Handy information on Lasik

Not someone's personal experience, but a site definitely worth a mention : http://www.ftc.gov/bcp/conline/pubs/health/lasik.htm Read rest of this account...

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.

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Fiona

This is Fiona's experience. Her site can be found at http://www.nigels.com/fiona/index.htm

Since the age of 9 when my eyes were first tested in primary school, I have had to wear glasses, with my prescription rapidly declining to -7.75 diopters, 1.25 astigmatism, considered severe in the following description ( I couldn't see my own feet!).

From http://www.rahmani.com/prescription.html
The degree of refractive disorder, or how much correction is needed, due to any of these conditions, is measured in something-called "diopters". The greater the degree of correction needed the higher the number of diopters. A negative diopter number indicates nearsightedness. A positive diopter number indicates farsightedness. Diopters are also used as a measure of astigmatism and presbyopia.

For nearsightedness the scale of diopters is given in increments of three and ranges from mild (less than -3.00 diopters) to moderate (-3.00 to -6.00 diopters) to severe (-6.00 to -9.00 diopters) to extreme (more than -9.00 diopters). Astigmatism is also measured from mild to extreme in increments of one. Mild astigmatism is considered to be less than 1.00 diopter while extreme astigmatism is anything greater than 3.00 diopters.
I hated glasses ever since I first learnt I needed them and refused to wear them. I actually went without watching tv for a year as punishment for not wearing them (pretty hard for a 10 year old but I am very stubborn!)

I started wearing contact lenses at age 12 when it became impossible to keep up with my school work without correction and my parents finally gave in. I wore contacts continuously throughout highschool, but by the time I started university my script had gotten much worse and I needed to change to hard contacts. I never got used to them as they are very uncomfortable to wear and dry out quickly, especially in a windy place like Melbourne. I kept trying new types and went through many of kinds of permanent and disposables, but had limited success and could only wear them for a few hours at a time. As a result I gave up martial arts and dance classes, and added most sports to the list of things I couldn't do, in particular water sports.

I had limited success with prescription goggles bought cheaply in Japan, but lost them in the surf which resulted in the dangerous situation of not being able to tell where the waves were coming from and being continually swamped.

I first heard about laser eye surgery while in highschool in 1991 and have followed the technology ever since. At the time, PRK was the most common, similar to LASIK but without the flap and considerably longer healing time.
See http://www.lasik1.com/LASIKvsPRK.html for a comparison.
I underwent testing every few years and was found suitable but didn't think at the time the risks were worth the gains. In 1997 I first had testing for what was then a relatively new procedure, LASIK, but was given the surgical outcome of being able to drive without needing glasses the best I could expect. I decided I would wait until the outcome was perfect vision, the same if not better than with my glasses.

I had LASIK on April 12, 2004 through the Dartmouth Medical Center in New Hampshire, USA.

As I already knew a lot about the process, I underwent a rather quick time frame from testing to surgery, having the tests two days before the procedure. I was surprised to hear that the technology has advanced even beyond what was needed to treat me.
On the day of the procedure I was given Valium to calm my nerves, which apparently is very commonly dished out in the US. I took both tablets as my legs were twitching in the waiting room and I didn't want to be shaking while under the laser!
Having never had Valium before I wasn't sure how to use it and didn't get a very good answer from the pharmacist and ended up taking it a bit too late. The full effect hit me about an hour after the operation and I felt very groggy.

The assistant started the procedure by putting a series of antibiotic drops in my eyes while going through the post-op care package. I then went into the surgery room, lay on the table and was given a toy moose to hold (strangle!). Starting with my right eye, the surgeon taped my eyelashes back as these are apparently a terrible source of germs, then put a brace in to hold my eye lid open. The impulse to blink was quite strong throughout the procedure so although I felt like the character in A Clockwork Orange, (see pic) I was glad it was there.

He next put anaesthetic drops in my eye (having numb eyes is really weird!) and put on the suction thing (?) to hold the eye in place. My head was in a hollow to keep upright and I was told to just keep looking at the red light. A cutting instrument (microkerotome) was then used to make a flap at the front of my eye. As the machine cut I could hear the whirring and my vision went black. I was warned this would happen but it was still very strange. This part was the most uncomfortable as the suction thing was quite tight and I could feel the cutting tool stinging a little, but it was over very quickly.

The surgeon lifted the flap and began the laser. I counted about six bursts of about 8-10 seconds each, with the laser stopping and shifting between. The most unpleasant part was the smell! This part was quite mentally challenging, lying very still and staring at the light and trying not to imagine what was happening. I think the moose toy suffocated at this stage!

The flap was placed back and some more drops put in, then onto the left eye.

