I started to answer some questions on BIX about this, but it quickly became longer than I intended. I decided to make an HTML page out of it. Here goes.
LASIK stands for Laser In-Situ Kera-something-or-other. This is not the "traditional" RK (radial keratotomy) procedure where they cut slits in your eyeball. This is lots higher-tech than that. Also lots more expensive. And lots better (I think).
The surgeon uses a micro-keratome (world's smallest buzzsaw) to cut a flap into your cornea. He lifts the flap out of the way, then blasts the exposed surface with an ultraviolet laser. Then he folds the flap down and spins his prayer wheel. If everything works as calculated, the cornea reshapes itself to focus light more precisely on your retina.
(There are much better explanations on lots of Web sites out there, including the American Eye Institute of Arizona and at the Emory Vision Correction Center. But they're not Lynx-friendly.)
If this description sends you reeling for the barf bag, read no further. Stick with glasses and contacts. I think I'm pretty much in the middle of the Squeamish Spectrum -- not a shrinking violet, not a nerves-of-steel type -- and the last few days have pretty much tested my limits.
LASIK costs about $2500. Per eye. And you want to do both. Your insurance doesn't cover it. They want cash.
If that pricetag is approximately as accessible to you as a personal dirigible, read no further. Stick with glasses and contacts.
LASIK is an experimental procedure. LASIK is an experimental procedure. LASIK is an experimental procedure. What I tell you three times is true.
There is a good chance that your vision will fluctuate for up to 90 days, and that you will need "throwaway" glasses or contacts during that period. There is a smaller but finite chance that your vision without glasses or contacts will be inferior to your best vision with glasses or contacts today. There is a still smaller but non-zero chance that your best corrected vision will be poorer than your best corrected vision today -- ;in other words, permanent loss of acuity. There is yet a smaller but still non-zero chance that you will go blind on one or both eyes. If you can't handle that, read no further. Stick with glasses and contacts.
I'm fortyish and have worn glasses since third grade. I tried all sorts of contacts at various points. Not enough oxygen circulation to let me wear hard or gas-perm lenses, and my astigmatism was too bad for even the toric soft lenses to work. Then, in my last eye exam, I had to get bifocals. The "old-fashioned" bifocals are incredibly crude, and the "progressive" type made me nauseous. So I was switching between three sets of glasses -- regular (distance) vision, distance-optimized dark glasses, and reading glasses. This wasn't fun.
For sake of comparison, this was my March 1998 refraction:
(Sorry, Lynxers. I won't do it again. :-)
In high-index plastic with anti-glare coating, my lenses cost $250 per pair (excluding frames), they took a month to come from Pentax Japan, and I had to buy three pair at a time, every couple of years. Then live in fear of dropping/losing/breaking a set. And at that, I was only corrected to about 20/30 on a good day, usually 20/40. (Uncorrected, my numbers were meaningless, but they guessed at something like 20/600.)
It was time to try something else.
My first plan was to get into the trial for the Keravision ICR (Intrastromal Corneal Ring). Look this up elsewhere on the Web, but its great advantage is supposed to be reversibility. You don't like it, you remove it, and your eye returns to normal in days.
I'm friends with the company, and was able to get considered for the U.S. trial. But my myopia is too bad... they're only accepting candidates with up to -5.0 diopters of correction. (Europe is different, by the way.) But the Emory surgeon running the local trial said I was a great candidate for LASIK.
I started doing some research. Talked to patients who had it done. Read lots of pros and cons. Then my wife booked us a trip to the Riviera this fall, and I'll be damned if I'm going to be blind on those beaches! So I scheduled surgery for last Friday, 19 June 1998.
Spent a morning at the Emory Clinic. First, they took a "nomograph" of my corneas. Those of you with Scouting or aviation experience will recognize this as a contour map. Mine confirmed what we already knew... highly myopic and astigmatic. The left eye was horrible; the nomograph looked like a three-leaf clover. No way that standard lenses can compensate for that. Then spent half an hour with my surgeon, talking through the pros and cons of the procedure. By coincidence, on the day I was there, an FDA panel recommended that Emory be the first site in the country to receive FDA approval for the LASIK procedure.
