Eye imbalance

I was just sitting in front of the TV and browsing the web on my laptop and noticed that my left eye was having issues focusing on the laptop up close (about 1 foot away), but the right eye was crystal clear. I guess they've got different prescriptions at this point in the healing.

11/30 Evening Macguyver

For all my whining about my vision getting worse through the day, the data certainly doesn't back me up. It may have gotten worse through the day, but my current vision is very good as far as post-op acuity goes.

Left eye:

12pt: 10% (previous best: 17%. Glasses: 90%)

18pt: 83% (previous best: 65%. Glasses: 96%)

27pt: 92% (previous best: 93%. Glasses: 94%)

40pt: 92% (previous best: 93%. Glasses: 100%)

60pt: 100% (previous best: 100%. Glasses: 100%)

[I stopped measuring the larger letters because it takes long enough already and I end up scoring 100% on them anyway. If I regress, I'll reinstate the big numbers]

So I was either very close to or better than my previous bests. The 12pt letters are a way away though - often, I have great difficulty simply finding them on the screen, let alone figuring out what they are. Simply getting to 100% at finding the 12pt letters will be an achievement.

Also, as of day 5 I haven't had:

-dry eyes

-pain

-eyelids glued to corneas

-halos

I have had:

-eyelashes glued to other eyelashes (caused by the super-viscous refresh drops at bedtime, I suspect)

-ghosts

-varying vision quality throughout the day

Down goes the resolution

Made it from 7:15 to 2:18pm, but finally had to turn down the resolution from 1920x1200 to something much lower.

Work, hour five

Finally broke down and turned up the text size in the browser. There's a gradual downhill slope in my vision, for sure. Tomorrow I'll try to do a morning-and-afternoon macguyver test to see if I can quantify the changes.

Half an hour into work

• Haven't had to increase my resolution or font size.
• Things are a little fuzzy, but not too bad.
• This morning was my first time outside in the dark - I didn't notice any halos or ghosting around streetlights, although point light sources like distant headlights aren't in good focus yet.

First real day back at work tomorrow

After my mini-vacation (Friday->Tuesday off from work), I'm back to work tomorrow. It looks like it'll go ok. I've basically been on my PC all day today with the exception of some exercise breaks, and had no problems. My vision right now at the end of the day is a bit worse than it was at the start, but I can still read without difficulty. I'll probably have to turn the resolution down and DPI up, but I have faith I'll be functional the whole day.

In other news, I look like I have two mild black eyes, and I'm guessing they're because of the typhoon of eyedrops that missed their target or overflowed over the last 5 days.

Mid-day update

I'm pretty bored today. Oddly, I feel more bored than the last couple days when I spent all day in bed listening to astronomy podcasts, so I think I'm going to hit up the astronomy podcasts some more. My vision is pretty good, such that aside from intermittent blurriness I've been able to use my computer at all times I've checked.

Macguyver test this morning for the left eye. About the same as the last left-eye test 2 days ago.

12pt: 13% (pre-op: 0%. Best post-op:17%)

18pt: 50% (pre-op: 5%. Best post-op: 65%)

27pt: 93% (pre-op: 5%. Best post-op: 46%)

40pt: 92% (pre-op: 10%. Best post-op: 93%)

All others: 100% (pre-op: worse)

Morning 4

Vision is pretty good today. Eye feels a little scratchy, even after lubrication drops, which is a bit weird.

The super-viscous lubrication drop for overnight use is extremely annoying. It's the consistency of those antibacterial handwashing gels, and ended up gluing my eyelashes together. I guess it keeps the eye lubricated though...

Day 3 checkup, round two

Right eye is all healed up.

