PRK Day 39: PRK Follow-Up and Visian ICL Measurements

Today I had an appointment that served two purposes: my one-month check-up for the PRK procedure I had in my right eye in December and repeat measurements for the Visian ICL to be implanted into my left eye in March.

PRK Update

My PRK update is pretty uneventful. I had my vision tested using the phoropter and Snellen chart, and I scored 20/30. This means I could see about the same number of letters at my 6 day follow-up appointment as I saw today, but my vision now is definitely crisper and I'm seeing more details. I should note, however, the my best corrected visual acuity (BCVA, so best vision I could get with glasses or contact lenses before PRK) was 20/25, so I'm pretty close! I couldn't get to 20/20 in that eye likely to due the cataract I was born with. I have a small amount of astigmatism left (formerly +1.5 now +0.5) which could potentially improve over the next few months. My eye pressure is great (sometimes the steroid drops can elevate eye pressure which can cause glaucoma). The tech said my eye was somewhat dry and to keep using the preservative-free eyedrops. I was then taken to a machine that mapped the shape of my corneas, and that was it for the PRK follow-up part of my appointment. 

In the last couple of days, the ghosting I was seeing has completely gone away. I'm still seeing some starbursts around bright lights both during the day and at night (like car headlights, TV light, etc.). My surgeon said this should improve over time as my cornea continues to heal. 

I am very happy I went through with PRK in my right eye and hope I see a bit more improvement in the next 3-6 months!

Visian ICL Update

I had a couple of measurements double-checked in my left eye for my upcoming Visian ICL surgery in March. The tech took me to another machine and said it takes "a bunch of measurements of your eye," like height and some other things I can't recall. Then the surgeon came in a took a white-to-white measurement to compare to the ultrasound measurement for sizing the ICL. 

I asked the surgeons some questions about potential complications, specifically from the iridotomy (small hole in the iris to prevent increased eye pressure and glaucoma) and from the ICL itself. She said that she hasn't encountered patients with the side effect of glare or white lines from the iridotomoy, but it's always a risk. I then asked about the risks of cataracts, which is the most common complication of posterior chamber ICL. At this point, it's a risk I'm willing to take. 

I'm nervous but looking forward to being able to see out of both eyes! For the last week, I've been wearing my glasses (with -11.00 in my left lens and non-prescription in my right eye) so they could get accurate measurements today of my eye that will have an ICL. Wearing my glasses has given me some terrible eye strain due to aniseikonia, where my left eye sees the world much smaller than my right eye. Even if I need glasses for driving after I get the ICL, today is the last day I'll ever have to wear my coke-bottle lens! There's no guarantee that the ICL will get me to 20/15, which is my current best corrected visual acuity in my left eye, but I should see a substantial improvement. 

My Visian ICL surgery is scheduled for the second week in March so I will post an update then. I'll probably also update about my PRK eye before then. 

Consultation Follow-Up Success

After failing my last follow-up appointment by wearing my contact lenses (which can change the shape of your cornea and skew the measurements needed for PRK), today was my rescheduled follow-up to make sure all of the measurements taken at my September consultation appointment were accurate.

Today was truly a repeat of my September appointment. The assistant checked prescription using the phoropter, and then I was led to a couple of different rooms where other measurements were taken (sorry, still not sure what they all are for or called!).

The surgeon then came into the room and said my measurements were all the same as my September appointment and we are good to go for the PRK surgery in December! I was told not to wear my glasses for at least a week before the procedure and that I would need to fill some eye drop prescriptions before the surgery.

Success!

Consultation Follow-Up Failure

So to recap, my right eye is very myopic (-6.50 sphere, +1.50 cylinder) and my left is is very, very myopic (-11.00 sphere, +.25 cylinder). I can see about 3 inches in front of my face, which means I need contacts or glasses to do anything, including reading books and computer work. At my last appointment my surgeon told me I am a candidate for PRK in my right eye and probably Visian ICL in my left eye.

Today I had my follow-up appointment to double-check my prescription and eye measurements for my right eye PRK surgery in December, and to have the chamber between my cornea and natural lens measured to make sure I'm a candidate for left eye Visian ICL which will be scheduled after the PRK surgery.

I went to work this morning before my appointment and wore my contact lenses. I took them out right before my appointment. When the assistant came into the room to check my prescription, I asked if wearing my contacts right before this appointment was okay since they make my eyes red and uncomfortable. To my surprise he said yes, I would have to reschedule my appointment! The surgeon then came in and said that soft contacts can sometimes change the shape of the cornea, and that someone (not sure who) should have told me not to wear my contacts for one week before this appointment and my original consultation in September! I swear, nobody ever told me that and now I feel silly for not knowing or asking before my first appointment.

The surgeon did say that I could still have my chamber measured for the ICL. I was taken to another room that had a reclining chair kind of like a dentist's chair. Another doctor explained that he was going to do an ultrasound to get very specific measurements of the inside of my eyeball. Apparently getting the correct size of the Visian ICL is incredibly important for accurate correction, avoiding endothelial cell loss, and avoiding cataracts caused by the ICL touching the natural lens, and the ultrasound is the most accurate way to determine your ICL size. I laid back in the chair and he numbed my eye and placed a silicone tube thing under my eyelids, which held my eye open and created a cup that he then poured cold liquid into. He asked me to look straight ahead and rubbed the ultrasound probe thingy all over the front of my eyeball. It was truly one of the strangest experiences I have ever had.

