My LASIK Experience


Some people have asked me about my LASIK experience, so I'll write about it here. It seems like a lot of people are getting it these days, so I'm surprised I'm unique enough to even ask about.

Background: I have had corrective lenses since the first grade. My prescription is currently -7.5 diopter in both eyes. It's actually -7.25 in one of them but that eye also has mild astigmatism so they just correct it by upping the prescription there. I have worn soft contacts since high school.

Short story: it's a divine miracle worked through the mad science of man.

Longer story:

I got my LASIK done at the Furlong Institute, where Phil got his done. I opted for the low-priced (but still rather pricey) custom wavefront LASIK that involves a physical blade. LASIK involves cutting a flap open on the surface of your eye before the excimer laser can reshape the cornea. There is a newer procedure that cuts the flap using a femtosecond laser if you are nervous about the blade, but it was more expensive (and I would have to drive further to get to the place) and I really wasn't nervous about the blade. I had a friend who didn't prefer the blade, and she was the one I learned about the laser alternative from. There is also another procedure that does not involve creating a flap but recovery is more painful.

In fact, I really wasn't nervous about anything. I'm extremely nervous about dentistry, but not about eye stuff. I think years of having contacts desensitized me to poking around in my eyes (I remember when I first got contacts that I was really jumpy about it), so I'm never nervous getting my eyes poked and was relatively blase about the idea of them cutting my eye with a blade. Also, the sheer number of people who've had this procedure done without complications (including people I know personally) made me pretty confident. I had first heard of it when I was a kid and it's been decades of advancement now, including that whole laser blade thing.

Before you do the surgery, you have a number of pre-surgery examinations. The first one happened in October when I went in to just inquire, and the second one was scheduled a week before the surgery. Both times, and then again just before the surgery itself, they put you in front of these machines and scan your eye to create a topography map of it. There's like three slightly different machines that all do (so far as I can tell) the same thing, presumably so there's a lot of cross-checking redundancy. In fact, there was so much redundancy that it made me feel very confident that barring some other type of failure that the laser correction part of the operation itself couldn't possibly go wrong. They also do a regular eye exam.

So I went in pretty relaxed. It also happened at the tail end of my winter break (Jan 2nd, for FSA reasons) so I'd been off work for nearly two weeks. They give you a mild sedative prior to the procedure but I half-suspect it wasn't even real - I didn't feel any sedative effects at all and it was the receptionist who offered it to me (are receptionists able to give out medication like that?), so maybe it was just a placebo. Supposedly it's "Ativan."

Anyhow, the first thing that struck me was how assembly-line it was. In the waiting room, there was another patient waiting to go before me (the whole procedure takes like 10 minutes), and after she went into the surgery room, they brought in another patient who was going after me. They kept doing things to make sure we weren't nervous, which was surprising to me (and the guy who joined me in the room, who I chatted with) since I figure anyone who is nervous about this procedure is just not going to do it. If you're afraid of the whole blade-in-the-eye thing, it's pretty easy to just decide to stick with glasses or contacts. There was light jazz playing in the room that struck me as being just a little too fast for a waiting room that was supposed to relax you. I turned it off briefly and played "Still Alive" on my iPhone.

Once I went into the surgery room, everything happened very quickly. The doctor was obviously quite practiced at it (he's done like 1500 cases) and while he was totally friendly and reassuring the whole time, the way I was guided through the process was almost a little brusque.

First, the doctor examines your eye one last time, and then you lie on an operating chair tilted back under an extremely intimidating machine. They don't waste any time bringing this thing over your eye - it's a little ring of light, with an orange dot in the middle that you're supposed to focus on - and they cover up your other eye. It was very intimidating, and I wondered if something was going to come out of it and just start operating on my eye, and then they told me it was just the microscope. They put in some numbing eyedrops, tape up your eyelashes so they don't get in the way (I was worried about this, so that was good), and then they stick these little racks under your eyelids to hold them open. Some people are apparently nervous about that, but I was glad because part of my worry was that my eyelashes and blinking would get in the way. The doctor is putting in numbing drops all this time, so you don't feel anything.

In order to cut the flap, they stick a thing on the surface of your eye that pulls at it slightly via suction, and then cut the flap. The idea here is that you're still awake and while you're trying to focus on the dot like they tell you to, your eye will inevitably move a bit. Because the cutting device is part of the device that is now attached to your eye, it's all one unit so minor eye twitches won't screw it up. Again, good.

Here's the part that was super-freaky for me. The cutting device is not a blade. I had envisioned something like a precision-guided razor blade or something, but no - it is apparently some sort of tiny oscillating saw. How do I know this? Well, I couldn't see it - in fact, when the thing that pulls your eye up slightly (I guess to give the surface a bit of clearance for the cut) your vision goes black for a second - but you can hear the spinning of the saw blade. And it is clearly the sound of a miniature saw blade. This totally freaked me out - I was like, "Holy shit, that is a tiny saw blade!" Of course, I didn't want to move or twitch in reaction to this realization in the slightest so I held absolutely still, though the rest of my body tensed up completely. I should note that the entire experience was still completely painless - it's not even the dull, persistent pain that you always feel at the dentist no matter how much painkiller they give you - it's just totally painless. But it was freaky.

