Thursday, July 13, 2000...
These are the days of miracle and wonder.
I have worn eyeglasses since I was five years old. I had both nearsightedness and astigmatism. In short, anything beyond about 3 inches from my nose was just a blur.
Yesterday I underwent laser vision correction surgery. Today I am writing this on my laptop computer, without the aid of any corrective lenses at all.
It feels like nothing short of a miracle. I wanted to write up my experience before it fades...
It all started about 3 months ago. I happened to notice that a co-worker looked different. The difference, it turned out, was that he had undergone a fairly new type of laser vision correction surgery called LASIK (LAser In-situ Keratomileusis). This is a procedure whereby the cornea is reshaped using a laser. This is done so that light rays are focused more precisely on the retina, thus reducing or eliminating the need for corrective lenses.
I had to investigate.
In southern New Hampshire, the largest vision center is Nashua Eye Associates, established in the early 70s by Dr. Charles Wingate. They offer free seminars to introduce and explain the procedure. The seminar is about an hour long. The doctors go through a set of slides, show a video, and answer questions. At the end of the seminar you have the opportunity to make an appointment for a screening consultation. They also have some information on the web at http://www.nashuaeye.com/laser/services.html#lasik.
I went to the seminar early in June, and made my screening appointment for the following week.
The screening is a thorough eye examination. During this exam they determine if you are a suitable candidate, and gather almost all of the information needed to perform the correction. They check your vision, the health of your eyes, the thickness of the cornea on each eye, and so on. They dilate your eyes, so it's a real good idea to either have someone to drive you home afterwards or to have a really good pair of sunglasses with you.
I passed my exam with flying colors, and Dr. Wingate indicated that I was an excellent candidate and could expect excellent results.
I took the first available surgery appointment that I could make -- yesterday, July 12.
A note about cost: LASIK isn't cheap. Nashua Eye charges $2,200 per eye. Most insurance programs do not cover this cost, although some are starting to cover at least a portion of it. Consult your insurance information. Most places that do LASIK also offer financing if you want to take that route.
A week prior to the surgery I had an appointment at the facility that houses the LASIK machine. This is located in Bedford, NH. At this appointment I made payment arrangements (translation: wrote a big check), and was given a tour of the facility. They also had me lay down on the LASIK machine, and used it to take pictures of both of my eyes. These pictures are used by the LASIK software to determine calibration parameters. Despite the tour and the pictures, I suspect that the real reason for this appointment is to collect the payment. Since insurance coverage is still fairly rare, collecting payment a week prior to the surgery effectively eliminates deadbeats.
My surgery was scheduled for yesterday at 2:30. My eyes are fairly dark, and therefore difficult to dilate, so they asked me to arrive at 1:30 so they could ensure that they could dilate my eyes to 7mm prior to the surgery. I was also given a prescription for a 5mg valium tablet, and told to take that at 1:30 when I arrived. Better living through chemicals! ;-)
I wasn't anxious about the surgery at all -- up until about noon yesterday. Around then I felt my anxiety level increasing ever so slightly. Sweaty palms, loss of appetite, and a slight "oh my god, what am I doing?" feeling. I knew, however, that this was just that old "fear of the unknown."
Patti accompanied me to the surgery. You absolutely need to be accompanied, as you cannot drive yourself home afterwards. We arrived promptly at 1:30. I took my valium. ;-)
They seated us in a room adjacent to the surgery room, and stared dilating my eyes. It took three doses of the dilation eye drops, and an hour to get my pupils up to 7mm. Most people take only one dose and 20 minutes.
While waiting for my eyes to dilate, the nurse explained the post-operative care procedures. Since there was a surgery right before mine, we also got to watch them perform the surgery -- both through an observation window, and via a TV monitor that is a slave of the LASIK machine's computer monitor. Yes, there's a GUI (graphical user interface) software program that controls the whole thing. The GUI is complete with progress bars, menus, and a big red "Abort Operation" button! I appreciated that last little feature, especially since it appeared that the laser was controlled by an NT workstation. ;-)
And then it was my turn.
