Tuesday, July 14, 2009

Basic Lasik

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Curious what getting lasered in the eyes feels like, and if anyone other than Tiger Woods endorses it?

Do you happen to know what an ophthalmic speculum is? They look like thin metal tongs, and you're going to get each arm of one shoved between your eyelids and your eyeball while you're awake. It'll leave two nice red spots on your sclera and make your eyelids puffy and feeling bruised for a few days. But the good news? That's probably the most physical discomfort you'll end up with, providing you TAKE YOUR PAINKILLERS ON TIME.

But from the beginning now...

My venue was a newly opened clinic in northern New York; the fam drove up in the middle of a snowy Northeast winter to get me lasered. It struck me as a chain operation from the look of the waiting room, which was filled with industrial low black couches and offered paper cups of cheap (but what can you say, it's free!) coffee. You'd think for a thousand bucks an eye (and that was a grand opening 50% discount deal, too) they'd be able to afford better refreshments for their sheep, but now that I think about it, they didn't own the fancy lasik machine, but rented it from a company. Smart company.

I had been given a sheet of instructions, most of which were mundane and so I don't recall them anymore. Stuff like "wear the provided masks at night to avoid rubbing your eyes after the surgery" (or you might dislodge the just cut flaps in your corneas...) The one note that still stays with me is the painkiller notice. I had my ibprofen and took them in the waiting room. (Mistake!)

As a note of warning to people who may run into this situation during their lasik experience: before we signed the final paperwork, a girl took me and the folks into a side room and proceeded to market a "special" lasik procedure that would cost quite a bit more, with better promised results. Being practical, penny-pinching Asian parents and more importantly, ones that don't take any scare tactic bullshit, they declined. Admittedly, the girl, aka sales rep, had me going for a bit - at this point I was minorly freaked and pretty much prepared to come out of this procedure blinded for life - but after some private discussion, the science and cost of the procedure didn't compute. Basically, the claim was that the "basic" procedure only hit a particular diameter of lens, and once your eye dilates in low light levels, there will be uncorrected regions of lens interfering with the corrected vision you get from the lasered diameter. The question, of course, is how much are you willing to pay for 20-20 poor resolution black and white rod vision anyway? If your pupils are dilated that much, there probably isn't much to see. Needless to say, having gotten the "basic" lasik, I still have fine night vision; admittedly some transparent, smeary "light ghosts" (google "ghosting" in conjunction with "lasik" or "vision") pop up every now and again beside bright lights in very dim places, but it's nothing that's affected my quality of nighttime navigation.

When my turn at the laser came, they put numbing drops in my eyes that dilate the pupils and made everything too bright (and me look stoned, apparently). They tapped the surface of each eye to make sure it was properly anesthetized. It's quite weird to be behind those eyes as they're tapped. You see the world ripple but feel nothing.

Properly numbed up and drugged up (for now, anyway), I lay down on a dentistesque chair and the guy propped open my eyelids. Yep, with those speculums. Lovely little things.

I don't recall the exact sequence of events as the actual lasiking began, but there was a lot of "stare straight ahead," "focus on the red light", "don't move your eyes" and seeing the underside of the guy's sleeve and the equipment. I felt nothing throughout this, besides the niggling discomfort of having your eyelids constantly pulled open and not being able to blink. There was a pulling pressure when they used a piece that reminded me of a microscope lens that fit around the cornea, and presumably cut the flap.

When the flap was pulled back, my vision naturally got weird and the red light I had been looking at broke up into strange watery little red lights. What was quite amazing was somewhere during the procedure, they pressed on my eye and left me temporarily looking at complete blackness filled with little sparks of red, green and blue dots. That was quite fascinating, though they warned me ahead of time in case such things freak me out. They don't, so long as it's temporary.

When the laser was doing its thing, it sounded a little like a mini machine gun: a series of small punching noises. They had said it smells like burning hair; I thought it smelled more like a dentist drill. No pain.

When the lasering was over and the cornea flap was replaced over my eye, that miracle happened. Already I was able to see things much more clearly through that eye, and no healing had even begun yet.

