Monday, February 23, 2009

Step by Step Lasik: details for those considering it

This will be a boring post for anyone not interested in having Lasik eye surgery. I am writing it because a few be-spectacled friends have asked for details of my recent Lasik surgery here in Dallas. I learned some good information from bloggers, myself, before I had the surgery.

Before I had Lasik (on February 6), my eyeglass prescription was 20/750. The next morning after Lasik, I was seeing "20/20 plus" -- ie, a little better than 20/20.

The only complications for me have been occasional dry eyes -- the expected complication for up to 3 months following -- and a blood clot/streak on my eye, mostly covered by my lid, which I don't feel at all. This is also supposed to go away. I have been warned to expect to wear reading glasses a bit sooner than I would have.


I spent years looking into this procedure and was screened by 3 different places -- Johns Hopkins, a Texas Laser Center calls Cornea Associates (recommended by an opthalmologist -- just a preliminary screening), and UT Southwestern (Zale-Lipshy) Laser Center.

My prescription was steep and my corneas moderately thin, so when I was screened at John's Hopkins 3 1/2 years ago, the doctor recommended I wait until the next generation of machine came out. This would allow me to take advantage of the best "Wavefront" machine possible and get the best results, rather than settling for a different, less precise kind of surgery. (More on that later)

I settled on UT Southwestern while here in Texas, because it was recommended by 2 trusted people and because it is a teaching hospital. I had heard that a teaching, university hospital like this would be more likely to have a long-view towards eye care, and also would not be as profit-driven. In other words, if it would be wiser for me to to wait, or not do, the surgery, I wanted the doctor to be very likely to so advise, and not be concerned about making money.

It is also important, as you search, to find a place which publishes their results, and to find a place where a surgeon, not a tech, will perform the procedure.

I was screened preliminarily, then later in-depth, at UT. Because of my still-borderline cornea thickness issue, the doctor decided to take measurements the day of surgery again, before he made a final decision on type of procedure. He would then determine, that day, whether to do conventional Lasik or the more "tissue hungry" Wavefront (more expensive by $350 per eye, better, more precise results, but uses more corneal tissue to get them).

Day of Surgery

The day of the surgery, the doctor took me in for some more measurements, and gave the go-ahead for for Wavefront. Hooray!

I understand many places prescribe Valium. UT did not offer that, and I didn't request it, as I don't like how it makes me feels.

The first step on the day of surgery was taking the basic measurements again. Then my eyeballs were numbed with drops and the doctor marked on my eyeball with permanent marker. (Funny!) He said he does this, because when we lie down, our eye shifts a bit, and this pre-marking would allow him to get his bearings.

Before I went in, they asked if I had any questions, and I requested that the doctor verbally walk through everything he did as he did it, so that I could know what was going on during the procedure. The doctor told me afterward that it is actually his policy to verbally walk through things, so that his assistants can catch him if he misses a step. I liked knowing that, even later!

This particular doctor is also a professor and has an entourage of interns and an experienced assistant or two following him around and assisting him. So along the way he explained different technical things to them out loud. He also had an assistant double check certain things he had done -- measurements and settings -- before he proceeded to do them. Two thumbs up! I'm all in favor of reducing human error!

After having the measurements done, my eyes were marked, and my eye balls numbed with drops again, and I was led to a room for the first part of the procedure, in which the corneal flaps are cut on each eye. This is the first of two parts of the operation where you have to hold yourself very still for a few seconds. This is also the part of the procedure where your eyes are open, but your vision goes black.

When I was laying down, one of the nurses gave me a teddy bear (I must confess, I thought this was extremely silly, but apparently this is standard operating procedure. It gives you something to clench onto if you feel the need to -- and I did end up clenching it at points, so I guess it made sense). A speculum is put in your eye to hold your eye open and your eyeball still.

The thing to know about this first part of the procedure is that there is pressure and significant manhandling of the eyeball, but it doesn't hurt. The eyeball itself has been numbed. The manhandling is more disconcerting on the first eye. When they do the second eye, it is not as disconcerting. (Because it has happened before! Like so many things in life.) In this first stage, the flap is cut and suddenly things go dark. I saw golden stars, too. (A special treat?)

