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Comment by cl3misch | Hacker News Reader

> As the epithelium does regrow naturally however, [PRK] is less likely (both in theory and in medical literature) to lead to dry eye

This is exactly opposite to how I understood and experienced healing after Trans-PRK. My eyes are still very dry 6 months post surgery. Being at the upper limit of Trans-PRK yourself, did you actually go through with the surgery? If yes, how was your healing process? I would be very interested in chatting about it, since I am not particularly happy with mine, and wondering what can be done (and whom to blame).

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Sorry to hear that it did not go well for you. Yes, I did go through with it, was in April of 2024 (Trans-PRK via a Schwind AMARIS) and I did have a rather painful recovery, especially on day two and three after the surgery.

From there on, the pain and foreign object feeling quickly subsided alongside the remaining "haze" and by day five, I neither had any subjective pain, nor any major issues reading text (both typed and digital). Had multiple check-ins of course, both at the clinic which performed the surgery and with my decades long ophthalmologist, no issues were found there either. Subjectively, I do not experience a heightened severity in dry eye symptoms for what that is worth.

Also had a clinical rotation in Ophthalmology just this month (small world, though was why I felt the urge to comment) and the attendings did assess my epithelium as having regrown evenly too.

What could have gone wrong for you and how to go about this, I really can't say and I am sure you have already considered /pursued it, but I can only suggest getting a second opinion from another established ophthalmologist, including looking at the eye drop regiment prior to the surgery and during, as well as post recovery.

Thanks for the elaborate answer. Reading about Schwind AMARIS it seems to be using SmartSurf which claims faster healing than conventional TransPRK. I can't assess how much of this is marketing speech or if it's basically the same as TransPRK.

In any case, I agree that a second opinion would be most helpful.

I couldn't tell one way or another, but honestly didn't choose that particular system for any reason beyond that being what was on offer where I live. My very limited reading prior to surgery though would indicate that currently there is no source showcasing a difference in subjective recovery experience between TransPRK and this Smartsurface. What has been used as a source when covering the technology is mainly focused on the first three months [0], rather than longer term as you are describing and does in my opinion not actually showcase a difference between Smartsurface and TransPRK specifically [1]. Full disclosure, I only include the name of the system because it felt like an HN thing to do. It wasn't some value judgement that these machines are superior or that others are inferior.

[0] https://crstodayeurope.com/wp-content/uploads/sites/5/2019/0... referenced from https://pubmed.ncbi.nlm.nih.gov/26871764/

[1] If you look at the source they are referencing, it compares TransPRK to aaPRK after three months and they were using Schwind machines, though did not clarify whether this was using Smartsurface. Very cursory search engine use tells me that this is toggleable, so an option on these machines. Even if this study did use Smartsurface though, that doesn't answer whether outcomes are different in TransPRK with Smartsurface vs TransPRK without Smartsurface. Additionally, I do not know whether this option was used in my case.

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