Essay: Laser Vision!

(Notes on Eye Laser Surgery)

2005-2006,

As legend has it, myopia correction surgery was the product of an accidental discovery: In the early seventies, a Russian teenager got in a fight and managed to get glass fragments from his glasses embedded in his eyes. Weeks after surgeon Syvatoslav Fyodorov removed the fragments, both of them were surprised to find out that the student’s eyesight had improved! Further research ensued and by the fall of 1974, Fyodorov started performing myopia correction surgeries on patients using a scalpel and a steady hand.

Months later, in unrelated developments, my own genetic code was assembled, with above-average results in most health-related characteristics except one: a predisposition toward heavy myopia.

Thirty years later, these two elements would intersect.

I underwent PRK/LASEK myopia-correction eye laser surgery on May 2nd, 2005. This is a chronicle of my experiences before, during and after the surgery. As I write and revise this paragraph, it has been eighteen months since the surgery and results, while satisfactory, are not ideal. I may have one or two warnings to give.

If you’re looking for medical advice, please go elsewhere. My heavy-duty disclaimer is this: Following any of the instructions below may make you go blind. Health advice should only be considered when it comes from qualified professionals. Consider what follows as the musings of “some guy on the Internet who underwent the procedure”.

 

Twenty years under the lenses

I got my first pair of glasses in 1985: grade six, age ten. Oh yes, I know all about the teasing and the way glasses set you apart in a crowd of kids who don’t need them. But given my penchant for cultivating an elitist intellectual image, it all ended up working for me more often than it didn’t. (No, I never had a pair of glasses broken by mischief or accident.)

I knew about eye laser surgery from scientific vulgarization magazines from the late eighties, but started hearing about it as a common procedure in the late nineties, and by 2000 was convinced that I’d get it sooner or later. Later, as it turns out: By 2000, there were still a few problems with the procedure (halos, under/overcorrection, more risks for patients with high myopia), my finances couldn’t handle it and it seemed to me as if the “sweet spot” of age versus surgery was about thirty, at which point vision is stable, but still young enough to recover gracefully and enjoy eyeglass-free vision for another ten or fifteen years before reading glasses make their appearance.

By 2005, pieces were in place: Technical problems were fast disappearing from the field with the introduction of wavefront technology. My own financial situation was secure, thanks to a paid-off mortgage. More importantly, my vision was stable after two minor changes in prescription in 2002 and 2004. Furthermore, other people around me were also getting the surgery without any complication, giving me access to a pool of experience I could learn from.

As far as selecting a place to undergo the surgery, Ottawa offered many options, but there was really one choice for me: While I heard good things about the LasikMD Clinic and the Focus Eye Center, my ophthalmologist immediately suggested the Ottawa Hospital Eye Institute. As part of the University of Ottawa and the Ottawa Hospital, the Eye Institute is a research unit with access to the latest technology and procedures. It’s much pricier than the alternatives, but whenever my vision is concerned; I’d rather have absolute peace of mind than a good deal. (as of May 2005, cost was a flat 1500$-per-eye fee, with I believe is at least double what’s being charged elsewhere)

So I called and got an appointment on March 24th.

 

A first look

I can, and will say plenty of nice things about the Eye Institute, but there’s no escaping the fact that it’s still part of a sprawling mega-hospital and suffers as such: It’s constantly filled with people, it’s far away from free parking, it’s accessible only through a lengthy walk through the entire hospital (and then an elevator ride to the third floor) and, let’s face it, it’s stuck right inside one of the most depressing places in the city. Things were made worse in 2005 by the construction of a dedicated ophthalmology wing: Access doors were blocked, jackhammers were heard and you had the feeling of an Institute just ready to move out of its overstrained lodgings. Things will undoubtedly have changed by the time you read this: The new wing should be ready in early 2007, and will allow the Eye Institute to move into more spacious quarters.

Hopefully, this move will allow them to improve the patient experience. At this moment, there is almost always a feeling of being stuck in an assembly line, especially during the first visit. Hello, please wait, look here, blink-blink-blink, read this, look there, please wait, here’s a few things you have to understand, any questions?, here’s your second appointment. The first visit is a time for generalities and a winnowing-down of potential patients, all over a backdrop of dozens of other people waiting in the reception area for this or that exotic optical condition. There are a lot of senior citizens. It’s all very depressing.