After both eyes have their flaps cut, you are told to lay still for 15 minutes. I asked why and I can't remember what the answer was. David had asked after me out in the lobby, and so a nurse came in to tell me, which was sweet. The nurses were very diligent about putting numbing drops in my eyes frequently all during the procedure -- maybe 3 or 4 times or more during the time I was having the procedure done.

There are clear plastic goggles on your eyes while you are waiting, but you can "see" again (still with poor eyesight but things are not black anymore). After 15 minutes, I was moved to a new room and I lay down under the special Allegretto laser machine, and the room was darkened.

At this point began the second part of the procedure. The machine's "coordinates" (my word choice) were set for my eyes. (Basically, my measurements were entered in a computer.)

The beauty of Wavefront technology is that the computer is able to precisely re-sculpt the eye to not only correct the basic prescription, but also to smooth and correct other natural irregularities (and all eyes have them, even 20/20 ones). This makes vision even clearer and cuts down on night vision issues and haze issues -- essentially making a smoother eye than found in nature.

I believe (this is my lay understanding) the special thing about the Allegretto version of Wavefront is that the wave pulses are faster than ever, and even better at correcting/accounting for tiny movements of the eyeball. Apparently, even when you hold very still and look at one point, your eye moves a tiny bit. These newer machines are able to account for that to a greater degree.

The machine came on, and I was told to look at the green light and not to stop looking at the green light, and to hold still. This "holding very still" was just for a 22 seconds, and the nurse kept updating me on elapsed time. It is not long at all.

But this was the time I felt a little bit of panic. For some reason, my mind played that horrible trick on me in which it wants to do the exact thing it is not supposed to do, and I felt driven to look away from the green light. Sort of the "Don't think of a pink elephant" phenomenon. I kept feeling an almost irresistible urge to look away from the green light! I prayed fervently -- that I would keep staring straight at the light -- and I did. Whew!

The second eye went much better, especially since I had experienced how short a period of time the whole process really is. This is not a painful process either, but one does smell a mild burning smell while the laser is cutting. I don't know if the smell was the machinery or my eye tissue.

The flaps are pulled back, and then a funny thing happens. The doctor takes, essentially, a tiny squeegie, and spends a good bit of time smoothing down the flap's edges and pushing out any air bubbles. In fact, the funny thing is, you get to watch the tiny squeegie at work on your eye, and you don't feel it because of the numbing drops!

After sitting up in the darkened room, I was given goggles to wear, told not to rub my eyes (I scrunched them when I shut them and they all exclaimed " don't do that!) and led to an exam room.

I sat down in the exam room, looked at the doctor and promptly started to cry. I could see him well without any lenses! (I am one of those who could not see the big E on the eye chart!)

All the interns were crowded round smiling, and the nurse. The nurse got teary, too, what a dear, and the doctor was simply beaming. He said tears were ok -- good for my eyes.


What a moment!

When he could get me to stop thanking him and shaking his hand, he measured me, and I was seeing 20/80. After total dependency on glasses and contacts since 4th grade -- for 30 years -- I could now already see fairly well without any lenses!


Before I left, I was given a prescription pain killer to take with food. As the numbing wears off, it really does feel like someone has taken a brillo pad to your eye. I was also handed darkened sunglasses to wear home. They advised me to keep my eyes closed for the trip home, though I confess I peeked a few times, and saw I could read license plates! Not even the "Tabasco-in-the-eye" feeling could dampen my mood!

But I have light-colored eyes, and the light was way too bright to handle, even with my eyes closed and the sunglasses, so I wrapped a sweater around my head to block out the light and get home comfortably. As soon as I got home I headed straight for the dark bedroom.

There I took the painkiller -- hydrocodone (ie generic vicodin) -- with food. But I had a reaction to it. My eye pain was significantly reduced by it, but I also spent the next 4 hours nauseous and vomiting. This is something I have frequently experienced with certain prescription painkillers and also anesthesia, so I wasn't surprised. Still, I was already so cheered by my vision results that I didn't care very much -- maybe the one time in life I have felt cheerful while vomiting!

This kind of reaction to Vicodin is not common, I don't think. Unless you're allergic to it, what I recommend is that you do take the painkiller before you even leave the laser center -- bring some food to take with it --so that you can manage your pain ahead of time.