After they did the cut, they folded it back, and the laser did its work. That part is totally fine - you just stare (blurrily, because the lens of your eye is folded back) at the orange light dot and you hear a series of zapping sounds as the laser is doing its thing (the sounds come from the machine, not your eye). The whole thing is computer-tracked so the small involuntary eye movements you accidentally make don't mess it up - the computer compensates for it. Then the doctor folds the flap back on, removes the lid-holding thing, takes off the tape, does some irrigating and checking, and covers up your eye. The entire procedure after the actual SAW BLADE is fairly relaxing and non-stressful, and your eye is being irrigated liberally so it feels fine. Again, all completely painless.

After the left eye though, my entire body was completely tense - in fact, I remember clearly that my chest was so tightened up that I couldn't relax and I wanted a couple moments to breathe deeply and try to loosen up but NO, now the doctor is moving right on to the other eye! Incidentally, all through the process the doctor is giving me status reports and at the end of the procedure with the left eye I was assured that I'd done excellently, so I was intellectually aware that things were okay, even if I was totally freaked out.

So now with the right eye I know what is going to happen and I am pretty tense, and hoping I don't do anything to screw it up. The doctor is moving on quickly, taping back my eyelids, etc, and applying the little suction thing and now I can hear the SAW BLADE coming. This time my eyes twitch just a bit more, and while it's doing the cutting, I can feel that it is ever so slightly pulling and stretching the surface of my eye. Well, it all finishes very quickly and the doctor doesn't seem concerned and the laser does its zap-zap-zap, he folds the flap back on, makes sure it's all good, irrigates it, etc, and untapes my eyelids.

I close my eyes carefully and sit up as instructed (because I don't want to, I dunno, let those loose eye flaps flop open or something) and am told that I can open my eyes. I open my eyes, and things are kind of blurry, but my vision is already better than it's ever been unaided. I can sort of see things and it just seems like things are a little cloudy. The doctor guides me over to the eye exam thing and examines my eyes again and cheerily declares them fine and tells me that I've done a great job.

I'm led out into a post-op waiting room and given a bunch of instructions about what eye drops I should apply in the next few days, some eye guards to wear and told to rest my eyes (sleep if possible) for the rest of the day and night. Shawn is there to take down all the post-op instructions in case it really was a sedative and I forget all this, and we both notice to our amusement that we are then guided to exit the facility through a different exit than we came in. Apparently there is the mild chance that a patient will be freaked out by the experience and they don't want the other people in the waiting room to be freaked out.

Overall, my experience had a very sinister sci-fi feel to it - the surgery room is dimly lit (your eyes are sensitive to light afterwards), there is a big loud complicated machine involved, and the doctor and the techs all seem to have this manner wherein it is more like you are being "processed and upgraded" rather than "healed in a caring manner." I'm not saying they were sloppy, just that the quality of their work was more like "efficient competence" rather than "loving care." The assembly-line-ness of it adds to the effect, although it's possible that it was just busy because everyone decided to schedule their procedures at the tail end of vacation but after the new year for the same insurance reasons I did.

Some other info:

- I had a 24-hour post-op checkup the next day. My vision checked out at 20/30, which they said was really good for just 24 hours after the surgery, and it's expected to improve. It continues to improve; in particular, the cloudiness is definitely going away. I get halos around lights in my night vision though and I'm hoping that will go away (or at least get better) too. In general I am quite pleased - I hope it recovers fully to 20/20 (or better, as there's a chance of that), but since my personal reasons for LASIK are related to the collapse of civilization, I've already met my goals and am quite satisfied.

- They are really careful not to guarantee anything, and in fact make you read, sign, and write a whole bunch of stuff stating that you understand the risks and the fact that there are no guarantees. I think the problem is that so many people have such a great experience with it that there is so much hype that when a rare person doesn't get stellar results (apparently a "bad" result is when someone is corrected to merely 20/30 or 20/40) that person gets really upset. Prior to the surgery they give you some research data to read and the funny thing about it is that it only shows a ~85% rate of achieving 20/20 or better, but it shows a 100% rate of achieving 20/40 or better. So there is basically no failure mode that is worse than that (20/40 is the legal limit for driving). In fact, there is an prospectus-like part of the document that lists all the possible things that can go wrong and for me, the worst thing I could come up with that could go wrong was a section listed as "mechanical failure" wherein the blade might stop midway through flap-cutting or the laser would run out of power and they'd have done a partial operation that would need to be aborted and re-done in 3 to 6 months. That sounded pretty bad to me, but not very high-probability.

- I had assumed the saw blade was circular (from the oscillation noise), but apparently it's more of a straight blade that moves back and forth.

Originally posted here on 2009 Jan 06, by Yishan Wong.