Comment by cullenking | Hacker News Reader

Comment by cullenking | Hacker News Reader

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There are a couple other mentions in this thread about PRK. I went the PRK route instead of Lasik, and don't regret it one bit. I chose PRK because it was less risky, and was more durable. Look it up yourself, but brief summary:

  - no flap, they remove top layer of cells with a scraper, then laser
  - no flap means stronger eyes. if you box, mountain bike, work in a high risk environment, it's the procedure to get
  - long recovery time, and it's pretty painful for the first week. ~ 2 weeks to reasonable vision, 4-6 weeks for 20/20 or better.
  - less chance of dry eyes (still a semi-common outcome)

My eye doctor, the casey eye institute, pushed lasik, but that was purely for what people commonly want. They were enthusiastic about PRK, considered it a better procedure for people who were OK with the recovery time, with less chance of complications.

My complications:

  - dry eyes, but nothing worse than contacts get midway through a day
  - sensitive eyes. meaning, a scratch on the eye becomes eye wateringly bad
  - slight halos at night, but again, nothing worse than contacts at the end of the day

I am happy with the results, would do it again, and am currently advising my wife to do PRK instead of lasik (she's on the fence of doing anything). I ride mountain bikes, dirt bikes, and do lots of building, so chances of complications with a flap are non-zero. If you haven't read, those complications are pretty bad - get lazik, take a stick to the eye a year later which causes the flap to dislodge, you now have potentially uncorrectable vision in that eye.

Search the rest of this discussion for PRK. If you aren't afraid of pain, discomfort, and a long recovery time, it's the procedure to get.

Also there's a HUGE difference in lasik or PRK providers. As you can imagine, it's worth spending extra. My procedure cost $4k total, which is $3k more than budget lasik providers. However, I worked with some top eye doctors that regularly perform serious eye surgery, and are at the forefront of optometry. Strip mall discount lasik has less time spent on planning, comes with less experience in recommending procedures, and has less experience working with complications. Definitely don't cheap out!

Supportive personal anecdote:

I got PRK in somewhat unusual circumstances, paying $1.6k total. My cornea thickness was compatible with the procedure (which is one of the big reasons to do LASIK over PRK, i think), but my offset was huge (-7.5, where PRK usually caps at ~-5).

The circumstances boil down to having it done in a foreign country, and they used a non-FDA approved eyedrop (toxic if it got in the bloodstream) that allowed the procedure to correct my offset fully. Four years later my vision is going strong.

Long recovery time was 2 weeks with fireworks in my eyes the first two days. After that it was logrithmic improvement in blurriness.

I would also highly recommend PRK, it enabled an entire lifestyle for me which heavy glasses actively discouraged, and there isnt a day i miss waking up to a blurry space.

> Definitely don't cheap out!

This is so important for any surgery where mistakes can be life-altering. When I was a teenager we cheaped out on braces with a dentist 3x cheaper than the other one we'd spoken to, and my teeth are now slightly misaligned and I have a fairly weak bite.

Fortunately it doesn't affect my outward appearance and I've gotten used to it as it's not too bad, so it was almost worth it for the valuable life lesson.

I forgot to mention this in my other response.

Most doctors will use the same equipment in the same area. For PRK they do a tomographic scan of your eye to determine a number of parameters, and then your doctor pre-programs the procedure.

In my case, the most direct action my doctor had during the procedure was cut back/replace the outer flap, and apply the drops.

I say this because 'cheap' (at least to me) implies someone with less skill or lower ability performing for a lower price. Since so much of the process is automated I'd say that only a small part of this applies.

Especially for those who are looking for a good price, ask revealing questions like where the equipment is, when it was recently obtained, how often this particular doctor has done it. And since costs aren't directly attributed to manual labor (and can easily crest 10k+ for a region), dont be afraid to negotiate and price compare.

How do you know which providers charge more because their product and competence is actually better, rather than because they are a low quality facility that just decided to charge more?

I don’t believe it’s as simple as finding a more expensive provider to ensure better outcomes.

In my case, I went to a world class eye institute that is part of OHSU. I am lucky in that we have a pretty serious research hospital here in Portland, so I didn't have to travel.

I don't know how you find the best in your area, but I was mostly referring to the strip mall lasik centers. If you aren't familiar with these, they are a budget lasik provider that has past generation equipment, run by technicians instead of eye doctors. They run ads on billboards, and in the local coupon books that are delivered to your house....These are the places that I think are mostly being referred to by the article.

Also in PDX - where did you end up going out of curiosity? Casey?

Yup!

>I ride mountain bikes, dirt bikes, and do lots of building

This is the main reason why I'm sceptical of laser eye surgery and contact lenses - even if you have 20/20 eyesight, there are a lot of circumstances where you should be wearing protective eyewear anyway. Laser eye surgery makes your eyes more vulnerable to damage and doesn't obviate the need for protection from dust, debris, caustic substances and UV radiation.

I religiously wear eye protection. Sticks can make their way around glasses / goggles. The flap created during lasik doesn't need an object in the eye to dislodge though, a blow to the head will do it in the right circumstance. Lasik makes your eyes more vulnerable to damage, PRK does not. This is why police/military/sports require PRK for corrective surgery, rather than lasik.

I presume he means to be able to make it easier to use eye protection (as one does not need glasses), not to avoid wearing eye protection.

How do you know the symptoms won't appear further down the road as you age? That's my only concern and fear.

I don’t!

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