Some notes:

• 20/25 in my left eye, 20/30 in my right. As every PRK blog ever has said, it feels blurrier than the numbers say.
• Cleared to drive today
• Cleared to use the cheaper and more numerous artificial tears
• Cleared to exercise vigourously tomorrow (T+4)
• Cleared to remove sunglasses on Wednesday (T+5)
• Don't need to do my checkup tomorrow, so next checkup is next Tuesday
• Walked to work to see how I'd do at work, and I can conclude I'm not ready for work yet. That's ok, I have tomorrow off at least, and enough vacation and/or sick days to extend my time off until I'm good.
• I notice that my vision is much better indoors than outdoors. Since there is still apparently some rough spots on the eye, I assume this is because when my pupil dilates indoors, it uses a greater fraction of older epithelium. Outdoors, it's using much more still-rough area. With that said, I don't think I'll feel comfortable driving with my current outdoor vision.

Apparently the #1 priority for healing now that the bandage is off is to keep the eye very well lubricated. The cells on the eye are still very delicate, so having my eyelid dry onto them could do some damage. For that purpose, they gave me a variety of viscosities of artificial tears.

Post-op checkup #3 - Bandage contacts out, but...

Both eyes' epitheliums (epithelia?) appeared to be fully healed so Dr Lisa took the contact lenses out. However, apparently the right eye is only at 98%, so I'm supposed to nap for the rest of this morning and return at 12:30 for another checkup.

She said that staying in bed with eyes closed the whole weekend was good to do, and can probably be credited with the fast healing (normally the contacts don't come out until tomorrow's checkup, and sometimes take longer).

So anyway, to bed!

A rollercoaster ride of vision

66 hour update:

My vision is fairly sharp this morning (still ghosty and smeary though). From the point of my post yesterday complaining about declining vision until I went to bed though, it had steadily gotten worse.

I have two guesses as to why it is better this morning:

1) The corneal epithelium has closed up, so I don't have a bunch of healing crap in front of my pupil

2) This is the normal morning-to-night swing that I have read about in other PRK recovery blogs.

Clearly, I'm reeeeaaallly hoping it's #1. My day-3 checkup appointment is in 90 minutes, so I'm hoping the contact can come out then. Otherwise, it's another 24 hours of closed eyes and being really careful.

Also, despite the opthmalogist's prediction of crappy vision coming true yesterday, her prediction that there may be associated pain/discomfort did not. So I'm now mostly past the point in the recovery where others have experienced pain, and still haven't had any. Woohoo!

Macguyver test results. Right eye today:

12pt: 3% (pre-op: 4%. glasses: 90%)

18pt: 58% (pre-op: 3%. glasses: 97%)

27pt: 77% (pre-op: 4%. glasses: 100%)

40pt: 100% (pre-op: 38%. glasses: 100%)

60pt: 92% (pre-op: 69%. glasses: 100%)

91pt: 91% (pre-op: 98%. glasses: 100%)

136pt: 100% (pre-op: 100%. glasses: 100%)

205pt: 100% (pre-op: 98%. glasses: 100%)

A little bit worse than yesterday's left-eye test, which aligns with how I qualitatively feel. This morning is my first day with very well-defined ghosts. I've got a ghost at 6 o'clock and 4 o'clock. When doing the macguyver test, I actually found that the ghosts were sometimes in better focus than the real number. However, when the letter got to be a certain size (60pt and 91pt), the ghosts would sometimes cover up and interfere with the real letter, hence why I screwed up in the bigger letters. If I got stuck with this quality of vision forever it wouldn't be the end of the world, but wouldn't be pleasant.

Damn you, advancing corneal epithelium

Just to quantify how much my vision has changed in the 9 hours since my macguyver test this morning...

For the left eye again. Numbers are [this morning] [now]

12pt: 17% - 0%

18pt: 65% - 0%

27pt: 100% - 3%

40pt: 100% - 51%

60pt: 100% - 91%

91pt: 96% - 100%

136pt: 100% - 100%

205pt: 100% - 100%

Aside from the 40pt result being 51% instead of 10%, this result was just as bad as my pre-surgery values. What a change in just a few hours.

Update: Just went upstairs to make dinner, and couldn't read the microwave - something I had specifically pointed out that I could read this morning. It's neat to see such a dramatic change when you know it is supposed to happen.

