My Laser Eye Surgery Experience
2014-02-07
How it Works
Laser surgery works by re-shaping your cornea to compensate for any nearsightedness, farsightedness and astigmatism (where your eye is stretched into an oval instead of being a perfect circle). There are two popular methods to do this. Both burn away part of your cornea with a laser. PRK does this right on the surface. There is more irritation, slower recovery, and higher chance of infection with PRK. LASIK cuts a flap in your cornea, and does the surgery under the flap before sealing it back up. It heals faster (they say you can work within 24 hours as opposed to several days to a week), but the cutting part isn’t exactly pleasant, and even after healing, the flap does weaken the eye a bit such that a severe blow to the eye in the future could dislodge the flap or cause more damage to the eye than would have happened with a PRK patient. As always, talk to a real doctor (ophthalmologist in this case) rather than taking anyone’s explanation over the internet at face value, especially someone who doesn’t even claim to be a doctor. That said, that’s pretty much it as far as I can tell. I went with LASIK; I didn’t have to take much time off work, but I probably shouldn’t become a UFC fighter now.
The flap they’ll cut during a LASIK surgery.
Eligibility/Scheduling Process
First thing you have to do is find out if you’re eligible for surgery. Your regular optometrist doesn’t do this. If you’re in Terrace you’ll want to schedule an appointment with Dr. Thomas Nagy at the Vision North Eye Centre in the medical building. The phone number is 250-615-5002. They have special equipment there to measure the thickness of your corneas, and presumably other things as well. They do all the regular checkup stuff in the process, and the whole visit costs $125. They’ll tell you what your options are then, and you can decide to schedule your surgery any time once it’s confirmed you’re eligible. In my case I decided the next day after some research, and had to stop by the office so they could witness me signing various consent forms, and make payment. How long in advance you have to wait will usually be a matter of months from what I hear, but in my case it was only ten days! With Dr. Nagy, LASIK and PRK surgeries are both $1200 an eye, or $1800/eye with the wavefront guided option, (which you can Google and Dr. Nagy can explain, but basically they just measure things more precisely and adapt the surgery accordingly). This includes all the drops, sunglasses, and follow-up appointments, basically everything except travel and accommodations.
A note about Dr. Nagy – I am a terrible judge of personality, but he struck me as a little odd. I reassured myself that any oddity must come from his inability to handle normal people with his level of genius, and I hope that’s what it was. He would ask me about my job, the usual small chat, but from the moment I started speaking until I stopped, he was constantly making “Hmm, mmm hmm, uh huh” sounds that really weren’t at all timed with the conversation. He was also deadpan and monotone. As he explained the potential risks of the procedure, you might expect an introductory sentence, something like “Now, this IS a surgical procedure, and although it almost always turns out, there ARE some risks involved, and it’s important you understand these. For example, in 1-2% of cases…” But he just starts listing things one at a time like he’s trying to list the 50 states or something. I swear if he’d said “Or I could sneeze and accidentally drive a scalpel through your eye”, his voice wouldn’t have changed a bit!
Surgery Experience
Pre-Op
The LASIK MD office where your surgery is performed is at 1281 West Georgia Street in Vancouver. It’s a few minutes’ walk from the Granville Skytrain station, and very well marked and easy to find. I showed up at 8:00 for my 8:30 appointment, and they immediately set me to work filling out consent forms and other such things.
Some of the forms I had already signed off on in Terrace, but I guess they want to be sure. I also had to sign off on some things that I was a little bothered I didn’t remember discussing with Dr. Nagy in advance. In particular, they mentioned the possibility of regression, which would require a second surgery down the road if my eyes healed too much, and they also mentioned that I had larger than normal pupils, increasing my chance of haloing following the surgery. I spoke to a doctor there about these details, and he explained that the risk of haloing was 1-2% and my eyes were hardly larger than normal. Regression surgery wouldn’t be at additional cost, but apparently was between 25% and 40% likely to be required (I got different figures from different doctors!) I have to say that I wasn’t particularly happy about this part of the process.
Overall I was there for at least a couple hours before my surgery began. During that time I met with three different doctors who 1) confirmed my current prescription, 2) reconfirmed various other aspects of my vision to make sure I was still eligible for surgery and my eyes don’t, I don’t know, randomly change shape or something, and 3) review with me how to apply my medicated drops, when to wear protective sunglasses, etc. Since I had never used contacts before, they were especially thorough about how to use the drops without poking myself in the eye.
Operation
Eventually they got me in a room all by myself, put a hair net on me, and applied some numbing drops to my eyes. I had to wait 15 minutes for that to take effect, and then I was brought into surgery. This was my first time seeing Dr. Nagy since I had arrived that day. He shook my hand, sat me down and quickly reviewed the details of the procedure, asked me if I had any questions, and when I said no, we got started.
