Experiences with TransPRK SmartPulse Laser Eye Surgery

I recently decided to have laser eye surgery to correct my mild myopia (-1.25). Based on my research, I initially wanted to get SMILE but having only -1.25 dioptres to correct meant I was ineligible as it makes the lenticule too thin to extract properly. The next best option appears to be TransPRK. I started this blog page to document my experiences and recovery as I found other similar blogs very useful when making my decisions. I'm 34 years old and have worn glasses since I was about 22 for any distance vision. I work as a system admin / developer so I'm in front of a computer for a lot of the day.

Consultation #1 - Bergman Clinics

My first consultation was at Bergman Clinics in Utrecht, Netherlands. The facility was very clean and modern and the staff friendly and knowledgeable. They perform all the necessary scans and tests in a single session, so you only need one pre-exam before treatment. My eyes were dropped with pupil dilating drops and another set that prevents them from focusing, so I was unable to do much for the rest of the day as my eyes were very sensitive. They recommended TransPRK, however I hadn't looked into this too much at the time and didn't have many questions.

After doing some more internet research on TransPRK, I found some good information about the available options. The Schwind Amaris 1050 RS laser system has what seems to be the best TransPRK treatment at the time of writing (2017), using SmartPulse / SmartSurfACE. This reduces recovery time compared to other options. Unfortunately Bergman Clinics only had the Schwind Amaris 750 S system, so I decided to Google around and find a clinic with the newer 1050 RS laser (and of course it never hurts to get a second opinion when it comes to your eyes!). I ended up finding EyeScan who had recently installed the 1050 RS in their Utrecht clinic, so I set up an appointment with them.

Consultation #2 - EyeScan

The EyeScan consultation was split into two parts - one visit with much of the same tests as Bergman (and again with the annoying eye drops) and a second visit at a different facility with even more of the same (although weaker eye drops that wore off sooner). They ended up also recommending TransPRK for treatment. This time I came prepared with more questions - in particular about focusing distance. I sit in front of a monitor for most of my work day and I usually don't wear glasses for this. My focus naturally falls on the screen without much effort, but if I wear my glasses I notice I am consciously focusing on the screen a lot. I was concerned this effect would carry over post-surgery and cause eye strain, but the doctor said that restoring my "normal" vision would make this less of an issue and it would go away after a week or so.

At the end of my 2nd exam at EyeScan I decided to go ahead and schedule in the surgery. I received a packet of eye cleaning wipes that I need to use for five days pre-surgery and an informed consent form and a prescription for post-surgery eye drops. My surgery is scheduled for the end of November so I'll be coming back and updating this blog entry with details about the surgery and recovery as soon as I'm able to use my computer again.

Day 0

My vision is good enough to use my computer again for short periods, so time for an update! The procedure itself went very quick - I arrived at the clinic after a light breakfast and was given 1000mg of paracetamol and 50mg diclofenac. I was pretty nervous and my body was reacting to it - I spent a good amount of time in the bathroom, luckily I'd arrived with plenty of time!

I was called into the prep room where I was given anaesthetic eye drops, they stung a little but it quickly faded. They went over the post-surgery tasks - mostly about the different types of eye drops I had to use and gave me a sleep mask to wear for a week. I was then taken to another room where I had betadine applied all around my eyes and nose, then a disposable surgical gown, hair net and shoe covers applied. I waited in this room for about five minutes contemplating what I've got myself into when they took me into the surgery room.

They instructed me to lie down on the bed and rest my head onto a mould that kept it in place. They put a leg rest under my knees to help keep me comfortable while lying there. A large piece of sticky cloth was placed over my whole face with just an opening for my eyes, then another piece covering the left eye. My right eye was then taped open with more sticky stuff (which while sounding unpleasant was nowhere near the Clockwork Orange setup my brain had conjured up!). The laser system was then moved into position over my eye and I was asked to focus on a flashing green light.

