Wayne

This is Wayne's experience. His site can be found at http://www.waynesthisandthat.com

After wearing glasses for forty years I decided to have LASIK (Laser Assisted in-SItu Keratomileusis.) I'd thought about it two years ago but decided to wait for the latest improvement (wavefront correction) to be approved. This occurred in August of 2003 and I immediately scheduled the operation. This page chronicles my thoughts, concerns, and experiences before, during and after having the procedure.

What is LASIK? The central front of the eye is called the cornea: a jelly-like transparent shell. It's thick enough so that it can be reshaped into a lens that can correct the eye's vision problems. In LASIK, a flap is cut from the front of the cornea, flipped out of the way, a laser sculpts the area of the cornea uncovered to the proper lens shape to correct that eye's vision problem and the flap is folded back. Local anesthetics eliminate pain and the correction is immediate. The procedure takes two minutes per eye and is done as an office visit.

Why LASIK? I'm tired of wearing glasses: they get scratched, dirty, fog up, perspiration drips on them, they're expensive (I'll break even on the cost of the LASIK operation in seven years), cause sores behind my ears, break, get out of alignment, get in the way, prevent me from seeing a complete field of view in binoculars and telescopes, and cause extreme distortion while playing billiards when I have to look through the top edge of the lens. This last point might seem trivial, but shooting pool is my main hobby and passion. I'm hopeful that clearer vision will help me shoot better. (Practice doesn't seem to be helping.)

How much did it cost and what did I get for my money? My LASIK cost $3500 for both eyes in September of 2003. For that I got a 2-hour screening exam, a checkup the day before the procedure, the procedure itself (while the operation only takes a few minutes, the check-in, preparation, procedure, and post-op exam takes two hours), a day-after check-up, a one-week check-up, a three-week check-up, a three-month check-up, a six-month evaluation with an option for a second touch-up LASIK if needed, a set of reading lenses and a final check-up one year after the procedure. Most of this time is spent with real doctors. I consider I'm getting a lot of doctor time for the investment.

Why wait two years for the wavefront correction option? When I first started considering LASIK in 2001, it could only correct for defocus (what makes us near or farsighted) and astigmatic aberrations. Wavefront correction enables much more precise sculpturing of the cornea to eliminate higher order aberrations (coma, trefoil, spherical) making it possible to achieve vision that's better than 20/20. In 2001, only eighty percent of LASIK patients achieved 20/20 vision. With wavefront correction this improved to 98 percent with many patients doing better. I felt these factors justified the wait.

Who to do it? Since I was going to hire someone to cut into my eyes I figured it made sense to shop for the best doctor rather than the best price. This sounds good but how to do it? The answer was simple: find out who eye doctors go to to perform LASIK on them. My optometrist, Doctor Steven Israel (please see the bottom of the page for his resume,) helped me locate such a doctor: Doctor Alan Berg (also please see the bottom of the page for his resume.)

Knife or laser cut? There are two options for cutting the corneal flap prior to sculpting the cornea: a knife or a laser. While the laser is more precise and produces a smoother cut, I elected the knife option. The complication rate with laser cutting is 50 percent because as the laser cuts through the cornea, the water in the cornea vaporizes causing haziness and slowed healing.

Initial concerns: My first concern was: Would I get my money's worth? To invest $3500 and still have to wear distance glasses was unattractive. The wavefront improvement reduced the odds of this happening low enough to justify the risk.

Much of my angst was in making the decision. Once I'd made it and paid the doctor, 90 percent of my tension faded away.

Another concern was for pain I might experience during the procedure. Prior to the surgery, the doctor ran several tests that required my eyes to be touched by various instruments. He used anesthetic drops and in each case I felt absolutely nothing. This assured me that I'd be able to handle the operation.

One of the advantages of being as nearsighted as I am is that I'm able to focus on objects held very close to my eyes: as little as three inches away. That's like carrying around a low power binocular microscope. .

The last concern was more psychological. I've worn glasses all my life, so much so that the only "me" I know is someone who wears glasses. Everyone I know has only seen me wearing them. After LASIK, except for reading, I will no longer wear glasses. In a way I will be a different person. It's an odd sensation.