T + 50 hours

As predicted at the checkup this morning, my vision sucks pretty bad right now. I can see the hard edges of the letters I'm typing right now, but there's tons of haze and smearing around bright lights.

I've been listening to The Naked Scientist podcast pretty much all day.

Checkup 2

Epithelium is at 65% in both eyes - "Exactly where we want it to be", and nothing health-wise to report.

Did way better on the snellen test today, though I'm not bothering asking for my 20/whatever numbers.

She said that the healing epithelium is right at the border of my pupil now, so I can expect a big increase in artifacts/ghosting/smearing, and possibly pain over the next 24-36 hours as it finishes up. This aligns nicely with me noticing my vision is a bit more smeary this morning.

Macguyver Results, 11/27

Left eye, just after eyedrops (eyedrops are key). [before score] [now score] [with glasses before score]

12pt: 0% - 17% - 66%

18pt: 5% - 65% - 96%

27pt: 5% - 100% - 94%

40pt: 10% - 100% - 100%

60pt: 68% - 100% - 100%

91pt: 91% - 96% - 100%

136pt: 100% - 100% - 100%

205pt: 96% - 100% - 100%

12pt went from 3% to 17%

18pt went from 23% to 65%

27pt went from 46% to 100%

40pt went from 93% to 100%

This is very exciting. Although I will say that the visual quality is not excellent. Screens have a bit of a smear around them and it still kinda feels like I'm wearing someone else's glasses. Also, my eyes are still low-grade itchy.

First pain!

I'm at about 40 hours right now, and around 4am (38ish hours) I had my first annoying levels of pain. I'm not sure to call it pain, "aggressive itchiness" would probably be better. To compare it to non-laser-related pain, I'd say it throbbed like a mild-to-bad sunburn. Right now, there is still some discomfort in the eyes. Average visual acuity seems worse than yesterday (especially after blinks), although it when it clears up it is very clear. I'll do another macguyver visual test soon.

T + 28 hours

Not a lot to report. Spent a lot of time listening to an audiobook, music, and a brief amount of time on the bike trainer (the doc said it was ok if I kept it in a low gear, so I just keep my eyes closed to keep sweat out of them and pedal away).

Still absolutely no pain (as I ranked it to the doctor, on a scale of 1 to 10 I'd give it a 0 or a -1), although I've had a few instances of top eyelashes briefly getting caught in the eyedrop cruft along the bottom. Also, the eye feels very slightly itchy if I keep it open too long without blinking.

Vision quality is variable, but not too extremely. For example, when I blink it actually gets kinda blurry, then clears up very well so I can read this text clearly until the next blink. As reported in other people's blog posts, putting in artificial tears makes things very clear.

Played Top Speed 3 (a racing game for the visually impaired) for about an hour with my eyes closed, and I think I'm going to head back to that. Maybe if I get a headphone extension I can do it in bed...

First checkup - all is well

This is going to be a pretty boring blog if it keeps going like this.

Did my first checkup today. No sign of infection, the eye is sufficiently lubricated, and the healing is exactly where I'm expected to be. Left eye did slightly worse than the right eye at the snellen chart.

I have thought of a good description of my vision right now, and it is that it feels like I'm wearing glasses that are of the wrong prescription for me. Things are mostly clear, but kinda fuzzy around high-contrast spots.

Night 1 complete

Managed to get through night 1. The worst-case scenario envisaged by my research was that my eyelids would get glued to the dried-out contacts and I wouldn't be able to open them when I wake up. Another possibly-concurrent scenario would be continuous stabbing or burning pain too great to sleep. I had a bunch of artificial tears by my bed, and had practiced getting at them with my eyes closed. However, no extreme measures were required. At about midnight things were feeling a little dry so I peeled back the eyeguards and stuck some artificial tears in, but for the rest of the night things were good. This might be because I was waking up pretty frequently on account of the eyeguards being a little annoying for a side-sleeper like me, so my eyelids didn't spend 8 straight hours staying still.

Still no pain, either of the stabbing or burning variety.

