Here’s what I’d like for my birthday: a trip to the Disneyland for dudes. Too bad it is only in Germany.
tech, life, and more
Archive for December, 2008
It’s not something I was originally looking to do. We had been using our pre-tax health savings account for the kids’ braces, and miscalculated the payment schedule, so we are at the end of the year with $2000 of unused money in that account. Use it or lose it. (I checked, when unused the money reverts back to the employer, not the government.) So my wife said “Aha! I want to get LASIK.” The procedure costs about $2200 per eye, so our health savings account would cover about half of the total cost. Our assumption is that it is better to spend another $2000 on something you want rather than throw the original $2000 away (we may need to rethink that one). She went in for a consultation, and discovered that she isn’t a good candidate because her cornea is too thin for the procedure. For her vision to get corrected, they were recommending a corneal implant, but it would be twice the cost and it sounded more risky. So she nixed the idea of corrective surgery. So she says to me, “Hey honey, how about if you take a look at LASIK?” I’m a bit uncomfortable with the idea of getting corrective surgery, since my career is sitting in front of a computer screen all day, and my contacts and glasses work fine, I’m worried about long-term complications. Losing my eyes would lose my career. Since getting an initial consultation has no cost and no commitment, might as well give that a shot. So I make an appointment.
After a number of tests, the doctor tells me I’m a good candidate. My uncorrected vision is 20/200 in one eye, and a bit worse in the other eye. However, with my glasses I can see 20/15. I do have some astigmatism that make my contacts more like 20/20. One of the doctor office people goes into detail explaining the procedure and such. Later I ask a friend at church who is an eye surgeon in the military about the procedure and the equipment that this office uses, he says he has performed about 60 of these procedures on patients, and had it performed on himself about 2 years ago, and he feels confident with it. He recognizes the equipment at this clinic (VISX Star S4 IR Laser / iLASIK / WaveScan / CustomVue) and says it is widely used and pretty much state of the art. So I’m thinking that if a doctor in this field would do it to themself, that is basically the ultimate test of confidence.
The office has an appointment open for the following week to perform the procedure, so I take it.
I’m asked to not wear my soft contacts for a week before the procedure. I’m told it has something to do with affecting the shape of the cornea, and they want it to be stable for the procedure. So I wear my glasses for a week (even during a touch football game that week).
There are two lasers that will be used for the procedure. The first, the intralase, creates the corneal flap. The second, the excimer laser, reshapes the cornea after the flap has been peeled back.
On the day of the procedure I show up at the office at 8am. No need for fasting, since there is no general anesthesia. They take me into a room for another test, they kind where you sit in a chair and put your chin and forehead in front of a machine that looks in your eye. It’s a scanner that measures my eye so that the excimer laser knows what to do. The office’s brochure says “â€¦the VISX WaveScan creates a WavePrint map, which reveals the way your entire optical system processes light. This creates a personalized fingerprint of your visionâ€¦allowing each of your eyes to be treated for their unique imperfections.” Relax and look at the red dot.
Then I’m taken to a waiting room. I’m given an optional Valium dose and some consent / waiver papers to sign. I read the papers and I see a few things that surprise me. First is verbage about getting one eye done at a time, therefore if something goes wrong, at least you still have one good eye. So it asks for me to write a short explanation why I want to have both eyes treated at the same time, as if doing so is a bit unusual. Funny, I don’t remember the doctor explaining that as an option, but my memory isn’t perfect. Second, there is some verbage explaining the risks of the procedure which includes terms like “potential catastrophic loss of vision”. That gives me pause. I had asked before quite a bit about the risks and the answers all sounded reasonable. So I assume this verbage is the cover-your-butt legalese (“you acknowledged that it was possible for this to go wrong”) and sign it. They give me several doses of anti-bacterial drops and a dose of numbing drops.
I am given a surgical cap to match my street clothes and proceed to the intralase room. The intralase system shines a laser to create small air bubbles in the cornea. Once the bubbles are there, the corneal flap can be peeled back without the need for a cutting knife. The staff tells me that the nice thing about the air bubble approach is that if the doctor doesn’t like how the air bubbles have formed, the rest of the procedure can be aborted and the air bubbles will dissipate on their own within a day or so. I lie down on a table (reclined chair, actually) and am given more numbing drops. They then bring out a device that looks like a small magnifying glass with the handle. The lens of the magnifying-glass thing is small enough fit on the surface of my eye, which is what they do. It doesn’t hurt, and I can see through it. Then I hear the doctor tell the technician, “Apply suction.” Then I feel this magnifying glass thing start sucking itself firmly onto my eye, and the vision in that eye goes dark. It’s hard to describe other than being visually numb in that eye. But the eye isn’t entirely physically numb, I feel the suction. The suction was a bit uncomfortable, even for someone used to contact lenses. Then a good-sized machine is placed over me that looks like a digital camera that is 3 feet wide, with the lens right over my suctioned eye. This is the intralase laser. Then the lens of the intralase laser then is slowly lowered until it makes contact with and is lined up to the magnifying glass on my eye. But then it keeps going, pushing down on my eye and creating pressure. It creates quite a bit of pressure, or in technical terms, it squishes the heck out of my eye. Since I’m laying on a table, I’ve got nowhere to back up. I let out a gentle verbal “aaaaaah” to let the staff know I’m uncomfortable (although not in significant pain) and the doctor says “Yes, the pressure may be uncomfortable, it won’t last long.” After about 30 seconds of squishing the machine lets up. The pressure was such a distraction I didn’t even notice the intralse laser working. They release the suction on the magnifying glass thing and I let out a sigh of relief. They repeat the process on the other eye.
