My Epi-Lasik Experience (long)

jvencius · #1 10-01-10, 18:44

On 9/9/10 k I had Epi-LASIK surgery from Dr. Rapuano (hereafter Dr. R) @ Corneal Associates in Philadelphia and so I thought I could share my experiences with that procedure since I haven't seen much, if any, discussion of that specific procedure on here. I decided to go with Epi-LASIK because it is, essentially, PRK but with 15 years of evolution in technique/technology. Just like PRK, it is a surface ablation procedure, not a mid-corneal ablation like regular LASIK and Dr. R said that he enthusiastically recommends Epi-LASIK for anyone subject to eye trauma or impacts, i.e. boxers, skydivers, LEO's, etc... Just recently he had a patient who had her LASIK flap get dislodged 10 years post-op and that isn't a risk I was willing to take, despite the faster recovery time for regular LASIK.

1 Day pre-op:
I went to Wills Eye Hospital the afternoon before my surgery for the pre-op exam. Normally they would do this exam a week or two before someone's surgery but since I flew in from out-of-state and since I called to get on their schedule almost 9 months early, they were willing to make an accomodation for me. First a tech took me back into an exam room and did a series of tests to measure my corneal topography, assess for any astigmatism (I have zero in either eye), and pupil diameter in a dark environment. Following some anesthetic and dilating drops she ran a test to check my corneal thickness with a wee-little ultrasound probe on the eyeballs. Once my pupils were sufficiently dilated Dr. R came in and did some other exams (dunno what he was looking for, but he said my eyes were otherwise healthy). When the exams were over, he spoke with me for ~30 minutes regarding my motivation for getting the surgery, the different surgical options and the pros/cons/risks of each, custom vs. non-custom surgery, and what I could expect post-op. I had done a ton of research beforehand so he didn't go into as much depth as he might have with someone who walked in off the street who wasn't so informed.

Surgery Day:
My parents drove me down to Wills since I would be in no condition to either drive myself home or take the train and we checked in to the surgery center about an hour before my scheduled time to fill out another stack of paperwork. At that point, Dr. R took me into the room with the Wavefront machine to do a super-detailed measurement of my cornea for the custom treatment I was scheduled for. After paying (total out-of-pocket for custom Epi-LASIK was $4250) a nurse took me back to start the pre-op series of antibiotic drops, clean the area around my eyes with antiseptic goo, and to go over my post-op instructions and eyedrop regimen. Shortly thereafter Dr. R came out and took me into the laser suite. With the exception of using an epikeratome to cleave the epithelium over my cornea vs. a PRK brush or LASIK microkeratome to cut a corneal flap, the actual laser procedure is very very similar between any of the laser-based refractive surgeries so I'll skip over that part. Once both of my eyes were done, I was lead to yet another exam room where Dr. R ran a quick check to see that the bandage contact lens he placed was in the correct position and then I was free to leave.

The first two hours post op sucked. My eyes hurt like hell, I was tearing heavily, and for some reason my nose was running like a mofo. After we got home I laid down in bed with the lights off and ice packs on both eyes to try and kill some of the pain. Most of that day I alternated taking Tylenol (have a scrip for Tylenol III but have only taken two of them) and laying in the dark with the ice packs. After the first two hours the bad pain subsided and settled down to a burning sensation as if I had been cutting onions in the kitchen. It wasn't painful, persay, just irritating.

1 Day post-op:
On Friday morning I woke up, put in the eyedrops I was Rx'ed, and Dad and I went into the city for my first checkup. Dr. R said I was seeing at 20/30 which was better than most folks and that my corneal epithelium had already healed ~ 2/3 of the way so I was ahead of schedule for that. He warned me to expect that as the epithelial defect came closer to healing completely that my visual acuity would decrease since there wasn't as wide of an area of smooth cornea to see through, somewhat akin to a pinhole or fisheye camera lens. Once the epithelium healed over then my vision would improve and I would be closer to the final result of the surgery. That was good since I wasn't surprised that night and Saturday that I couldn't see nearly as well as I could one day post-op. Overall my vision was decent and while things were blurry, I could walk down the street without tripping or bumping into things. I continued putting in the antibiotic and steroid drops every 4 hours and using lubricating drops as needed for comfort.

2 Days post-op:
Other than somewhat reduced visual acuity (everything was blurrier) and some more irritation that was possibly from being outside for a time, day 2 was pretty similar to day 1. I continued with the drop regimen, taking regular Tylenol for pain during the day, and Tylenol III at night.