It was all over in about 10 minutes, and I sat up and my first thought was 'it didn't work' but then I blinked and I could see, albeit with haze. I sat with the surgeon in recovery for a few minutes while he shone a light in my eyes to check the flap, then it was off home. By now the Valium was starting to take hold making me a bit groggy, and whilst I was aware of everything, couldn't seem to retain anything and kept asking the same questions.

I spent the next two hours with my eyes mostly closed, wearing sunglasses, as I was driven home. We stopped a couple of times to put artificial tears in. I only used the pain killer drops once, about an hour after the op and should have used them as soon as my eyes started to scratch - do this!
As we got home mid afternoon, I wasn't ready to sleep and lay on the couch listening to old episodes of Melrose Place.

The next morning l could see quite well and drove myself to my post op appointment. It was amazing to drive with peripheral vision, after hating driving for so long as I was never sure there was no one in my blind spots changing lanes. My vision was 20/20 in both eyes.

Week one- I used drops for anti-inflamation and antibiotics on a four-hourly schedule, plus artificial tears every half hour. My distance vision is fantastic and my night vision has improved dramatically. I am now able to read signs at night and halos are greatly reduced. My near vision has taken longer to adjust to, I found I could no longer focus at less than about 10 cm in front of my face and I felt I needed to hold things further away when reading. When I mentioned this to other people, some laughed and said 'that's how normal people see!' The muscles in my eyes are still adjusting to their new focal length and I am glad I didn't have to work for a week after the surgery which gave me time to recover. If I'd had to stare at a computer I would have had trouble due to my focal length wavering and the need for constant lubricating drops. During the first week I had the most trouble with close work such as computers, embroidery and reading. This was very frustrating as patience is not one of my virtues!
For the first two days it felt like my glasses were still pressing on my nose. Most mornings I look for my glasses, and I find myself lifting my glasses to wipe my eyes. While exercising, I have an urge to push them up.

Week two - I started a new job and my vision became increasingly stable and I had no trouble using the computer or doing close work for hours on end. I'm still using the artificial tears at least every hour because I have drier than average eyes. Sometimes it felt like wearing contact lenses - I wanted to take them out then remembered that I'm not wearing them!

3 Months - At my checkup it was recorded that I have better vision than with glasses. I absolutely love having peripheral vision and I have found my hand-eye coordination has greatly improved. I danced down the hallway at work when I realised I could throw things in the bin from across the room without lining it up and concentrating very hard. I have been in caving and out at night and my sight in dull light and night vision is so much better. After reading extensively on the web and talking to other patients, this seems to be a problem for many people and I feel very fortunate I had such a good result. One odd thing I noticed is reading signs from the car at a distance, before they were too blury till I got right up to them. Now I can read the letters but sometimes not the word. Most people when reading their native language read by recognition, not sounding out the word and I realised I am not used to seeing words in the distance and have not associated them yet.

I still think like a glassered person and am only just starting to realise how many activities have opened up for me. I have tried aerobics and soccer and can't wait to go swimming (it's not hot enough here!). I was getting worried that I had freed myself from glasses, only to become dependent on eye drops so at the three month mark I cut down and realised that I didn't have the scratchy feeling anymore, I was actually addicted to the lubricated feeling. As soon as I cut back, my own natural tears started up and now I only use the drops when I wake up and maybe late at night if neccessary. The urge to constantly push up my glasses has wained a bit but is still there. I also still have dents on the sides of my skull from where the glasses pushed for years.


All in all, the operation outcome was fantastic and I thoroughly recommend it. I now look at people with glasses feel a bit sorry for them and hope that someday they might know how great it is too. Some people tell me that they are too scared or that the procedure is too expensive, I hope that my experience can give perspective on the pros and cons. I found the procedure unnerving, but quick and effective. It's essential to have someone looking after you for the first six hours - driving you home, bringing you drinks and being generally reassuring. The freedom the surgery has given me is amazing - a huge change after 20 years of restrictions and I am still discovering new and wonderful things I can do.

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Bhavesh

This is Vesh's account. Also well worth checking out his posts - I especially liked the one about "black-hairy tongue" (ewww). His website is at http://www.veshman.com/mt/

I finally had enough reasons to get Lasik, the most recent one being when my brother noticed the indentation and discoloration of skin on the side of my head from my glasses when I took them off. I was so sick of glasses, what with them fogging up and the most inopportune moments, falling off your head, causing glares, making athletic activities harder (like when you glasses shake on a mountain bike ride, or when you start sweating on your lenses so that you can't see). Just a big royal pain....

