My LASIK Experience

Introduction
On Wednesday, June 12, 2002, I had LASIK surgery to correct my near sightedness (contact lense prescription -5.50). Since there were a number of things about LASIK I did not understand prior to experiencing them (particularly the nature of the surgery itself), I thought I would write this page to share my experiences with anyone else who is considering it.

LASIK stands for "laser assisted in situ keratomileusis". It is a surgical procedure used to correct certain types of refraction problems in eyes, such as my near sightedness. You can find additional information about LASIK at this web page.

Please note that this is only my experience and yours might be different. I am not a medical doctor and nothing in this page should be construed as medical advice. Please consult a physician for details on this or any other medical procedure.


Selecting a Doctor
My vision had been stable for over two years before I decided to get LASIK. I had a contact in the excimer laser business who supplied several surgeon recommendations. I also asked friends who had had the surgery for recommendations. It turns out that one of the friends who was most satisified with his surgery had used a doctor in the same practice as the person my laser company contact had identified as the top academic ophthalmologist in Chicago. This doctor was also affiliated with one of the top academic institutions in Chicago. So despite the higher cost of this doctor, I decided to give him a shot. Money is not the issue when my eyesight is concerned.


Pre-Surgery Process
I called to schedule an appointment as a referral from a previous patient. No referral from my optometrist was necessary. An initial screening visit consisted of a brief examination of how bad my vision was (as with a regular eye doctor) plus a brief measurement of the thickness of my cornea. This last bit was done with a thin metal probe touched to my eye after the application of some numbing drops. I didn't feel a thing.

The doctor explained the general nature of the surgery and asked me about my expectations. He particularly tried to set low expectations, saying that 90% of patients see 20/40 or better post surgery, that this was good enough for driving, even at night, and that probably it was good enough for most ordinary activities. He particuarly cited reading movie subtitles as a possible problem with 20/40 vision, something I was not happy to hear since I watch lots of foreign films. He also explained options for dealing with less than perfect vision after the surgery (do nothing, glasses, or a "touch up" procedure). He mentioned that nobody had ever gone blind from LASIK, but it was possible to end up with permanently distored vision that could not be corrected. He described possible post-operative complications, including a "halo effect" around lights at night (which he thought there was a very good chance of me getting) and eye dryness. All in all, it was a pretty good "scare job". The one area I thought was lacking was his description of the surgery itself. This was a common complaint among people I know who had LASIK. A common piece of advice would start "they won't tell you this before the surgery, but..."

After all this, I did ask the doctor about his experience and how his patients had fared. According to him, of all the patients treated by his practice, no one had ever gotten less than 20/40. After the surgery he confided that only about 1 in 20 gets less than 20/20 vision. Most of those the result of improper healing. He didn't say, but my guess is that many of those people did not care for themselves properly after the surgery.

I told him I wanted to go forward and so we scheduled an appointment for a very detailed exam that would determine my ultimate qualification for the surgery, as well as collect the measurements needed for the surgery itself. One thing that came as a surprise to me was that I could not wear contacts for two weeks prior to this exam. Apparently contact lenses distort the shape of the eye. Unfortunately, I did not even own a pair of glasses so I had to go out and buy one! Needless to say I got the cheapest one I could find that was even halfway decent looking.

The next visit was by far the most thorough eye exam I have ever had. It was mostly done with my eyes dilated, so reading and light sensitivity for a couple hours afterward were problems. He tested my vision several different ways. I wish I had taken notes that the time. One was through that normal periscope looking thing. Another was by adding a bunch of lenses to a set of glasses. The also made me stare into a flashing orange light for a while in order to take a detailed map of my cornea. My eye was examined using his microscope for quite some time. The thickness of my cornea was checked again. I was given a glaucoma test that involved actually touching a probe to my eye (not the usual awful puff of air).

After all this poking and peeking, I was pronounced fit for surgery, which I could schedule at any time. My wedding was upcoming in a month and recalling the small bloody looking splotches on my friend's eye after he got LASIK, I asked about that side effect, which he had previously not mentioned. He said, yes, often capillaries burst in the eye during surgery, resulting in that effect, which could last several weeks. It would probably be best to wait until after the wedding if I didn't want that in my photos.


The Procedure
The actual procedure takes approximately 15 minutes front to back. The evening before and the morning of surgery I was instructed to scrub my eyelids and eyelashes to remove excess oil. I arrived, signed in, and was escorted to the "operating room" after a typical wait. I had to initial a laundry list of horrors that could happen to me on a disclosure sheet and also sign another waiver form since I planned to do both eyes at the same time. My doctor recommended doing one at a time, but finding the schedule to do that was difficult as I was told I could not travel for a week after the surgery and travel is a big part of my job. So both eyes it was.

To start off, a medical assistant performed another eyelid scrub. I was given a funny little hat to wear to keep my hair out of your face. Kind of a joke for a buzz cut bald guy like me. Then I was seated in a reclining chair similar to that you'd find in a dentist office. My head was wedged between two adjustable arms that prevented excess head movement. My doctor gave me a teddy bear to squeeze for stress relief. Clear markings indicated that many previous patients had throttled its neck.

