Laser Vision Correction

If you haven't yet, you may want to read the Laser Vision Correction: the results story that describes the surgery I underwent, and results. Read this article first, though.

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8/12/99

As you may or may not know, I've been investigating laser vision correction of
late.  Many people have asked me to tell them what I learned while looking into
it, so I decided to write up a brief summary of the experience, and what I plan
to do.

First, the basics.  Corrective eye surgery has been around for quite some time. 
The original procedure done in the 60's and 70's was known as RK (Refractive
Keratectomy), which involved making incisions with a surgical blade in your
cornea to reshape the parabola and properly focus the incoming light on the back
of your eye.

In 1980, a "cool laser" known as the Excimer laser was invented, and made it
possible for this same technique to be with a non-invasive laser beam.  Two
computer-calibrated beams of light are trained on your eye; at the exact point
where the two laser beams intersect, there is enough power to evaporate a few
microns of tissue, resulting in microscopic cuts on your cornea.  This achieves
the same effect as the RK surgery, but without the risks of scar tissue,
weakening of the cornea, etc.  This is known as PRK (Photo-Refractive
Keratectomy).

A newer variant of the PRK surgery is known as "LASIK".  What they do different
is that they cut a tiny bit of your eye, pull the flap back, and they do the same
laser correction as PRK, but they do it from the inside rather than on the
cornea's surface.  The actual incision is extremely small (microscopic) and
entirely painless.

Before I get into the details of each procedure, I'll tell you my situation.  I
don't wear contacts because I really don't like the idea of sticking something in
and out of my eye; it bothers me.  Contacts also seem like quite a hassle.  I
wear glasses most of the time, but they can get rather annoying; I've had several
marginally comical episodes where I wander around my house trying to find my
glasses.  They also get in the way while doing active sports like diving, hiking
(they fog up!), etc.  I also wouldn't mind not having to wear them for aesthetic
reasons, but that's not a big concern (if I was that worried about it, I'd get
over my aversion to contact lenses).

My vision is not bad; it's -1 to maybe -2 on the scale that optometrist use, but
it's bad enough that things seem fuzzy (although marginally so) from just a meter
or two away without glasses.  I can get by without glasses, but my eyesight is
bad enough that I don't want to.  I also have astigmatism, which means that my
cornea isn't perfectly round.  Laser vision correction can correct both
conditions.

I would never have blade eye surgery done, I don't care how safe it is.  Having
someone carve up my eye like a Halloween pumpkin just doesn't sit well with me;
thus when I heard about laser surgery, I was intrigued.  My main concern with
laser surgery was that it is relatively new; what happens in 10 years?  20 years?

It turns out that although they've only been doing PRK surgery in the US for a
decade or so, they've been doing it in other parts of the world for nearly twice
as long (the US is historically very conservative about allowing new medical
procedures and medications, preferring to let the rest of the world be our guinea
pigs).

I also rationalized it this way: in 20 years from now, I'll be knocking on on 50
years old (I'll be a few years shy, but still, close enough).  At that point in
time, my eyesight will most likely be deteriorating in other ways as well (at
about that age, typically, you end up needing bifocals or reading glasses,
because you become far-sighted).  This will happen whether or not I have my
vision corrected with laser surgery now.

It's worth it to me to have glasses/contact-free vision for the next 10-20 years.
 Moreover, the evidence suggests that laser vision correction does not adversely
affect your long-term vision.  Your eyes will get worse, but they will do that
anyway, and for different reasons.  There are people around who had their vision
corrected with lasers 15-19 years ago, and there haven't been any unexpected
findings.

Most encouraging was the fact that the doctors and consultants that I met with at
the eye clinic had the exact procedure done on them that I was thinking of
getting.  These people know their shit, and they believe in the procedure enough
to get it themselves.  To me, that spoke volumes.

Both procedures are expensive; expect to end up paying close to $4,000 for both
eyes, if you get the procedure done in the US.  I say that because I'm told that
in Canada, for instance, the same procedure is an order of magnitude cheaper. 
One of the reasons it is cheaper in Canada is that they've been doing it longer;
another is that they don't have as many governmental agencies looking over their
shoulder as we do in the US.  I trust the Canadians for beer and hockey, but I'm
inclined to *want* a highly-supervised practice doing surgery on my eyes, even if
it costs a bit more.

You can finance it, so that you pay off the procedure in 1-5 years.  The interest
rate will vary with location; I was quoted about 11%.  It seems like a pretty
good investment to me.  This is a purely optional procedure; medical insurance
will not pay for any of it.

Now, the differences between the two procedures.  Firstly, LASIK is the newer of
the two procedures, but it they are both based on the same principle.  I was told
that over the past 3 months, they had 1 patient have PRK done, and several
hundred do LASIK.  This is the opposite of how the ratio went just a few short
years ago.

The reason most people are opting for LASIK is that your vision is corrected in a
matter of days; the recovery period (during which your vision is blurry) is
typically 3-5 days, during which time you treat your eyes with eye drops.  After
a week, your vision should be clear, and as good as it was while you were wearing
your glasses/contacts.

The recovery period depends on how bad your eyesight was to begin with; the worse
off it was, the more incisions they will need to make, and so the more time your
eye will need to heal itself.  Other than the first day, there is usually no pain
associated with the surgery (even the first day's pain is described just as the
feeling of a bit of sand in your eyes; minor discomfort), though your vision will
be blurry during the recovery period.  You cannot wear glasses or contacts during
this period to correct for it, you just need to deal with the fact that your
vision is blurry as your eye heals.  Take the day off of work, and expect to be
relatively reclusive for the weekend.

The one person who had PRK done did it because he was a secret service agent. 
The secret service has a policy that invasive eye surgery disqualifies you, but
since PRK is only a laser that affects the surface of the eye, it is considered
OK.

For PRK, the recovery period again depends on how much they needed to correct
your vision, but unlike LASIK, they are talking about a recovery period that is
measured in weeks, not days.  Because the correction is done on the surface
instead of inside the eye, you also have to wear a protective contact lens over
your eye for the first 3 days after your surgery, and use drops in your eyes to
help promote the healing for several months.

The bottom line is that 3 months down the road, your vision will be the same
whether you opt for PRK or LASIK, but LASIK will get you there quicker.  My take
on it is that I don't like the idea of having a slice cut in my eye, but I was
assured that I'd be anesthetized, and the entire procedure is very short (and the
cut microscopic, just big enough for a laser beam to get through).  Because you
have to wear a contact lens after using PRK anyway, I'm leaning towards being
brave and going with LASIK (for me, it's brave, I hate the idea of a cut in my
eye, even if it's microscopic).

I'm pretty sure that I'm going to go ahead and have this done, when I have the
money to do it.  The procedure involves three stages:

a) The pre-exam where they explain it all to you and make sure you are a
candidate for laser vision correction (this is free, I've already done it)

b) A pre-op where they map your eyes with a computer to determine the exact
nature of the cuts to make

c) The actual surgery (which is supposed to last no more than 30 minutes) --
you'll need to take the day to recover, though, because your vision will be
blurry.

There are also a number of quick follow up visits in the year following the
surgery, to make sure all is proceeding well.  I'll write up my experience with
it all in case it'll be of use to you.  Hopefully the next time I write to you
about this, it'll be without glasses.

.....

Other strange adventures, stories, and pictures can be found here. If you have any questions, please feel free to email me at: andrew@AmbrosiaSW.com

Andrew Welch / el Presidente / Ambrosia Software, Inc.