So I finally did it. I used the laser surgery with Wavefront technology. I am post-operative day #6 now, and my vision keeps getting better and better. I am very pleased with the results so far.

I have always wanted to be rid of glasses, but was very scared about the procedure and about the potential for side effects and bad outcomes. Going through the procedure is definitely one of the scariest things I have done, even though it is easy.

The tipping points for me finally doing it were:

# Wavefront technology
# Using one of the principal investigators in the FDA trials as my surgeon
# Success that others had 5-7 years out
# Wanted to look good for the the ladies

1 Wavefront is based on research done on NASA telescopes. It measures how light exits and enters the eye. For Lasik Wavefront, 200 measurements are made of the eye. Essentially, a corneal surface map. This is in contrast to the three measurements done prior to Wavefront analysis. The laser then custom treats your cornea for the best possible outcome, doing a little more here, a little less there. Also, the laser's eye tracking system is wicked fast and makes up for the uncontrollable saccadic eye movements that your eye naturally makes. Supposedly, the side effects such as halo, glare and starburst are near-zero with wavefront.

So, I felt a lot better about it.

2 Coleman Kraff, MD of the Kraff Eye Institute has been doing research for the FDA on these lasers since 1991. He's done over 18,000 eyes, and has not had any serious complications. That was reassuring (but I was still scared). He was very confident about my eyes, and felt that I was well within the normal range of people who can do this surgery. I really wanted to hear that. I wanted to be in the middle somewhere, not at the edge.

3 Since more and more people have done Lasik, I was just running into a lot of people who had it done. No one I'd met had had any complications, and a few of them were over 5 years out. That was reassuring.

4 Self-explanatory.

The Procedure

So I had all my pre-op stuff done, where they do all the different tests, make sure your cornea is thick enough, see how much astigmatism there is, see if you qualify for Wavefront, etc..

Now was the day of reckoning. My last day with glasses. I was trying to play it cool, listening to my iPod, and working on my iBook while I waited. But then the moment comes where they call your name to go into the operating theater.

So I go in, lay down on the operating table, and the nurses are prepping me. They put some anesthetic in my eye...no big deal, I've put tons of anesthesia in other peoples eyes. Then they swab the area to get rid of stray bacteria and then tell me not to move my hands or touch my face.

And then it was like being a 3rd year medical student in the Operating Room for the first time...all of a sudden my ear starts itching and I'm not allowed to touch it. In the OR, once you are sterile, you are not allowed to touch anything that is not sterile. If you do, the surgical nurses point you out really loudly and exclaim that you are no longer sterile, make you look like an idiot to everyone else in the room, and loudly shows her annoyance at your lack of technique in the OR. The case gets delayed, you have to go scrub again, you feel horrible and like you're the reason that anything that goes wrong in the case will be your fault. In reality, it's not that big of a deal, but when you're new, it feels like the biggest thing, and I think the nurses have fun picking on lowly medical students. But, I digress.....

I can't touch my ear and all I can think about is my friickin' ear. It's consuming like 80% of my attention...I just need to itch it..once....dammit. Just like in the OR as a 3rd year medical student.

Then the surgeon starts..forget the ear. A bunch of numbing medicine goes in and he starts to put the eyelid retractor on. I feel a little pain...Hey, I'm not supposed to feel any pain right? Did they put enough anesthesia in? What if it hurts when the laser hits?? I push those thoughts aside.

I think the next step is where he actually makes a slice of the cornea. He says that things are going to go dark for a bit...dark?? fine, I can handle that Indeed, things start going dark....but wait!! I can still see the red flashing light! is it supposed to be DARK OR NOT?? Which one is it? Calmly I tell him that I can still see the red flashing light. He says that's fine. Good....

Now I can see again, things are almost their usual blurry way. Then I can see him pull the corneal flap over, and I actually still see pretty well...everything just a bit fuzzier. (Me saying that I can see pretty well is like saying blue is actually red...maybe not that bad..)

Now it's time for the laser. Just focus on the red light. The laser is going to burn for 43 seconds. Just focus on the light. Nurses on either side of me are saying different numbers...6.2 ...... 7.8 ..... 3.4 .... I have no idea what they mean but it's in stereo.

"Ok, Bhavesh, just 40 seconds left" 40 SECONDS!! ONLY THREE SECONDS WENT BY?? Ok, focus on the light...is my eye moving....is the light moving?? I'm not really seeing the light right now....is my eye still in the right place?

"Ok, Bhavesh, you're doing good...30 seconds to go..." Still 30!!??!! That's all we've done so far? Ok, stay calm....relax...deep breath...wait! focus!! on! the! light! Holy cow...this is my one chance....don't mess it up...keep your eye still... Now, the laser is more than making up for my neuroticism, but hey, it's my eyes.

