Saturday, April 28, 2012

My Experience With The Slice-And-Zap

I just got my eyes sliced and zapped!

If you're like me, you've heard about a lot of people "getting Lasik done," but not about what the actual process involves.  So, I thought I'd share my experience to help de-mystify it for anyone else who might be curious.  Keep in mind that everyone's experience is different, so take what I write with a grain of salt as being representative of all procedures...but hopefully it'll still provide some useful information for anyone who might be considering it themselves.  If this kind of thing bores you, then I wouldn't recommend continuing on.  I won't be offended, I promise.  :)

If you know me, you know I like to research big things like this before pulling the trigger.  Living in Kansas City provides a really unique benefit.  Apparently, some cutting-edge eye surgeon decided to make his home in KC back in the 1980s.  Being one of only four or five surgeons experimenting with lasers at the time, a lot of top-quality talent came here to study and learn from him, and a number of them stayed here.  Now, we have the benefit of several top-notch laser surgery places right here in town, a very unusual scenario for a city our size.

What is Lasik surgery?  When you boil it down, it's a two-part procedure to correct your vision.  First they cut a hinged flap in the front surface of the eyeball (the cornea), then the problem spots in the eye are corrected.  The flap is then put back into place, and you're done.  An over-simplified explanation of the two options I considered would be blade/laser and laser/laser methods.  The blade/laser is where a physical blade is used to cut the hinged flap, the laser/laser uses a laser to cut the hinged flap.  Both methods use a laser to perform the correction down underneath.  You can do a standard correction or a custom correction.  As I understand it, the basic difference between the two is that the standard will use the laser to re-shape the cornea and smooth down the high spots, but the custom will actually go into much more detail to clean up the little junk ("peaks and valleys") that cause little tiny issues like stars around lights at night, or things like that.  Some vision problems can be corrected by lasers, some cannot.  I'll let you figure out your own situation with your eye doctor rather than getting into it here.

I narrowed my search down to DurrieVision and Silverstein, the two places that I thought were the best with their respective technology, though I've got friends who had great experiences with other places, too.  Basically, pick your favorite name brand place here in town and you'll be fine...just don't go with one of the cheap little places that haven't been around a long time.  Silverstein uses the blade/laser method, and DurrieVision uses the laser/laser method.  I had consultations with both Silverstein and DurrieVision and asked lots of questions.  The blade/laser method is older and a very mature technology.  Thousands of these procedures are performed each year with an exceedingly small risk of adverse complications.  However, DurrieVision's laser/laser method is probably the cleaner method, with quicker recovery time and less chance of adverse complications.  Because it's a laser cutting that flap, it's a more precise and controlled cut, with nothing physically contacting the eye.  It was also fully double the cost.  And, from what I could learn, the difference in complication rate between the two was a fraction of 1%, so we're really talking about a statistically meaningless difference in outcome for double the price.

I chose Silverstein.

They told me all the stuff you normally hear - despite a small risk yadda yadda yadda, most people are feeling great and experiencing clear vision within 24 hours of the surgery, sometimes the same day.  You go in, you take a Valium, you get it done, you go home, you take a nap, you eat dinner and go to bed, and then you wake up the next morning to a bright and shiny new world of clear vision.

That's more or less correct, but they left out a few details, and that's really why I wanted to share all this with you.

I got there at 7:15am on Friday morning, paid, and signed a few papers.  No surprises there.  They walked me back to the prep room and I put on a gown and a floppy hat (with a sticker bearing my name on the front) while asking me questions about any medications I'm taking and what I had for breakfast.  They took my blood pressure, which was elevated by about 25% compared to normal (hey, I was nervous! I'll touch more on this in a minute...).  She also asked my name and why I was there.  This is apparently something they do now to make sure they don't accidentally slice and zap someone's eyeballs when they're actually there for something else (I joked with her about the soon-to-be-amputee writing in Sharpie "not this leg" on the leg that wasn't going to be cut off, which she didn't appear to find at all funny).  Anyway, I took some ibuprofen and Valium, and they sat me down.  Then she proceeded to explain about forty-seven different rules that I had to be sure to follow after the surgery - no swimming, no aggressive activity, no face in the shower, no saunas, NO TOUCHING OF THE EYES, and so on.  Right about the time my eyes were glazing over from trying to remember all of it, she mentioned that they were all typed up for me and I would take a copy home.  Whew!  No worries.  She left, and I waited my turn.

And waited...and waited...and waited...

While I was waiting, I heard several more Lasik candidates come in and go through the same prep phase I had just completed (though no one else offered up such spectacular Sharpie jokes).  I noticed that blood pressures were consistently way, way above where they should have been.  Of the six or seven I heard, mine was actually the second lowest of the bunch, so that made me feel better.  As the wait dragged on, I started to get impatient.  After about an hour, the lady came around again and told us that they were re-calibrating the laser just to make sure everything was correct before continuing.  Suddenly, I was okay with the delay.  A few minutes later, Lindsey and Hadley came back to say hi.  Linds could have stayed with me, but kids weren't generally allowed back there, so they just popped in for a minute and went back to the waiting room.