On the other hand, a techno-nerd like me could really get interested into the fancy new toys of ophthalmology. There’s no more of that “read this chart (click) is this better? (click) is this worse?” subjective nonsense. It’s all mathematical-models-made-by-machines now. The three tests I remember were

  • staring in a machine to see a red light (this is the wavefront machine, which shines a light in your eyes and then mathematically maps your cornea; you get a printout with your exact prescription),
  • staring in a machine as a blue light rotated (this, I believe, to map out the curvature of your eye) and
  • staring in another machine as an image of a rosetta steadily focused (I have no idea what this was about; maybe testing speed of focusing?) (After staring in this machine in every one of my subsequent checkups, it may be a tool to evaluate the clarity of the cornea)

Throughout the process, you’re handled by a series of doctors and nurses in kind of a juggling operation. At some point, you’re given a guide to read (very general information, most of which is available on the Eye Institute web site) and then, later, most prospective first-visit patients are herded in a small conference room where a nurse explains in much better detail what’s involved in the procedure. More importantly, she also answers questions.

After that, you’re given the results of your tests. I had been worried about that; my ophthalmologist had warned me, for instance, that my moderately high myopia (5.50 in one eye and 5.25 in the other, if that means anything to you) could be a problem, as could be the large size of my pupils. As it turns out, technology had moved on: As the doctor explained to me, laser correction mechanisms were now completely reliable until +6 diopters of myopia, and my pupils were never mentioned once they were measured. But, as the doctor said, “you may not be a good candidate for eye correction surgery.”

Whaaat?

There was, as it turns out, a complication: my eyeballs were deformed. No panic there; roughly forty percent of the population suffers from astigmatism, a condition in which the eyeball is slightly squashed in the head, producing some aberrations. I knew about it; my ophthalmologist had detected slight degrees of astigmatism during my regular checkups. But surely that couldn’t
be a problem, right?

Probably not. But they’d like to run a few more tests to be sure. How about coming in for a second visit (the usual pre-operation check-up) and letting the senior doctors take a look at it?

 

Some technical details

I’m sorry to bring in the technical details, but this information is essential to understand the next part. First, you must grasp that there are at least three different kinds of eye surgery.

The first one, Radial Keratotomy (RK), is the oldest, the grossest and -by now- the least practiced. It consists in physically cutting into your cornea with a fine scalpel. It’s what good old Doc Fyodorov invented in the 1970s. As you may expect, this type of procedure has now been almost completely been replaced by laser-based surgery, though it’s worth noting that it was being performed as late as the mid-nineties. (A friend of mine had it performed in, I believe, 1992-1993 and got ten good glasses-free years out of it. She doesn’t have any regrets.)

The current refinement of this procedure is called Photorefractive Keratectomy (PRK). It is, essentially, the same type of surgery except performed with an eximer laser. During the operation, the layer of epithelial cells that covers your eyes is removed and the laser cuts incisions on the surface of the cornea. Then you have to wait weeks until the epithelial cells regenerate themselves and the cornea readjusts into its new shape. (A refinement of this procedure is called LASEK, but don’t confuse it with what follows.)

Laser Intrastromal Keratomileusis (LASIK) is a newer and different type of procedure. An ultra-thin blade is used to cut open part of your cornea, creating a “flap” that is gently peeled open. An eximer laser is then used to correct your vision defects inside the cornea. Finally, the flap is replaced and the operation is over.

You may ask yourself why people would voluntarily elect to have their cornea cut open in LASIK when the less-invasive PRK is also available. The answer is all about recovery time: Patients having undergone LASIK can be up and working in days. PRK, on the other hand, requires weeks of gradual recovery, and it can take up to six months before the results stabilize. On the other hand, well, LASIK introduces new risks in the procedure by the creation of the “flap” and technically leaves permanent lesions, as the cornea never completely regenerates itself and is "held together" by the surface layer of epithelial cells.

As you may expect, I’ve never been a fan of the LASIK procedure. Which is just as well because…

 

A second visit

I’ll be honest; I believe in the influence of the mind on the body because I’ve experienced it time and time again. Examination periods in high school and my first years of university were either accompanied or followed by flu. My eye exams are usually scheduled on days where my eyes surprisingly don’t feel so well. Once I was warned that “there may be something to check”, the next few weeks were plagued by the conviction that there was something wrong with my vision. I became something of an ocular hypochondriac, convinced that there was something off all the time.