The rest of the procedure pretty much went the same. 43 seconds felt like 4.3 minutes. Numbers being announced on either side of my head, and I'm trying not to fuck up my chances of having perfect vision.

"Ok, great job Bhavesh, now it's time for the other eye"

The second eye went a little better than the first, but still scary.

Post-op Complication

Of course, my biggest fear: a complication. Shortly after the procedure was done, I felt something move in my left (dominant) eye. Like a crinkled contact lens. The surgeon confirmed....the flap moved. Of all the gin joints in all the world.....

"Wow...man, that really moved...I haven't seen this hardly at all...the last time was ten years ago.." Great....just what I want to hear....But I'm cool...you're the best, so I'm sure it will be fine

Dr. Kraff went on to re-smooth the flap down using the slit-lamp, and then put a contact lens over it to keep it down.

Just trying to get the lens in was a bit of a struggle..."Wow, you have tough eyes..." Yeah...just get it in as perfectly as possible....

The lens went in, and I was to go home and try to sleep, no reading, no computer, no TV. Just rest. After my complication, I was not going to argue with that: Vicodin and Valium to the rescue.

POD #0

The day you actually get the surgery done is not bad...everything looks hazy, maybe a little like there is a layer of water on your eyes. Antibiotics and steroids need to go into your eyes every 4 hours. I set the timer on my Timex Ironman Expedition watch to remind me. My dad came over from the office to meet me after the operation and cabbed it home with me and ended up spending the night to help take care of me...how great is that?

I went home and went to bed (getting to wear these really sexy eye shields so I don't rub my eyes while I'm sleeping)...woke up for a while, put the drops in my eye, and went back to bed...I just wanted to make it till my post-op exam at 8 am the next morning. The drugs helped. Dr. Kraff made a personal phone call to see how I was doing...that was nice.

POD #1

7 a.m. Wake up, put the drops in...everything is going to be crystal clear, right? Of course not. Better than yesterday, but still kind of hazy. My left eye is looking better...maybe the flap stayed down and is perfect now. I get over to the doctors office thanks to a ride from my friend Ted.

Slit lamp - still crinkled. Damn! More anesthesia. And a little more. Ok, some more. Removal of contact lens. Re-smoothing of the flap. Sit for a while for a recheck. I put on my iPod and close my eyes. I don't even think about opening them. Recheck: perfect. Follow up for the 1-week post-op.

My left eye is hazy again, but it starts to get clearer and clearer as the day goes on. I go home and try to rest. I need my left eye. So I take it easy until I have to go to work in a few hours.

Seeing patients was good. Got my mind off my eyes. I kept using the drops and the natural tears.

POD #2

Wake up, looking even better. Still fuzzy here and there, but getting better. I go to work again, and then to a work holiday party. My first party without glasses or contact lenses. I was so hot...:). Got home, found out my Porsche got side swiped...

POD #3

Wake up around 5:30 am..have to be at work by 7am. Ok, the vision is really starting to get better. There is no difference in haze L comparted R. Things are sharper. My Porsche was still hit...it wasn't a bad dream.

POD #4-6

My vision keeps getting sharper and sharper by the day. I feel more and more comfortable. There is a bit of halo around stoplights and headlights, but not really around signs for restaurants and things like that. I only see the halo or glare around high contrasty lights. And the light itself is really sharp. I hope it improves, but even if I have to live with this for the rest of my life, it's worth it.

POD #7

Go in for a recheck of the eyes. Vision in the left eye (the one with the complication): 20/15. Right eye: 20/25. Both acceptable, but confirms what I already knew...I could definitely see the discrepancy, but I'm sure it's something I can get used to. If I can live with it, I'm done. If it bothers me in 6 months, maybe I'll try for an "enhancement".

Conclusion: I am really, really happy so far. It's simply amazing that I am not wearing glasses. Mentally I still think I have them. I still start to look for my glasses in the morning, or try to dodge them if I have to scratch my nose or something.

Definitely one of the scariest things I've done, but also it has been very rewarding. It feels awesome, just awesome, to be cruising around with normal vision, wearing sunglasses if I want to, just really looking people straight in the eye and knowing they can look straight in yours..it's totally awesome.

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Damian

I had Lasik on my eyes on the 17th of December 2004. It's now 2 months to the day after that and I can happily report that my eyes have never been better. No fumbling for glasses in the middle of the night. No dry contact lenses falling out when away from the house. No red marks on my nose from wearing glasses all day.

I still get the four-eyes jokes, but only in an ironic way for old-times sake.