First, they have you lay down on the seat/bed thing. As soon as I did, a nurse handed me two stress balls. I hadn’t anticipated this, and looked a little confused. She said “If you feel the need to close your eyes squeeze these instead”. It was exactly that moment that it hit me that this procedure could be a little… intense. I honestly wasn’t nervous until this point!
The next shocker was the instrument they pull down over my face with all the lights and lasers attached. I was expecting a dentist’s chair lamp to illuminate the situation. Not so! Four wide rectangles, each an arrangement of bright white LEDs, perhaps 4 tall, 6 across? The rectangles themselves were angled to form a wide, open-ended diamond. Inside the diamond were two green lights with a red light in the centre, all three in a line. I never entirely understood the function of these lights. The green ones I presume are for alignment. The red one must have been the one doing the actual reshaping of my cornea, but you can’t tell when it does anything. It’s just always on. And it completely overwhelms your eye, flooding everything you see with red static, like you see when a laser is pointed into a video camera in the movies, kind of. The instrument as a whole is close enough that you see basically nothing else during the surgery.
The closest thing I could find online to the view I had during my surgery
Now, I’d already watched a video of what happens next online, so I knew what was coming. First, they cover one eye, and then they apply some tape to help hold the other eye open, and then finally they insert a simple speculum to hold it completely open for the duration of the surgery. Honestly, this speculum thing was responsible for at least 50% of my discomfort right there. You’re never in tons of pain, but what pain you are in, you can thank this thing for. It applies a fair bit of pressure, anyways. Next, they use some kind of a small stamp on a stick to apply a bit of ink to mark your eye. I don’t know what they do this for, but don’t worry about it – it really isn’t a problem. Having them put drops in my eyes is more distressing than this thing was. You won’t actually see the ink or anything.
Once this is done, the hardest part of the whole process happens – note that this is with LASIK only. They put a small metal device over your eye. I gather it applies some suction, but I don’t know if that’s to secure it, or to suck up blood once the time comes. Then, they twist a lever, or something, and kind of like a cigar cutter I guess, this thing cuts across the surface of your cornea, almost all the way end to end. You don’t feel pain during this time, but there is pressure, and it’s definitely intense, for lack of a better word. You squeeze the stress balls. You don’t like it. Your vision goes a little red, and you realize that somehow when you put a razor into something completely clear, blood appears. It’s a little strange.
At this point, Dr. Nagy asked me if things went dim. He said they would go dim when we spoke just before surgery too. But of course, he KNOWS they’re dim. There’s an opaque metal razor directly blocking my pupil. They can’t not be dim. He really means to say “Don’t worry, it’s normal that things are dim, that’s just because there’s a razor in your eyeball right now!” In my somewhat pissy state at the time, this annoyed me. That shouldn’t surprise anyone.
So, that’s the hard part. It’s honestly not THAT hard. Once that’s done, they remove the cutting device, and then use a very simple tool to flip the flap back. At this point your eye isn’t the right shape anymore! It’s like looking through privacy glass in a bathroom or something. You have a general sense of shapes but it’s hopelessly blurry. At this moment you realize just how much your life is in this guy’s hands.
They then ask you to look into the laser (which will track your eye movement and stop itself if you look away, so it’s not like you need to practice staring in a mirror for this to work). The laser is by far the easiest thing for you to actually distinguish in front of you. You stare at it for 15 seconds, it does its work. You can’t tell it’s doing anything. Yes, there’s a burning smell. Doesn’t matter. Some people say it disgusted them, but they’re crazy. Razors in the eyeballs are far more difficult for my brain to tolerate, anyways.
After the laser does its work, they flip the flap back into place, and your vision is miraculously restored. Your eyes are still very wet with artificial tears and whatnot, but your vision is probably already better than it ever was with glasses, or at least close to it.
Then, they release the clamp, and only then do you realize just how much that clamp was at fault for any discomfort you felt. And you’re relieved!
But then they do the second eye…
After this, they sit you up, and you go do the same old drill with your chin and forehead pressed into a machine while they take a look at things. They might hold your eye open and poke at the flaps a bit to line them up perfectly. After this is done, they sit you in a room, apply the first round of your medicated drops, put some sunglasses on you, and tell you to just lay there and not touch anything for 45 minutes. After that they look at your eyes one more time to make sure things are still lined up, they tell you to show up the next morning for a follow-up, and to go home and sleep.
Post-Op
And that’s what I did. I walked out of the building, my eyes slightly irritated but really not all that bad, and realized that I could already see fairly clearly. I occasionally get an itchy allergic reaction to animals that compels me to rub my eyes, and that is far more uncomfortable than this was. I was really only aware that I had a desire to close my eyes, and that I could see. It’s bizarre, it happens so fast. It seems like it should take more time, more effort. But it’s just done! The urge to close my eyes increased to the point where I was eagerly counting the stops on the Skytrain, but 45 minutes later I was in bed, and two hours after that, I got up to take a look at myself in the mirror for the first time. And I could see.