Biggest decision was whether to do both eyes at once, or separate them by a week or so. There's no adjustment they can make based on the first eye, and the interim half-corrected state sounded very disorienting, so I went for both at once. Opinions differ strongly on this, so you should make up your own mind. Deciding factor for me was that you cannot have one eye done then wear a single eyeglass lens; the magnifications are too different. You have to wear a contact lens on the uncorrected eye. I can't wear contacts, so that was the clincher.
So I confirmed a surgery date and went home. Then spent two weeks wondering if I'd done a very stupid thing.
Arrived at 9:30 am in a light drizzle (this is not meaningless local color, as will become clear). Was in the surgical suite by 10:00. Noticed it was raining harder. Heard some thunder. Wondered idly what would happen if they had a power surge while I was under the laser.
Note: Don't think about such things. Bad karma.
Emory uses the latest-available (in the U.S.) slit-scanning laser; the Nidek 5500. Other locations use older "broad beam" devices that sounded a lot more problematic to me. Lots of people from all over the country fly to Emory, even when folks in their home town do LASIK. Take that for what it's worth.
Four technicians in the room, plus Dr. Weiner, my surgeon. Lots of bantering; the team was comfortable together, which made me feel confident. I asked one of them how much of my cornea they planned to ablate; he replied "86.3 microns exactly!" Earlier, a different tech had measured my corneas at 540 and 560 microns deep respectively, so this sounded like a reasonable margin of error.
I laid down in the chair. Major design flaw--no handgrips. I wanted something fat and padded, kind of like the grips on a roller coaster. Was left crushing the hand of a very sweet nurse, who probably still has bruises from it. (Sorry, Jane!)
First, they insert a "speculum" between your eyelids, preventing you from blinking. If you've seen A Clockwork Orange, you know how user-friendly this is. Then they put a suction ring on your cornea to immobilize the eyeball. The first try for me didn't work; they had to roll me back out and ice down my right eye before they could get good suction. Second try worked. Hurt like a sonofabitch. Once they turn on the suction, your vision blacks out due to pressure differentials; blood stops feeding the retina. They don't like leaving this on for long, obviously.
Then the buzzsaw,then a fuzzy red aiming light, then the (invisible) laser with a whiff of ozone. Flap down, speculum out, and blinking felt wonderful. Vision was like looking through heavy gauze.
Repeat for the left eye. This time, good suction on the first try, so much less painful... but I don't think I could have handled a third one. This was a highly un-fun half hour or so.
Had just sat up and was trying to get oriented. Still gauzy vision. My wife came in and I could recognize her from across the room -- without glasses. Then I looked over at the fire extinguisher on the wall and could read the label: ARAMAX. (The things you remember!) I burst into tears. If you're not highly nearsighted, you wouldn't understand.
Right then--remember the bad karma above?--the power went off for the whole building. (Actually, the whole neighborhood.) I had been under the laser less than three minutes previously. Luckily, since I was still sitting in the chair, they hadn't wheeled in the next victim... I mean, patient.
These lasers are major power drains, and they do not have battery/UPS backup. According to the surgeon, if it failed halfway through, they would button you up, let your cornea heal as best it could, and have you come back in 90 days to try again. That would be 90 days of poor to terrible vision.
If the weatherman predicts thunderstorms the day of your surgery, don't go.
So we stumble down the hall in the dark to a recovery room where, I kid you not, the surgeon does my post-op exam by flashlight. I could already feel that the right eye (the one that gave so much trouble) hurt a lot more than the left. Could he have done something if the power were on? I'll never know.
My wife drove me home, filling a prescription for Demerol on the way. After an hour of trying to convince myself that Excedrin was good enough, I took one. I don't remember anything else about Friday. She pried my eyes open every four hours for eyedrops, but I wasn't there.
Back to the clinic (with electricity, luckily, restored). My right eye was hurting badly; the left eye felt fine. Vision in both was very blurry -- like taking my glasses and smearing Vaseline across the lenses. Both were ridiculously light-sensitive. In the car going over, I was wearing two sets of dark glasses -- a standard drugstore pair, with a pair of the dorky-looking "Solar Shields" on top. Still hurt to be outside in the sunshine.
