I can see!

So, I had my LASIK surgery today. I’m still reeling a bit, from the process itself as well as the implications for the rest of my life. For the curious, here’s how the process went:

Part One: Qualifying

On Monday I underwent a battery of tests in preparation for the LASIK procedure. This included a refraction, the classic “eye exam” where the optometrist determines your level of near- or farsightedness and the amount and location of any astigmatism. (Astigmatism is an irregularity in the spherical shape of the eye, and can occur vertically, horizontally, or at any diagonal angle.) Until a few years ago, this refraction was done exclusively by means of the familiar phoropter device - the set of oversized eyeglasses on a stand, which the doctor would adjust while asking you, “Which is clearer, 1…or 2? 2…or 3? How about now? 3…or 4?” Now the process is done by a device called an autorefractor - you simply put your face up to a screen, a red light comes in and out of focus a few times, and poof! the computer spits out your complete prescription. The optometrist then quickly confirms the autorefractor’s diagnosis using the phoropter. In my case, I needed -1.75 diopters of correction, and had another -1.25 diopters of more or less vertical astigmatism, in each eye, both of which are well within the operable range of LASIK.

The next test was a detailed map of the surface of my corneas, testing for any irregularities, defects, or even indentations left over from my days of contact lens use (even soft contacts indent your corneas, and you can see it clearly on the corneal map - it’s why LASIK patients typically have to discontinue wearing contact lenses for a few weeks to a few months before surgery). For this test, you once again put your eyes up to a screen, this time with a set of tightly nested concentric circles with a tiny camera in the middle. By taking a picture of the reflection of the concentric circles, the device deduces the topography of the cornea. The resulting color “map” looks very much like an elevation map of a round hill. The test revealed that my corneas are as spherical and regular as a sumo wrestler on a high-fiber diet.

The final test measures the thickness of the cornea. Since LASIK involves removing corneal tissue, and greater levels of correction require the removal of greater amounts of tissue, thin corneas can make LASIK impossible for some people. The test involves a narrow, rectangular strobe camera which rapidly spins in front of the eye, taking pictures as it goes, which are then interpolated into one round master picture. The resulting readout looks like a depth chart of a body of water - a circle with thicknesses (in microns) indicated at various points. Fortunately, my corneas appear to be as sturdily built as the rest of me. Whoo-hoo.

Having passed all three tests (like Indiana Jones and the Last Crusade, perhaps?), I was given the green light to schedule my surgery for today, Friday. Yesterday afternoon before I left work, I re-took all three tests to make certain the initial results were correct, and that nothing had changed (they were, and it hadn’t). In the meanwhile, I started a precribed regimen of antibiotic eyedrops as well as Restasis, a prescription eyedrop that stimulates tear production and would help counteract the temporary dry eyes which are the most common side effect of LASIK.

Part Two: Surgery

So I worked most of the day today. We close at 3:00 on Fridays (what can I say; we’re a doctor’s office), so I put myself on the surgery schedule for 2:30. That way I would be in the actual surgery room right after 3:00, so that co-workers could come join in the spectacle. Between 2:30 and 3:00 was the pre-surgery work-up:

  • I put a surgical cap on my head and bootees over my shoes.
  • I removed my eyeglasses (for the last time).
  • One of the surgery techs applied more antibiotic drops as well as local anesthetic drops. Having your eyeballs numbed is a bizarre feeling - they feel like lead.
  • The tech then cleaned the area around each eye with iodine, much like you see them do on any surgery show on TV. She then wiped off the iodine so that I wasn’t left looking like a raccoon.
  • I was given 10 mg of Diazepam (Valium). This is intended to calm the patient during the procedure and encourage him or her to sleep afterwards, which is the best way to start recovery.

By 3:00, I was ready to go. I walked into the surgery room and laid down on the chair, which is similar to a dentist’s chair except that there’s a padded ring under your head to help hold it still.

LASIK is a two-part procedure. The first procedure is the creation of a thin round flap of tissue on the cornea. One edge of the flap is left uncut so that the flap can be peeled back to allow the excimer laser to work on the underlying tissue (correcting the patient’s vision), then put back into place, where it heals with no stitches necessary. Up until 2003, this flap was created by a device called a microkeratome, which is a stainless steel blade that spins, somewhat like a tiny version of a deli meat slicer. While many LASIK surgeons still opt for this method, the state of the art today is a device called the Intralase, which uses a microscopically thin laser beam to create the flap. The benefits include added safety (and perceived safety; it’s nice to be able to tell a prospective patient that no blade will be touching their eye) as well as precision. An Intralase-created corneal flap is around 110 microns thick. By comparison, the hairs on your head average between 60 and 100 microns. Now that’s thin.