I was also given steroid drops and antibiotic drops, to apply very frequently at first, and less frequently later. Everyone naps right after the surgery but I did not feel at all like napping -- obviously.

After explaining the whole process to my eager and curious children ("Gross, mom! That's cool!") in the darkened room, finally recovering from nausea, and chatting with my sweet mom who came to watch the kids while David helped me, I went to bed that night with goggles on. These goggles are to keep you from rubbing or scratching your eyes in your sleep. You wear them at night for a week.

The next morning, I could see with sunglasses on. As we drove to the clinic I found I could read street signs. At the exam, I was able to read part of the 20/15 line!

The weeks following this procedure I have diligently used my eye drops and the moisture drops (given by the clinic) to alleviate the occasional very mild discomfort. I did have some light sensitivity for the next day or so, no longer than that. I do wear my sunglasses a little more frequently as it is windy in Texas and that is mildly uncomfortable in terms of dryness. It's only been a few weeks. I found, for the first week, that my eyes would tire more easily, and computer work was more draining. But things have quickly settled out.

For 3 months, I need to avoid water sports and not get water in my eyes. I can shower and bathe as usual.

The benefits of this outpatient procedure -- for someone with allergies and also someone who loves the outdoors and swimming and yard work -- are huge! It is a daily, hourly delight to just go about my business without worrying about my contacts getting blurry or "goopy," and without thinking of glasses. It is wonderful to wake up and see immediately. I still get a tiny thrill each morning when I wake up and see right away!


rebecca said...

I am so glad that you posted this, and that you had good results. As you know, my experience was totally different and I think the key is going to a top-rate physician in a clinical setting like you did.

My vision was not that bad, and my thinking was "meh, it's Lasik, not rocket science... people have been doing it for years." I went to a reputable clinic where medical doctors perform the procedures, but it could not have been more profit-driven place. The doctor's son does the used car salesman bit after the evaluation. Blech! That should have been my first warning, but I really just wanted it done and didn't even imagine side-effects at that point.

I had the Zyoptix custom bladeless procedure, with Valium. The Valium wasn't presented as an option, and I didn't ask about declining it. (Which I should have, because I always have issues "coming down" from meds like that.) I remember some of the same things that you do, especially the smell of burning eye, but I don't remember if my procedure had one part or two. The Valium really messes with the memory, but the one plus is that I didn't experience the pink elephant phenomenon, which I TOTALLY would have otherwise. (It's just the personality!)

The place I went wanted me to take an Ambien right after the procedure, but no way was I going to do that at 10am. The problem was that the brillo pad burning eyes and the coming down off of Valium was a bad combo. I was so agitated that Dave called the place and was told by the doctor's son to put more numbing drops in my eyes and give me more Valium. Apparently, I said an extremely unkind thing about the doctor's son at that point, but I have no recollection of that. Good thing Alex was at school and Caroline was down for her nap. The drops helped enough to get me through the additional hour or so of burning eyes.

My vision was pretty good that night, and 20-20 the next day, but for several weeks it felt like I was looking through a glare or haze. It was really disconcerting at first, then started to get a little better. My follow up care was so frustrating because of how cautious the docs were about over-promising results. I got a lot of "I expect it to get better over time, but we'll have to wait and see."

Also, I did a rigorous vision test about 10 days post-op (the machine one, not read the chart) and my vision was 20-25, which was discouraging after being 20-20 the day after.

The one thing that kept me hoping was that my outdoor vision in sunlight was amazing right away. Looking out the window of my office, I felt like I could see for miles and miles of crystal clear landscape.

It took a full month for my "eyeball streaks" to go away. I learned that they were not from the procedure itself, rather they were from the device used to hold my eye open. I think that device must have been used rather aggressively in my case, because the streaks were quite prominent.

It has been almost two months since my procedure, and I have been happy with my vision for about 2 weeks now. Not at all happy about how I got here, though. If I had it to do again, I would go to a reputable surgeon at a hospital like you did. It's not rocket science, but it is eyes! I think it would have been a world of difference having someone who was willing to take the time to explain the process and really discuss any post-op concerns.

annechamb said...

Rebecca, What an experience! THANK you so much for sharing this. I think this will be a very useful post to those considering the procedure.