfect, or at least, better than it was before. Any improvement past that would have been incremental. Sorry I don't have more concrete dates, I actually kept a detailed journal but lost it along the way.

    I feel like my night vision took a small hit, but that could just be age. My eyes are light sensitive, but they always have been. But we're talking like, full Florida sun on white pavement. Looking at a screen doesn't make my eyes feel blinded.

    Lemme know if you have any questions I can help with.

    Side note: My wife got LASIK a few years back. Her recovery time was way less, and could see much better with a day or two. Her only problem was dry eyes that seemed to last a few months, but that went away too.

    If I had to do it again, I'm not sure what I'd pick. After seeing how quick and painless LASIK is, I may go that route. I'm of the opinion that any force strong enough to 'rip open your flap' is going to cause eye injury one way or another.

  • by pknomad on 12/30/22, 7:18 PM

    I got my PRK done few weeks ago and my advice to people is take at least 2 week PTO.

    My recovery was interesting because my left and right eye healed at a very different pace.

    Your vision at 5 days is going to be... non-optimal. Yes, the protective lens comes off usually by 5 days but that's purely because the epithelium should have grown back by then.

    I saw 20/25 on my left eye from day 2 but saw 20/80 on my right eye around the same time frame. It also was super hazy even after the lens came off. I was afraid that I would need a "touch-up". The first week is all about epithelium recovery so you won't be able to see much or see things well. I personally had to zoom in everything in low brightness and even then reading was a struggle.

    Second week I think is where the "interesting recovery" happens. You start seeing less weird artifacts from surgery (starbursts, halos, dry eyes, etc if you have them) and the vision seems to band quite a bit. I was able to see more comfortably and was willing to go outside (with shades though).

    By 4th week+ - All the artifacts have pretty much gone away aside from occasional dry eyes. I'm in east coast right now where it's super dry and cold so I'm sure that also plays a role too.

    Here's my prescription before surgery:

    Sphere, Cylinder, Axis: R -2.50 -1.75 172 L -2.75 -1.75 8

    No info or corneal thickness but it was super thick according to my ophthalmologist and was a candidate for PRK, LASIK, and SMILE.

  • by youniverse on 12/30/22, 10:39 PM

    Used to work in an ophthalmic office, happy to answer any questions I can.

    This is a quality of life thing, if you want to have better vision, no point in worrying about bad outcomes that you can not control. Bad outcomes are unlikely, this isn't open heart surgery. Best advice I can give is make sure your surgeon has done multiple PRKs recently so he's not too rusty.

    Give yourself 5-7 days at least, everyone's eyes heal differently. Get numbing drops/ointment from the Dr.

    You may have to adjust to light sensitivity and such but our brains are pretty good at adapting and you will get used to it. Looking at screens isn't an issue I've heard of but you can always manipulate your brightness and warm to accommodate yourself.

    I would advise PRK > LASIK because in the future getting the correct refraction for your cataract surgery (in your 65-80s) could be more difficult.

    Depending on your prescription, this could drastically improve the next ~30 years of your life until cataract surgery.

    For artificial tears / lubricating drops I'd recommend getting Optase. I've tried the market and like them the most. From the EU I believe but they are everywhere now. They're on amazon.

    Good luck.

  • by subnil on 12/30/22, 7:03 PM

    I got PRK in college due to my terrible vision (ineligible for LASIK). One of the best decisions I’ve ever made.

    Here are my thoughts / recommendations:

    (1). Find a highly recommended, extremely experienced doctor for your surgery. Please, do not skimp on this. You only have one set of eyes.

    (2). Plan to take a week off (at least) from work. If you have a partner or family who can assist you, then ask if they could help / check in on you during the week.

    (3). Recovery is painful. Not initially, but once the epithelial cells on your eyes have regrown for a few days, light sensitivity and pain become more pronounced. Expect to sleep in a dark room and listen to podcasts.

    In summary, I highly recommend the surgery. Anecdotally, it has been great for me. Again, the crucial bit is finding a surgeon you’re confident in, scheduling your PTO and caregiving (if possible).