Step 1 - The screening exam: During this exam my corneas were tested to make sure they were thick enough and the correct shape to support the surgery. Both eyes were also carefully checked for general health. One test required eye drops that open the pupil. The effect lasted 36 hours, during which time I had to wear dark sunglasses outside. None of the tests were painful. The hardest one was where a bright light is used to examine the retina. The light was so bright that it caused my eyes to tear. But, the discomfort was more like straining to lift something heavier than you can manage, not the sharp pain of a cut. None of the drops itched or burned. This exam took place two weeks before the surgery.

Step 2 - The day-before exam: I went in for one last quick exam the day before the surgery. It consisted of checking my eyes' required correction and general health. This makes four times my eyes have been checked in preparation for LASIK. The doctor explained that even though the wavefront examining machine will do it again prior to the surgery, it's important to have good solid values so the doctor can make sure that the machine reads my eyes correctly. Also, some people have a difficult time providing consistent answers during eye exams. By repeating it several times the doctor can take an average of all the tests to obtain more accurate numbers for the amount of required correction.

The day of the surgery: Pre-surgery instructions were few and simple: don't eat or drink anything with caffeine for four hours prior to the operation and don't wear any cologne, perfume, after shave, facial lotion or eye makeup. Had I worn soft contact lens I would have needed to leave them out 72 hours before the surgery. Hard contacts should not be used for three weeks before the operation.

Step 3 - The surgery: I arrived at the LASIK surgeon's office at 2:00 PM. After I signed the obligatory warning and release forms, the operating surgeon once again checked the amount of correction needed for my nearsightedness and astigmatism using standard equipment. Then I was given a small dose of Valium to relax me. Next a technician tested the shape and thickness of my corneas. Finally it was time for the wavefront analyzer itself - what I'd waited two years for.

The wavefront analyzing machine looks like many of the measuring devices in a optometrist's office. It's a desktop unit with chin and forehead rests. You look into a dark tube with a small red line tracing a shape a little like a car's steering wheal.

I was asked to gaze at it without focusing. The image twisted and warped for two seconds during the measurement process as the device is sent a beam into the eye and recorded what it looked like as it reflected back out. It then compared that record to what the light reflected from an optically perfect eye should like and generated the following maps for my eyes:

Middle green zones are areas where my eyes are performing normally. Blue denotes areas where the eye is nearsighted and yellow where it is farsighted, relative to my overall corrections for nearsightedness and astigmatism. These maps show the small, local defects caused by irregularities in the shape of the lens and retina that can subtract from vision sharpness even after nearsightedness and astigmatism are corrected. (For scale, the horizontal and vertical white lines are one millimeter apart.) This information is fed into the computer that controls the laser that sculpts the cornea. When combined with the correction program for my nearsightedness and astigmatism, they enable the LASIK process to correct my eyes so that I might be able to achieve better than 20/20 vision. The test was repeated three times for each eye and was completely painless.

Next came the surgery. A nurse placed a bag over my hair to keep it out of the way, then walked me into the operating suite where I laid down on a comfortable bench. Anesthetic drops were added to my right eye. Tape was used to hold eyelashes out of the way. The drops took hold immediately and even though I was completely awake I could feel nothing in my eye. I was rolled under the laser machine

and could see a flashing orange-red dot surrounded by a yellowish ring.

It was bright enough to see clearly but not so bright as to cause discomfort. The central red light was blurred. Although I couldn't feel it, the next step was to thoroughly clean the eye and mark it with two indexing circles so that after the surgery the corneal flap could be repositioned in exactly the same position.

Next a device was placed on my eye that sliced off a thin layer of the cornea. Although I'd been warned that I might feel a slight, non-painful pressure or suction during this procedure, I felt absolutely nothing. An instrument was inserted under the flap (again, I felt nothing) and the corneal flap was peeled back.

(Look carefully and you can see wrinkles in the flap
indicating that it is a soft flexible material.)

This process only took 20 seconds.

