jvencius
10-01-10, 17:44
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.
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.