I rescheduled my follow-up appointment for two weeks from today, and won't wear my contact lenses at all between now and then.

Consultation Appointment: Approved for PRK and (probably) ICL

Today I had my consultation appointment for refractive surgery at my local university hospital, where I learned what my options are for correcting my terrible vision.

First the assistant tested my vision and asked if I needed a new glasses prescription at the appointment today. Since's it's been a year since my last exam, I said yes. The assistant said my prescription hadn't changed in the last year (he compared it to my old prescription I brought in)--yay! My current prescription is:

Right: -6.50 (sphere), +1.5 (cylinder)
Left: -11.00 (sphere), +.25 (cylinder)

My eyes have always had very different prescriptions, with the left being way worse, even though the cataract is in my right eye. I think that it's uncommon to have such different vision in both eyes, but I'm not sure.

At this appointment they did a bunch of tests in different rooms, where different people took measurements of my cornea and other parts of my eyes, dilated my eyes, rechecked my prescription after dilation, and then I met with the ophthalmologist who will be doing my surgeries. Our visit was short and sweet. She said I am a candidate for PRK (photorefractive keratectomy - like LASIK with without the flap) in my right eye and  probably Visian ICL (implantable collamer lens or sometimes called implantable contact lens) in my left eye. She said "probably" because they would need to do one more test to make sure the chamber between my cornea and natural lens was big enough for the Visian ICL to fit. I asked about clear lens exchange for my right eye, since that's what another ophthalmologist had recommended at my last consultation 7-8 years ago, but she said she would not perform that procedure on a 30 year old since I would lose my ability to "accommodate" and no longer be able to see close up. Everyone needs reading glasses by age 40-50, so I still have 10-20 years left to read without glasses and I would not want to lose that!

The ophthalmologist then told me that since the surgeries take place at different locations (Visian ICL at the hospital and PRK at the laser center), she would perform PRK first and then ICL a couple of months later. She then sent me to talk to the refractive counselor who could answer any other questions I had and discuss payment and scheduling.

The counselor was very knowledgeable and nice, and let me know that she had also had PRK at this center! Honestly, before this appointment I had researched lasik, CLE, and ICL but hadn't read much about PRK. I asked her a bunch of questions about possible complications, the healing process, etc. The counselor reassured me that the procedure was very conservative with a lower complication rate than lasik, and could be repeated if revisions were necessary. She also put my mind at ease when she said that this center (which is actually part of the local university hospital) and my surgeon are very conservative and only approve about half of the people who have consultations. I like that they seem driven by the latest research and helping people see, rather than making a lot of money by doing hundreds of procedures a day.

We scheduled a follow-up appointment for early November where they will double-check every measurement to make sure the laser is perfectly calibrated for PRK in my right eye, and measure the space in my left eye to make sure there is enough space for the ICL. We scheduled PRK for mid-December when I'll have a couple of weeks off work to heal, and will schedule the ICL surgery after I have PRK.

When I got home I spent some time reading about my ophthalmologist. She's an MD with over 10 years of experience, who specializes in corneal, cataract, and refractive surgeries. She completed a fellowship after her medical degree in these specializations, and has great reviews online. I have thought about having another consultation at another center to compare options and prices, but feel confident with this surgeon and center.

Refractive Surgery Consultation Scheduled!

My Polar Cataract
(see the white dot in the middle?)

I've scheduled a consultation for refractive (corrective) eye surgery, which is tomorrow! I've been searching and reading blogs about the process, and figured I would write about my own experience too.

Here's some background about my eye situation. I was born with a polar anterior cataract in my right eye. It's very small (but still visible if you look hard enough), completely opaque, and right in the center of my eye. The cataract hasn't ever changed shape or size. I had an eyepatch over my left eye when I was 3 or 4 since the eye doctor was worried that I might develop a lazy eye since not as much light can get into the cataract eye, making it much weaker.

Then, in sixth grade around age 12, my eyesight started to deteriorate in both eyes and I became myopic. I started wearing soft contacts around 13, which I wore everyday. I got my first pair of glasses at 16 or 17, to wear when I was too lazy to put in my contacts.

My Glasses

My vision continued to get worse throughout my 20s, and I'd have to get a new exam and prescription
every year. I had a consultation for refractive surgery when I was 22 or 23, before I went to grad school. I knew my vision was not stable but I wanted to see what my options were, since I was already completely blind without contacts or glasses. The ophthalmologist then told me that I could have clear lens exchange (cataract surgery) in my right eye, and an implantable contact lens (Visian ICL) in my left eye since the vision in my left eye was too poor for LASIK.

My vision continued to get worse every year until I was about 28. Now I'm 30, done with grad school, live in a city with fantastic health care, have a real job with a good salary and an FSA, and so I've scheduled a consultation to see what my options are! I'll update as I go through this process.