Before I had the operation I read every report I could from people like myself. This was immensely helpful and enabled me to get beyond the risks and realise that this was a straight-forward, routine procedure. As a result I wanted to start this blog to share my experience and to collect the experiences of others in one place.

Back to me.

I was forced to get glasses at age 12 when my best friend got sick of me copying his school work at the back of the class and told my mother. Nice one Shaun. For the following 19 years I wore a combination of glasses and contacts. Glasses for day, contacts for play. This wasn't such a big deal and many many people live the rest of their lives like this. It was annoying though. The annoyance built up over 19 years and boiled over when I lost my glasses on the way to work one day. That afternoon I called the Eye Institute and booked an appointment.

My first appointment was fairly typical for anyone that has ever had an eye examination. My prescription was checked and I was talked through a summary of the procedure.

My second appointment involved the application of eye-drops that dilate the pupil. I've read that some people found these uncomfortable. Now pain, and therefore comfort, is a very subjective thing. Years ago, I used to clean my contacts with Hydrogen Peroxide. Forgetting to neutralise that solution and then putting those suckers in your eye was uncomfortable (a screaming, yelling kind of uncomfortable). These eye drops had a slight stinging sensation but about as painful as an eye-lash getting in your eye. Once my pupils were dilated, the nurse sat me in front of a machine that maps the surface of your cornea and also measures its thickness. I had thought that my eyes were smooth and round like a table-tennis ball. In reality, they are more like an apple that has been dropped repeatedly on the floor. The result is a coloured map of your eyes. I'll put it up here shortly. This map is used to guide the Laser so as to get a perfect result. Previous versions of Lasik didn't do this map and the Laser cut based on your prescription. This took about an hour in all and I was back at work with no issues aside from boredom.

I waited 2 weeks until the operation. I could have had it done the next Friday - in fact I think they were keen to do it that day, however a couple of factors stopped me :

1. New Zealand was putting in tough anti-smoking laws in 2 weeks that ban smoking from all bars and restaurants. Nice if your eyes are healing.


2. I was too scared to jump into it so quickly.

On the day of the operation I arrived at 3:45pm and read a magazine for 5 minutes. My brain was hyperactive and had me thinking that this might be the last magazine I'd read (ahhhh!). The nurse led me through to the operating theatre and put a sexy pair of cloth socks over my shoes. I asked if I could take a pair home to help dust the house but she politely refused. She put some anaesthetic eye-drops in and had me lie on a bed for 10 minutes. I was then led over to a bed sitting under a rather large piece of equipment. The Laser!

This is where my experience goes from 'Rosy' to 'Dark and Stormy'.

A few things first. The stlye of Lasik that I was having requires a flap to be cut in your eye. This flap is then folded back and the Laser burns away some of your cornea from underneath it. The flap is then folded back over and hey presto you can see.

The doctor applies a device to your eyes to widen them as much as possible to allow the flap to be large enough so that your direct vision is not affected. If it was too small then you would have fuzzy peripheral vision. I can't recall anyone telling me that I had squinty little eyes. My mother certainly didn't, but then mothers'll love anything right? The problem I had was that as my eyes were narrow the distance between my cheekbone and eyebrow-bone wasn't sufficient. Due to this the doctor had to rachet the device until it felt like my eye socket was being stretched. I felt some empathy with those people who cut their leg bones to add some height. Odd comment but you can see where I'm coming from.

It wasn't so much that this stretching was painful. It wasn't. It was more that it was totally unexpected.

Then a device is lowered and presses into your open eye. It doesn't hurt but is a little claustraphobic. This device then slices a flap on your eye. This freaked me out. I could feel it cut my eye but as there are no nerves on the surface there is no pain. As soon as the cut is made you lose your vision.

Well that is the difficult bit. Compared to that the actual Laser was over in about 30 seconds. All I had to do was to look at a red light, something that I'm used to from the Auckland traffic. The nurse reads out a series of numbers which I took to be either the lottery results or the movement of my eye in relation to some set tolerances.

Now you don't have to worry that you'll move your eye and the Laser will make you blind. They have a eye-tracking system that locks on to your pupil and will stop the Laser if you move outside of some set tolerances.

The second eye was relaxing by comparison. As I was expecting the stretching of my eye, it was uncomfortable but not unbearable. The flap-cutting process wasn't as freaky the second time around. My red-light-staring skills had improved since the last eye and it went very smoothly. The flaps were folded back over and my goggles were applied. These goggles are made of stiff cardboard and are designed to stop you scratching your eyes. They look pretty goofy. Kind of like a white version of these Oakley sunglasses. I was then gently led to a darkened room. The lovely nurse said I could try to open my eyes. I thought that this was surely too soon, but sure enough I could see my feet. I wasn't blind! yay, that wasn't my last magazine.