In the exam room, a different surgeon (mine only works Fridays, it turns out) checked me out. As I feared, the right eye had a "complication."
LASIK is an experimental procedure. Remember?
There was an "infiltration" underneath the flap. That could be an infection, that could be an immune reaction, that could be contamination, that could be anything. Only way to find out was to raise the flap, scrape out the gunk, rinse off the interior surfaces, and close it up again. This time, the flap needed three sutures to stay in place. Then he put a "bandage contact" in place to protect the sutures... this was roughly similar to a standard soft contact, but translucent, like wax paper. The gunk was sent off to the lab for culturing.
Boys and girls, this hurt a lot. Partially because it came as a surprise, partially because he had to poke pretty hard to raise the flap (it was busily healing around the infiltration), partially because my eye was so swollen that the speculum was like inserting a bear trap, partially because I had to wear that damn contact, which felt as thick as a penny. My right eye swelled shut, so that adding eyedrops became a three-handed, two-person operation.
The surgeon told me that this "infiltration" occurred in about one out of every 500 patients. Mathematical thought for the day: a 99.8% success rate is meaningless when you're one of the 0.2%...
Home again for a few hours, but had to be back at the clinic that afternoon. Our bedroom is mostly windows, which was pure agony. Needed to keep air circulating, so I couldn't wear a blindfold. My wife nailed blankets over the windows to darken the room. Still felt like a solar furnace. (The blankets are still there; today, the room is like the inside of a cave. All in the perception...) More Demerol.
For the trip back to the clinic that afternoon, I had both sets of sunglasses plus a towel over my head. Looked ridiculous, I'm sure. Got carsick for the first time since I was five. I don't remember the second visit, but we went home with seven different bottles of eyedrops to use on a mind-boggling schedule. More Demerol.
No exaggeration: Saturday was the worst day of my life.
Still no vision in my right eye -- which I knew was a side effect of the swelling and the bandage contact, but still damn scary. Another visit to the clinic, where they rejiggered my regimen of eyedrops. Thank God my wife was there to keep track, since I was basically non-functional. A third surgeon this time; I was getting quite familiar with the whole staff!
Home again, but no Demerol this time... just sleep. Woke up around noon, and my right eye opened for the first time in over 24 hours. This was wonderful! The swelling was on its way down. Waves of relief.
So now I was conscious and coherent, but still couldn't see worth a damn. Certainly couldn't read... and if I'm awake 16 hours a day, I'm reading for 14 of them. My wife went out and rented some books on tape... a Godsend. Listened to two books before bedtime. Began to feel like I hadn't been incredibly stupid after all.
First thing in the morning, back to the clinic, where a fourth (!) surgeon removed two of the three sutures... and the triple-damned contact bandage, hurrah! My vision in my right eye improved dramatically and instantly. For the first time, I was able to pass a standard eye exam... between 20/25 and 20/30 in each eye, with no astigmatism. Wow!
Not as good as it sounds, though, since letters (and everything else) were still quite fuzzy. In other words, I can read a smaller line on the eye chart than I could with glasses -- but now it takes concentration, whereas before I could read (or not read) text at a glance. This is normal for LASIK, and should continue to improve over the next few weeks. Says so, right here on the label.
I drove us home in celebration; my first time behind the wheel since Thursday evening. Still light-sensitive, but a single pair of cheapo sunglasses was doing the job. At the suggestion of the clinic, I stopped by the drugstore and picked up a $20 pair of reading glasses (very light +1.25 magnification); they actually help me focus a lot on the newspaper and the computer screen. Caught up on four days worth of paper mail and email.
Went for a walk that night. As predicted, headlights and streetlights have a benign glow about them -- nothing like the starbursts reported by RK patients. This glow is also supposed to fade with time. I'm not sure if it's the eye learning to throw a sharper image onto the retina, the brain performing some fancy signal processing, or (most likely) a bit of both. It's distracting--very much like driving in very faint fog--but certainly not debilitating.
My standard morning pilgrimage to the clinic, where Saturday's surgeon (my first repeat!) removed the final suture and took me off most of my various eyedrops. My left eye hasn't hurt in a couple of days. My right eye still has some twinges, but nothing serious.