Still no sand-in-eye feeling.

Still no discomfort of any kind from the bandage contact.

Given those things and given how hard I've heard recovery CAN be, I am going to be continuing the "keep my eyes shut in the basement all damn day" approach to recovery.

T+5 hours, feeling great

It's now been 5 hours. I have had absolutely no pain, and my vision is noticeably better than it was without glasses.

Some comments:

-The surgeon said that I had exceptionally deep eye sockets, and actually had to use his speculum from a non-normal direction to keep my left eye open. Hope that didn't cause any errors, but at least if they did they were to my worse eye.

-It's hard to keep your eye pointed ahead when the surgeon is fiddling around with tools. Your brain thinks the little red target is jostling about since it is being projected at different spots on your retina, but you're not sure if you should keep your muscles still (and accept this bad aiming) or trying to re-center the red light

-The steroid drops are kinda annoying, as they give a haze over your vision

-I'm halfway through listening to flatland. Important note: don't have your media player program on shuffle when starting an audiobook. Stuff gets confusing.

I also did my self-test. Numbers below are [uncorrected before] [now] [corrected before]. The middle number is the new reading.

Left eye:

12pt: 0% - 3% - 66%

18pt: 5% - 23% - 96%

27pt: 5% - 46% - 94%

40pt: 10% - 93% - 100%

60pt: 68% - 96% - 100%

91pt: 91% - 100% - 100%

136pt: 100% - 100% - 100%

205pt: 96% - 100% - 100%

Right eye:

12pt: 4% - 0% - 90%

18pt: 3% - 10% - 97%

27pt: 4% - 24% - 100%

40pt: 38% - 87% - 100%

60pt: 69% - 97% - 100%

91pt: 98% - 100% - 100%

136pt: 100% - 100% - 100%

205pt: 98% - 100% - 100%

Encouraging to see the 40 and 60pt numbers in both eyes approach the corrected results from before. Hopefully when things get cleaner I'll get even better. Though I understand there'll be some regression first as the cornea heals.

Time for my zymar, then some more flatland in bed.

1 hour to go

I'm still pretty wound up. Reading all those other blog posts of people's recoveries (and occasionally, their failure to recover) has probably not helped my nerves at this point. Hopefully they'll help me get through the recovery process though.

Nervous nervous nervous

I doubt I'm going to be very sleepy tonight... I'll probably get a bunch of nervous rides on the bike trainer and rowing machine though...

One more way to justify getting the surgery

There are 8760 hours in a year.

Of those 8760 hours, I will spend 3285 of them sleeping (I really like sleeping, and this count probably understates the total)

Of the remaining 5475 hours, I will spend ~2300 of them working or commuting to work (9.5 hours per day including commute is a conservative estimate)

Of the remaining 3175 hours, I will spend probably 730 of them cooking or eating

There are 2445 hours left. Some of those will be spent washing, cleaning, or doing chores.

• This year, I spent probably 100 hours in enormous wraparound safety glasses at robotics competitions.
• Assuming 30km/h (3600km), I spent ~120 hours on my bike
• Assuming 60km/h (10000km), I spent ~166 hours driving my car
• Assuming a half-hour per day of non-bike exercise, I spent 180 hours running, rowing, or swimming
• I spent 168 hours in the dominican republic trying to squint and find my friends or trying to fit my sunglasses over my normal glasses, or worrying that they'd get kicked or stepped on while I was swimming.
• I spent 15 or so hours actually competing in triathlons
• I spent 7 hours competing in citychases

So nearly a third of the free-time hours I had this year were spent doing activities that would be improved without corrective lenses. This seems to be the strongest argument for attempting to become correction-free. Hopefully it works out.