After 10 minutes in the dark room I was ready to go. My girlfriend picked me up and took me home. I had been given a large bottle of pain killers, however I didn't need to take a single one.

Do you remember when you were young and still believed in Santa Claus? Do you remember waking up very early on Christmas morning and not being able to sleep? Well that was what I had that night. I slept well but woke up at about 6am - not exactly wide-eyed, but certainly wide awake. The first thing that I noticed was that I could see the clock at the other end of the room. I'd never been able to see that clock before. The fact that it read 6:01 and my appointment wasn't until 8am was slightly depressing. I wasn't sure if I was allowed to keep my eyes open or had to leave them shut, so I left them shut. It turns out that it doesn't matter as long as you don't touch them.

In fact, that's worthy of a new paragraph. The mantra. The bible. The koran for Lasik surgery is don't touch your eyes. If you can follow this then you'll do just fine.

7:30am rolled along and I got ready for the unveiling. My girlfriend lent me her sexiest eye-shades (picture to come), and we headed for the Eye Institute. The doctor said he'd never seen such spectacular eye-shades on a heterosexual man before. We went into a darkened room and he removed my DIY-Oakleys, put some comfort drops in and had me blink the gumminess away. I could see! I could see the whole room and my girlfriend waving from the other side of it. A fantastic feeling.

After a brief eye test I drove home - only 15 hours after the operation. No pain and only a slight sensitivity to sunlight. We went out to the newly smokeless pubs of Auckland that night. I had quite large bloody areas where the flap had been cut which a few people found disturbing. I told everyone that the blood was from where my girlfriend had hit me. Very believable.

The following week I was on leave and wanted to dig in the garden (I'm not old and boring, honest). I though that I shouldn't exert myself too much and was constantly worried about my flaps popping out (which sounds quite rude), or doing some damage to my eyes. They reccomend that you don't do any rigourous exercise for a week after the operation. And don't go swimming for 2 weeks. Turns out that these reccommendations are mostly to support the 'Mantra'. If you exercise, you'll sweat and if sweat gets in your eyes, you'll try to rub them. Bad. If you go swimming and your eyes get wet or you get salt in them, you'll try to run them. Again - Bad.

So I put some protective goggles on (see through plastic and non-goofy) and continued with the digging.

After 1 week I realised that I could see the shower floor. Ewww. And that I could see my back. Interesting.

After 3 weeks the blood had gone from my eyes.

After 4 weeks I had forgotten that I ever wore glasses.

After 8 weeks, I have no issues at all. My eye-sight isn't perfect. I still have a slight astigmatism in my right eye, but it's better vision than I had with my glasses, and more than I expected.

I'm tempted to say that I wish I had this done years ago, however I've heard from people that had it done then and it sounds a lot more painful. One friend had PRK Laser treatment and had to sit in pain in a dark room with no TV or books for 2 weeks. Compare that to my 15 hours with goofy goggles.

I would definitely reccomend Lasik to anyone considering it. The risks aren't as great as you think. Out of the 33,000 eyes that have been Lasered at my clinic, no one has gone blind and only 4 eyes have developed infections.

I think I was most worried about the flaps coming loose. My doctor said that after about 2 weeks it would take someone scratching their eye with their fingernail to dislodge the flap. Even then he was doubtful.

Cost: $2540 per eye
Doctor: Bruce Hadden
Clinic: Eye Institute - www.eyeinstitute.co.nz
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Karl

This is the account of Karl from Maryland. His site is at http://chaostime.com/about/index.html

I've thought about getting laser surgery for many years. Price was mostly the reason why I hadn't done it before now, but I was also a little concerned about the risks. In May, 2000 I decided I wanted to check out the options for refractive correction. I called and made an appointment to go to the Wilmer Eye Clinic at Johns Hopkins Hospital in Baltimore.

The consultation:

My appointment lasted about 45 minutes. They gave me a complete retinal and eye exam, and well as check my current glasses and vision. The doctor told me that I was a candidate. She confirmed what I already knew - that I would lose the ability to see things to "point blank range" that I enjoyed as a nearsighted person. I would also lose some clarity and magnification of things at close range. In short, after the surgery I would see like a "normal" person. The doctor also said that it was possible that if I had the surgery I would need glasses to read after the age of 40.

