Mapgirl’s Fiscal Challenge

Updated status: My PRK eye is not doing well. The bandage lens was drying out but I didn’t know it. I never wore contact lenses so I had no idea I was supposed to be soaking the lens as much as possible during the first 48 hours. So I have SPK, which mainfests itself as cloudiness, but continued use of my steroid and anti-inflammatory meds cleared it up. As of last week, I see 20/25 out of my PRK eye.

Since I tend to write in a rambly and undiscplined fashion just to get something out daily, I thought I should make a little chart of costs for you.

What Does Laser Vision Correction Surgery Cost?
Medications:
17.99 - Generic Tobramycin substitute for Zymar at ~$75. Also called Tobramax.
38.97 - Tylenol 3 for pain, Gabapentin pain reliever (Also called Neurontin), and 50 Refresh Plus single-use, preservative-free eye drops

Surgery:
$4790.00 including all pre- and post-operative exams. With PRK, I am going to have at least 5 follow up exams, 24 hours, 3 days, 1 week, 2 months and 3 months after surgery.

Total:
$4846.96+~$40-80 for more single-use eye drops for a full month

I am going to have use the single-use eye drops for at least one month. The bulk package of 50 vials is going to last me a week due to the SPK problem in my right eye. I find that I used them almost hourly the first few days after surgery and that still wasn’t enough for the PRK eye. The doctor’s pre-printed treatment plan says to chill them for PRK, which I thought I would hate, but honestly, I kind of like the cold eye drop. It does make my eyes feel better.

As far as eye drops go, I’ll be honest here and tell you that the other brand available in single-use, preservative-free vials is Systane. I personally like the Systane vials better. The plastic they use is not as stiff as the Refresh Plus drops and easier to squeeze. That sounds dumb, but while you are trying to line it up with your eye, look downwards/to the side, AND put the drop in, having squeeze extra hard is annoying. Plus with the PRK eye, I feel like I can really flush stuff out with a prolonged squeeze of the softer plastic.

Shop around for the single-use vials. Rite-Aid had them for $18 a box. Giant grocery store for $16. I think I saw them at CVS even cheaper, but I also got a coupon in the box I did buy, so it is worth it to buy it one box at a time and see if there is a coupon inside to save money on the next box or two.

This is stating the obvious, but opt for Lasik if you can. Someone asked me if I could have delayed my left eye surgery and had a smaller suction ring ordered to use for me eye so I could do Lasik on it instead of PRK. I didn’t even think to ask that question. I could have sworn they said they didn’t have a smaller one available. I am kicking myself because with PRK you have many more follow up exams and it will cost me a pretty penny to haul my butt out to my regular eye doctor because she is located near my old job location in the burbs and not near my new job. It sucks because she hardly has weekend hours, but I think the other doctor in her practice does. As it was, on Tuesday, she was late to my appointment and had locked my chart in her office so the other doctor in the practice couldn’t see me without any info.

As far as your goggles go, I got a free pair of them, but let me tell you, they are what military people politely call glasses from the PX, “BCG’s”, e.g. Birth Control Glasses/Goggles. If you want something slightly more stylish to wear so you don’t accidentally rub your eyes or touch them in any way while healing, try MSA’s instead. MSA is the chic term my boyfriend and I developed for his tight-fitting, bug-eye shop glasses. His came from Mine Safety Appliances and were free from a plant visit he did for work. I am quite mad at him for letting me wear the BCG’s to a hockey game and bar before remembering that he had these at the house. The funny thing is that I actually did get a compliment on them the next night at the chic 18th Street Lounge in DC. (Sam “The Man” Burns was spinning.) Mind you, these are close fitting goggles and will fog up, but they did keep some jerk from elbowing me in the eyeball while walking through a crowd.

A lot of people have asked me about the surgery and their number one fear is having stuff touch their eye and getting freaked out during surgery. All I can say to them is take the valium when it’s offered and afterwards, you will think nothing of what has happened. It’s not a big deal. I have worse and more prolonged pain from monthly cramping. If you can eat your pain for 10 minutes, you can do this. A blinding migraine is far worse than laser eye surgery. All you have to do is lie still and focus on a blinking dot. And no, I didn’t have a burning smell, and yes, the laser room was very cold, but as there was a snow storm in DC that day, I was already dressed very warmly. FWIW, I’ve seen industrial lasers cooled with 10,000 gallons of water, so I guess I’m not surprised that it was chilly in there. Temperature does effect chemistry and physics, and people, that is exactly what lasers are about, chemistry and physics.