They first put me in a somewhat normal eye exam room, sitting in a normal eye exam chair, looking into a not-unusual eye doctor type of apparatus. Anyone who has had their eyes examined knows what I mean -- "put your chin on the chin rest, and lean your head against the top rail,...". Instead of being one of those big lens thingies, however, this was actually a powerful microscope. Dr. Wingate first put some eye drop anesthesia in my eyes (this stuff works quickly and effectively) and then he used the microscope to look at my eyes while using some sort of pen to mark some lines on my eyes. These lines, he explained, would be used to calibrate the laser for correcting my astigmatism. It seems that your eyes rotate ever so slightly when you lay down, but they want to correct your vision for when you are sitting up. So they mark your eyes sitting up and then can tell how much they rotate when you are laying down.
Now we went into the surgery room. This room is very much kept in "clean room" state. It's got a heck of a powerful HVAC system in it, and I'm certain it is designed to eliminate dust and dirt particles in the air. The doctor and nurses are all in surgical scrubs, right down to those little surgical booties over their shoes. They don't make you wear those, but they do put a cute little surgical hat on your head, covering your hair. Patti was sorry she didn't bring a camera when they put my hat on me!
You lay down on a table, and scoot yourself underneath the laser apparatus. You position yourself so that one eye can look up at a red light in the laser apparatus. Your job, pretty much, is to look at that red light.
They put a pillow underneath your knees, and give you "Laser Lamby" to hold. "Laser Lamby" is a stuffed animal (a lamb). Pretty much it just gives your hands something to hold onto. It's effective, and I'm sure I squeezed the heck out of that poor lamb over the next twenty minutes.
They did my left eye, then my right. The eye that is not being operated on is covered during the procedure.
First, they applied some more eye drop anesthesia. Then they had me close my eye and they cleaned my eyelid and the area around my eye using, I'm sure, some sort of sterilizing solution.
Next they positioned an eyelid speculum around my eye. This is a metal apparatus that grips your eyelid and prevents you from blinking. It sounds nasty, I know, and I wouldn't want to have them put one on my eye every day, but all in all it wasn't so bad. Remember, with the eye drop anesthesia you cannot feel anything.
Now came the part that I look back on as, perhaps, the most frightening. I'm not sure that frightening is the correct word -- the most anxiety- provoking is perhaps more accurate. They placed a small suction ring on my eye (around the cornea), and then pressurized my eye. When they do this, you lose your vision in that eye - they warn you ahead of time. From the seriousness of the conversation between the doctor and nurses, I suspect that this is a delicate and critical procedure. It's a very weird sensation when the pressurization starts and your vision goes out. It comes right back, but is scary. Don't forget -- I didn't feel a thing while this was happening. It's only the visual sensation that you are aware of.
The suction ring apparatus serves as the platform for the microkeratome. This is basically a circular saw for the eye! So once the eye is pressurized, the microkeratome cuts a thin flap of the corneal tissue. The microkeratome sounds exactly like a saw while it is doing its job. Patti tells me that she could not bring herself to watch this part.
The thin flap isn't cut all the way around -- it's left attached at the top of your eye, and when the microkeratome is done cutting they use a solution to fold the flap back and out of the way. You can see this happening. Very weird.
From when they put the suction ring on your eye to when they fold the flap back can't be more than 60-seconds. It's weird, it's anxiety-provoking, but it's quick. At this point you are definitely practicing the art of being *very* still. ;-)
Next, it's time for the laser to do its stuff. This is where the Star Wars technology comes in. They press a button and the laser locks on to the marks on your eye. It's just like Top Gun. Once the GUI displays the "Locked On" message, they press a button that lets the laser do its stuff. Your job is to look at the red light (ok, the red blob) and be still. The doctor counts out the progress percentage numbers as the GUI progress bar updates. This, too, is quick -- perhaps 2 to 3 minutes. You don't really see anything as this is happening, just the red blob that the doctor keeps telling you to look at. What really surprised me was the smell -- a slightly burnt sort of smell. As the doctor got up to 75% done and more, I know that I was tense and just hoping for it to be over. Laser Lamby took the brunt of my anxiety.
When the doctor announced that it was finished, a big sigh of relief -- at least mentally if not physically. After all, they still have the eyelid speculum holding your eye open.
Finishing up takes another 3 to 4 minutes. They use a solution to float your corneal flap back into place, and then use a variety of solutions and sponges to smooth it out and make sure its all OK. With the sponges you can see that they are touching your eye, but you cannot feel anything.
