Recovering from LASIK Surgery

Many of our patients are concerned about their recovery process after LASIK and don’t want to do anything that might jeopardize their outcome of clear uncorrected vision after vision correction surgery. This is certainly understandable! You will have made a large investment in yourself through doing vision correction surgery. In this blog post, I will go over the recovery time and what to expect after LASIK, PRK, ICL, and lens replacement surgery which includes refractive lens exchange (RLE) and cataract surgery. I hope this information helps and encourages you to see us at SharpeVision for what millions of other Americans have done over the years and who now enjoy clear vision. It’s wonderful to be able to see clearly without thick glasses and contact lenses – I should know. I had LASIK on my own eyes many years ago, and have performed PRK on my wife and my mother, LASIK on one of my children, and ICL on another. They all are seeing perfectly clearly without glasses or contacts!

How Much Recovery Time is Needed for LASIK?

The LASIK recovery process is fascinating to me. Many academic papers show that there may be some healing after LASIK for up to a year. What we call “clinical“ recovery is more like one to three months. That is to say that after one to three months your vision and comfort is generally perfect, if not sooner. I have separated the recovery process into three basic categories:

1. Day 1 (day of surgery)
2. Day 2-1 month after surgery
3. Month 2-6 after surgery

Day 1: Immediately after your LASIK Surgery

Your vision will be foggy and blurry. You may be under the influence of Valium, which hopefully will help you to sleep after your LASIK surgery. I always talk to my patients and give them just a few things to remember, but don’t worry about remembering, we will write it all down! I also give all my patients my personal cell number, so they can get in touch with me easily. I enjoy being very accessible for patients so that, if they’re worried, they can talk to me directly. The numbing drops in your eyes for the surgery generally make you very comfortable immediately after the surgery. Unfortunately, the numbing drops don’t last terribly long. Usually 10 to 30 minutes your surgery your eyes will start to burn and water. This generally lasts four or five hours but sometimes longer. We always give numbing drops to take home.

The things I tell my patients immediately postoperatively are:

• Go directly home. Don’t try to stop off at the drive-through or anywhere else. You won’t be very comfortable, so it’s best to get straight home.
• We include a cold compress in your RecoveryKit for you to use on the ride home. It won’t last very long, so I recommend that you prepare for your LASIK recovery by having cold gel packs in the refrigerator or freezer. You can place the cold gel packs on your eyelids as you lie down and try to go to sleep.
• Come in tired and then try to go to sleep when you get home. Often my patients tell me that they didn’t sleep well the night before. This is a good thing! If you can go to sleep when you get home, hopefully you will sleep through the initial LASIK recovery of burning and watering of your eyes. You can also take ibuprofen, Tylenol, or a sleep aid such as Advil p.m., Tylenol p.m., or melatonin.
• We also supply “comfort drops“ that will be in your RecoveryKit. These are numbing drops for short term use in the first four to six hours after your LASIK procedure so that you can sleep. If the comfort drops don’t give you relief after a minute or two, just put another one in if you can. Your eyes will be watering, so it can be somewhat difficult to get them in. If you cannot get in the comfort drops, don’t worry. They are not necessary but often help relieve some of the burning and watering of your eyes.
• A sensation of irritation and watering after LASIK, unfortunately, is normal but fortunately short-term. Usually it’s four to six hours but can be more or less. I hope you will be comfortable and hope you will fall asleep for as long as possible after your LASIK to help you get you through the normal burning and watering during the initial phase of recovery.

