Razors and Lasers

Preface: This is an older piece of writing that I thought was in my blog, but apparently wasn’t.

I first starting thinking about LASIK in April of 2000. I had a girlfriend who was going for an eye exam and consultation for LASIK and so I decided to tag along to learn more. The doctor’s office seemed thorough and competent, and I was over-due for an eye exam myself, so I made an appointment for myself soon thereafter. Primarily, I was interested in finding out if my glasses prescription had gotten any worse and to check on the health of my eyes in general. However, there was this small part of me that was interested in finding out if my deplorable myopia and astigmatism eliminated me as a candidate for the procedure.

The exam showed that my eyes were as bad as I thought, but at least they hadn’t changed significantly since my last exam. Roughly, my left eye was -6.5 diopters and my right eye was -8 diopters. If you’re used to the older 20/20 scale, -6 diopters translates to 20/800 vision. In other words, I was as blind as justice. The whole eye chart experience usually starts with me saying “What chart?” I was surprised to find out that I was still within range of being an acceptable candidate for LASIK. Of course, no guarantees are made of results, but they had a long list of referrals of patients with much worse vision who had been corrected to 20/20. And no one had ever gone blind from LASIK, so my worst fear was allayed.

So the exam was reassuring and informative, but I was still pretty apprehensive. Let me explain what the LASIK process is like. LASIK stands for “laser-assisted intrastromal in-situ keratomileusis”. That doesn’t help much, does it? In short, they give you a mild muscle relaxant and some eye drops to numb the eyeball itself. You lie down in a chair and they slide a large mechanism into place above your head. A doctor applies a spring clamp to hold your eyelids open and uses a fancy razor to slice off a flap of your cornea (the “lens” of your eyeball). You stare into a laser while it burns away parts of your eye until you have a rounded surface of the right shape and height, and then the corneal flap is flipped back into place. The corneal flap is smoothed and patted into place and the next eye is done. The entire procedure takes less than ten minutes.

I should explain that I am extremely squeamish about having my eyes touched. I briefly tried contacts when I was a teen, with miserable results. Because of my astigmatism, I had to use what were euphemistically called “semi-soft” contacts, which is to say they felt like shards of glass scraping across my eye. But, primarily I failed at wearing contacts because I just couldn’t stand jabbing my finger into my eye to put the contacts in or take them out. Despite my best efforts, deep breathing and guilt over the expense, my eyelids would spasm uncontrollably every time I brought my finger within range. Sigh.

So, LASIK basically scared me stiff. The thought of eyeclamps being installed evoked memories of A Clockwork Orange, real horrorshow. So, the exam was interesting, but I had trouble working up any enthusiasm for actually following up on it.

About a week later, a co-worker had the procedure done, and was thrilled with the results. He waxed rhapsodic about the ease of the procedure, the trivial recovery and the glorious results. He couldn’t recommend it enough. Within a week, my girlfriend made her appointment for the procedure, so I got to see the process up close. As a long-time contacts wearer, she was somewhat more comfortable with having her eyes touched and probed. Still, razors and lasers are another thing altogether, so she had her fair share of pre-op nervousness. The Valium didn’t do much for her, but she walked into the surgery room like a good soldier, endured the surgery and walked out again in about four minutes. She could tell immediate results, but her eyes were pretty sensitive to light and basically she wanted to get home and to curl up in a ball for a while. Once she was home, the pain started to grow and she took a Vicodin and waited for it to kick in. She had a couple of hours of tearful pain before she finally fell asleep for the afternoon. I woke her up for a round of eyedrops and the worst had passed. Her eyes felt a little gritty and abused, but things improved rapidly from there.

As luck would have it, I broke my glasses frames that weekend. Great, just great. Finding frames that fit my massive skull is a huge pain, and they tend to cost a small fortune, and new frames almost never fit the old lenses, so I would need to have new lenses made, and the polycarb lenses I get take about a week to get made… this was not good. Or… did I dare think about it… I could bite the bullet and get LASIK done. I decided there would never be a more perfect time, I would never have a better excuse. So I made the appointment.

In the three days leading to the surgery, I kept pondering the same question, like some Zen koan. With insufficient drugs and no physical restraints, what could possibly keep me lying in a chair while some quack took a razor to my eyeball and started shaving off a slice? I had visions of leaping up from the chair mid-procedure and running away, corneal flap flapping in the breeze. Shudder. The three people I knew who had gone through this before all assured me it would be fine, but rational comfort doesn’t do much against irrational fear.

The appointed hour came and I arrived at the clinic. To hell with stoicism; I made sure every receptionist, nurse and intern I encountered knew I was close to full-blown panic and not to mess around. I was given 15mg of Valium, which I was told was a stout dose. The nurse came over to administer the first round of eye drops and got a first-hand glimpse at the challenges ahead. I couldn’t keep my lids open for the drops, despite my best efforts and her experienced hands. Somehow, she splashed enough drops on my face that some trickled into my eyes, and then she happily retreated to her station to wait for my Valium to kick in. And waited. And waited. Every ten minutes or so she would ask me “How are you doing?” I would answer nervously, “HowamIsupposedtobefeeling?Ican’ttellany difference.Whatshoulditfeelike?DoIseemmorerelaxed?” She looked at me grimly, we wrestled with another round of eye drops with roughly the same results, and she went to fetch the doctor. The doctor looked me over and said “Give him another 5mg of Valium.” As the nurse handed me another pill, she said “This makes 20mg. That’s the same amount we gave the Oakland Raiders linebackers when they came in for this.” Great, I’m not sure if I was supposed to be proud or embarrassed. I settled back and waited for this extra dose to take effect, and the nurse starting sending other patients into the operating room ahead of me. “I don’t think he’s ready next; let’s let this other patient go ahead.” The clock ticked and I couldn’t feel any change from this drug at all.