Then they take the speculum off, and you blink a few times, and they use more solutions to irrigate your eye.
Start to finish, perhaps 10 minutes.
After they did my left eye, they went immediately to the right eye. Same procedure, same experiences, different eye.
When I sat up after the whole procedure was done, I could tell immediately that my vision had changed. There was a sharpness that was noticeable. However, you cannot see immediately -- your vision is cloudy, sort of like looking at the world through cellophane.
We went back to the first room for a look at my eyes with the first microscope. Dr. Wingate noticed a very small fiber in my left eye that he did not like, and so he had me go back into the laser room where they reattached the speculum and irrigated and dried my eye with sponges once again. He wanted to be absolutely certain that there was nothing in my eye. After a second visit to the examining room, he was satisfied and then I was sent on my way home.
The world was very bright. Even with sunglasses, the world was too bright to keep my eyes open. I kept them closed the whole way home.
Once home I just hung out in our back room, resting, for the rest of the day. I watched and listened to the New Hampshire House of Representatives impeach our chief justice of the Supreme Court, and dozed on and off. It was a good thing to have the impeachment session on the New Hampshire public TV and radio, as it kept me occupied for a good six hours or more -- it didn't really require vision, and was endlessly fascinating. Without something like that, I might have gone bonkers trying to rest.
By 8 or 9pm, my vision was improving. The light sensitivity was fading, but my vision was still somewhat clouded. You know when you are really sleepy, and have difficulty clearing your eyes to see? My vision was sort of like that. Light sources, in particular, would smear. And I certainly couldn't focus on anything close up -- reading would have been impossible. But I could tell that I could see. By the end of the evening, I could read the clock on the cable box across the room.
They give you clear eye shields (with air holes) to tape over your eyes whenever sleeping or bathing. You have to use these for the first week. I thought it would really s*ck to try to sleep with these things taped to my face, but I slept like a rock last night.
This morning when I woke up, it was nothing short of amazing. Almost all of the cloudiness was gone. As the day has progressed, I think my vision keeps on improving.
My distance vision is nothing short of amazing. Gazing out at my back yard, everything is clear and sharp. I can see the line of trees at the back of the lawn, 200 feet away, easily as well as I could with my glasses before the surgery. I think this applies to anything at about ten feet and beyond.
My near vision isn't quite so sharp (yet). That's not to say it isn't good - I read the newspaper this morning, and I'm reading and typing on my laptop without much difficulty at all. But with close vision (1 to 3 feet), I still notice some of the cloudiness/haziness. This should slowly clear up over the next several days.
I cannot focus on anything closer than 6 to 8 inches at all yet. This is a particularly odd sensation, as prior to the surgery things had to be that close for me to focus on them at all. This, too, seems to be improving with time.
I had a follow-up eye exam this afternoon, 24 hours after the surgery. Dr. Wingate examined my eyes for any signs of infection or trouble with the healing of the corneal flap. He then tested my vision. My vision with both eyes open is just about at 20/20. My left eye alone is at 20/20, and my right is at 20/25. This is interesting to me, as last night I could definitely see out of my right eye significantly better than my left eye. My left eye is my dominant eye, so I'm happy with its improvement.
I have antibiotic eye drops that I need to use 4 times a day, and I also have drops to keep my eyes moist. These latter drops are the same drops that contact lens wearers use to keep their eyes moist. My eyes are very dry, and perhaps slightly itchy. I'd love to rub them, but of course that is a big no no.
My next follow-up exam is in a week. As my eyes heal over the next several weeks, I should notice a gradual improvement in my close vision.
That's about it. I'm simply speechless about how amazing this technology is. Dr. Wingate himself told me that four years ago he would not have believed how good this technology would be. I believe him.
Would I recommend this for others? Absolutely. Aside from the cost, I would not hesitate to urge others from seeing if they qualify. The literature I have indicates that they can correct you if your range of correction is less than -10 diopters (myopia/nearsightedness) with up to -4 diopters for astigmatism.
I know that a lot of people are hesitant because of the fear factor. I hope my first-person description alleviates some of that. It's a quick procedure, and it really is painless -- you do not feel it at all. And when it is done, you can see!
These are the days of miracle and wonder.