3 Days post-op:
Woke up feeling pretty good and the pain/burning sensation in my eyes like I had yesterday is gone. Things are still blurry but not so bad as yesterday so I'm pretty sure the epithelial defect is healed over. Still continuing with the drops but only needed the steroid drops until Post-op day #2, per Dr R. That was OK by me since (oddly) they created an unpleasant/bitter taste on the back of my tongue a minute or so after I put them in. It wasn't terrible, just strange. I'm still pretty light-sensitive but not nearly so much as the first two days. Still, I pretty much live in my Oakleys and they make a lot of difference when I go outside whether I'm comfortable or cringing every time I have to look at a light source (oncoming car headlights at night aren't much fun at all...).

4 Days post-op:
Went to Dr. R today for a checkup--he said my epithelium has healed completely in both eyes so he gave me some numbing drops and took out both of the bandage contacts. With those contacts out, my visual acuity decreased a tiny bit (had been ~20/30 with them in) but that will improve over the next few days/weeks/months as both the epithelium remodels itself smoother and the corneal stroma heals. I have absolutely no pain and just the tiniest bit of discomfort but it's not even worth taking a Tylenol to take that edge off. I'm on a 4x/day regimen for the Rx drops I have and he said to use OTC lubricating drops as necessary for comfort. Overall, he said that I'm healing well faster than average and that's probably due to (1) taking it very easy on my eyes in the couple days post-op and (2) both eating right and taking the uber-high doses of omega-3 supplements I've been on. Since I'm healed up, I won't have to go back to Dr. R on Friday for that last checkup and now I'll have to visit my ophthalmologist out in CA every 4-6 weeks for follow-ups.

3 week post-op update:

My vision continues to get incrementally better every day but like Dr. R said, it does fluctuate some throughout the day depending on a couple different factors. The primary factor affecting my visual acuity is the amount of moisture on the surface of my eyeballs, i.e. immediately after putting in either the steroid anti-inflammatory drops or the lubricant comfort drops I have (Refresh Sensitive, if it matters to anyone...) my vision is REALLY REALLY good. Yesterday I ate some "Atomic" wings for lunch and while they weren't uber-hot, there was enough spice in them that I teared up a little and sure enough, I could see quite well for a few minutes afterward. I'm not sure whether it's primarily from the strain of looking at a computer screen or some other factor of my job, but when my eyes get tired my vision deteriorates a bit but some of the aforementioned Refresh drops clears things right up. I'm still a tiny bit light-sensitive outdoors but the BIP lenses in my Oakley Flak Jackets are just the ticket for those bright days and Persimmon-tinted lenses are the heat at night--just enough transmittance that it doesn't feel like I'm in a darkened room and enough glare reduction from oncoming car headlights that I'm not a terror behind the wheel. Overall, I'm happy that Dr. R warned me of what to expect and every day I'm happier and happier that I got the surgery done.

Hmac · #2 10-01-10, 18:50

Sounds like a good experience thanks to good prep info from the doctor. I had radial keratoplasty 15 years ago, in the pre-laser days. Eyesight is still 20/20, but presbyopia has certainly become an issue.

genegoesfast · #3 10-01-10, 18:57

Congrats sounds like it will be well worth it.

agr1279 · #4 10-01-10, 20:17

Thanks. That is good information. What was your vision going into it?

Dan

jvencius · #5 10-01-10, 20:32

Quote:

Originally Posted by agr1279

Thanks. That is good information. What was your vision going into it?

Dan

I don't know just how bad it was but it sure wasn't good--I could find the crapper in the middle of the night w/o my glasses but that was about it. Driving was a definite no-go and even though I could wear contacts, there were just enough drawbacks to 'em that surgery became a much more desireable option once I got into my 30's. FWIW I'm 32 and Dr. R said that is a good age to get eye surgery since my prescription is stable and I'm mature enough to take care of myself during the post-op time b/c the 4x/day drop regimen is very important to maintain.

jvencius · #6 10-01-10, 20:38

Quote:

Originally Posted by Hmac

Sounds like a good experience thanks to good prep info from the doctor. I had radial keratoplasty 15 years ago, in the pre-laser days. Eyesight is still 20/20, but presbyopia has certainly become an issue.

Yep--if I hadn't known to expect the fluctuating acuity and the longer recovery time for Epi-LASIK vs. other refractive procedures, I would have been quite concerned but since Dr. R's pre-op brief was so thorough, I'm not worried at all.