After 45 minutes of waiting, I finally stood up. “This isn’t going to get any better. Let’s just do it.” I was prepared to grit my teeth and try my best to simply suffer through it. She took my chart back to the operating room, and then led me back.

The room where the procedure was done was small, but rather full of people. One person led me to a fully reclined chair like something from a dentist’s office and I stretched out flat. The chair was swung around to bring my head to position under a bulky device, which I assumed was the business end of the laser. The box hung about 14 inches from my face and I found myself staring at a small red light like HAL’s “eye” from 2001. Oddly enough, the light was comforting; it was close enough that it dominated my field of vision and so I wasn’t nearly as aware (and frightened) of all the other things that were happening in the room. One of the people in the room took position at my hip and held my hand for comfort.

The doctor taped a small shield over my left eye and carefully moved the laser so that it was directly over my right eye. He adjusted a small beanbag under my head and then talked to me about staring directly into the light, not flinching, not moving my head, not looking away… At this stage, I would have gladly paid double the price if the procedure could have been done while I was unconscious.

The doctor settled one device against my lower eyelid and then smoothly settled a clamp in place between my eyelids, keeping them pried so far open it hurt. Drops were added to the eye and I got an additional admonition to stare at the light. I felt a gentle tugging at the surface of my eyeball and just about the time I realized that was the shaving of the corneal flap, it was done. The doctor cautioned me that the light was going to fade, but that didn’t mean I was going blind, and that I should still try to stare at where the light used to be. He made a gentle motion and the corneal flap was peeled back and everything went dark. Panic was just beginning to set in when my other senses suddenly got enough activity to keep me distracted.

The laser started burning. In the background I could hear some rhythmic mechanical thudding noise that had to be related to the generator feeding the laser. Thunk. Thunk. Thunk. Thunk. Much closer, I could hear a static/sizzling noise, like a cross between the rasp of an arc welder and the sound of frying bacon. I was practically holding my breath trying to be as still as possible, but I took a shallow gasp and could immediately smell an acrid tang in the air. The sounds and smells were of my own eyeball burning.

After the first couple of seconds, the red light came back, fuzzy and scattered and flickering, but I could at least see something. There was a dancing bluish glow around the edges from the burning of the laser and I tightened my grip on the hand of my designated comforter. The doctor would calmly pronounce numbers as this happened “37 16” to have them echoed by some other person in the room, “37 16”. After 12 hours that lasted less than a minute, the laser went quiet and the burning smell faded. The doctor brushed my eye and my vision flickered as the corneal flap settled back into place. My eye was flushed with more drops and the flap was brushed smooth and the edges were gently tamped into place around the edges of the slice. More drops were added and then the clamps were removed from my eyelids. My lids fluttered and spasmed for a second before gratefully closing shut. The shield that had been taped over my left eye was removed and gently taped into place over my right eye. The laser mechanism slid a small amount to the left and the doctor again started his mantra about keeping my head and eyes still. I took a deep breath, flexed my hand for a moment and resumed my death grip on the hand of the anonymous saint of the surgery.

The left eye was done in the same fashion as the right. I’m not sure if I was more scared because I knew better just what was happening at each stage, or perhaps more at ease because I had survived it once. The sizzling sounds and smells had one more chance to be etched into my brain and then it was all over. My eye was awash with drops, the clamps were removed and I could luxuriate in closed eyes, safely hidden behind lids that were content to stay closed for a while. The taped shield was removed from my right eye, and I was guided to sit upright and handed a pair of wrap-around sunglasses that were three sizes too small, to keep things dark and to help me resist the urge to rub my eyes. Someone took my arm and led me out of the room, total elapsed time under five minutes. Probably the hardest five minutes in my life.

Even as I was being driven down the street away from the clinic, I was gingerly opening my eyes and noticing all the things I could see. “I can read that license plate. I can see the prices at the gas station. I can read that billboard. I can read that sign.” I was strongly reminded of my experience when I got my first pair of glasses at 11 years old and could tell for the first time that trees actually had hundreds of thousands of tiny, distinct, discernible leaves.

Thankfully, my recovery afterwards was trouble-free. I didn’t have any appreciable pain. My vision fluxuated a bit but was always enough of a remarkable improvement that I couldn’t help but be pleased and amazed. I learned a new technique for putting in eye drops that worked even for my twitchy lids. I had a brief follow-up exam the next morning and despite some blurriness, both eyes tested at roughly 20/20 and I got a card from the doctor that said I was legal to drive without glasses.

It’s been a week now and I’m definitely glad I did it, even considering all the trauma. My vision is probably better than it ever was with glasses, and I’m pleasantly surprised when I catch myself reaching for my glasses in the morning or moving to push up my glasses at work and I find that there’s nothing there. My vision feels a little blurry at times, and I have very definite halos around bright lights at night, but these things are expected in the first month of healing. I’ll get checked again in a month, and then again two months after that when they expect all healing to be fully completed. At that time, they’ll decide just how close to 20/20 we got and whether any follow-up surgery is suggested. I’m trying not to think of the prospect of doing it all again.

I bought my first pair of sunglasses in twenty years.

Footnote: A few people have read this and had a response like “What a nightmare! I’m never doing that!” I didn’t write this with the intent of scaring anyone away from the procedure. I really am happy that I did it and I’m pleased with the results. The “horrorshow” had more to do with my own fears and neuroses. Really, if you think you might be interested, go in for an exam, talk to a doctor about it. A number of clinics will even let you watch surgeries through a window or over a camera broadcast. Don’t get scared away on account of me.