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January 15, 2013 / jeremycarr

A Considered Approach to LASIK

Disclaimer- What follows is a personal account of my experience with LASIK.  Carry a big grain of salt, do your own research, go to a reputable doctor.  Consider yourself warned.

enhanced-buzz-30866-1270680807-39LASIK.  The promised land for anyone with sub 20/20 vision.  Having dumped some money into my Flex account last year, read a ton of research, and spoken with dozens of people, I went through with LASIK surgery 5 weeks ago.  Results?  Couldn’t be happier!  Below is a deconstruction of the experience.

Procedure Overview

LASIK consists of 2 pre-op visits, the operation, and several post-op visits.  In the pre-op visits, the eye doctor will take measurements of your eye to assess eligibility for LASIK (flap+reshaping) vs PRK (no flap), estimate how much your vision will improve, and evaluate risk factors.  The LASIK operation itself takes less than 5 minutes- create a flap, reshape the cornea, and replace the flap.  Patients typically can return to normal day-to-day activity after 24 hours, while full healing takes 3-6 months.

Benefits, Risk, Technology, Cost?

  • Benefits- I wore glasses 90%+ of the time since I spend all day staring at glowing rectangles, and contacts dry out my eyes.  Switching to contacts for exercise was a sobering reminder of just how much peripheral vision I was losing due to glasses.  And yes, it’s a minor inconvenience to have to don double glasses for 3d movies, but consider rock climbing (being stuck blind on the wall after losing glasses to a 100 foot drop… still puts butterflies in my stomach) or mountaineering (fingers, used to put in/take out contacts, can get awfully gross after a week on the mountainside)…  End of the day, glasses and contacts don’t REALLY bother me, but they could be quite annoying.  Aside from which LASIK frequently results in BETTER than 20/20 vision…
  • Risks- Assuming you’re eligible for LASIK (age, stable vision, no dry eye, etc),the three primary short term risks my research turned up were glare, halos, and dry eye.  Doctors assess your risk likelihood for these side effects pre-operation, I turned out to be low risk.  Longer term, it’s rumored that LASIK can accelerate the need for reading glasses after age 40.  Turns out this is unrelated to LASIK, aside from which I had already been wearing glasses every day.  Finally, since LASIK isn’t a one-time deal and “touch up” operations are possible, I’m confident with the precision of the modern procedure.
  • lasik_1smTechnology- Three major technology developments are worth highlighting since LASIK’s introduction in 1989.  Early LASIK procedures employed microkeratomes (blade) to create the flap resulting in the majority of complications; after 1999 using IntraLase (laser) to create the flap is safer and nearly ubiquitous.  Second, standard LASIK reshapes the eye based on prescription alone, resulting in a loss of precision. Custom or wavefront LASIK maps the optics of your eye using 300+ measurements and reshapes accordingly, decreasing risk and potentially improving contrast sensitivity and fine detail.  Lastly, technology borrowed from missile tracking systems tracks your eye during the procedure itself, ensuring tiny or large eye movements don’t affect the procedure.
  • Cost- LASIK is a discretionary medical procedure, and typically not covered by insurance.  Using the latest technology (Wavefront and IntraLase) costs an additional few hundred dollars/eye.  To give a ballpark idea of prices- India $250/eye.  Singapore $1000/eye.  Great US doctor $2000/eye.  Dr. Edward Manche of the Stanford Laser Center $3000/eye.  Let’s just say OTHER eye doctors go to Manche for their surgery.  Given the importance of vision to my life (understatement), my goal was to spend as much as possible.  I chose Manche.

Before

There are 1 or 2 pre-operation visits. Most clinics offer a free consultation to take measurements of your eye, and discuss whether you’re eligible for LASIK.  Come armed with questions.  If you decide to go ahead with the procedure, there will typically be a pre-operation final checkup in addition to the consultation.  In my case, I just had one visit prior to the day of the surgery.

During

Moretsky-Cassidy-History-of-LASIKThe operation takes less than 5 mins, make sure to bring someone to drive you home.  Here’s a detailed account of the procedure.  The entire procedure is essentially cut a flap in each eye, open flap, reshape cornea, replace flap for each eye.  Notable events- the flap cutting procedure uses suction to keep your eye steady; practically speaking it doesn’t hurt due to the anesthetics, but it was still a bit disconcerting since I felt a fair amount of pressure on my eye and the world went dark.  The actual reshaping laser took ~10 second per eye.  It didn’t hurt, but it was interesting to note that I could faintly smell some burning.  Lastly, the doctor lifts and replaces the flap for each eye using a tiny device.  Having my cornea exposed with no eye flap for protection… I (irrationally) felt incredibly vulnerable during this part of the procedure.

After

I could see immediatelyafter the operation.  Walking out of the office, the world was a little blurry, but my vision was already noticeably better than before the procedure…  The first 30 minutes, my eyes couldn’t really feel anything due to numbing drops.  After 4 hours, it felt like there was a little something in my eye; or when my eyes would get very tired.  NO EYE RUBBING, didn’t watch TV, tried to sleep (wearing my protective glasses) as much as possible…  At this point, the main actual risk was accidentally moving your flap from rubbing my eyes.  I was told “this is very painful, you will know if you’ve done it.”

The following day, I woke up a little groggy, but was able to see clearly.  Like really really clearly.  Vision was now limited by the number of pixels I could see, not resolution.  Drove myself to my 1-day checkup… 20/15 vision, psyched!

The following weeks, I used my prescribed eye drops and followed the post-prescription procedures. Began exercising again after a week and went scuba diving after 3 weeks.  My 1 month checkup was uneventful, halo/glare has gone away at this point, and I still see incredibly clearly.  A minor nuance I’ve noticed is my eyes can occasionally take a fraction of a second to focus on an object; Manche assures me this is supposed to go away with time.

Wrap Up

LASIK has unequivocally changed my life for the better.  I don’t need to worry about glasses or contacts, and improved vision has transformed the world into a richer, more vibrant place.  With mature modern LASIK technology and relatively low risk, do yourself a favor and get an initial consultation if you’ve been thinking about LASIK.

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2 Comments

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