After the flap was peeled out of the way, the flashing red dot looked noticeably more blurred. I heard a rapid snapping at about three beats per second indicating that the laser was at work reshaping the cornea. I could see a faint white flashing point of light tracing circles. I was instructed to look directly at the flashing red dot. The laser automatically tracks and corrects for small eye movements. If I were to move my eye too far, the laser stops and waits until the eye is back in place, at which time the sculpting picks up where it left off. This didn't happen during my operation. The snapping stopped after 40 seconds and the corneal flap was folded back into place. I could immediately see that the flashing red light, which before had been a blur, now showed sharp detail, almost as if I could make out the light's filament and support wires. The surgeon spent a minute washing and smoothing the cornea. Total time expended for preparing the eye, cutting the corneal flap, sculpting the cornea and putting everything back together was three minutes. The procedure was repeated on the left eye. The only difference was that during the cutting of the corneal flap I could feel a little pressure and had some sensation during the actual cutting. Not pain. Just an indefinable sensation. The doctors and nurses commented that this was common and didn't know what caused it.

During the sculpting process, the laser removed a maximum depth of one-tenth of a millimeter of corneal material to form a concave lens. Since my corneas are over five times that thick, plenty of cornea is left to to perform it's function. Someone less nearsighted would have less material removed. Farsighted people would have the edges removed to produce a convex lens. Although I couldn't see it, my wife, who watched the procedure from an observation room, commented that she could see faint wisps of steam coming off my eye while the laser was on.

Immediately after the left eye was completed I sat up on the bench and opened my eyes. Although the room appeared as if I were looking through a light fog, everything was as sharp as if I was wearing glasses. Transparent shields were taped over my eyes and after receiving instructions on how to care for my eyes over the next few weeks I was free to go.

To outsiders my eyes looked absolutely clear, as if nothing had happened. The surgery left no cloudiness in the appearance of my eyes.

Throughout the procedure, everyone on on the staff were extremely warm, friendly, encouraging and worked at the highest level of professionalism and competence.

I'd been given two more Valiums to help me sleep over the next five hours, during which time I was told my eyes would experience some burning. I elected not to take the Valium right away because I was afraid I'd fall asleep during the hour and a half it took for my wife to drive me home and I was concerned she wouldn't be able to get me out of the car. For the first half hour I only experienced a very mild, almost unnoticeable burning. During the second half hour this increased enough to be bothersome, but was still so mild that if I had been doing anything other than laying quietly with my eyes closed I probably wouldn't have noticed. By the end of an hour and a half the burning increased to the point where my eyes started to tear, not from pain but as a natural reaction to attempt to wash an irritant away. By this time I'd say the sensation was uncomfortable, but not painful. We got home shortly after that, I took the Valiums and slept six hours. When I woke up my eyes felt almost normal. The only thing I noticed is that the skin around the eyes felt puffy and a little irritated, like they would be after a hay fever attack. I administered the drops I'd been given and went back to sleep. By morning, 12 hours after the operation, my eyes felt perfectly normal and except for a little cloudiness, my vision was sharper than I'd ever had with glasses. I had my day-after exam at which time my doctor stated everything had gone perfectly and my eyes were healing fine.

Post-operative care consisted of simply keeping my eyes closed as much as possible for the first 36 hours and applying two types of drops four times a day for the next few days. One was an antibotic to prevent infection and the other was a steroid to slow the healing process, which prevents scarring. These drops didn't cause any burning or discomfort. One of them, 1 percent Pred Forte, was milky and clouded my vision for five mintues after application. Three or four times over the first day I noticed very fleeting sensations like I had a hair in one eye or the other. This was extremely mild, non-painful and passed in seconds. By the end of the second day all the fogginess I'd noticed immediately after the operation was gone. At night the shields had to be taped back on so that I wouldn't accidentally rub my eyes and disturb the corneal flap. I was directed not to exercise for at least five days, avoid dusty environments at least that long, use sterile eye drops if I experienced dryness, avoid getting soap or water in my eyes for the first month and wear the eye shields when I slept for the first two weeks.

One thing I learned very quickly during the first few days was to avoid hard blinking or tightening my eyelids while they were closed. This created a painful sensation like the corneal flap was about to be wrinkled.

The most important thing is to avoid rubbing the eyes at all costs. This could wrinkle the corneal flap and ruin your sight beyond repair.