Lastly, please note that your bathing habits are going to have to change here. Lulugal has already mentioned her doctors have told her she can’t wash her face. I showered less frequently that I would have liked because when I do shower, I had a stinging sensation on my eyes even though no water has actually entered them. I kept them shut, but it still hurt like crazy. I had to wash my hair in the tub instead. So please note that you may encounter some dermal issues after surgery.

ps - While looking for a reference to SPK, I found this list of questions to ask your doctor when you have vision correction surgery. Even though it says ‘Post-op’, I would definitely consult this list pre- and post-operation and use it to educate yourself on the risks if I could do it over again.

All was successful with my surgery last week. There were only two problems, but not huge ones. Since I changed jobs, I don’t have an insurance card yet, so I’ve paid for all of meds out-of-pocket. That’s not the problem though, and I’ll explain why.

First of all, I told the nurses, technicians, and doctors that I am allergic to Cipro. Yes, I am going to die in an anthrax attack. But really, it will be quick and painless relative to having hives cover my body, because I found out the hard way about my allergy. This meant that I could not use Zymar, the regular antibiotic they give patients, as it is in the same class. I wish they discovered this error before I spent $75 on the Zymar. However, the replacement, Tobramax was only $18 and I was able to return the Zymar, unopened, for a full refund! YAY!

Advice: If you are doing this on a budget and are not insured, you should ask your doctor if Tobramax is a suitable alternative for you because of its reduced cost. Your doctor may write you a prescription for it instead. Heck, they might even give you free sample sizes. (Which I will explain later.)

Second, everything was going lousy on Thursday for me. I had to rearrange my schedule due to different constraints with work (meeting my new project team at an off-site location far from my doctor’s office) and then the horrible snowy weather we had. I was running late big time, but since the weather was crappy, the laser eye center didn’t think anything of it when I showed up 10 minutes late.

I put the surgery on my credit card as I have not yet received a Medical FSA card yet. (Did you know this has been renamed in 2008? It’s now called Healthcare FSA instead.) It’s going to ding my credit score as I will now have a high utilization, but I don’t care. I had to do it, and reimbursement papers will be submitted soon, as I will have to ask for reimbursement for the surgery (approximately $4800) and for all the medications (approximately $50-60).

One thing I forgot about is a valium pill. They offer it to you. I remember they mentioned it to me a few weeks ago and I thought I didn’t want it. Benzodiazapams suck. I hate how groggy valium makes me feel. But this time, being all tense about driving in bad weather, being late, and a small amount of anxiety about permanently jacking up my vision, I said ok. I advise you to only take half, because I was really woozy for a whole day. I’ll explain more about this too.

Right before going into the laser room, my doctor did a quick check of my eyes. He looked at my right eye and said it was great, but when he looked at my left he was concerned that my eye socket was a bit small. He was thinking that he might have to do PRK instead and explained that with Lasik, they fit a ring on your eye socket and it couples with the laser to create a tight seal and fix the laser’s position. Unfortunately, my eye socket might be too small to fit the ring and it could pop out, which would be very bad. So I signed paperwork for PRK surgery as well as the Lasik and away I went into the laser room.

Lasik takes about 2 minutes. No lie. It’s very quick. They fit the ring on, you stare at an orange blinky light, stuff is very blurry and you can see the doctor manipulate stuff in front of your eyeball. It’s not a big deal. The doctor was able to do my right eye very quickly. However, sure enough, when it came to my left eye, they put the ring on and as the laser lowered to couple to the ring, it popped out. The doctor apologized and went ahead with PRK instead. The difference is basically rather than cut a flap, they scrape away the epithelial cells. It takes a lot longer to heal, bu the results will essentially be the same. Honestly, it only took a few minutes more. I couldn’t have been in the laser room more than 10 minutes total. And that includes another post-op check of my eyes.

With the PRK, they also put a protective bandage contact lens in, which isn’t necessary with Lasik.