She informed me that my pupils dilated to 7mm, which is on the high side of average. The eximer laser they use only corrects 6.5mm of the cornea, so in very dim light I would be seeing through the ridge between the corrected and uncorrected part of my cornea. This would cause a "haloing" effect around light sources. She was unsure exactly how pronounced it would be for me, but said it would be very similar to when I wore my contacts at night. She suggested wearing my contacts for a week straight. This was to see if I could live with the loss of my better than average near vision I enjoy as a nearsighted person, and to see if the haloing would bother me too much. That would approximate what it would be like with corrected vision. At work, I do close work with very small objects and was concerned about how much near vision I would lose. The consultation cost $95 - which is deducted from your surgery bill should you decide to go through with it.

I wore my contacts for a week at work and decided that I could deal with the loss of my very clear "point blank" vision. I was concerned with the haloing effect the doctor talked about and the list of possible side effects. I did a great deal of considering before deciding to go through with the surgery.
The surgery:

On the day of my surgery, they gave me another short exam and tested my vision again. I had to sign all the scary consent forms and then the most scary one of all - the bill. The remaining balance of the $5000. There are many cheaper places to go, but I wanted the best in the country - That's Johns Hopkins. http://www.wilmer.jhu.edu/departments/REFRACT.HTM

They sent me back to the waiting room until they were ready for the surgery to begin. When they called me in to the surgery room, the made me put a silly blue paper shower cap on. The nurse gave me two squeezy-stress-things to hold, and sat me down in a dentist-like chair that reclined all the way. They lowered me down and slid my head under an apparatus that was several meters long and about a half meter wide. It was attached to a much larger device on the floor by a movable arm and large cables. They taped my left eye closed with a small piece of masking tape. The doctor explained everything she was going to do before she did it. She had her nurse perform many of the steps involved. The doctor had me look at the "blinking red light" which was just an LED inside the laser housing for you to focus on. She told me to stare at the red blinking light for the entire procedure.

First, the nurse put numbing drops in my eyes, then the doctor placed the speculum on my eye then. (see : A Clockwork Orange) A speculum is a device that keeps your eye from blinking. It didn't hurt at all, but it was a little strange. I didn't actually have the urge to blink, but I may have been subconsciously suppressing that myself - I'm not sure. The nurse then lowered a little device down onto my eye. It looked like a transparent ring from my perspective. It made contact with my eye. I could not "feel" it because of the numbing drops, but I was aware of it. It was a little but like when I had a tooth pulled at the dentist. I had Novocain and could not "feel" the tooth - but I could feel the forces acting on the surrounding tissue and bones. Ok, well maybe not quite like that, but you get the idea. I couldn't feel it directly, but indirectly through non-numbed areas I was aware of things. The nurse turned on the suction. This device suctions your eyeball to it so it can't move around too much while the incision is made and the laser is operating. When the suction turned on, everything got very blurry and dim. Eventually going almost black after about a second or two. The doctor had prepared me for this. She told me to keep staring at where the light was, and that some vision would return after a moment. The doctor then took a pointer and marked my cornea. She touched it in about four or five different places. I could not see any markings she was making from my perspective - just her touching my eyeball with a thin, pencil like object. This is done so they know exactly where to reposition the flap when they fold it back down. She then used the computer to control the microkeratome, which cuts a flap in your cornea. Don't ask me what a microkeratome is. It sounded like a little buzz saw and lasted maybe a second or two. The doctor then took what looked like a pair of tweezers and lifted the flap she had made in my cornea. When she did this everything got WAY blurry. She told me to keep staring at the red blinking light in case I had forgotten or gotten overwhelmed and was wigging out. I wasn't - it was actually cool. The red light was a red blur now. The technician/ assistant had programmed my parameters into the laser while all this was going on. The tech told me the computer had determined a 20 second sequence was needed for this eye. She warned me before the laser stared. When it did, there was no visible effect at all. There was a "tick-tick-tick-tick" sound from the large device on the floor - that's it. It was a little difficult to keep staring at the red-blur-dot. I'm not sure if this was because the laser was reshaping my cornea, my slight apprehension manifesting itself, or just jitters. I wondered how critical it was to keep completely still and did my best. When it was done, the doctor folded the flap in my cornea back into place. She used a spatula-like device to smooth it down and line it up with the marks she had made. They removed the suction and the scapula. They had me close my right eye and untaped my left. The whole procedure for that eye took about 2-3 minutes.

The left eye went pretty much exactly like the right except I had a 25 second round with the laser because my vision was worse in that eye. I did actually squeeze the stress-squeezy-thing in my left hand for this eye. I think the doctor may have noticed, or it might have been something else, because she rubbed my left arm a little during the laser procedure for this eye. I was grateful for the touch. It's amazing what a small touch can do. People always underestimate the power of touch. When they were done, they had me slowly stand up. The nurse told me that some people get dizzy because the reclining chair puts your head slightly below your heart. The doctor told me everything went perfectly.