They told me the system was taking a picture of my eye then before I knew it there was a loud sound which I can best describe as a combination between a table saw and dot matrix printer and my vision started blurring. I kept as still as I could although I could feel my heartrate elevating while the assistant counted down the remaining time. There was a bit of a burning smell, rather like burned hair but it didn't last long. In all, it was over in about 15-20 seconds. They dropped plenty of eye drops or something in my eye immediately afterwards, then swabbed them briefly with something and then placed the bandage contact lens in. Then pretty much the same thing for my other eye and it was done. I took a minute to let my adrenaline settle and then they took a look at my eyes and a few minutes later I was out of there. Overall I would describe the procedure as uncomfortable, but definitely not painful in any way.

Immediately afterwards, I was quite surprised how well I could still see. I imagined it being very blurry but it was close to how I was seeing without glasses (but for all distances). I could still barely read my phone to respond to messages from the person picking me up. I was in no pain whatsoever and felt no discomfort, but I knew this wouldn't last so I went straight back home to rest.

Around three hours after surgery I started feeling pain and a sensation of grit / sand in my eyes. I put it off but it gradually got worse and I took 1000mg paracetamol. It took a while for it to kick in and eventually I was in a lot of pain, I couldn't keep still and my eyes were constantly watering and looked very red and swollen. Eventually the painkillers kicked in and it subsided for a bit, although the scratchy sensation was definitely still there. During the day I was using eye drops roughly every hour, I'm not used to it and keep blinking or missing my eye a few times.

I took another 1000mg paracetamol later in the evening and then went to sleep. Sleeping itself was quite annoying - in between the pain and the sleep mask it was very uncomfortable. I usually sleep on my side but with the mask / goggles on, this made it push into my face which was not very pleasant. Eventually I fell asleep, although I woke up in the middle of the night a few times.

Day 1

In the morning my right eye was stuck shut - it required a bit of effort to open and there was a small amount of yellowish fluid. I applied more eye drops, took another 1000mg paracetamol and then headed off for the followup appointment.

During the followup they did a basic exam to check how the eyes were healing. My right eye was healing faster apparently, but both were looking fine and I was done in about five minutes. The rest of the day went fine, lubricating eye drops every hour or so and very little pain until the evening. I took 500mg paracetamol for that and then went to sleep, again having a restless night and waking up at 4am.

My vision was about the same as the previous day - most things were blurry but close vision was improving very slightly.

Day 2

No problems with my eyes sticking in the morning, although they were very dry and I immediately had to use the lubricating drops. I experienced very little pain or discomfort and didn't have to use any painkillers today. My vision was still blurry but I could do some basic computer work with a larger font size, although it hurt to look at the screen for longer periods. I'm getting better at aiming the eye drops so less of it ends up on my face!

Day 3

Showering is getting annoying, as I can't use shampoo so my hair is getting rather oily. I got a haircut the day before the surgery which I'm glad I did now. Vision has improved a bit - I can now make out the edges of the contact lens they put in my eyes. I've never worn contacts before so I was a bit concerned how I would feel with them, but honestly if they hadn't told me about them I probably wouldn't have even noticed them. I still had very dry eyes in the morning and needed lubricating drops ASAP, but my vision has improved enough for me to write this update with a normal font size. Most things are still very blurry though especially at distance. I'm not experiencing any pain or discomfort (except when my eyes get dry) any more. I'm actually quite surprised (and happy!), since reading other blogs I expected the worst pain on days 2 and 3, but other than the pain immediately after surgery, it's not been an issue at all for me - I didn't even need to take any of the diclofenac I was prescribed. I guess that's the benefit of the SmartPulse / SmartSurfACE system?

I'll continue updating over the next few days, but I don't really think there's much more that will happen other than continual vision improvements. So far vision is about the same as I was without glasses, although near vision is still blurrier than before. I have my next appointment on Monday (two days from this post) to remove the contact lens, so I'll probably update again around then.