Measurement - The Macguyver test

For measuring my recovery, I designed a little protocol which I named after the famous TV guy that was always making stuff up. I was going to print off a snellen chart, but I figure I'd either end up wasting a lot of time and paper printing new ones each time (since I'd otherwise just end up memorizing the letters on a good day, thus messing up measurement of a bad day), so I wrote a little java app that places a single 12, 18, 27, 40, 60, 91, 136, or 205pt letter on the screen, and I have to press the key for it. I back my chair up against the bed (about 6ft away from my 23.2" monitors), block an eye with a DVD case, and when I'm done (250 letters per eye) the app tells me the percentage success rates for each size. After a few trials, it looks like it gives fairly consistent data.

And here is my pre-op data. Note that I should get about 4% correct for a given font size, since that would be about the guessing success rate

With glasses (aka my best-corrected acuity or BCVA). Left eye, then right.

12pt: 66%, 91%

18pt: 96% 97%

27pt: 94% 100%

40pt: 100% 100%

60pt: 100% 100%

91pt: 100% 100%

136pt: 100% 100%

205pt: 100% 100%

Obviously the hope is to exceed these values post-op, but I'd probably be satisfied with just getting close to them. A 12pt value is really small from 6ft away.

Without glasses (this is what the surgery will really be compared against)

12pt: 0%, 4%

18pt: 5%, 3%

27pt: 5%, 4%

40pt: 10%, 38%

60pt: 68%, 69%

91pt: 91%, 98%

136pt: 100%, 100%

205pt: 96%, 98%

While doing these, I really noticed how non-uniform my uncorrected vision is. Moving my head around so that I'm looking through different spots in my eye would result in letters coming into and out of focus. Sometimes an O would look like an infinity symbol due to something (astigmatism?) for example. I've heard PRK recoveries involve a decent amount of ghosting, but I should keep in mind my uncorrected vision was no picnic pre-op with regards to artifacting either.

Expectations & Hopes

I'm hoping for 20/20 vision, but I'm expecting at least 20/40 in order to drive legally without glasses.

I'm expecting to be down for the count for the 4 days (until Tuesday) following surgery due to pain, the bandage contacts feeling like sand in my eye, and blurry vision.

I'm hoping to be able to return to work by Wednesday, though I'm open and prepared (goodbye vacation days :-( ) for the possibility of that falling through. Many of the PRK recovery stories indicated that it is usually possible to return within a week, though I expect it'll be a hassle and I'll need huge fonts.

I'm hoping for decent vision reliability by early January (1.5 months from now), though I totally expect it'll be wildly varying from day to day and week to week.

I'm expecting to get a couple minutes of glorious clear vision just after the surgery before the healing process starts. Maybe I should bring something complex to look at...

I'm hoping I don't have "pain worse than childbirth" during the first 4 days, which was described in another PRK recovery blog I read.

I expect it'll take 6 months to confidently label this venture a failure or success.

I hope that if this is a bad failure, I will be able to think of a way to either maintain my current job or find another way to make money.

3-weeks-after update: This post was very pessimistic.
-I'm well past 20/40 already
-I was down for 3 days, but mainly because of doctors orders to rest myself and my eyes. No pain, no sand-in-eye feeling (except for the first couple hours after they took my contact out), much boredom due to lying in bed all day. Listened to lots of podcasts and audiobooks.
-Returned to work on Wednesday as planned. Things were a little fuzzy by the afternoons of my first 2 days, but otherwise fine.
-Vision reliability is excellent at week 3. Morning-to-afternoon degradation is noticeable some days, but far from crippling.
-I did have a few minutes of excellent vision post-surgery, but it stayed excellent (by the standards of my pre-op sans-glasses vision) until 2 days after when visual quality dove for 12 hours or so.
-No pain post-op, as previously mentioned.
-It is still reasonable to wait 6 months to label this a success or failure
-It's looking as of 3 weeks post-op that I won't have to worry about changing vocations due to eye damage.

Doing PRK tomorrow

I'm going in for my PRK appointment tomorrow, so I thought I'd post this blog so that others might read about my experiences like I have obsessively googled other people's experiences. Hopefully it will add more data to some future googler's research, for good (hopefully) or bad (oh I so hope not).