How well did the LASIK work? Prior to the operation my eyesight was 20/400. With glasses I had 20/22 in my right eye and 20/23 in my left. Using both eyes I had 20/21 vision. (Using both eyes improves total vision.) Twenty-four hours after the operation I had 20/18 in my right eye and 20/14 in my left. The next day my left eye was even sharper while my right had temporarily deteriorated to 20/22. Such fluctuations are normal for the first three weeks. By the end of the second week my eyes were consitantly functioning at 20/17.

NEW!!! Driving Card!

The morning after the operation I went into my doctor for a quick exam. Had I asked for it, he could have given me the card pictured above that makes it legal for me to drive without glasses until I had the time to get into DMV to have my license changed.



Healing: I can't honestly comment on this because as of the day after the operation I haven't felt any out of the ordinary sensations in either eye: no burning, no itching, or foreign object sensations.

My vision fluctuated from day to day. One day can begin with my right eye seeing as poorly as 20/25. By the end of the day it can be better than 20/20. The same thing happens to my other eye. Occasionally they both get super sharp and I can pick out the shapes of individual leaves on a tree two blocks away. Other times, mostly right after I wake up, my vision is so poor it isn't safe for me to drive. My optometrist explained that this results from varying amounts of dryness in the eyes. This evened out by the end of the third week.

The amount of glare from car headlights was blinding the night after the operation. It would have been unsafe to drive. A week later, the glare was about half as bad, but still too much to drive safely at night. By the end of the second week the glare was still noticable, but I felt comfortable driving at night.

The biggest hassle with the LASIK has been having to tape the eye shields on every night. By the end of the second week I was ready to smash them underfoot.

The only problem I had during the first two weeks was that twice I developed horizontal dry lines on an eye because during sleep my eyelid didn't close all the way. This condition wasn't painful but did cause the vision in that eye to deteriorate to 20/30 for half a day. This is not uncommon because after LASIK the eye's ability to produce the lubrication that normally prevents this is reduced. In both cases all it took to clear it up was a few drops and waiting eight hours for the eye to heal that area. By the next morning the eye was perfect again. This condition can occur even in people who don't have LASIK.

Was it worth it? Yes, but not without costs. At 52 years old, my eyes have lost most of their ability to focus. This means I still need glasses for reading as I had before, but I was aware of that going into the operation. Most people spend the majority of their time looking at objects that are within four feet of them. For me this is in the hard-to-focus zone, so much of what I view looks blurred unless I want to wear glasses. This effect has nothing to do with the surgery. Also, I miss being able to focus on the very small objects that my extreme nearsightedness allowed me to, but overall I'm completely satisfied with the results and would do it again.

One aspect that has been better than I'd hoped is how clear everything appears because I'm no longer looking through a plate of glass (plastic, really) and all the dust, scratches and smudges its surface invariably picks up. Being able to see without glasses is clearer than having to look through even thoroughly cleaned new glasses.

A word to billiard players: The physics of optics demand that as a corrective lens is positioned closer to the eye, the range over which the eye can achieve a clear focus is reduced. For me this means that when I wore glasses I could still get a clear focus on objects as close as four feet. With LASIK, the corrective lens, my cornea, is much closer to the eye than the lenses of my old glasses. Because of this I sometimes need to be be as much as seven feet away from an object to see it sharply. This is partially dependant on the amount of ambient light. Outside, in bright sun, I can see sharply within three feet because my pupils close down enough to create a clearer focus, much in the same way a pinhole camera can take a sharp picture even though it has no lens. In average room lighting an object needs to be at more than six feet away to be sharp without close-up glasses. I mention this to anyone in their fifties thinking that LASIK might eliminate the need for glasses when shooting billiards. Unless they are blessed by having retained their youthful focusing capabilities, they may still need to wear glasses while playing. This will also depend on the amount of LASIK correction required: the less the correction, the closer you should be able to focus. I wish I had discussed this in more detail with my doctor.

What does it look like? The cue ball, typically three feet away is blurred, but not so much that I can't see where to hit it for the required spin control. The average object ball, six feet away, is slightly blurred and balls all the way across the table are fairly sharp. The blur isn't like that of an out-of-focus picture, but more like a case of double vision. The amount of blurring varies from day to day, so I'm hopeful that by the time I'm completely healed all the balls will be sharper. As of the second week, it does seem to be getting better, especially late in the day.