Understand something: I’ve had glasses for 18 years. For 18 years, I have been unable to look myself in the eye. The glasses get in the way. There’s glare, there’s smudges, it just isn’t the same. Really being able to look myself in the eye, study myself in a way that even a lover would find too close and uncomfortable, it’s an amazing experience. I could watch my iris grow and shrink. Stare into the muscle material like I’ve only seen in photos before. Look around my eyelids, see my tear ducts, the inner edge of my eye lids, all of that. I haven’t seen these things since I was too young to notice, or too young to remember.
It turns out that a hotel is a great place to discover what life with eyes is like, because the bedroom and the bathroom are the two places I’m used to functioning blind. Seeing the texture in the towels I hadn’t noticed before, that was something. Later that night, seeing a subtle but distinct edge on the black TV against the white wall, even in utter darkness. These were the things I noticed right away.
Now, I knew I had some drops to apply. Specifically they give you a clear antibacterial drop and a white steroid anti-inflammatory drop to use 4x a day for the first 5 days (every 2 hours on day 1 for the steroids), and then artificial tears to use after the medicated drops, and for who-knows-how-long after that whenever your eyes feel dry. Apparently the surgery damages nerves that kind of hard-wire to your tear ducts, and it can take months before they heal sufficiently that your tear ducts fully pick up the slack and moisturize your eyes for themselves. I had never applied drops before, but it was quite easy to figure out once I ignored the advice I was given to use a mirror, which compelled me to stare directly at it, and watch as the drops fell on my cheeks instead of my eyes. Much easier to just sit down, look up and away (exposing the outside of your face, so the drop comes from the outside in towards your tear duct, covering the whole thing), and go to it.
Unfortunately the steroid drops are kind of thick, and especially on day 1 they insist you don’t touch your eye – I think if it didn’t hurt their cause, they would have slapped me across the face to drive that point home once I’d had my surgery! So I had some mucusy white goop and blood in the corner of my eye and dried to my lashes for the first day, before I decided to take matters into control and carefully clean myself up. And the drops aren’t just thick! I had to think for a minute to realize WHY they warn you that these drops can result in an aftertaste (they don’t tell you what kind, which of course means it’s bad). They aren’t ninja-ing your brain. Steroids must just be THAT bitter, the kind of bitter where you realize the human brain just didn’t evolve to process this taste, and it just defaults to bitter-bad-chemical-don’t-eat-it. A drop in each eye, 5-10 minutes, and enough of that stuff makes it into your sinuses and down the back of your throat that you do get a bit of a gross taste in your mouth. You don’t need to dread it, it’s just impressive that something could taste THAT bad in such trace amounts.
I spent the rest of the day in the hotel, listening to stand-up comedy mostly, and sleeping. You wear the sunglasses throughout this so you don’t reflexively rub your eyes, and you aren’t supposed to stare at anything for very long, so your eyes don’t dry out as easily, so this is the most obvious option.
The next day, I had my checkup first thing in the morning. Again I showed up half an hour early, but they saw me right away. They confirmed my vision was 20/20 in my dominant eye, and 30/20 in the other eye with a strong likelihood of improvement in the coming weeks (which I think is slowly happening, but time will tell – others have told me their vision improved over the next few weeks too though!) This is good enough to drive, and good enough to read with only a bit of difficulty if my brain decides to fall back on the weaker eye while reading fine print. The doctor who did this checkup, he too was a little odd – seemed perfectly normal all through the exam, but as soon as he’s done his work, without any kind of “wrap-up” sentence, he simply says “have a good day”, turns away and starts doing paperwork, still sitting right in front of you while you’re seated in your exam chair. I kind of had to walk around him just to get out of the room. Odd little things…
Following all this, there was one more amusing thing I’ve noticed: since my glasses, in addition to sharpening everything, would subtly shrink everything as well, when I was walking through the Metrotown mall, I took a look at a cell phone booth and was convinced a new generation of cell phones had come out, with even more ridiculously large screens than the last. I kept taking my iPhone 4S out to compare, sure that these phones were obscenely large. Similarly, when I bought a pop at the Vancouver airport, I had thought I bought a 700 ml bottle until I read it and confirmed it was only 591 ml.
Another quirk was that I really did feel uncomfortable not having glasses on. For the first three days or so, I felt a little relieved whenever I put sunglasses on. It just felt right, somehow.
Now, haloing seems to be VERY common in the first few months after surgery. Almost everyone I’ve talked to that has had the surgery had it. If you’re not sure if you know what this is, you really probably do. Smudged glasses give you something similar all the time, I’m sure. It’s a glow surrounding bright lights. It’s annoying, and at times at night headlights can actually drown out a considerable amount of vision on the road in front of you, but I’ve never felt truly unable to drive. Perhaps in heavy metropolitan traffic I would though. But it usually does go away, remaining to some degree in a couple percent of cases, from what I’ve read.
The flap they’ll cut during a LASIK surgery.
Photo: Peretz Partensky via Wikimedia Commons (CC BY 2.0) — Lasik_eye_surgery.jpg