At any rate, I laid down on the chair and the Intralase machine was brought in above my head. First on my right eye, then on my left, the surgeon then created my flaps. This was accomplished by first placing a suction ring on the eye being worked upon. The suction ring has the dual task of holding the eye still and flattening the cornea slightly. With my eyes numbed, the only sensation from the ring was one of slight, distant pressure. Looking into the chamber of the Intralase machine while it worked was quite the experience. I don’t know whether there are many lasers in there, or one laser and many mirrors, but it was like looking into a kaleidoscope full of cut gemstones and LED lights. The process took thirty seconds per eye, and when I sat up, everything was instantly blurry, since there was now a layer of corneal tissue on each eye that was only loosely attached.

At this point I was helped into another chair, this one under the excimer laser. My eyelid was held open with restraints (I’m sure it looked like A Clockwork Orange) while my eye was flushed with more anesthetic drops, to keep it moist as well as numb it further. Once this was done, the excimer laser was lowered into place over my eye. This alien-looking device had a pinpoint green light in the center, and four arms radiating out and down from it. Each of these arms had an array of red lasers at the tip, and all four came to focus on my eye. Dr. Mann then used a small steel probe to gently pull back the corneal flap. As soon as he did so, everything went completely blurry. The pinpoint green light became a haze, and the banks of red lasers became a vague halo around the periphery of my vision.

In the LASIK procedure, the results from the three tests I mentioned above are used to program the excimer laser, which then reshapes the inner layers of the cornea to correct (in my case) the nearsightedness and astigmatism. Since it’s a custom procedure based on extremely detailed maps of the cornea, LASIK can ideally give a better end result, in terms of visual acuity, than glasses or contact lenses, which cannot take into account individual aberrations. At any rate, as soon as the excimer laser started working, I was subjected to as psychedelic an experience as I’ve ever had. The red lights, previously hazy while at rest, came to life with fantastic sharpness, blasting intricate patterns of bright red onto my eyes, and the patterns changed rapidly - many times per second. It was pretty trippy. In less than fifteen seconds, the first eye was done. The surgeon then used another steel tool to lay the flap back in place. Then the process was repeated on the other eye. In all, I was in the operating room for perhaps fifteen minutes.

Part Three: After Surgery

Afterwards, I was taken to a post-op exam room adjacent to the surgery area, where Dr. Mann looked at each of my eyes under a slit lamp to ensure that the flaps were properly back in place, and nothing odd had occurred (they were, and it hadn’t). Once he was satisfied, he put a pair of clear plastic shields over my eyes, which I was to wear for the rest of the day. He then left me with a tech to go over my regimen of eyedrops once more - five days of antibiotic drops, anti-inflammatory drops, analgesic drops and lots of artificial tears.

I rode home with Uncle Toi, laid down on my bed and took a Valium-induced nap. As soon as I woke up, I stepped out into the living room and took off the shields.

Holy shit, I can see.

There are still some slight haloes around light sources, which are supposed to go away as the flap fully heals, but…I can see. I’ve been wearing glasses and/or contact lenses since I was nine years old. While my vision wasn’t unbearably bad - I could always get it to 20/20 with glasses or contacts - it wasn’t great, either; I could never drive a car or enjoy a movie without them. To not be dependent on vision correction anymore…I’m not sure I can describe the feeling to someone who doesn’t wear glasses or contacts themselves. To not have to worry about glasses fogging, glasses breaking, glasses slipping off, contacts tearing, contact drying up, buying contacts, buying contact solutions…the word freedom seems trite and inadequate, but it’s all I’ve got. And hell, I haven’t even been outside yet. I’m sure it will take some time before it really dawns on me how cool this is.

Good night and thanks for reading!

Wow. That’s a great write-up! You’ve answered lots of questions I had about the procedure.

I’m glad things went well for you. :slight_smile:

I’ve been curious about LASIK as well. Thanks for the information, and keep us posted!

DISCLAIMER: In the interests of full disclosure, I should note that I also work at this clinic, and have done so for a little over three months.