Day 5

Nothing much to report over the weekend, vision isn't really much different yet. Today I went back to EyeScan for the bandage contact lens removal. First they look at your eyes to check how the healing is going - both of mine looked great and the corneal epithelium had regrown. Fluorescent drops were put in my eyes which made my vision temporarily orange but it only lasted a few minutes. Next came the lens removal. This was a bit uncomfortable as it involved the staff member touching your eye, you don't really notice though since you're looking in another direction. The first one came off without a problem and some minor discomfort. The second one didn't go as smooth, I ended up blinking at some point as it was very uncomfortable. The 2nd attempt was successful, however I had a very strong sensation of something in my eye. After some investigation we found an eyelash that had slipped in while the lens was being removed. After that was taken out there was no more discomfort.

I'm back at home now and my vision is considerably worse all around, writing this blog post is difficult as the text is so blurry again. This is apparently normal - now that the lens is removed my vision will shift around a lot as the cells in the eye move around. My next appointment is on Friday so I'll update again then.

Day 13

I had my followup appointment a few days ago and everything is going fine. I was able to see a bit more of the Snellen chart and I've noticed good improvement in distance vision. Computer work is still annoying as everything still has a slight blurriness to it which you really notice when working with text on a monitor. I went out at night and didn't notice any starbusts or halos which I was seeing in the earlier days.

I stopped using the antibiotic eye drops six days ago and started with "FML Liquifilm" three times a day. It's an anti-inflammatory, not entirely sure why it's needed but best to do what they say! This new drop has the side effect of tasting absolutely awful. And no, I didn't drink it on purpose! It turns out your tear ducts are connected in such a way that any fluid in your eye will eventually drain to the back of your throat. The first time I used them I didn't close my tear ducts (apply light pressure to the corner of your eye near your nose) and five minutes later I almost wanted to throw up. Since then I've been meticulous about blocking my tear ducts immediately and making sure any residue is removed after the 30 seconds I have to keep my eye closed. I still get the taste every now and then but it isn't as strong as the first time. When I brought this up at my appointment, I was told that this could result in a temporary loss of voice if it continues and was prescribed a different type of drop if I feel the need to change. So far I'm sticking it out and haven't noticed any voice problems.

Next update will be around Christmas as my appointment is a few days before.

Day 90+

So I kind of forgot to update this post, I ended up traveling to Los Angeles for all of January - it's very important to wear sunglasses all the time if you're in a bright area like this! Since the last update I've finished with all the drops and had my 3 month followup appointment. My vision is really good now, I want to say it was a tiny bit sharper with glasses but I think this is a result of the gradual change that you get from recovery vs the instant sharpness you get when putting on glasses. I think I was reading the 20/20 (6/6) lines on the Snellen chart without a problem and even made out a few on the next line. I do have a little bit of haze in one of my eyes (that's what the FML Liquifilm is supposed to prevent), but it's not enough to really notice an issue and it should heal itself over time.

The only small issue I have is that my eyes still aren't used to their new focusing distances. If I relax my eyes everything shifts out of focus, but this will supposedly pass over time. I also have a small lump forming in my eyelid that is apparently the result of a blocked gland, it's supposed to go away on its own but it's been there longer than it should have so I'm heading to the GP next week to get it checked out.

Overall I'm very happy with the result and would recommend it to others. The improvement in vision is very gradual during the recovery, so you won't immediately feel the improvement like you get with glasses and contact lenses so it can be a bit disappointing in the early stages. I haven't noticed any of the issues typically associated with laser vision correction - no halos or starbursts etc which I'm happy about.

One Year Later

I recently had my one year checkup at EyeScan. Everything looks great - I have very slight astigmatism in one eye but overall my vision is still "excellent". There've been no noticeable changes in sharpness or any other issues since my previous update. The focusing thing is still present when I allow it to happen but I really don't notice it during my day-to-day, I expect the same thing happens with glasses anyway. Overall, I'm still happy with the outcome and would definitely recommend it.