Question and Answer with Dr. Holzman
Who is most likely to benefit from PRK?
Generally, those that benefit from PRK might fall into four general categories.
1. Occupation/profression … police offices in tough areas, those in the military, those considering these occupations in the future.
2. High contact hobbies … martial arts, rugby, boxing; generally super active adults that might consider these hobbies in the future.
3. Anatomical considerations … EBMD, tight eyelids, less than perfect scans, major lid squeezers.
4. Patient’s personal preference … some patients just want PRK, maybe their friends or family members had PRK, or they can’t deal with the idea of a flap being on their eye.
What about your technique limits a patient’s discomfort?
In the past, people have been very leary of PRK because of the initial period of discomfort. However, PRK now is totally not what PRK was way back when. There are many ways that one can control discomfort that naturally occurs during the initial post-op period.
In no particular order, some of my key techniques for limiting post-PRK discomfort include:
1. Use of frequent, chilled artificial tears post-op,
2. Intraoperative cooling of the cornea with frozen BSS prior to start of surgery,
3. Smaller epithelial defects.
4. Neurontin (oral gabapentin) before surgery to work more effectively and continued for the first few days post-op,
5. Bandage contact lens,
6. Diluted tetracaine, known as the “comfort drop” for breakthrough discomfort (but it is rarely actually used),
7. Topical NSAIDs, and, of course,
8. Proper education on expectations.
It’s important to educate patients on what to expect with PRK healing. Sugar coating it never got anyone anywhere, so I will just be honest. With my personal techniques for limiting pain, most patients will experience discomfort during the first 5 days post-op. During that time, the vision is also blurriest, so most patients take that time off from work. Most patients are feeling much better starting the second week after surgery, and their vision is also improved so that they are comfortable with driving to familiar places. Each week, the vision improves slowly with most patients starting to meet their endpoints at about 4-6 weeks post-op. When patients understand what will happen, they are better prepared, less frustrated.