I couldn't feel any noticeable effects of the Valium, which was a bit concerning to me.  I have a REALLY strong blink reflex (as the poor optometrist who stood there watching me for 30 minutes trying to put in my first contact a few years ago can confirm), and my eyes have always been extremely sensitive.  I guess I had expected they would give me enough Valium to make me unaware of my surroundings while still being barely awake.  Not so.  I didn't feel a thing, and was getting concerned at how they were going to secure me enough to attach a suction cup onto my eyeball and slice it with a blade without blinding me permanently because I blinked at the wrong moment.  Visions of 15th century torture racks and headgear presented themselves in my overactive imagination...

Eventually, it was my turn.  They walked me into a cold white room with a couple of nurses in purple scrubs and lots of equipment.  No kidding, it was just like in the movies.  Did I mention it was cold?  Because it was really cold.  And this is from a guy who loves cold weather.  It was a good thing I had worn the socks and tennis shoes rather than sandals, or involuntary shivering may have been an issue.  Anyway, I laid down on my back on the table and they asked me again what my name was and why I was there.  Successfully answering both questions correctly (again), my table was scooted under the laser until I was staring up at a pretty red blinking light.  Doctor Silverstein (I'm going to call him "Doc" from this point on, not because I know him personally but because it's much shorter to type than "Dr. Silverstein") walked in and introduced himself.  I have no idea what he looked like because he was all garbed up behind a mask and a hat, but he was very nice.  At this point, things kind of blur together a bit, but I'll try to reconstruct the steps in the correct order.

Doc fiddled with the laser for a minute, and then I found out how they intended to keep my eyes open during this high-tech surgery: low-tech tape.  No, I'm not kidding.  They started on my right eye, taping my eyelids to my forehead and cheek to hold them open, and then it felt like they put some sort of clamp down on the tape to hold things in place.  It wasn't painful, exactly, but I'd certainly call it uncomfortable.  I would imagine that anyone with a normal blink reflex would find it so, but for me it was really unsettling - I desperately wanted to blink, but was completely unable to do so.  At the same time, it was reassuring that I wouldn't be able to blink in the middle of the procedure and mess anything up.  Doc held my head and asked me to shift this way and that way until my eye was lined up properly under the laser, and then he pressed a round circle thingy down on my eyeball briefly (I think it was to mark the center of the pupil or something like that).  I was told to watch the blinking red light the whole time, which I did, but it was still a very...strange...experience to watch this all happen from inside my head.

Doc pressed another round thing down on my eyeball -- did I mention how weird it was to watch something come right down onto your eyeball, feel it press down tight, and then stay there?? -- and this time I think it was the suction cup that would hold the blade in place to slice open the flap.  On the one hand it was really cool to see it happen from the inside, but on the other it was really creepy - it was like watching a movie through a blurry lens, but with the added sensation of feeling strong pressure on a part of my body that had an equally strong conviction that it shouldn't ever be touched like that.  Doc was talking me through what he was doing and what was coming up ("next you'll hear a buzz, don't be startled"), but I was just focused on trying not to move and on watching the blinking red light.  I thought I managed it pretty well, all things considered...and maybe the Valium was helping here more than I thought.  Anyway, that last round thing he pressed down on my eyeball involved a lot of pressure (though again, I wouldn't call it pain) and made everything fade out to black, which was probably just as well since that was the point where the blade sliced open the flap on my cornea.  The next thing I saw was a little paintbrush-looking thing that he used to peel back the slice, and I remember thinking that it had happened quicker than I expected.  When the flap was
peeled back, my vision got just a little bit brighter and a bit more washed out, as if a filter had been removed from my vision.  Knowing that my eye was now exposed, I simply tried to concentrate on the blinking red light.  Next came a rapid series of green flashes and more buzzing as the laser did its reconstructive work.  In just a few seconds, it was done.

Doc pushed the flap back in place, then used the paintbrush to squeegie out all the air pockets (I don't know if that's what he was actually doing, but that's what it appeared to be and felt like), and then he may have spread something else on there, too, I don't quite remember.  They disassembled the apparatus, and my right eye was done.  A bit sore around the eye socket and feeling a little scratchy on the eye itself, but otherwise fine.