Day 2 to 1 Month after Your LASIK Surgery

In this period, the recovery is somewhat variable. Most patients are seeing perfect or near perfect. The two most common reasons by far for blurriness in the initial first month after LASIK are:

1. Dryness: Almost everyone has some degree of dryness temporarily after LASIK. The symptoms manifest typically as waking up with vision that is foggier than when you went to sleep. Or having tired eyes along with increasing fogginess and fluctuation of your vision throughout the day. These symptoms are generally more pronounced in women as compared to men. Dryness is also generally worse as we get older. Typically in our late 40s and 50s, the amount of water component of our tears decreases. This can be manifested as burning of the eyes, fogginess, and grittiness. Itching of the eyes is generally more likely to be allergies versus dryness, although both are possible.
2. The second reason for blurriness after LASIK is any residual prescription. If this occurs, we can do an “enhancement“ procedure to adjust for small amounts of residual nearsightedness, astigmatism, or farsightedness. Overall, the chances of needing an enhancement are less than 2% of all LASIK patients. In my practice, I will wait at least three months to allow your eyes to heal as well as any dryness to resolve. The chances of you needing an enhancement increase slightly as the amount of your prescription increases. There is also a slightly greater chance of needing an enhancement if you are over 40 years old versus under 40 years old. It’s pretty easy to do an enhancement for LASIK, and you won’t feel the pressing on your eyes because we have already made the LASIK flap. We can simply lift that flap up, do the small degree of laser correction, and put it right back. Your recovery is somewhat similar, but generally the recovery is quicker on an enhancement versus the original LASIK procedure.

Month 2 to Month 6 after Your LASIK Surgery

From 30 days onward, any improvement is very subtle. The most common issue at this timeframe is dryness as described above. We can use additional techniques if your dryness is more pronounced. Remember that all postoperative visits are at no extra charge, and you have your surgeon’s cell phone number for questions. The vast majority of our patients with more pronounced dry eyes after LASIK are patients over 40 years old and mostly female. Examples of additional therapy for dryness are: using thicker tears/gel drops, especially while you are asleep. Using ophthalmic lubricating ointment while you are asleep also protects the surface of your eyes from drying out. There are many other potential treatments for dryness, which I discuss in another blog post. Dryness generally gets better in the first month, but it’s not terribly unusual for some milder symptoms to persist in month two to six. If there is a question that you may need an enhancement procedure, we measure the prescription component at about one month, then we repeat this measurement at three months. Assuming they are stable (which they usually are) the enhancement procedure is scheduled and can be done anytime after three months, assuming that everything else looks healthy.

How Much Recovery Time is Needed for PRK?

The recovery time after PRK is similar to LASIK at the one-month mark and beyond. In fact, statistically, LASIK patients do better vision-wise in the first month, but PRK patients catch up statistically and are indistinguishable in terms of outcomes as compared to LASIK. In the early 2000s, there was a definitive meta-analysis done of all the PRK versus LASIK studies and found that LASIK and PRK are no different in terms of outcomes. This has been our experience also at SharpeVision Modern LASIK. However, the recovery time for PRK is very different than that of LASIK in the first week to one month. I always tell my patients that if we could edit out the first week after PRK, we might never do LASIK again.

PRK Recovery: No LASIK Flap

Performing the PRK procedure is slightly easier than performing LASIK because we only use one laser for PRK as compared to two lasers for LASIK. The difference is that with PRK, we are not making a LASIK flap. Instead, we simply remove the thin layer of skin (corneal epithelium) for PRK. This is done gently with a soft sponge and patients feel nothing. The same laser is then applied and the same change in your corneal surface is effected. From this point onward, PRK recovery is more difficult, because the superficial skin layer is removed and has to regrow over the surface of your eyes. The coverage of the corneal surface is generally complete at three to five days postoperatively, but it’s definitely not healed yet. The corneal epithelium will continue to smooth out and remodel for several months, which is why the vision tends to improve a large amount in the first week or two, then improve slowly over the next six to eight weeks.

Day 5 PRK Recovery

We leave a bandage contact lens in the eye until day five postoperatively, when it is removed. The recovery at this point generally leaves our patients with 20/40 vision give or take. This is usually good enough to pass a driver’s license test, but not nearly as good as it will ultimately get. I always say that PRK is a “pain“ literally and figuratively. The literal pain is in the first 48 hours. We place a bandage contact lens on the eye immediately after the laser portion of the procedure. We also give a bigger bottle of numbing drops and recommend ibuprofen and/or Tylenol. We also give pain medication called gabapentin which decreases the need for the narcotic pain medicine Norco. Norco is generally for “breakthrough“ pain that most people have to some degree or another. The figurative pain is that your vision is blurry as that superficial epithelium is healing across the surface. Most people have vision that is generally worse on day three or four and then starts getting better. From day five onward, you most likely would feel like you can drive a car, although it’s still difficult to read road signs, and your vision may fluctuate. Light sensitivity is also very common at this stage and can last several months, although light sensitivity improves a lot in the first weeks of your PRK recovery process.