Starting the procedure, I was laid back horizontal in the chair. I could see a blinking red light (think a blinking HAL from 2001: A Space Odyssey) which is the light you are supposed to stare at from the laser. A patch was put over the eye that was not being operated on. A film simlar to scotch tape was used to tape down my eyelashes out of the way. Numbing drops were put into my eyes. A device was then put on my eyes to keep them pried open (think A Clockwork Orange), which involved some moderate pressure but little pain. My eyes are sunken behind a low forehead like some Neandertal so this was a bit complicated for my doctor. Once this was done, a suction device was placed on the eyeball and activated. On activation, I slowly went blind, which is a good thing since I probably didn't want to see what happened next, which is that a cutting intrument with a clearly audible blade noise cut a flap in my cornea. Once the flap was cut, the device was removed and vision restored. With the flap open, I could still see, but very, very poorly. The suction device put significant and very unpleasant (though not painful) pressure on my eye. The flap cutting procedure is IMO the worse part of the whole process. Going blind during the suction was something that everyone I talked to said their doctor had not mentioned prior to the surgery.

Above me the flashing red light of the laser guide was basically a blob. I was instructed to stare at that directly while the doctor activated the laser to vaporize a layer on the inside of the cornea. The laser itself makes a moderately loud "clacking" noise. Mine was on for about 30-40 seconds. I could clearly smell somthing burning. It could have been the smell of the vaporized cornea, or possibly it was just the ozone smell of some electrical component on the laser. A computer guidance system automatically keeps the laser focsed on the flap if you move your eye a bit. If you move it too far, the laser shuts off as a safety precaution. Once the lasering was complete, the flap was repositioned and the doctor used a little miniature squeegee to do detailed adjustments on it, which was as unpleasant as it sounds because you can actually see it being done.

All was well, so the devices on my eye were removed and the same procedure was completed on the other eye. When I was done with both eyes, I was told I could look around normally, but not to touch or rub my eyes. I could see, but there was a lot of distortion. My vision was clearly not 20/20, but I could see well enough to read the clock on the wall, something I never would have been able to do before. Driving was out of the question, so it is a good thing someone came with me to drive me home.

I found the whole procedure moderately freaky. As with most people I know who've done the surgery, I would suggest doing both eyes at the same time because once you get out of that chair you're not going to want to get back in it. Still, I only slightly mangled the teddy bear and nervously kicked by feet around a bit. According to my doctor, virtually no one freaks out completely. Only about 1 in 100 require a sedative to calm them.

Be sure you like your doctor's demeanor. Because you are fully conscious during the surgery, beside manner is critical. If the doctor says something like "Hurry up! We're going to lose him!" you'll probably freak out. My doctor was excellent in this regard, always appearing calm and in control. He was particularly good about never making a statement with any negative connotations. When an assistant botched something like prying my eyes open, he didn't correct them, but rather just issued calm instructions that made it seem like nothing had happened. He also was very good at telling me what was going to happen next, and giving constant encouragment.


Post-Surgery
After the surgery was over, I was given two types of medicated eye drops that needed to be put into my eyes four times daily for a week. One of these was an antibiotic. The other was a steroidal anti-inflamatory. I used them religiously. I was told, BE SURE NOT TO RUB YOUR EYES. Don't even touch them for the first couple days if you can avoid it. I was given goggles to wear when sleeping for the first week so that I didn't inadvertently rub my eyes in my sleep. I was also given a pair of very ugly sunglasses to wear outdoors for the first week as my eyes would be sensitive to light. If you don't have a pair, go buy some that you'd actually be seen in public with. You can use those. Otherwise you'll end up looking like an old lady who just had cataract surgery like I did.

When you go home, it is recommended that you take a nap. I'd did so (Be sure to wear your goggles). When I got up after this brief nap, I could see much, much better. My eyes felt a bit like they had some dust in them. Don't rub! This "scratchiness" is normal and generally wears off after a couple days. While sleeping during my post surgical nap and the first night, I also noticed a bit of stinging and burning in my eyes. I was instructed not to read or use a computer (anything where I was likely to stare and not blink) the first day.

The next morning, I woke up with very good vision, though I noticed my left eye could see far better than my right. The feeling of grit in my eyes was almost gone and by the end of the day had disappeared completely. I went for my followup and my right eye was definitely not seeing well. I could barely read the top line on the chart. The doctor described my eyes as "impressively dry" and said that dryness was causing the problems. I had been warned about dry eyes as a consequence of surgery but had only put in some artificial drops once. I was instructed to do so more regularly. In addition, the doctor inserted a microscopic plug into one of the drainage ducts on my right eye to keep any tears I was producing from draining into the nasal cavity.

From then on for the rest of the first week, I put in drops every two hours or so. By the time of my next followup visit a few days later, I was seeing 20/20, though my right eye was still slightly worse than my left. There are additional followups I will be required to make at the one month and six month points.

Eye dryness is the major side effect of LASIK surgery in my case. The surgery interferes with your eye's ability to sense dryness, thus you don't produce enough tears. Supposedly this is much improved by the one month mark and continues to get better. However, I know people who a couple years after their surgery are still occasionally using eye drops. Anyone contemplating surgery should expect to be regularly using artificial tears for at least a few months afterwards. I was told by an assistant to use their sample whenever I felt I needed it. However, I had great difficulty sensing dryness in my eyes most of the time, so bought an industrial sized bottle and just started putting them in regularly.

Another side effect is the previously described "halo effect". As I generally had this while wearing contacts at night, it was not a shock. I'm told this is also something that will diminish over time. Personally, I do not find it bothersome.


Conclusion
I hope anyone contemplating LASIK surgery finds this description of the process useful. I'm not completely through it all yet and may update this page as conditions warrant.

Good luck!