After the intralase is done with the second eye I can see, my vision is like looking through glasses that have been smeared with Vaseline. I assume I’m looking through all the air bubbles that were just created. They lead me down the hall to the room with the excimer laser. I lie down on the table (reclined chair). They place a shield over one eye and start working on the other. They start by taping back my upper and lower lid. They then place what looks like a round grommet in the eye, I’m assuming it is to prevent the lids from interfering with the corneal area. About 2 feet in front of my face is the excimer laser system, it has an illuminated white circle and a flashing red dot in the middle. It’s kind of like an electronic Cyclops. I can see the doctor gently poking around in my eye with a small instrument. After a few moments of that, the Cyclops becomes more blurry that it was originally. I assume at this point that the corneal flap has been peeled back. They ask me to focus on the red blinking light. Another few moments and then I can hear the staff saying words like “acquiringâ€¦verifyingâ€¦25 secondsâ€¦” Then I can hear them counting down and the laser is making a loud clicking noise. Midway through this there is a difference in how focused that the Cyclops appears. The clicking stops and then the doctor does some more gentle poking around in my eye with an instrument. In a moment the Cyclops comes into better focus, and I assume the corneal flap has been placed back. The grommet is removed, the tape is removed, and they move to the other eye. After the numbing drops I received earlier, and squishing of the intralase system, I don’t really feel a thing during this entire excimer process. As far as the discomfort goes, if you can survive the intralase process, you are home free. The tape removal (with a couple of my eyebrow hairs) is what hurts the most in the excimer room.
Then I am led to a regular exam room and the doctor uses a regular non-invasive microscope to look at how the corneal flap is resting. He says “Perfect.” And I’m done. They lead me out to the waiting room for my wife to take me home. Since the air bubbles are still present, my vision is too cloudy to drive myself, and there is a bit of discomfort in my eyes. It feels best to leave them closed. But I can open them enough to dial my cell phone. They give me a packet that includes two kinds of medicated drops, and a package of lubricating drops. There is more stuff in the packet which I’ll describe below.
My wife takes me home. I can see a bit, but I prefer not to keep my eyes open. I lie down in bed to just rest, turn on my iPod, and the Valium in my system helps me take a 2 hour nap. I’m supposed to take the medicated drops every 2 hours, so I do that after I wake up. The drops don’t hurt. I get a bite to eat. Now my eyes are starting to hurt, as the numbing drops wear off, and I definitely prefer to keep my eyes closed. I lie back down in bed and put my iPod back on. I take another unanticipated 2 hour nap, I’m assuming it’s the Valium still in my system. My eyes feel like there is some sand in them but not scratchy. More drops, this time I stay awake through the podcast I was listening to earlier. About 6 hours after the surgery, the discomfort starts to get better. Keep putting in drops every 2 hours. I still prefer to keep them closed, and I figure out part of it is light sensitivity. If I cover my head with a blanket so it is dark, I can open them longer than in the light. Still hurts a bit.
Some friends come over that evening to check on me. I can see them and walk around the house by myself, although there is still some cloudiness. One of them says, “Wow, I was expecting to see you with giant bandages on your head, and instead no bandages and you can even see me.” Considering that 8 hours earlier my eye was peeled open and shot with a laser, it is pretty amazing. I get a good night rest, even with the day naps. For the first week, I need to wear sports goggles while sleeping at night. I assume it is for side sleepers so the pillow doesn’t put pressure on the eye, or to prevent you from rubbing your eye and displace the corneal flap.
The next day the sandy discomfort is gone. I can see with good focus but with what I’d call a “halo effect”. Any areas of high contrast appear to have a fuzzy halo around the bright part. It’s almost like I have my glasses with a little bit of fog. I go to the doctor’s office for a followup visit. The vision in both eyes is checked with the usual chart and I can see 20/15 in both eyes, even though I still have the halo effect. I ask the doctor about the halo effect, and he says it is normal and will probably take about 3 months to clear up. I work at home using my laptop most of this day. I’m back in the office the next day.
A few days later, the cloudiness has cleared up but the halo effect is still there. I’m starting to get used to the halo a bit. The halo does cause some difficulty for night driving, but it is manageable if I am careful where to look and concentrate. I also have an increased need to wear sunglasses in daylight.
It feels quite weird to not take my contacts out at night and instead go to bed with clear vision and wake up with clear vision. I do feel a tiny bit of pressure around my eye, but perhaps that is from the cold I have. A week after the procedure I should be able to graduate from the medicated eye drops, but I’m told I should use the lubricating eye drops for at least a couple more months. So far so good. I’ll consider it a real success when the halo effect goes away and I don’t need eye drops anymore.
In retrospect, there wasn’t much pain or discomfort.
You might want to take a look at Wikipedia, they have a pretty good article on the subject.
I’ll post followup comments here.