I have noticed that because I'm no longer restricted to only lowering my head far enough to look through the tops of my glasses, I'm able to get a better "aim" on the object ball. All in all LASIK inproved my game, which was the main reason I had it done.

One option would be to get a pair of special glasses for billiards. For the average shot, my eye is three feet from the cue ball and six feet from the object ball. A pair of very weak reading glasses, something down around +0.75, should provide the perfect amount of correction at the average distance of four and a half feet. (Hopefully I still have enough focusing depth left to cover the range of three to six feet.) The weak power of such lenses means that the distortion from looking though the top of the lenses will be minimal, unlike my previous glasses. Glare will still be a problem but it may be worth it. A better solution might be to increase the light over the table. This could sharpen my focus by evoking the pinhole effect. I'll wait on this until at least three months have passed. By that time my eyes should have completely healed and stabilized. Hopefully all the balls will be sharp all the time by then.

An issue of convenience: Prior to the surgery, I wore distance glasses all the time and if I needed to look at something close I simply glanced under the lens. Now I don't wear glasses so I have to carry reading glasses clipped to my belt. When I want to look at something close I have to pull them out and put them on. This is more of a hassle than the old way. If you still have a large focusing range this won't be necessary, but it will if you don't. Still, the convenience of not having to wear glasses most of the time more than makes up for this.

What I learned: The doctor gave me special tape to stick the eye shields on at night. Using fresh tape every night and made sure the shields are very secure. One of mine came off once and in the morning I was worried that I might have rubbed that eye in my sleep.

The tape is very sticky and leaves a gummy residue. Neither alcohol nor my wife's fingernail polish remover dissolved it. I discovered that mineral spirits from a hardware store removed it quickly.

After the third day of taping the shields to my eyes, I noticed a minor rash developing on one small area of skin to which the tape had repeated been taped. I assume this was the result of repeated, though mild, trauma from pulling the tape off. I found that varying the locations tape is applied keeps this from happening.

I found an excellent way to spend the first 36 hours was with my eyes closed was to get some books on tape from the library and listen to them. I found it necessary to wear some sort of comfortable eye protection so that if I drifted off to sleep I won't accidentally rub my eyes.

While a pair of reading lenses were included in the price of the LASIK, the doctor recommended waiting a week before getting them to let my eyes settle down. I agreed, but quickly discovered that not being able to read or see close objects clearly was annoying. To hold me until the good reading glasses were available, I picked up a pair of +1.75 reading glasses from Wal-Mart for a few dollars. They worked fine and were a lot cheaper than the $200 I used to pay for a pair of reading glasses. (What do you know... the LASIK is already starting to pay for itself!) For very close work I got a pair of +3.25 glasses. These are useful for getting out splinters and untangling things like my wife's small gold chains.

My instructions stated that I shouldn't exercise for at least five days after the operation. I waited seven and found that while weightlifting, my eyes would automatically close tight and strain during heavy lifts. When that happened I could feel some discomfort in the corneas. From this I learned to keep my eyes open at least another week to avoid injuring the corneal flap.

I was driving along two days after the surgery enjoying my new ultra-sharp vision when some dust blew in the car's window and toward my eyes. Even though I was wearing cloose fitting wrap around sunglasses, a few specks got into the corner of my left eye. Fortunately nothing happened, but in the worst of all possible worlds a speck might have gotten caught in the edge of the corneal flap and caused all sorts of problems. I decided to keep the driver's side window closed for the first two weeks of healing.



One-month update.

My eyes have continued to heal without any direct complications. During the second two weeks I experienced no foreign body sensations at all and the day-to-day fluctuations in visual acuity have tapered off as I had been told they would. My sight appears to be settling down to 20/18. However, there has been one potentially dangerous side effect.

Four times during the second two weeks I woke up with either the left or right eye being so foggy I couldn't see at all out of it. Occasionally that eye might have a very slight burning sensation, but nothing uncomfortable. It turned out that my eye lid had opened up a slit during the night and a thin line of dryness formed on the cornea. Normally the eye can prevent this dry-line phenomenon, but the LASIK reduces this capability enough to where it can be a problem. The condition clears up in 24 to 48 hours depending on the severity of the dryness. This became such a recurring problem that I became concerned that if it happened two nights in a row in the same eye permanent damage could result.

