Education
good vision a whole lot more than y'all. Starting at the age of 12, my days began with
vision fuzzier than an Al Gore mathematical analysis. That is, until I had my eyes
zapped by the friendly doctors at Laser Vision Centers in St. Louis. Why'd I do it? It's
sort of like asking a guy in a wheelchair if he'd spend $3,000 and an hour of his time
in exchange for walking again. Poor vision is a handicap, and LASIK is an easy fix.
So I called the Laser Vision office, got educated, and ended up with perfect vision for
the first time in 18 years.
Poor Vision + Dirt Bikes = Expensive
One afternoon in 1995, while stranded on a muddy hillside with a dozen other racers,
I received my first lesson in what corrected vision can do for you in the woods. I took
off my fogged-up goggles, began dragging my bike back down the hill, and got hit
with mud spray from a guy charging up the hill. A piece of mud shot into my eye and
that was the last I saw of a $75 contact lens. After that, switching to disposables for
races kept the replacement costs down, but I was never completely satisfied with the
clarity of soft lenses. And when I was riding, the contacts dried out my eyes and I had
to remember to blink frequently. So the dirt-bike-related issues were part of the
equation that led me to LASIK.
LASIK Education
In the 1990's, a guy I knew had the old-style RK procedure, where they actually cut
your eyeballs with small knives. To me, that would rank right up there with having my
bowels surgically removed. Actually, it worked out good for him. With RK, the idea
was to make some cuts that would weaken the cornea so it flattened out and
improved distance vision. Problem was, it permanently weakened the eyes to the
point that eye protection was highly recommended for contact sports. We've come a
long way since then, and LASIK is now the most common corrective surgery for
myopia. The concept is fairly simple: reshape the cornea back to the way it was in
your pre-corrective days. It's done with a laser that sculpts the cornea.
LASIK prices have generally come down from 3-5 years ago when the procedure was
fairly new. I've heard of prices as low as $500 per eye and as high as $2,500 per
eye. Laser Vision's cost was $1,500/eye. For the cost-conscious, look for referral
discounts or choose a less popular day for surgery (early in the week) and you might
get the cost reduced a little. For me, it wasn't the cost as much as is was my comfort
with the doctor performing the surgery and the equipment that was used. Here are
some of the key questions to ask:
-- How many procedures has the doctor performed? (I'd be comfortable with 1,000 or
more)
-- What are the doctor's qualifications and background?
-- Does the cost of surgery include post-op visits? (it should)
-- What percentage of patients have to come back for additional corrective
procedures? (i.e. problems with the procedure that required another session under
the laser)
-- What kind of equipment is used, how new is it, and what is the maximum pupil size
that the laser can handle? (if the laser resembles the rifle-mounted scope you saw in
last month's Guns & Ammo, move on to the next doctor)
Even if you've asked all the questions and were satisfied with the responses, be
cautious if the doctor downplays the risks and/or encourages you to proceed even
though you have above-average risk of side effects. Most doctors are very upfront in
explaining the risks and will usually recommend other options if you're not a good
candidate, but a small minority are all about volume.
The Procedure
On my first visit to Laser Vision, I watched a cool video of someone getting his eyes
worked on. The procedure doesn't last long - maybe 5 minutes per eye. Dr. Steve
Wexler and his crew have done about 10,000 of these and they don't waste any time.
I had them set up my pre-op exam for two days before the actual surgery and I was
instructed to take out my gas permeable contact lenses 3 weeks ahead of the exam.
Hello, glasses. The pre-op exam is where they take measurements of the eye and
make sure that you're a good candidate. Most people qualify just fine, but if your
corneas are too thin, you probably won't want to have LASIK. Pupil diameter is also
taken into consideration, as those with wider pupils have higher risk of side effects
like "halo" and "starburst" (most noticeable at night, when you look at a light fixture
and see a glow around the light).
The pre-op exam was cool because they dilated my eyes and I looked like I'd just got
back from a 24-hour rave. This lasted well into the following day, and when I
mentioned the rave comparison to my banking co-workers, they didn't know what they
hell I was talking about (they just thought I was stoned). Overall, my pre-op exam
was good, except that one pupil was just a little large. The laser is designed for a
maximum pupil diameter of something like 6.5mm, and I was 7.0mm in one eye.