Some details:

I'm 25, male and in very good shape. I've had glasses since I was 7 or so, but I've had an extremely stable prescription since at least 2002-2003. I'm -2.2 in my right eye, -3.7 in my left. I stare at a computer for 90% of my job. I try to spend most of my summers outdoors running triathlons, training for triathlons, doing adventure races, going on vacations, and occasionally doing car racing. All of these things depend on good vision, and all of them are impeded to some extent by having to wear corrective lenses.

Why:

Answering 'why' is pretty important, as I essentially have to imagine an angry, blinded (or visually impaired) version of yourself screaming "whhhhyyyyy!" (to no-one in particular, since everything would just be blurry or ghosted blobs) and try to justify doing the refractive surgery still. For me, attempting to go glasses-free is important on a bunch of points:

Safety: Both when riding my bike (3500km this year, all on public roads) and driving my car, I find that my uncorrected near-peripheral vision takes up far too much space. When looking backwards while backing up, checking blind spots, checking for approaching vehicles, or just monitoring what's going on, it can often take several looks or several seconds to figure out what is there. Especially on a bike, completely turning around to get a in-glasses look at an object is difficult and dangerous. Also in the case of a bike or running, my glasses often get covered in sweat, rain, and/or fog, which makes detecting approaching obstacles very difficult if not impossible.

Comfort: Not wearing glasses is better than wearing glasses or contacts. Here's a list of things that suck about glasses, comfort-wise:

• Walking into a building in the winter and having them fog up
• Wearing safety glasses over them at robotics, and having them fog up
• Having them give my nose and ears rashes in the summer from being in contact with my skin while I'm sweating
• Having to constantly push them up my nose when running or cycling
• Not being able to look down in the summer because they might slip off my sweaty ears
• Having to clean them all the time
• Having to replace them
• Having to worry about where they are
• Every now and then, crushing them because I forgot where they are and sat on them
• Having to find a place to put them every time I want to do something that precludes their use (swimming, mainly)
• Falling out of a boat unexpectedly and having them fall off. I've done rowing in the past and may again in the future, so this is a concern

Quality of life: This isn't a really good argument to the hypothetical blinded-me of the future whose quality of life would/will probably suck, but it would be very nice if at a triathlon, beach, or pool, I could find my friends without first scurrying to where I put my glasses. It would be nice if I could see someone waving to me across a pool or beach. It would be nice if I could recognize someone from more than 6ft away without having to have previously memorized what colour their wetsuit/bathing suit/shirt was that day.

Probability: There is a very good (70%, according to one thing I found) that I'll be 20/20 or better. There is a very small (<2.5%) chance that I'll have an "unsatisfactory" experience. Since I'm healthy, have a mild prescription, and I'm in a position to reliably execute the eyedrop and care plan, I hope I can swing those chances more in the direction of a good outcome. The surgeon at TLC is experienced, TLC is a dedicated laser centre, and PRK is the safer of the RS options available there. TLC is close by and my work hours are flexible, so I should be able to deal with any developing problems easily. Having a permanently-lowered best-corrected-visual-acuity is a bigger negative change than a gain in uncorrected-visual-acuity, but it is an unlikely outcome. The expected return from this surgery is a gain, not a loss.

Why not contacts? This one is a bit of a problem for me - I haven't tried contacts, but I feel they wouldn't be a good match. I don't know enough about them to strictly rule them out, but I do know that they can have their own problems: they require more fastidious maintenance and cleaning, require constant refilling, can be forgotten about and give you issues if worn too long. If I end up with a bad outcome from this, it is certain that my lack of trying contacts will be the sorest point with the vision-impaired me.

So with that more soul-searching question out of the way, some simpler questions:

When? Friday Nov 25th @ 1:45pm

Where? TLC Waterloo, at the UW Optometry centre

Cashola? $4390 for the surgery and a year of follow-up appointments.

You could buy a sweet racing bike with that! I know, but I'd only use a sweet racing bike 7-8 times per year, compared to all the time with improved (or horribly impaired) vision.

How: Take a mild sedative, remove epithelium, then shoot a laser at my cornea. Weeeeee!