  • by mdaniel on 12/30/22, 7:17 PM

    Another vote for PRK, and for the same reason: I didn't want the flap. You'll want to invest in a Costco sized box of those rewetting drops for the next several years because dry eye will be a constant thing

    I do have halos, but I don't think I have light sensitivity and I have been constantly looking at a screen for the past innumerable years without ill effects. I'm coming up on the age where I'm going to have to consider a touch-up or something similar because my non-dominant eye has reverted a little. I only notice it when covering one eye at a time

    If I had to do it over again, I 100% would still choose PRK

  • by toomuchtodo on 12/31/22, 12:05 AM

    Absolutely worth it. Had surgery 12 years ago, approaching 40 and my eyes are still 20/20. Have spent the last decade staring at screens 8 hours a day 5 days a week. Highly recommend PRK over LASIK. My desire was to be able to participate in adventure sports or take a punch without concern for the LASIK flap.

    (Procedure was done in Chicago by UICs Optomology Dept head at the Millennium Park Eye Center; confirm your surgeon’s experience and skill level, and ask what their complication rate is)

  • by AbundantSalmon on 12/30/22, 7:11 PM

    I am in my early 30s and got PRK in my late 20s and absolutely do not regret my decision at all! It's been such a quality of life improvement. I am also a BJJ/Judo player and it really beats having to deal with contacts/glasses all the time. I believe they usually will have wanted you to have tried contacts for a time to make sure that contacts aren't a good use case for you, as with any surgeries there are always risks involves which the ophthalmologist will run through with you.

    For me, this is so much better than contacts, not having to fumble around for glasses in the morning and being able to see clearly stuff that is further than 20 cm from my face is life changing (my prescription was -5.5 + astigmatism, so not the worse but still pretty bad) which I haven't been able to since I was like 12 years old. I know a bunch of people who have had it done and very happy as well and I do mention it to other friends. Though it is a personal choice as it is a very elective surgery.

    1 week is the bare minimum to be able to took a screen again for a long length of time and "full" recovery can be months (you'll still be able to drive and use the computer fine but there will be some "fuzziness"). I was able to work after the one week. One of my eyes was over-corrected, as basically there is a bit of art of these types of surgery as it relies on the body's healing factor, and after a year of monitoring (which would have been standard even if the over-correction wasn't detected) hoping that it would work it self out, we had to redo the that eye and both eyes were fine after that.

    You definitely want to not force it, just take sick/annual leave and don't stress out about working. I'm not based in the US but if you are, I would really recommend you research who you're getting your treatment from and what laser/approach they might be using. Because when I was researching before my decision it seemed like a lot of horror stories were US based (this just might be due to the demographic of the internet posters though). Stories of no contact with an ophthalmologist before the surgery, the surgery being done by technicians and not the surgeon, the responsible surgeon was based out of the state and only approved the surgeries, no follow up monitoring after surgery etc.

    If you have an specific questions post then below and I am happy to answer.

  • by nyrulez on 12/30/22, 6:51 PM

    I had PRK done in 2010 and still have 20/20 all these years later. Definitely a huge upgrade to my quality of life as I hated glasses/contact lenses.

    I went with a high end clinic in NYC recommended by a colleague. They had weekly appointments for eye tests before and after the operation and I thought it was very carefully done. Also it's one eye at a time. So picking the right clinic/doc could be a factor.

    I just wore sunglasses for a while and it was fine in 1-2 weeks.

  • by heresjohnny on 12/30/22, 6:35 PM

    Have been looking into laser surgery myself as well. Have you considered SMILE [1]? It’s the newest treatment: recovery time can be as fast as a few hours (full healing of course takes longer) and it doesn’t leave a “flap”.

    [1] https://en.wikipedia.org/wiki/Small_incision_lenticule_extra...

  • by sbolt on 12/30/22, 11:25 PM

    For anyone exploring the idea of getting laser eye surgery i wrote about my experience. I got LASIK and it was the best thing I ever did. https://seanbolton.dev/2022/02/04/my-lasik-experience/
  • by saluki on 12/30/22, 6:41 PM

    Vision is too important . . . it seems too risky.
  • by jimmygrapes on 12/31/22, 12:03 AM

    I got PRK through a (well regarded) military hospital in the late 2000s. They made me sign a waiver that said I acknowledge there is approximately 1.5% chance my eyeballs would change with age and the procedure would be ineffective. I said hell yeah, let's go for it, especially since it's free.