Repeat with the second eye. All while the family was gawking at the entire procedure on a tv screen outside the procedure room. I think that was the most awkward part of the whole thing.

My vision got cloudier not long after the procedure was over; I assume cells were dying and would have to regenerate for me to regain my transparent corneas again. Everything in the dimmed recovery room was cloudy but also sharp. And confusing, just like the previous statement. Before we left, there was a lot of warning about not rubbing my eyes, not getting them wet, wearing sunglasses during the day and an eye protector at night, and using a series of eye drops religiously to avoid infection and dryness.

By the time I got outside, the pain hit with the force of a tornado to the face. Even through the agony, I recall noting the interesting fact that the pain came in cycles, like ow ow ow OW OW OW ow ow ow rather than a single long burning OOOOOOW. No idea why that might be, but all I remember was it was intense, it was relentless, it was mothereffin' BAD. I don't normally have a problem with pain, but this was really something else. Once a tiny gnat hit the surface of my eye during a bike ride, and that was enough to almost run me into a tree. That gnat-impacted eye burned for almost half an hour afterwards. This was the concerted screaming pain of two sliced and peeled back corneas and two burnt lenses. OW.

Really.

There was nonstop tearing all the way to the hotel, and even at the hotel it continued. I recall having several deathwishes when I crawled into bed and tried to ignore the unignorable. Eventually, finally, the painkillers I took way too late kicked in and I fell asleep.

The weeks after the procedure were annoying but uneventful. I used the drops, I didn't rub out my corneas and the fogginess cleared gradually. No real pain or discomfort besides some grainy sensations that didn't really bother me too much. While I saw halos around any bright lights up until probably 6 months after the procedure, I was able to start using my newfound vision pretty much from post-op Day 1.

One other major concern I had was how tired my eyes would be after getting this done. Having worn glasses for the past 20+ years of my life left them very achy, sore and painful often. Often after staring at a computer screen for umpteen hours. Only taking off my glasses and letting my eyes "rest" would alleiviate the soreness, and I was quite nervous that getting lasik would be the equivalent of gluing the glasses to my eyeballs, leaving my eyes perpetually tired and with no way to "revert" to the "natural" resting, but highly myopic state. I'm happy to say my eyes have not felt that level of tiredness after it was done, and there has been a noticeable lack of eye strain compared to when I wore glasses.

Thank the eye gods! Er, eye docs!

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To state my biases outright:
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--Would you recommend it? Yes, yes I would.
--How bad was your vision? Generally speaking , it was quite poor without my glasses, about -7.0 to -7.5 for both eyes. My crapulous vision made finding lost glasses without help, identifying people in the pool and reading anything further than a foot from my face well-nigh impossible. It had stabilized for a year or two before I got the procedure done (I was 21 when I was lasered).
--Did it hurt? Ohhhhhhh you betcha it can! My eyes were two flaming balls of searing pain incarnate for about 30 eternal minutes after the local anesthesia wore off. Do note, however, that this was entirely my own fault and would be easily avoided by taking systemic painkillers EARLY. Not 10 min before the procedure begins.
--How's your vision now? It's been over two years since the procedure. The last time I checked, my vision is 20-20 in one eye and 20-15 in the other. Might be a bit different now, but I don't notice it if it is.
--Any side/negative effects? For several months after the procedure, I saw oft-mentioned and somewhat dreaded "halos" around any bright light, especially in dim environments. They gradually vanished, though on a rare occasion nowadays they might reappear briefly, then my eyes do some strange refocusing thing and they clear out. I will sometimes see whispy ghost smears of bright light in dim places like subway tunnels even now, but overall my night vision remains good and I have so far not found myself debilitated in any way. I still drive on highways at night in the rain, I still stare at computer screens in dark rooms all the time and I can still see at 3am where the bathroom door is.
--Should I do it? If your glasses are so thick so your eyes look three times as small as they really are, if you can't or don't want to do contacts, if you can afford it and if you research your clinic so you don't end up blind from some quack, then based on my experience so far, I'd say go for it!
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