However, they assured me that this was a relatively minor difference that shouldn't
cause any undue risk of side effects. So I went ahead with the scheduled surgery
two days later.
The Day My Life Changed
On a Friday morning, my friend Resmi drove me to the office. She and her husband
both had LASIK performed by Laser Vision Centers and highly recommended Dr.
Wexler's gang. Patients are not allowed to drive home afterwards, for a couple a
reasons. They administer half a pill of valium to help you relax before the procedure.
The half-valium isn't enough to have much noticeable effect, but regardless, you are
technically drugged up so driving is out. Afterwards they tape on some cool-looking
eye shields (would make that Boner dude from U2 proud) to keep foreign objects out
of your eyes, which distorts vision. Along with the drugs and distortions, some
people's vision can be a little fuzzy right after the procedure, before the eyes have a
chance to heal. So everyone leaves the office with a driver.
Friday is the most popular day to have LASIK because recovery can take place over
the weekend. Most people are back at work the following Monday. I came in at 8:00
a.m. and was given my half-Valium (the other half of the pill was supposed to be for
when I got home, but I didn't use it). Even without the Valium I didn't really feel tense
or nervous, since several of my friends and co-workers have had LASIK. Hearing
their stories gave me a pretty good idea of what to expect. I was also given some
eye-numbing drops and a lovely hair net to wear throughout the procedure.
At 8:30 a.m. I entered the "laser room" and lay down on a comfortable, fully-reclining
table. One eye was taped shut, and with the other eye I was instructed to focus on a
flashing red light above me. The first step was taping back my eyelashes to keep
them out of the way. Next, a device was put around the eye to keep the eyelids wide
open. The pressure was a little uncomfortable, but I got used to it. Along with this
was plenty of lubricating liquid to keep the eye moist. Another device was placed on
top of the pupil/cornea area, the purpose of which was to cut a thin "flap" to give the
laser access to the cornea (note: I'm telling this the way I understood it...the folks at
Laser Vision can explain it a whole lot better). For a moment, I lost vision and saw
nothing but black "sky" and shooting red stars. A moment later my vision returned
and I focused intently on the red light while they fired the laser into my eye for about
20 seconds. The "flap" was put back into place, the instruments removed from the
eye, and they did the same thing to the other eye.
Afterwards, eye shields were taped to my face and I was sent home. On the way out,
I deposited my glasses in a box full of eyewear from some of the many people who
left the office with fully corrected vision. As instructed, I tried to keep my eyes closed
for the next 12 hours, which wasn't too hard. I went to sleep for awhile, listened to
some music, and talked on the phone. I had some burning for a couple of hours
after the numbing drops wore off, but nothing unbearable.
The Follow-Up
The next morning I went back for my day-after exam and had 20/20 vision in the right
eye and 20/25 in the left eye. At the 3-day exam my vision was perfect. My previous
vision was 20/400, which means I could see at 20 feet what a person with normal
vision could see at 400 feet (the prescription numbers were something like 3.50 and
4.00).
For one week after the procedure, I used two sets of eye drops four times a day. One
was an antibiotic and the other was an anti-inflammatory. I also used
non-preservative lubricating drops for when my eyes became dry (which was pretty
frequent) and some gel-type lubricant at night. I was back at work the next week and
felt pretty good unless I spent too much time at the computer (had to curb the at-work
web surfing). There was some variation in the quality of vision for the first couple
weeks afterwards, but that was usually a result of dry eyes.
The Conclusion
Six months later, I'm generally satisfied with my 20/20 vision. At night, I do get the
"starburst" effect when looking at lights, which is kind of annoying when I drive.
Staring at computer screens for an extended period makes my eyes more dry and
tired than they used to be, and I'm still fighting dryness at night. But the benefits far
outweight the minor inconveniences, especially when I'm outside in windy or dusty
conditions. For dirt biking, I never have to worry about a dry contact lens, or worse,
losing a contact lens. I consider LASIK to be one of the best investments I've ever
made.
Update 5/19/03
It's been about 16 months since LASIK and my eyes are great. Depending on the
days I had them tested, my eyes were never worse than 20/25. The dryness that
persisted for the first 6 months after the procedure went away shortly thereafter . I
was never so happy to wake up in the morning with crud in my eyes. I still have some
"starburst" at night, but I'm used to it. The benefits far outweigh the trade-offs.