How Much Recovery Time is Needed for ICL?

The EVO ICL is in amazing procedure for those with moderate to high degrees of nearsightedness and astigmatism. There is quite a bit of overlap in those that qualify for LASIK/PRK and the ICL procedure. Often the anatomy of your eyes will determine which procedure is recommended. Some people have enough tissue to do LASIK as well as enough space to place an ICL (Implantable contact lens) inside your eye behind your iris. The ICL procedure is the most comfortable of our procedures. You will feel very little during the procedure. Perhaps the worst part of the ICL procedure is the brightness of the operating microscope light. With the ICL procedure, your vision is similar to LASIK and PRK on day one in that your vision will be foggy and blurry. The difference with the ICL is that your pupils are widely dilated, so you won’t be able to see anything up close for 12 to 48 hours. There is typically little to no discomfort after the ICL procedure. The incision is about 3 mm at the junction of where the white and colored part of your eye meet. This is so small that you may not feel anything at all, other than maybe slight dryness as well as light sensitivity. The overall ICL recovery process is similar to LASIK recovery and very fast. Most patients are seeing 20/20 or better on day one after ICL, although your vision will still be foggy and you’ll see more glare/halos on day one. These halos improve quickly and most people don’t notice them after several days or several weeks. The LASIK recovery process and ICL recovery process are very close to the same. The difference is that the LASIK recovery process involves four to six hours of burning and irritation, as described above.

How Much Recovery Time is Needed After Lens Replacement Surgery?

Lens replacement surgery has two different basic types: refractive lens exchange (RLE) and cataract surgery. RLE is the exact same procedure as cataract surgery except for the fact that with cataract surgery, insurance companies generally contribute somewhat to the cost. As we age, the natural lens of our eyes becomes dysfunctional and less flexible starting in our 40s and 50s, which make bifocals and readers necessary. The lens later becomes more dysfunctional as it becomes less clear as a cataract forms. The RLE procedure removes your dysfunctional lens and replaces it with a custom multifocal intraocular which corrects nearsightedness, astigmatism, and the need for reading glasses-AND you won’t need cataract surgery when you’re older. It’s one and done surgery that corrects everything at once!

After lens replacement surgery, you will typically be comfortable and experience foggy vision. There is generally little to no discomfort postoperatively and most of our patients would pass a drivers test without any glasses on day one postoperatively. The bonus is that with the multifocal lens, your vision will be focused up close as well as far away.

Screen Time After LASIK

I generally don’t limit the amount of screen time after LASIK at all. I talk more about that here. Most patients will have some degree of dryness which manifests as foggy, fluctuating vision over the first month or more. There is no harm done by using a screen, and let’s face it – everyone uses screens most of the day. Many patients will experience more eye fatigue and fluctuating vision after long periods on screens, but it won’t damage anything or impair your LASIK recovery. I recommend keeping a bottle of artificial tears nearby, so that you can use them frequently if you feel tired. Hydrate well! Some folks think that fish oil may be a benefit to help the recovery of the surface of your eyes after LASIK. Some people recommend the 20–20–20 rule which states that every 20 minutes, you should look at something 20 feet away for 20 seconds to rest your eyes. It’s a reasonable idea, I think. But there’s no evidence of any harm if you don’t do it.

When Can I Resume Using my Phone?

You can use your phone four to six hours after LASIK. In the initial four to six hours, your eyes will burn and water, and it’s best if you sleep or relax. Remember to hydrate well and try to keep your eyes closed, using a cool compresses if it feels good. After that, if you can do it in terms of comfort, you can use your phone as much as you want.

When Can I Resume Using my Computer?

