ICL Month 11 / PRK Month 11: Regression and Dry Eye Update

Well, I had my next follow up appointment and am still seeing 20/15 out of my left (ICL) eye. The vision in my right (PRK) eye has regressed from 20/25 to 20/40. I go in for another appointment in four months and if the 20/40 vision has stabilized, I can have a touch up if I want. I'm not sure if I do, I think it would be at full cost. Something to think about.

My dry eye in my right (PRK) eye has improved slightly, maybe. My surgeon said it looks better than at my last appointment, but I can't really tell. I'm not looking forward to allergy season starting in a couple of months, but I will just keep using the rewetting drops and hope for the best!

ICL Month 1 / PRK Month 4: Another Follow-Up Appointment

Last week I had another follow-up appointment. Everything was good. ICL vault was still high but not causing any inflammation and not blocking the iridotomy so the vault probably won't cause increased eye pressure (glaucoma). The white haze or fog I was experiencing in my left (ICL) eye is much, much better and I feel like my ability to see contrast is nearly back to "normal."

I could (barely, after staring for a while) read all of the letters on the 20/20 line with my right (PRK) eye and easily read all of the 20/15 letters with my left (ICL) eye. In practice, my vision out of my right eye definitely does not seem like 20/20. When it's bright/sunny, which is almost every day here, the glare makes everything in the distance blurry and I can't read even large street signs, even with sunglasses on. I don't know if this has really gotten better in the last few months so we'll see if it improves any more. Vision out of my ICL eye is incredible during the day. It's good at night too, but I do see halos around lights still.

Interestingly, my aniseikonia has switched, so now the picture out of my right eye is smaller than the vision out of my left eye! Not only is the right eye image smaller, but it's slightly shorter, like everything is slightly squished vertically. It's been difficult to get used to, and I notice it most when I'm reading. It's like my eyes aren't working together completely, which maybe they never were and I just never paid as much attention to my vision as I have in the past four months.

Allergy season for me has also started so I've started taking antihistamines everyday. This has made my eyes drier but it's not too bad. I'm trying to use less of the preservative free lubricating eye drops but sometimes I still need them. I'm going to try Systane gel drops to see if that relieves the dryness, especially over night.

I'll have another follow up appointment in two months!

PRK Day 60 (Two Months): Some Observations about my Changing Vision

Well, it's been 60 days--or about two months--since my PRK surgery in my right eye. My vision is still up and down, and I have good days and bad days. If I squint I can see very well, but I sometimes still having blurry distance vision and double-vision and always have starbursts.

Morning vs. Evening 

This biggest difference in my vision is still morning versus evening. When I wake up, my vision is very crisp and clear. I still have starbursts around lights regardless of how dark or bright the environment is but I don't have any ghosting or double/vision. When I first wake up my vision is as good, if not better, than it was with glasses or contacts pre-surgery.

As the day goes on, especially if I do a lot of computer work or reading (which is all day, 6 days a week for me due to my job), my vision deteriorates pretty rapidly (within the first hour or so of waking up. Even though I use eyedrops every 30-60 minutes when I'm on the computer, I develop ghosting or double/triple vision pretty quickly. I try to take breaks every 10-20 minutes to look out the window, which I think helps a little bit.

If I take a nap, my vision is crystal clear again when I wake up.

Light vs. Dark Environment

I also notice some differences between light and dark environments. When it's really bright outside, or there are a lot of lights on, my vision is much worse. Sunglasses help somewhat, but not completely. I notice that when I'm on the bus with my sunglasses on and looking out through the tinted (maybe polarized?) windows, everything looks super clear. But when I get off the bus and still have my sunglasses on, everything gets fuzzier. I'm going to purchase some sunglasses that are polarized and see if that helps.

In dark environments, like inside with the curtains closed and just one light on or outside on a really overcast day, my vision is much better. I think I actually see better at night than I did before with contacts or glasses, with the exception of starbursts coming from headlights and traffic lights. Halogen headlights are especially bothersome. 

Near Distance Vs. Far Distance

My near vision, within about 20-30 feet, is pretty good all the time. I don't notice it fluctuate very much depending on time of day or brightness. My reading vision out of just my right eye has never been great due to the cataract--I need more lights on to read printed things or more contrast on the computer. Pre-surgery, I could see about six inches in front of my face without contacts or glasses. Now I can see pretty clearly for 20-30 feet all the time.

However, when I've been awake and reading and/or it's really bright out, my vision past 20-30 feet will get blurred due to ghosting or double/triple vision and glare. I won't be able to read street signs or license plates from afar. I also notice that it takes a long time for me to refocus on objects that are far away after I've been looking at things close up for an extended amount of time. If I look at the window right now, for example, the tree in the distance looks somewhat blurry. But if I blink a bunch of times and stare at the tree, it comes into better focus in about five seconds. I'm not sure if this is due to dry eye or what. But then everything just starts over with a new day, with great vision in after I wake up!

A few days ago I started using the steroid drops just two times a day, which is down from 3 times a day. I'll take the drops for about one more month and then I'll be free! My next PRK follow-up appointment will be at three months after my PRK surgery, which will be the same appointment as my ICL one-day follow up.

PRK Day 45: More Vision Ups and Downs

It's been 45 days--or over six weeks--since my PRK surgery in my right eye, and my vision still fluctuates a lot. I was surprised to hear at my last appointment that my eye was really dry, which is something I have never dealt with. I've been trying to stay hydrated and use lubricating eye drops often, but I'm not sure it's helping. I recently read about a research study that showed that 5% of eyes developed chronic dry eye after PRK, even though none had dry eye before the surgery! I hope that doesn't happen to me, but I also live in a dry climate now and spend a lot of time in front of my computer, so dry eye is a possible side effect.

What starbursts look like to me

I also reported in my last post that my ghosting/double-vision had resolved. Well, that doesn't actually seem to be true anymore. Sometimes I see ghosting and sometimes there's none, which again, is probably related to dry eye. Starbursts are still present during the day and night. My vision is still significantly better than weeks 2-4, which I'm very happy about, but it goes up and day throughout the day and between days. Some days I wake up with great vision and it stays pretty good throughout the day, other days I can't see very well for the entire day. The instructions from my surgeon say to use lubricating eye drops at least four times a day as needed, and the past few days I've been using them once every hour or two (while awake). 

I'm also looking forward to stopping steroid eye drops. I have to take them for three months and I'm about half way through. The first month I used prednisolone (tapered from four times a day for one week, to two times a day for three weeks), the second month I'm using fluorometholone 3 times a day, and the third month I'll use fluorometholone 2 times a day. They sting when I put them in my eye and leave a bad taste in my mouth. I think I had to use the drops for so long (3 months) because my prescription was so high (-6.5 diopters, +1.5 astigmatism). I've read that steroid drops reduce the risk of corneal haze, but they also slow down healing. 

PRK recovery is soooo slow, but I do think it's worth it to avoid additional complications that can come with LASIK. I wasn't a candidate for LASIK anyway, according to my surgeon, so it was PRK or nothing in my right eye. Still no regrets, and I'll keep updating with my progress. 

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.