    It was, as others have said, slightly deceptive; immediately after the initial painless procedure, I could suddenly see the millisecond ticks on the analog clock on the far wall. I didn't even know those existed before, since my glasses were also military issued and bare minimum quality/effort was put into ensuring I could see (and I was never able to afford glasses prior to that). I could see the fine hairs on the edges of the nurse's cheek. It was a memory I'll never forget.

    Soon after (a few hours) the pain set in, so I took the first of many percocets I had been sent home with. Started with just a splitting headache. I had never worn contacts before, and the hard plastic ones I had in felt like sharp weights on my eyeballs that cut my eyelid. I was diligent with the eye drops, which helped a lot, but didn't eliminate the feeling. I went to sleep. I was on medical leave for 7 days.

    Woke up the next day and couldn't open my eyes. I tried, just couldn't. They were stuck. I put a few of the prescribed eye drops (3 different bottles iirc) into/on my eyelids in hopes of lubing them up, and eventually I was able to peel the eyelids off the contacts. It felt like I had dived eyes-open into fine sand churned up in salt water; slightly painful, burning, bur bearable. More drops once I got the eyes open. Things were blurred more than ever before, but I was told to expect that. Eyes were dilated, so I could read a book at arms length in dim light, but no screens or LED lighting or going outside. Dimmable warm color halogen floor lamps gained my undying respect. More percocets after the headache came back, plus they made me feel warm and happy. Fell asleep for 30m, 1h, 7h, 12m, with waking moments dedicated to pissing and shitting and eating through my stockpile of microwaveable pre-made meals and old DFAC leftovers. Lots of water.

    After 4 days of the same, the pain began to intensify; now the sandy salt water was filled with vinegar and ghost peppers. Percocets dosage doubled. Vision stopped being so blurry, though, so there was progress. I could see the faces in the patterns of the popcorn ceiling again. Music stopped giving me pressure headaches, so I stopped sleeping so much, but now there was a sort of vertigo as my vision changed seemingly randomly from blurry to focused as my brain adapted to the modified input. Had to move slow and be careful, like I had broken a hip. Eyes still burned but the percocets and eye drops made it tolerable. Started eating better since I could use the stove and oven better. Bananas helped. I noticed how much piss had escaped the toilet bowl in the days (weeks? months?) and cleaned it up.

    Around day 7 it felt like sand crabs had hatched in a sandy Tabasco sea; less burning, more sharp random jolts of pain, consistent vague burning and grittiness. I ran out of percocets except for 2. I got a pal to bring me some vodka, and I washed the last 2 down with a Ketel One and tonic. Last day of leave, had to be back at work tomorrow, might as well have fun. I could look at screens by then, and it was reasonably clear; eyes were still overly dilated (was it the percocets or the vodka or the surgery? all of the above?) so I had to sit far from my 15" Vizio TV, but I could play a match of Halo without vomiting from the eye pain and vertigo.

    Strangely enough, day 8, when I woke up, there was no pain. I could see mostly clearly. Had to wear sunglasses in formation and throughout the day (which required significant bureaucratic effort in order to procure a physical "waiver" for presentation to the inevitable hardass), but goddam, I could see leaves.

    Did you know that trees had leaves IRL and not just in stories? I didn't. I thought it was like how the sun is a circle with straight lines in childhood drawings, a representation. I mean, I knew intellectually about leaves; I knew some basic biology and botany and all, I had seen leaves alone, I knew they were real, but I had never seen them as isolated elements while still on a tree.

    Did you know that drywall has a texture? Did you know that there's a difference between l and I and 1 and |? Did you know that outer ears can have hair? Did you know that bar straws are hollow?

    I knew all of this, of course, but I had never seen it until I had healed up from PRK. It was a miracle, I had been baptized and emerged with clarity of vision. I wished I had more percocets but accepted the trade-off.

    9 months later I noticed I was squinting to read my e-mail at my desk. I got a check up at the optometrist on base and was issued a new prescription for glasses. Not as bad as before: -2.75R and -2.50L instead of -7.50 and -7.00 as before the PRK.

    I was the 1.5% they warned me about.

    Over 15 years later, I got a free private sector consult to see if I was eligible for a "touch up" procedure. Despite the clinic's supposed capitalistic incentive, they said my cornea is too thin to consider corrective surgery. "But, look on the bright side," the bubbly, young, glasses-wearing technician said to me, "technology has changed a lot lately, so we might find a way to fix you up before it's too late!"