I may need reading glasses once I get into my 40's b/c the changes in the to cause people to need them aren't the same changes that laser surgery corrects but I'd rather pay $5 for a pair of readers at CVS than have to depend on glasses or contacts full-time.

spm917 · #7 10-01-10, 21:35

Congrats. Here is insider tip. Sometimes the flap doesn't work in epi lasik and you automatically get PRK. The results 6 months out should be the same but you will have more discomfort after surgery.

jvencius · #8 10-01-10, 21:48

Quote:

Originally Posted by spm917

Congrats. Here is insider tip. Sometimes the flap doesn't work in epi lasik and you automatically get PRK. The results 6 months out should be the same but you will have more discomfort after surgery.

The "flaps" as they were (different for Epi-LASIK vs. regular LASIK--the Epi-LASIK flap is much much much thinner and is discarded) for both my eyes went perfect.

Vash1023 · #9 10-01-10, 22:41

really wish i could afford that...

worn glasses my whole life and its really held me back

jvencius · #10 10-01-10, 22:51

Quote:

Originally Posted by Vash1023

really wish i could afford that...

worn glasses my whole life and its really held me back

I had to decide "OK, no more gun stuff/hotrod parts for the truck for a while" and once I did that, the saving process to accumulate the $5K for the surgery/flight to PA/miscellaneous expenses got easier. It still took nearly a year to accumulate that much but it was awfully nice to write a check to the surgeon w/o having to take out a loan or run up my cc to pay for the operation.

motorwerks · #11 10-01-10, 23:12

I had mine done over 2 years ago..... its been EPIC! I'm still better then 20/10 from legally blind.

Von Rheydt · #12 10-02-10, 10:07

Had it done around 5 years back.

Results far better than hoped for. Took me from a +3.5 prescription needed for daily life down to a +1 prescription for reading only. Presbyopia has taken its toll and I am now on a +1.5 for reading and tinkering around but for everything else I am lens free. Still technically a 20/20.

Check UK prices they may be lower than USA, there is a better exchange rate at the moment..........and they ain't 3rd world Docs in the UK. I went here:

http://www.accuvision.co.uk/

Hmac · #13 10-02-10, 11:33

Quote:

Originally Posted by jvencius

Yep--if I hadn't known to expect the fluctuating acuity and the longer recovery time for Epi-LASIK vs. other refractive procedures, I would have been quite concerned but since Dr. R's pre-op brief was so thorough, I'm not worried at all.

I may need reading glasses once I get into my 40's b/c the changes in the to cause people to need them aren't the same changes that laser surgery corrects but I'd rather pay $5 for a pair of readers at CVS than have to depend on glasses or contacts full-time.

Yeh, that was my rationale too and it's worked out great. You can save ton of money on eyeglasses, which tend to get VERY expensive when one ages to the point of needing bifocals, especially since the presbyopia tends to advance over 10-15 years starting about age 40 and you need new prescriptions every couple of years.

One problem with presbyopia has been my ability to see the front sights of pistols. Bought a couple of stick-on 1.5 lenses and put one on the dominant-eye lens of my shooting glasses. Hasn't been a problem at all for using any kind of HWS, though.

The RK didn't hurt at all...about 24 hours of feeling like a little sand in my eyes. 20-10 vision right away, no loss of contrast. My ophthalmologist is a friend (and colleague) so the refractive surgery didn't cost me anything. I traded him a colonoscopy for it

. I got the better deal.

Von Rheydt · #14 10-02-10, 11:48

Quote:

Originally Posted by Hmac

You can save ton of money on eyeglasses, which tend to get VERY expensive when one ages to the point of needing bifocals, especially since the presbyopia tends to advance over 10-15 years starting about age 40 and you need new prescriptions every couple of years.

What motivated me to investigated the surgery was that at the time it was time to renew my glasses. I had my walking/driving around daily glasses, bifocals and reading glasses along with a spare pair of daily glasses. The whole new set would have cost around $800 - $1000 to get replaced - so that money was put into the surgery instead. Now I get my eyes chencked eyery year and only wear disposables from CVS/Walgreens.

Hmac · #15 10-02-10, 11:56

Quote:

Originally Posted by Von Rheydt

What motivated me to investigated the surgery was that at the time it was time to renew my glasses. I had my walking/driving around daily glasses, bifocals and reading glasses along with a spare pair of daily glasses. The whole new set would have cost around $800 - $1000 to get replaced - so that money was put into the surgery instead. Now I get my eyes chencked eyery year and only wear disposables from CVS/Walgreens.