Vision is far from perfect, but it's promising. I'm certainly able to drive, day or night. I can read the paper or a computer screen. I have set my Macintosh monitor back from 1024x768 to a blast-from-the-past 640x480 (and it's amazing how many Web pages don't work at what used to be standard resolution!). I look forward to going back to a larger desktop.
I find that I want a little more light indoors than I used to, but my wife likes that! (I always thought one 60-watt bulb per room was sufficient; she would put 500-watt halogens in every socket if I let her.) Still light-sensitive outside, but I always have been... my old prescription dark glasses could be used to watch eclipses. Depth perception is a bit skewed (as I discovered when trying to play fetch with the dogs!), but that's a learned response; it's trainable.
Well, tomorrow I go back to work... no more special treatment. I cancelled a plane trip this week, but more out of paranoia than of any real threat; I could have flown today with no problem. I expect my acuity to gradually improve, with minor temporary setbacks, over the next couple of months. I'm looking forward to being able to rapidly re-focus again, so that I don't need these reading glasses (at least for a few more years, by which time biology will make them inevitable!).
Could I live forever with the vision I have today, with no improvement? Yes. Would I like to? No. Do I expect to? No. I expect to be 20/25 uncorrected and 20/20 with thin glasses in three months.
The big question: my $5000 buys a free "touch-up" anytime between three and six months. If, three months from now, my vision isn't improved over today, would I undergo this procedure again?
I don't know.
I'll attempt to update this diary sporadically. Comments welcome via email. There are lots more patient histories, good and bad, at the Arizona site, www.americaneye.com.Good luck!
--Stephen Fleming, Atlanta, 23 June 98
Back at work. Nothing really earthshaking to report. Lots of people commented on my incredibly hideous right eye (lots of bleeding under the surface). Lots of questions about the surgery and the aftermath. Now I'm just being patient, waiting for the fuzzies to go away.
Thanks to those of you who have written with your own stories! I'll update this when it makes sense, but probably not daily.
My vision has been deteriorating steadily for several days, but I decided to wait until my two-week checkup to quantify things. Saw my fifth surgeon at Emory, who confirmed that everything was healing nicely. The refraction, however, was depressing. The left eye is stable at around 20/30, but the right eye has crashed to 20/160. Worse yet, they can't dial in a prescription to clear up the right eye; it has multiple images, no matter what. With my left eye closed, I cannot read or drive; I basically have one functioning eye, plus a blur that subjectively is no better than my original vision.
He told me to cut back on the steroid drops and come back in a week for a new refraction. The steroids apparently reshape the corneal surface and can affect acuity. We'll see. I'd be happy with glasses at this point, but this is unacceptable.
Went out to watch fireworks. Found out an interesting side effect. My right eye has always been dominant, but the left eye is the one that's currently functional. I have to relearn how to use a camera! It's hard to use it with my left eye!
Fireworks were awfully fuzzy. I think my night vision is worse than it was a week ago.
I'm looking forward to my next refraction on Wednesday. I'm hoping to get a set of glasses that will return me to acceptable vision until I'm eligible for my three-month "touch-up." (To answer my question above -- even with all the problems I've had, I'll definitely get my right eye redone unless things improve dramatically. Jury is still out on the left eye.)
At this precise moment, I'd pay the original $5000 again just to have my old eyesight back. The rational part of me knows it will get better, but it's damn frustrating.
Back for another checkup, and a long-awaited refraction. The doctor (I forget which one, this time) says that my troublesome right eye is healing nicely, but that I should start taking steroid drops again (Vexol) for another two weeks.
Jane checks me out and comes up with the following prescription:
Spherical Cylindrical Axis O.D. (right) -3.25 +1.25 005 O.S. (left) -0.75 +0.25 154
This still doesn't quite fix the right eye (20/40), but is 20/20 in the left. The reason is obvious when I look at the new nomograph... the left eye is smooth, but the left eye looks like it's been shaped with a ball peen hammer.
I trot off to LensCrafters and have lenses made for my old frames. Expensive! Since one of the lenses is over 3 diopters of correction, the pair costs something like $150.