My doctor explained that this problem was exacerbated by the very low humidity of my high desert location. People living in regions of normal humidity shouldn't have as much of a problem with it. He said he could give me a pair of night time contact lens that would prevent this or I could try using an eye ointment. I opted for the ointment. It seems to have solved the problem, but is extremely messy to use. It gums up my eyelashes so that it feels like someone's smeared Vaseline across my eyelids. But, this is better than being blind in one eye for a day or two.

I've never had this problem before so I began trying to discover what, in addition to the surgery, could be causing it. I found out that I sleep on my side and as the house gets colder in the morning, I tend to curl up a little tighter. As I do so, the side of my face drags down across the pillow. This pulls the skin of my forehead up and in so doing, opens my eyelid a small fraction of an inch. I told my wife that I could wear a Halloween mask as night and that should prevent the problem. I thought her comment, "Well, waking up to a Holloween mask would be a nice improvement," was singularly unnecessary.

I plan to continue with the ointment for two weeks to verify that it has solved the problem, then transition to a liquijell, a thick drop halfway between regular eye drops and the ointment to see if they work as well. They're much more comfortable to use.

One thing I've noticed about the ointment is that my vision seems clearer in the morning when I use it than when I don't. Previously, even on my best days, there would be an hour or two after waking during which my vision was weak. With the ointment, my vision is good from the moment I wake.


NEW!!! Six week update!

I've used the eye ointment for two weeks and haven't woken up once with a dry line problem. Had I know how well this stuff worked I would have used it from the first day. The minor discomfort is more than made up for by avoiding the dry eye problem. I plan to switch to the thick eye drops starting tonight. Hopefully my eyes have healed enough to not need the ointment any more.

NEW!!! Two days later

After two nights of the liquigel thick eye drops I went back to the ointment. The drops turned out to be more uncomfortable than the ointment. They felt cold and produced a slight burning sensation going in. They were messier. They tended to glue eyelashes to my eyelids. I woke up with dry crusts in the corners of my eyes. My eyes felt drier in the morning. Compared to all these problems the slight greasiness of the ointment was much to be preferred.

Another point in favor of the ointment is that I learned how to apply it to greatly reduce its messiness. The directions instruct users to deposit 1/4 inch of the ointment on the inside of the lower eyelid by pulling the eyelid down. I found that most of the ointment got squeezed out of the eye and onto the eyelid when after applying it I closed my eyes and blinked a few times, a natural thing to do. Now what I do is instead of simply releasing the lower lid, I gently pull it out and up before releasing. This way the ointment gets trapped under the lid instead of squashed out. Then I get into bed without blinking and close my eyes, being careful not to the blink or open them again. This helps keep the ointment from being pushed out onto the outsides of the eyelids. If I get up during the night I try to remember to keep my eyes closed as much as is safe. Using these techniques, I was able to reduce the amount of greasiness by more than half.

I intend using the ointment until two months from the surgery have passed then see if I can sleep without any night time eye moisturizers without developing the annoying dry line problem.

NEW!!! Eight week update!

I tested my acuity at the two-month mark at the local Wal-Mart vision center. I could read all ten of the letters on the 20/15 line and seven out of eight on the 20/13 line. Interpolation indicates my vision is working at 20/13.25. That's outstanding.

I've discontinued the use of the eye ointment and so far have not had any of the dry-line problems that plagued me during the first month.

NEW!!! Ten week update!

It appears I spoke too soon. On the morning of the end of the tenth week I woke up with haziness and a slight stinging sensation in my left eye, sure signs that the dry line problem had gotten me once again. After a month of not having this happen, it was extremely disappointing. It would seem that it takes many months for the eyes to completely heel. On the good side, two days ago I tried my luck on the eye chart at Wal-Mart and got 8 out of 8 correct on the 20/13 line. I was careful to make sure that I was truly seeing them clearly enough to identify what the letters were as opposed to remembering what they were from the last time I tested myself.



NEW!!! Three month checkup!

The doctor reported that I'm healing perfectly. His main focus was to check to see if any epiphilio (spelling?) cells from the surface of the eye had gotten under the corneal flap. If they had they would grow and attack the cornia. There weren't any.