Also, I purposely didn’t title this thread “Ask the guy who…” but I would be more than happy to answer any questions people have upon reading the OP. I’m not trying to sell LASIK to anyone (well, not to any of you folks, anyway), and believe me that if I wake up blind tomorrow or something, you’ll be the first to know about it, but in the meanwhile I’m in the unique position of being a recent patient as well as knowing a lot about the procedure. :slight_smile:

I’m very middle-of-the-road in most things, but when it comes to my eyesight, I am extremely conservative. The thought of undergoing a procedure that is not reversible should I be one of the statistical minority who come out from it badly leaves me cold. As long as I can see 20-20 with my glasses, I’ll probably stick with those.

But the procedure is becoming more and more common in Thailand and India, both places heavily advertising a growing medical-tourism industry. (Sex-change operations are another big draw for Thailand.) I dunno, though. There was a *Time * report a few years back detailing the pros and cons of having it done at all in general and over her in particular. It recommended caution about having it done in Thailand or India. No doubt the situation has improved since then. If I could be 100% sure of it being done correctly, I might do it. My eyes are very bad – cannot see the big E at the top of the chart witout my glasses – but I’m 20-20 with glasses. However, because of the particular condition of my eyes, it’s almost impossible to get new glasses made. The places here just cannot handle the prescription. It’s not uncommon for me to have to take the glasses back at least once to have them redone. (It was the same in the US, too.) But lately, I’ve had to make do with a old pair, because a couple of years ago, I went to four different places, all supposedly top-notch, and none of them could make them right. They blamed the doctor’s prescription, the doctor blamed the glassers-makers. And I went to several eye doctors. Gave up finally. Normally, medical care is tops here, but there’s just something about my particualr eyes that defies their efforts.

Too, I’ve had one eye doctor tell me I would not be a good Lasik candidate and another who wanted to give it a go. That did not instill me with confidence. Like I said, the quality of medical care here is normally high by Western standards, but I’m not ready to play around with my eyesight.

Thanks for the info. Sadly, I have to wait for full cyborg replacements… I’m not going to get 'em fixed till I can see in color afterwards.

Wow, that was a great read!

I’m myopic (with slight astigmatism) and I checked with my eye doctor about getting LASIK. He discouraged me from having it done because I would then need glasses for reading. Most of my daily work is close-up (computer) so this didn’t make any sense for me at all. I’d be getting rid of the glasses for distance and would need them on for close-up stuff. Not a good trade off.

Does this happen in all cases I wonder? I’m over 40 so maybe only in my age range. It sucks that they can’t fix the distance vision without screwing up the close up vision (in my case anyway).

In your age range(and it happens to pretty much everyone some time between 45 and 55), it’s normal to begin to lose the ability to focus on very near objects. The condition is called presbyopia, and it comes from a combination of two processes: the crystalline lens (the one behind your cornea and iris) growing thicker with age, and the muscles whose job it is to move that lens losing their tone and elasticity. It’s why people who never needed glasses before start needing reading glasses in middle age, and why people who were nearsighted start needing bifocals instead of single vision lenses.

Since presbyopia is a mechanical problem rather than an aberration in the structure of the eye (like myopia or astigmatism), it can’t be treated with standard LASIK. There is a surgical solution, however, called monovision or blended vision. Blended vision is the biological equivalent of bifocals; one eye is adjusted (via LASIK) for optimized near vision and one is optimized (again, with LASIK) for distance vision. It isn’t as weird as it sounds - the brain trains itself within a few days to know which eye is for which job, and a large majority of patients have good results with it. What a doctor will often do is put the prospective patient into a pair of contact lenses or glasses that simulate the result of a blended vision procedure, so that the patient can live that way for a week or two and decide if it’s something they want to do.

Hope that helps! IANAOphthalmologist and all that good stuff. :slight_smile:

Dopers are so darn smart! Thanks for that explanation, I think it’s better than my ophthalmologist would have done.

The problem is, I don’t need glasses for close-up, only for distance (I’m 49). The ophthamologist said I likely wouldn’t need them if I don’t need them by now…but the LASIK would cause me to need them.

Does that seem right or should I seek another opinion?

My wife had LASIK about three years ago, and is happy as a pig in shit.

She was so myopic that she was on the verge of being legally blind without vision correction, and the liberation it has given her has been really moving to watch. She now doesn’t have great twighlight vision, but that’s the only downside.

Cool. :cool: I’m so glad it worked out for you!

Do you still have your last pair of glasses? Like a souvenir of times gone by…

I’m so happy for you! This part of your story had me slightly teary. I can imagine how that feels, since I know what it is to be chained to contacts. I don’t think I’m a candidate for LASIK, but I’m awfully glad it went so well for you. Enjoy!