By Dr Theunis Botha

In August 2020 I decided to follow through with my own refractive surgery.

Two reasons:

TransPRK was the obvious choice. No flap. No other surgeon performing the creation of the flap. In fact, no human intervention at all. Just me, all my planning, and the laser. (I thank Dr York for locking the laser on my eyes and taking the responsibility of performing my procedure.) No risk of flap complications or other LASIK or SMILE related issues. However small. As a microsurgeon, any risk is too high I felt and the reason I haven't done it earlier. Yes, the recovery period was going to be a tiny nuisance (compared with LASIK of course), but plenty of patients recover quickly, so why not myself too?

Pre-operative vision was 6/3 in both eyes. Take note, that is better than normal at 6/6. However, this was with a slight head tilt downwards, in effect "pinholing" myself (to negate my refractive error) to achieve this visual acuity. My refractive errors were right 0.00/-2.00 and left 0.00/-2.75, quite high astigmatism you might note. Realistically, I had 6/6 vision which is still considered normal, so I was very well adapted to my astigmatism. With spectacles I could get to 6/3 without a blink and everything looked 3D. Now for those of you that do not see 3D every day, the world is actually 3D like when watching a 3D movie. The rest of the ones that do see this as part of their lives, won't have a concept of not seeing 3D. In my job I work with vision, I understood the difference between "normal" vision and "high quality" vision very well, even though difficult to document. On stereopsis testing, I could test down to the finest of 3D tests, therefore the difference between spectacles and no spectacles were really minuscule, but still visible to me. I could see the difference, especially when operating inside the eye where I mostly used monocular clues to judge depth rather than actually seeing in 3D to judge depth. I am a very conservative surgeon, thus this never actually bothered me, but the need for improvement was there.

For all practical purposes, my vision was "normal" without specs with all visual quality measurements including visual acuity, contrast sensitivity and stereopsis testing. But I could still see that difference in quality with specs.

I worked and saw patients up to the point of the surgery. Surgery was on a Friday afternoon at 2 pm before a planned week's leave. The laser took about 32 seconds per eye. Contact lenses were placed. I packed my bags and drove myself home. Blurry vision, but testing 6/7.5 already minutes after the laser procedure. I couldn't formally test myself on leave, but could see the difference by the first evening. Everything was crisp at times, even better than with my specs. In the darkness, lights had pinpoint sources, rather than vague scattered halo's. I had discomfort, but not enough to warrant pain tablets. At times I could feel the contact lens on the exposed stromal surface, and then just self-medicated with lubricants. By Day 2 I was not aware of my contacts at all anymore. No pain, no discomfort. Cloudy vision and some major fluctuations. By Day 4 the contacts came out and my fluctuations became less. I was reading my cellphone throughout, so we could say I was functional immediately. I was driving short distances immediately, but by Day 7 I was comfortable to drive in heavy traffic. By Day 10 I was for all practical purposes as I was before surgery with spectacles and better, with the exception of some dry eye symptoms and minor fluctuations at times. I asked a colleague to put punctal plugs in for me at Day 14, I have not used a single lubricant drop since then and my vision has been perfect and even improving since then.

This recovery scenario is quite typical. Some patients recover much quicker. Some slightly longer. But all recover. I have seen everything from epithelial closure at 36 hours with immediate 6/3 vision to delayed healing up to two weeks (in only two patients). As soon as the epithelium is closed, there is not much risk anymore. Essentially a virgin cornea with some shape change. I must make a short comment here: this recovery is quite typical for Schwind Amaris TransPRK, not for TransPRK done with other laser platforms. Ask your refractive surgeon what platform he or she uses and then what the recovery is, they will say about a month for normal vision. This is simply not the case with this system.

Do I do TransPRK for all my patients? No. LASIK is my procedure of choice. LASIK is an extremely safe procedure. The quick recovery period with the "wow" factor trumps all. SMILE is also an excellent option if one has the funds for it, but still the same results as LASIK and TransPRK visually.

Would I go through this again. Absolutely. When I start needing readers spectacles, I will plan all and take a week's break. I know full well that there will be some adjustment then to get used to my new slightly compromised distance vision, but from seeing the disgust in a presbyopes eyes from needing those readers when they have had perfect vision their whole life, I believe it will be worth the plunge.