NEW!!! Fourth month update!

After three and a half months I quit using the eye ointment. Since then I haven't had any occurrences of the "dry-line" problem. Also, the slight difference in sharpness between the left and right eyes is now almost impossible to detect. It could be that the right eye has sharpened, the left has weakened, or my mind has adapted to even things out. The last makes the most sense. My doctor explained that almost everyone is born with eyes that see the world with slightly different magnifications. In time the brain learns to compensate for this. I think this is what has happened in my case.

NEW!!! Five month update!

After having no problems with my eyes for two months, I was surprise to wake up in February with a return of the dry-line problem. It cleared up in a day and caused no pain, but this indicates that eyes are still occasionally (actually rarely) susceptible to this problem long after the surgery. This happens so seldom that I don't intent going back to using the eye ointment.

NEW!!! Six month update and two important hints!

I'd had no more problems since the one mentioned above. At six months I went in for an exam and the doctor pronounced me perfectly healed. Although it will be another six months until the cornea could be considered completely whole, for all intents and purposes mine was a closed case.

How are the eyes working? During the exam I could make out half of the letters on the 20/10 line of the doctor's eye chart. Considering that he mentioned his chart is a little small for the distance he sets it at, this implies that I may have a vision rating as good as 20/12, which is incredible.

The doctor mentioned two things that are important to everyone who has LASIK.

First, glaucoma is a condition where there is too much fluid pressure in the eye. The pressure is measured by pushing in on the cornea and measuring how much pressure it takes to deform it by a specified amount. The problem is that the resisting force is the sum of both the fluid pressure inside the eye and the resistance to bending of the cornea. After LASIK, the cornea is thinner so it can't push back as much as it did before the operation. Consequently after LASIK it can appear that you have normal fluid pressure when it's actually too high. For example, my pressure was 20 before the operation. After LASIK, it dropped to 16 because the cornea was thinner and it's part of the resisting force was reduced. Now, let's say in ten years I go to a different doctor and he measures my fluid pressure and gets a reading of 19. If he didn't know that the LASIK had reduced my readings by 4, he would think I was okay where in reality I had an actual internal fluid pressure of 19 + 4 = 23, which is too high.

Second, it's important to remember how much correction the LASIK procedure put into your cornea in the event that you ever have to have the lenses in your eyes replaced because of cataracts. If not, the doctor selecting the replacement lenses could choose some that don't take into account the fact that your corneas have already been reformed into lenses. For example, my sight before LASIK was 20/400. Now, with my refigured corneas and existing lenses, I'm about 20/18. If I get cataracts and a doctor put in standard lenses that didn't take into account the correction provided my resculpted corneas, I'd end up with a total correction (corneas plus new lenses) of -400. I'd be so near sighted that the glasses to correct it would look like the bottoms of Coke bottles. This can be a tricky problem because many people have LASIK when they are young and remembering what their correction was for 40 to 60 years is hard.


Ten Months After the Operation: During the dry months of summer I'm having problems with the dry-line problem mentioned before. I seem to get one about twice a month. They are usually minor and clear up in four to six hours, but still annoying. I'm beginning to get concerned that this may end up being a long term side effect of the LASIK. This never happened to once in my entire life prior to the LASIK.

I've learned to use eye ointment the night before I have to do anything important, like battle my brother in law in billiards.

Interesting piece of information: In very young children, the eye lens is almost as soft as a marshmallow. That's why they are able to have such a wide range to their depth of focus: their lenses are so soft they easily stretch or compress to focus over a huge range. By the time people are well into their fifties, the eye's lens has hardened to the point where it's almost like a piece of glass. Because it's so hard, the focusing muscle surrounding it can't stretch or compress it and we lose our ability to focus. Hence, we need reading glasses. Fortunately, the lens hardens so that it's in focus for distant objects so we can still drive and function without glasses under most conditions. Perhaps the next great breakthrough in eye surgery will be the implantation of flexible eye lenses that will not only correct distance vision like LASIK does now, but also allow us to focus on close objects. This would have to be done while the focusing muscles of the eye are still in good condition, sometime prior to being 50. After that, the muscle atrophies to the point where even if a flexible lens were installed the muscles wouldn't be strong enough to focus it.