Because they want you to sleep for a few hours right away, they give me Tylenol PM after they reviewed my PRK and Lasik healing/medication treatments, because there are different medications for each one. And they wrote me some extra prescriptions for pain medications. Before my friend took me home, we went to the drugstore and I picked up the meds along with some extra eye drops. With eye surgery you have to get single-use preservative-free drops. Total for two prescriptions and eye drops was about $40. Really, it was cheaper than I thought. Also, they give me two small vials of Tobramax for my PRK eye, not knowing that I already have some anyway due to the Cipro allergy. So more free medication for me!

On our way back to my friend’s house, we decide that I am going to sleep over for a few hours and her husband will drive me back later because the weather is going to change to rain and the roads might be better. If not, I’ll just stay over. I crawled into their spare bedroom and conk out. I slept from 4pm till MIDNIGHT! I could hear voices downstairs wondering if they should check on me, but I’m way too tired from the Tylenol PM and valium to even shout out that I’m ok. Basically, I roll over and sleep till midnight. At that point, I wake up and crawl downstairs for a glass of water, slice of pizza and slice of cheesecake. I put in my first round of eye drops and go back to sleep.

In the morning, I do all of my eye drops at 8am and take the oral medication I need as well. I take a nap and get up around 10:30 for the next round of drops. With Lasik, you put in Pred Forte every 2 hours you are awake (a medication my doctor provided). Due to an anti-inflammatory drop for the PRK that’s every 12 hours (also provided), I try to set myself onto an even hour schedule for everything. I line up the drugs in order in front of each eye and treat the right eye first, then the left eye. They recommend doing each eye separately so you don’t get confused. I recommend lining the drops up on the counter in order, so you don’t lose your place.

The funny thing is that the lubricating drop has to be chilled for the PRK eye. I ask my doctor about this later and it’s just for comfort. I think this is crazy to put in an ice-cold eye drop, but it really does help lower the inflammation, so I am going to continue to do it.

Later in the day I go to see my regular eye doctor and I made a stupid mistake of not bringing all the meds and treatment plans with me. Due to the confusion about Tobramax, the doctor calls the laser center and gets it all straightened out. It’s all good and I am cleared to drive. I see 20/20 out of my Lasik eye, and 20/50 out of my PRK eye. This after a mere 24 hours. WOW. That is really cool.

The eye doctor tells me that my Lasik eye will be fully healed in about a week, but cautions me that the PRK eye can take up to 2-3 months to heal and settle into its final prescription. It may or may not reach 20/20. I tell her that’s ok. She says though it’s 20/50 now, when I come back in 3 days, she will remove the bandage contact for me and my vision will improve even further.

I still feel woozy from the valium and Tylenol PM. I continue to drink a lot of water to metabolize the medication. But I’m also having a low grade headache. The doctor asks me if I have any pain and I tell her not really. I only had a regular Tylenol even though I have a prescription for Tylenol 3. I just don’t need it since there is no acute pain.

Now that I’m writing this in my funky, don’t-rub-your-eyes, goggles, I realize that I still have a low grade headache and I’m sure it’s due to a slight amount of squinting from my 20/50 eye and this stupid elastic strap on the goggles.

But all in all, I’m happy I’ve done it. Feel free to comment or email me any questions you might have. I’m not a medical professional by any means, but I did have two types of procedures and they were both successful. Even if my PRK eye stays at 20/50, I have made great improvements already. If you have a desire to get rid of your glasses, I highly recommend laser surgery and I am happy to recommend my surgeon to you. (I get a $25 gas card if you do.) Also, to save money, I recommend asking your friends if they have referral coupons for other doctors. Apparently some of the laser centers around DC give them to patients, I just chose a specific surgeon who had done work on several of my friends and I felt extremely confident about getting good care. More than anything, be confident in your doctor when selecting your surgeon. Though the preliminary checks were done by a doctor that didn’t notice my Cipro allergy, as they reviewed my chart later, they caught the error and called right away. Better late than never.

Also, Lulugal has a write up of her own experiences at How I Save Money. Take a look and compare and contrast. Talk to as many folks as you can about the details since everyone has a different take on things. (And her treatment protocol is very different from mine. The meds aren’t even the same name, which makes me wonder if she’s in a different country and they’re branded differently.)