The other issue for me was that I have a number of hobbies that require helmets and/or goggles of various types. Eyeglasses were always a huge PITA for stuff like that. Contact lenses are only a little better. Furthermore, the risk of blindness from use of contacts is greater than the risk from refractive surgery.

jvencius · #16 10-12-10, 17:01

1 month post-op update:

I just went to an ophthalmologist out here (Dr. Amir @ Pacific Eye in San Luis Obispo, if it matters to anyone...) and he said that my eyes are healing remarkably well. My right eye is completely clear and there is only one very small spot of haze in my left eye that the drops I'm already taking (down to 3x/day now r the next month) should clear that up over time. He said that spot of haze is causing the slight but non-bothersome halos I see around bright light sources (oncoming car headlights, streetlights, etc...) at night but those halos will go away as the haze clears. I still have absolutely zero discomfort/irritation and the non-Rx lubricant drops help quite bit if my eyes get a little dry in the wind or when I stare at a 'puter screen for too long. My vision tested at 20/20 with fluctuations towards 20/15 when I'm relaxed and there is a good layer of tear film or drops on my eyes. Dr. Amir said that as my cornea heals and the epithelium goes through successive generations of remodeling, my vision should stabilize at 20/15 or so (couldn't put an exact number on it) and that was very very good news. Overall, I'm still happy as hell to have gotten he surgery and think it was VERY well worth the expense.

rob_s · #17 10-12-10, 17:09

I really really want to do something like this but I'm in front of a computer 12 hours a day. I can't even wear contacts any more. and what I hear most people call "success" and that they are happy with would constitute monumental failures to me (i.e. halos, light sensitivity, etc.). I hope they keep improving things and maybe one day I'll get out of the glasses.

Von Rheydt · #18 10-12-10, 20:08

Rob, I was dubious and walked away from the surgery once because I asked for wavefront and was told that it was only done for extreme cases............and cost more. Truth was the Doc I saw had the older style kit that he was still committed to a lease on and was only able to offer that.

What turned me on to wavefront was a paper written by a Navy Doc in San Diego. He had gone from fighter jock to eye surgeon. His whole approach was that experienced pilots in their late 30's and early 40's were suffering from deteriorating eyesight that precluded them from flight duties. So he moved through perfecting the various surgeries and eventually settled on wavefront. At the time I read his paper he had included Navy SEAL's in his patient group and was experiencing much success.

I read about halo's and aircon sensitivity and to be honest the prospect of someone shining a laser into my eyeball scared the shit out of me. On the day I nearly walked away. But, I stayed and each eye took around 1 minute to zap. The effects are immediate and astounding.

Yes, there are bad cases. Some Docs will only deal with minimal correction - less risk for them. I will put my hand up and say yes I DID - I DO NOT NOW - suffer from aircon sensitivity. Wavefront minimises the potential for halo effect and I don't drive at night so I don't notice if I have it anyway.

I spent the first couple of days post op wearing skydive goggles. And every time I showered for the first week post-op I wore a dive mask .......... sounds stupid, but "If there is a risk eliminate it", so I did.

My guy that did the op in the UK is the consultant for many pro soccer players, the British olympic team and many other pro-athletes. He told me that even Tiger had the op done, it helps you pick out a flag on the green more easily apparently. And, even though I need glasses for close up stuff again now out at distance I have the ability to distinguish detail that a sniper would be proud of.

chadbag · #19 10-13-10, 01:01

Quote:

Originally Posted by rob_s

I really really want to do something like this but I'm in front of a computer 12 hours a day. I can't even wear contacts any more. and what I hear most people call "success" and that they are happy with would constitute monumental failures to me (i.e. halos, light sensitivity, etc.). I hope they keep improving things and maybe one day I'll get out of the glasses.

I sit in front of computers at least that long. I had it done 2.5 years ago. Wavefront etc.

I get a small amount of hallowing on distant headlights, etc. It disappears as it gets closer. I don't have light sensitivity that I notice and have no problems sitting in front of the computer. I was 42 when I got it and am 44 now.

Just a point of reference for you.

Watrdawg · #20 10-13-10, 08:19

I had regular LASIK done back in 98 and have not looked back at all. All puns intended. I went from a 5.0 and 5.5 contact prescription, which means I couldn't see my hand 12" in front of my face clearly to 20/15. I have been that way ever since. Now that I'm 46 I am starting to have to wear cheaters to read. I'm sure that part of that is because I'm in front of a computer 6-8 hrs a day. I never had any complications. My eyes were dry for about a year and I had to keep drops with me most of the time. No halo effect at night or anything.

One thing I would recommend if anyone is thinking about any type of corrective surgery is to go to the best doctor available and don't worry about the cost. If the Doc say you are not a candidate or whould only do one eye at a time or whatever follow his advice. A Dentist friend of mine had the same surgery and initially saw the same physician. He was told to do one eye at a time and didn't want to. He went to someone else who would accomodate him and they really messed up his eyes. He came out of there worse off than what he went in with. It's a shame but he can be an arrogant ass sometimes so he probably deserved his fate.