The left was essentially the same, but they didn't get a solid suction on the eyeball the first time, so they had to take the cup off and try again.  This one actually did hurt a bit, partly because they managed to grab part of my eyebrow with the tape, so every tug and twitch from that point on pulled just a little bit, and I'm mildly surprised I still have that eyebrow intact.  I had to really focus on that red blinking light for the left eye!  At the end of it, they had to put a contact lens on my left eye to help keep things in place.  I assume that the second attempt at clamping down with the suction cup meant things were a little more loosey-goosey than normal, and Doc didn't want to take any chances of something shifting around.  He was very nice, and thanked me for allowing him the privilege of trusting him with such an important thing.  I didn't really respond at the time, being a bit concerned at what happened with my left eye.  Assuming all goes well, I'll have to write him a note and drop it off at my next visit.

After that they walked me back to the recovery room.

I could see out of both eyes, but everything looked kind of foggy, like looking through a slightly tinted window or a misty early morning day, or maybe a smoky room (without being able to distinguish the individual curls of smoke).  No pain to speak of, just a little bit sore from the tape/clamp setup.  I was walked out to Lindsey and Hadley almost immediately, and we went upstairs to have a quick check-up before we left.  Everything looked good, so we headed home.  It was VERY bright outside!

They told me to go home, take some drops of two kinds of medicine (one antibiotic and one anti-inflammatory), and then take a nap. 
I hadn't brought sunglasses with me because my only pair were my prescription ones, and I was expecting them to provide a 3D-glasses kind of thing for my trip home.  Instead, I spent most of it with my eyes closed.  I dutifully followed instructions, deviating only to eat some lunch before the nap.  My lovely wife put up with me through lunch -- since I was still largely unable to open my eyes, she had to help me a bit -- then got me situated in the basement where it was blessedly dark, and I promptly fell asleep for a couple of hours.

One thing they neglect to mention in the Lasik marketing brochure is the idiotic "shields" you have to wear when you sleep.  They're ridiculous, bug-eye looking things that you tape over your eyes when you nap or go to bed.  They're supposed to prevent you from rubbing your eyes while unconscious or semi-conscious, but they're really not comfortable and they look absolutely retarded.  The tape also leaves sticky residue on your skin, and by the way you're not supposed to wash the skin around your eyes because that would risk getting soap in your eyes.  I felt like a rabid insect.  As for the look...well, it's a good thing sleep occurs in darkness, is all I can say!

When I woke up my right eye was feeling great.  No dryness, no itchiness, and very clear vision.  Success!  My left eye, on the other hand, was still a wreck.  Almost completely blurry, it was constantly watering and it felt like I had a painful scratch on it.  It was driving me nuts, especially because I wasn't supposed to touch my eyes at all - the closest I was supposed to get was a light brush of a Kleenex to wipe away liquid, but NO PRESSURE.  Well, that sounds nice, but it worked about as well as drying off the sand on a beach.  It wasn't long before my eyelids were matted from residual liquid build-up, and that only increased the irritation and general misery.  Unable to do anything else -- no reading, no computer, etc. -- I went to bed a little after 10pm.  I can't remember the last time I went to bed at 10pm.  It's been years, probably since before Connor was born.  I put on a movie but it was too bright and blurry to watch -- and my left eye continued to rebel against me -- so I just taped on my bug eyes and listened to it until I fell asleep.  This wasn't exactly the first-day resolution they had promised, but I was hopeful that the second part of the promise would hold true, and that the next morning would be the jackpot.

Nope.  My left eye still bothered me a lot.  In addition, I must have slept wrong on my neck somehow, because I had a horrendous headache!  It was one of those headaches that was so bad that it made me nauseous every time I moved.  I staggered my way through getting dressed and taking some ibuprofen, and my dear, dear wife gave me a gentle scalp massage.  At this point, I wasn't really feelin' the love toward Doc & Co. at Silverstein.

Still, once I was up and around, had some caffeine, and we were on the way to the follow-up visit, things were better.  I was pretty sure (or at least really hopeful) that the blurriness and the irritation in my left eye would be alleviated once that cursed contact had been removed.  That was the first thing they did when I sat back down in the chair.  It took the doctor (different one, not Silverstein) a couple of attempts to get it off my eye, and he finally had to resort to a quick grab with some tiny tweezers (did I mention I have a really strong blink reflex?), but within minutes I was feeling much better.

They did another quick evaluation, determined that everything looked good, and gave me a few more instructions.  Then we were off.  My left eye was still a bit blurry, but it was more of a minor nuisance at this point than anything else, and I was able to drive home without any problems.

In terms of ongoing treatment, I'm supposed to take two kinds of eye drops four times a day, plus artificial tears every hour or two all day long, and of course I have to wear the bug eyes at night.  But, as I'm typing this about 36 hours after getting up off the table, things are looking much, much better than they have in years.  If a good night's sleep provides as marked an improvement in my left eye as it did for my right eye last night, tomorrow should be fantastic.

Oh, and I bought some normal (and stylish) sunglasses today.  Sweet...

I'll post another update after things settle down a bit more, but that's the bulk of the story.  I hope it's useful to someone out there.

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