I was led out by another doctor to the waiting room. He taped both eyes shut and had me sit for 20 minutes. When he came back he untaped my eyes and brought me to an examining room to check the position of the flaps. He told me they were perfect and gave me instructions on the administering of drops to my eyes for the next week. One was a steroid to lesson swelling, and another was an antibiotic, I forget what the third was for. I was only half listening to him because I was WATCHING HIM. CLEARLY and WITHOUT GLASSES. I guess he must get that quite a bit, because he had it all written down on a piece of paper for me. When I went outside, the sunlight was a little bright. They had dilated my pupils some, so everything was blurry because of that. The guy who was driving me home asked how my vision was. "Everything is clear except for the fact that it's all blurry." was my reply. He thought I was joking, but I wasn't. I could tell that everything was clear now - it was just the dilated pupils that was making things fuzzy in the bright light.

The better vision was a little like getting used to a new pair of glasses. My eyes aren't used to seeing through a correctly shaped cornea, so the muscles have to focus differently. They had me wear plastic covers over my eyes the first night of sleeping so I wouldn't rub my eyes by accident. My left eye was very scratchy for the first 24 hours. I returned the next day for them to check the flaps again and my vision. The flaps were fine and my vision was 20/20 in my right eye and 20/25 in my left. The doctor said that my left eye would likely improve some as it healed.
Afterwards:

Some random observations the first week

* My eyes are very dry and I have to use re-wetting drops in them about a few dozen times a day. The doctor told me this was normal.
* Mirrors are strange. I keep seeing some good looking guy in them for an instant before I realize that it's me.
* I tried to take off my glasses once, and I've tried to push them up on my nose a few times.
* I've thought a number of times, "I should take my contacts out."
* The halos are not very pronounced, and only appear around lights of a certain brightness at night - stars have no halos at all, nor do bright lights. Haloing is a byproduct of the surgery anyway, that usually last for the first few months. I expect that my haloing will get a little less over time.
* My near vision is very different. When I hold things close, like a book, the print is much smaller than it was before. I can read, but I have to hold things farther away than I did before to read them.
* I noticed something strange today. After working all day my eyes were a little tired. Things would get blurry for a moment every once in a while. I think that my eyes were just allowing the muscles to go back to their old resting state, instead of the newly corrected one. A half conscious effort brought everything back into perfect clarity and focus.
* Getting used to wearing sunglasses is a little strange. I've had photo-gray lenses for the last 15 or so years. I never had to wear sunglasses. I bought a nice pair of wrap around sunglasses at the Harley shop in Daytona back in March. People can't see my eyes when I wear them. This causes them to give me a wider berth than they normally would. That's just an enhancement of the effect caused by the long hair and long goatee.

Observations from the second week

* My eyes rarely get dry that I have to use re-wetting drops in them.
* My left eye's vision has improved from 20/25 to what I guess to be very close to 20/20.
* The halos have lessened a little bit and don't really bother me at all.
* I push my glasses (that aren't there) up on my nose about once a day.
* Reading improved after the first week to the point where I could stare at a computer screen and not get a headache or have my eyes feel like they were working extra hard.
* Mirrors don't startle me anymore.
* I am still getting used to the fact that I'll NEVER have to wear glasses again. I put my old glasses in the kitchen cabinet above the phone. I open it up every few days to get something and see them sitting in there. They look very old and bulky. Did I actually wear those on my face all the time?!?!?! They look like a relic.
* I notice people with glasses much more than before.

Third week

* Innate eyeball protection is gone. I am now prey to every flying gnat, bouncing pebble and speeding piece of airborne dust. There's no longer a shield of glass between me and the world of eyeball irritating UFOs.
* Taking a shower is nice. I enjoy being able to see clearly without having to worry about my contacts washing out and down the drain.
* I have had some unexpected side effects. They didn't warn me about this at the clinic. I have been experiencing severe arrogance and vanity. These symptoms only come occasionally, and are actually quite enjoyable. I love calling people "four eyes" now and pointing my finger and laughing.

One Month

* My one month check up shows my vision to be 20/20 in my left eye and 20/15 in my right.

The months after

* My vision has been stable and has not changed at all in over 6 months.
* The halo effect is much less than before, and hardly noticable. I think that's a combination of it lessening over time and me getting used to it.
* My eyes are more sensitive to bright light, especially at night.
* My night vision is slightly reduced, it is more difficult to see in near complete darkness.

One year after

* My vision is still perfect and I don't notice the halos at all anymore.
* Although my night vision is still the same, it really doesn't affect what I do.
* I am convinced that this proceedure was one of the best things I ever did.

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