The same recommendations above apply for using your computer. I think it’s reasonable to take it easy the first 24 hours or so just to get through the initial recovery. You really can go that long without using your computer!

What are the Limitations on Driving after LASIK?

The limitations on your driving may be a little different. If you are not seeing clearly, you are not driving safely. The vast majority of our patients (probably greater than 90%) would pass a driver’s test easily on day one postoperatively. The requirements for passing a driver’s test are 20/40 vision, with or without correction. After your LASIK surgery, you will no longer need correction, but in the first 24 hours your vision will likely be foggy or blurry to some degree.

When Can I Exercise After LASIK?

I always tell my patients you can do whatever you feel comfortable doing, but don’t get hit in the eye. That is, you can go snowboarding, head a soccer ball, stand on your head for yoga inversions, but don’t let your toddler (or anything) poke you in the eye. The LASIK flap is not easily moved. The LASIK flap will not move from squeezing, blinking, or using your eyes. In my practice after 25 years of doing laser vision correction on about 85,000 eyes, I have had several dozen people have some sort of eye trauma and move the flap. In my experience, the most common reason for the LASIK flap moving is a toddler about 18 months old. A newborn won’t poke you in the eye (obviously), a five-year-old won’t poke you in the eye, most likely, but a toddler that you pick up and hold has discovered his or her fingers and likes to explore. One time I had a patient who was reading to her daughter, and her daughter turned around and said “look mommy“ and poked her mom directly in the eye and the flap moved. (I repositioned it without further problems). This seems to happen anywhere from one week to three months postoperatively. The LASIK flap adheres to the underlying surface and that bond gets stronger for several months. There are case reports of people having eye injuries years after LASIK and the flap moving, but my feeling is that this risk is extremely small in the first place, and any eye trauma can create injuries regardless of whether or not you’ve had LASIK surgery. Eye trauma years after LASIK can potentially move the LASIK flap, but may be severe enough to cause other internal eye injuries or external injuries such as eyelid laceration or tearing of the conjunctiva or iris. All injuries are unique and can be serious and must be seen by an ophthalmologist (Eye MD) as soon as possible after the injury. The LASIK flap, in my experience, can in most injuries be repositioned safely and have no further issues, although this may not always be the case.

When Can I Resume All Other Activities After LASIK?

As stated above, “you can do whatever you want whenever you want, just get the eyedrops in and don’t get poked in the eye.“ Everything else will be fine. Your eyes may be dryer if you use them a lot, but you can use artificial tears to soothe and comfort your eyes, as well as improve your vision.

What if I Have Blurry Vision After LASIK Surgery?

Most blurry vision after LASIK surgery is due to one of two things: residual prescription or dryness. The most common by far is dryness, and that will get better for weeks to months after LASIK surgery. Many diagnostic tools can be used as well as therapeutic treatments to improve dryness, but for most people, it’s just a matter of using artificial tears and giving it time to heal. Your eye surgeon can help you if you have any concerns. Residual refractive prescription happens in about 2% of all patients who will need an additional simple procedure called a “enhancement“ to adjust any small amounts of nearsightedness or astigmatism.

When Can I Exercise After LASIK?

You can exercise as much as you want. If you are engaged in heavy exercise and have sweat in your eyes, it will burn because it’s salty, but it won’t do any damage. I would drink a lot of water and use artificial tears to dilute the salt.

When Can I Swim After LASIK Recovery?

Swimming is the one activity that I would recommend waiting a minimum of a week to engage in. You generally will want to wear goggles or a mask when swimming anyway. Anyone swimming without goggles or mask will have blurry vision regardless of whether or not they have had LASIK surgery. However, with goggles or a mask on, you should see quite clearly. This is a big change for anyone who has had blurry vision while swimming. A pretty nice benefit that you may not have thought about prior to having your LASIK surgery.

The Benefit of LASIK Surgery!

One of the main benefits of LASIK surgery is exactly what we’ve been describing above: you can go back to regular activities 4 to 6 hours after your procedure! Live your life to the fullest with minimal downtime. Use the medicated drops as directed, and you will be fine. How cool is that?!