My vision is clearly better with these lenses on Day 20... but it steadily deteriorates over the weekend. Later, I realize that this is a side effect of going back on the Vexol drops. Wish I had known. But, instead...
I go back, complaining that my right eye has blurred to the point of unusability over the preceding week. For the very first time since my surgery, I see the doctor who performed the procedure -- he's only at the clinic on Fridays. He's happy with the healing process, and switches me from Vexol to FML drops, which are apparently weaker and don't distort my vision as much.
A different tech performs a refraction, and comes up with the following:
Spherical Cylindrical Axis O.D. (right) -4.50 +2.75 042 O.S. (left) -1.00 spherical N/A
Wow! Hard to believe that these eyeballs belong to the same person as a week earlier!
He claims that this prescription makes me 20/32 in the right eye, and 20/25 in the left. I'm also becoming very skeptical of "20/whatever" measurements. Just because I can read the 20/25 line doesn't mean I can read it quickly. Does anyone remember tachistoscopes? They flash a word up for a fraction of a second; we used them in reading classes back in the Sixties. I think the eye clinic should use a setup like that... reading the 20/40 line instantly is a more accurate measurement than being able to puzzle out the 20/25 line after five seconds of concentration.
Ah, well. Back to LensCrafters. They have a 30-day guarantee where they will remake lenses for free. This turns out to be a very useful thing. Don't go anywhere that doesn't offer the same deal.
An hour later, I am incredibly depressed. I can't see out of these damn things. I find myself using drugstore "cheaters" to read, and nothing at all for driving. Of course, I can't read street signs...
This is bad. I wish I had last week's glasses back. In hindsight, I should have gone back and swapped the lenses.
But now I start tapering off the steroid drops, and I hope that things will get better soon.
My travel schedule made it impossible to get back during the preceding week. I scheduled an appointment with Jane Couser, who strikes me as the most competent tech there. She repeats the refraction, and winds up reasonably close to her measurements of Day 20:
Spherical Cylindrical Axis O.D. (right) -3.00 +2.00 013 O.S. (left) -0.75 +0.25 157
So the left eye prescription remains essentially unchanged from two weeks earlier, with a bit of adjustment on the right. Drastic improvement! She claims 20/25 in both eyes, and I believe her. All techs are not created equal... that Day 29 prescription was just blundering.
Back to LensCrafters again... but I wimp out and use a different branch, not wanting to admit this is my third set of lenses in thirty days. (Actually, double that, since I've had both clear and sunglasses made each time.)
Nirvana! I don't give a damn if I ever get to see without glasses... but, for the first time in 40 days, I can see as well as I could before going under the laser.
These glasses work. I am functioning. I am content.
I have been delinquent in updating this page, but I hope this is useful to the folks reading it. I am completely off all eyedrops, and I am noticing that night vision is still pretty blurry, but definitely improved. We went to a concert at Chastain Park a couple of nights ago, and the candles were a bit fuzzy, but the multiple images were less noticeable than a couple of weeks ago.
Acuity? For the first time since surgery, I have just experimented with returning my monitor to 1024x768 resolution. Hmm. Maybe not. I can read everything, but it's a strain. Back to 832x624, which is no problem. I miss the desktop real estate, but I can live with it.
Street signs are still a bit of a challenge, but no more so than with my old Coke-bottle-bottom glasses.
I have a two-month checkup scheduled for Friday, which I hope will be incredibly boring. Dr. Weiner (my surgeon) is convinced that I should enhance both eyes at the 90-day point. It turns out that we'll be travelling overseas right after that, and there's no way I'm going to take the risk... but I will consider it at around the 4-month point. We will see. At the moment, I'm just happy to be essentially back where I was before surgery... 20/25 in both eyes, with glasses.
...9 August 1998
Good Lord! I'm astonished. I hadn't visited my own page lately... but nearly 6,000 people have visited this page since I posted it a few months ago! Maybe this Web thing isn't a fad like CB radio... :-)
The two-month visit was incredibly boring; sorry for not updating the page.
A couple of weeks ago, I finally went back for either a late 90-day visit, or an early six-month visit (I had to reschedule my appointment a couple of times due to business issues). The good news is that my flaps have both healed nicely... in fact, when looking at my eyes under magnification, the surgeon had to refer to my file to remind himself which one had the complications!
The ever-competent Jane did my refraction again:
Spherical Cylindrical Axis O.D. (right) -2.25 +1.50 001 O.S. (left) -1.00 spherical N/A
So the astigmatism is completely gone from my left eye! With correction, I'm 20/25 in both eyes, and I can fake 20/20 in the left if I squint a little.
The bad news is that the astigmatism in my right eye is still bad enough that they're not confident that I can achieve 20/30 without some sort of lens (contact or spectacle), even after an enhancement. The left eye is a textbook candidate, and probably could be tweaked to perfection or darn near it.
Dr. Weiner, my original surgeon conducted my follow-up... and he pointed out the potential risks and benefits of an enhancement fairly. He did present a feeling of urgency -- saying that he could lift my existing flaps up to six months after surgery, but after that would need to use the microkeratome again to slice new flaps. Shiver! I don't want to go through that again, so I could hear the clock ticking loudly... six months is next week.
But I decided to get a second opinion, and scheduled a duplicate follow-up with Dr. Waring, the director of the clinic. He also recommended an enhancement for both eyes, to make my vision as good as possible. But he flatly contradicted my original surgeon, saying that flap healing varied dramatically from patient to patient. In some cases, they healed so quickly that they could not be lifted after four months... in other cases, he had lifted them without using the microkeratome up to four years after surgery. So there is no clock ticking after all...
I got new glasses made with the new refraction, and am reasonably happy. I think my corrected vision is at least as good as pre-surgery.Still a bit of "flare" around lights at night, but driving with glasses feels perfectly safe. Perhaps a little reduction in contrast sensitivity. But quite acceptable. And my uncorrected vision is furlongs better than before!
So... should I schedule the enhancement, and finish the job?
My wife argues "yes"... after all I've been through, I "owe it to myself" to wind up with vision as close to perfect as God and the laws of medicine will allow.
But. I make my living as a venture capital investor. That means I'm far too intimately familiar with the concept of "sunk costs." The money I've spent, the pain I've experienced, the hours I've dedicated to clinic visits... those are gone. As far as my prospects for improved vision through an enhancement are concerned, it's as if those costs never existed. Factoring those into a decision today is pointless at best, and misleading at worst. All I can do is weight future costs versus future benefits.
Financially, the Emory Clinic covers the enhancement in the original fee, so there's no dollar risk. Medically, my corneas have healed well enough that I have zero increased risk of complication compared to a statistical average patient off the street. Emotionally -- I feel as though I've dodged a bullet. The summer was absolute misery. The odds against it happening again are astronomical... but not zero.
The question comes down to this: If I had been born with the vision I have today, and if someone offered LASIK to me for free, would I walk into the clinic?
What I have works for me. I'm still wearing glasses, and I may wear them for the rest of my life. My corrected vision is about equal to what it was before surgery. Was the improvement in my uncorrected vision worth $5000 and a month of terror? Probably not. Do I feel that the Emory Clinic did anything wrong? Absolutely not; I think they are superb. Would I recommend the surgeon who worked on my to a friend? Absolutely yes; in fact, I have. Am I making an emotional, irrational decision here? You betcha.
Your mileage may vary. Other people in my shoes would make, and have made, different decisions. And I may change my mind in the future, assuming my flaps can still be lifted months or years post-surgery. Or someone may come up with a variant on LASIK, or a completely new procedure, that pushes me over the edge. In the meantime, I'm happy that my corneas have healed nicely, I'm happy that my glasses are a lot thinner, and I'm happy not to have to go through an enhancement.
I may not update this page again, but I appreciate the dozens of supportive emails I have received. Best of luck to all of you who are contemplating LASIK, or any other correction procedure. Do your homework, choose what's best for you, and never look back.
...15 December 1998
Two brief updates:
...26 March 1999
PS -- Sorry about the length of this page; it has grown a bit since the first posting. If I had time, I'd break it into screen-sized HTML chunks, all nicely linked with buttons. Life is too short. Scroll with it. :-)