All was cleared up during the second visit, scheduled for April 26th. More tests, this time along with anesthetic drops and the infamous “poke-you-in-the-eye” pressure test. Some of those were quite cool: I remember looking in a machine with concentric blue circles (more curvature-of-the-eye stuff). Better: the machine that measures the depth of your cornea while touching your eyeball actually makes a “concentric wave” effect that is reminiscent of those old RKO “radio wave” special effects.

As it turns out, I have mild asymmetric astigmatism, a non-optimal situation that is nevertheless seen in roughly 15-20% of the population: My eyeball is not perfectly round, and is compressed unevenly. If asymmetric astigmatism is detected early on in children, it may be a precursor condition of a fairly nasty (but rare; less than 50-200 cases in 100,000 people) defect called Keratoconus. At my age, though, asymmetric astigmatism is usually stable and is indicative of, well, an asymmetric cornea.

The scary and reassuring part of this is that they’ve only started to diagnose this condition in the past three years, since the introduction of wavefront mapping equipment. While mild asymmetric astigmatism is no big deal in PRK surgeries (current data suggests no difference between results of patient with or without it), it is definitely a show-stopper if what you want is LASIK: Not only does common sense suggest that cutting into an unevenly-shaped cornea is a bad idea, but some evidence suggests that many LASIK regression cases are closely linked with pre-existing asymmetric astigmatism. LASIK weakens the cornea; hence patient with asymmetric astigmatism are actively discouraged from getting that surgery.

But no such counter-indication exists for PRK, and that’s relatively good news given how I wasn’t going for LASIK anyway. The senior doctors at the eye institute concurred that there wasn’t any significant risk given the mildness of my condition and the results obtained by the clinic’s history of PRK procedures.

(Actually, let me qualify that: any laser eye surgery is risky, certainly more so than staying home and not undergoing anything. It requires faith in the system, a bit of audacity and a certain tolerance of risk to actually decide to undergo laser surgery. And you do so without assurance: The thick legal document you have to sign in order to proceed forward is hilariously blunt regarding how many things can go wrong during the recovery period: no one gets zapped in the eye with laser with a guarantee that things will go well. Success rates are ever-improving: latest Eye Institute statistics suggest that since the introduction of wavefront mapping, at least 99% of patients get at least 20/40 driving vision and at least 95% get at least 20/20 perfect vision. If you can tolerate the wait, chances are that the surgery in five years will be safer, easier and cheaper. But can you wait five years before getting rid of your glasses?)

All risks were outlined and explained. I had them write down complicated words on paper so that I could research them myself (indeed, all of their information later checked out when I investigated the condition on the Internet). Frankly, I had made my decision back in 2000; this visit was really only to see if there was a valid reason not to go forward.

So I signed the contract. Next step: The operation on Monday, May 2nd, 2005.

 

Operation Day

If you think you can just waltz in, get zapped and go home, you’ll be disappointed: More tests are made in order to verify that your wavefront measurements are as exact as possible. Then there’s a curiously low-tech “is-this better (click) is this worse?” lens-trying session: As it happens, even the most accurate physical correction is subject to the vagaries of the eye/brain interface: Some people’s vision is wired so that they see “better” with a touch of over-correction or under-correction. The wavefront measurement is then altered slightly to take in account those personal preferences, and (in my case, anyway), to over-correct slightly so that, in years from now, age-related eyesight will gradually ease into better correction.

I was then led, along with another patient and my brother (who would act as my designated driver), into a small waiting room just across the excimer laser room where the magic happens. The nurse on duty then dispensed the required eye-drops, analgesic tablets and mild tranquilizers. During that time, we started hearing a series of clicks coming from the laser room: As it turned out, this was the calibration of the excimer laser. Out of respect for the other patient, I ref
rained from cackling something about “the executioner sharpens his axe” to my brother.

Painkillers are an amusing thing: For someone like me, who’s deeply distrustful of brain-altering chemicals (I seldom take even aspirin), there’s almost a reluctance to even acknowledge that they’re working. I kept testing myself with silly questions like “Am I sleepy?” (No), “Do I want to go out and dance the polka?” (No, but then I never would) and so on, always fearing that I may be one of those freak-metabolism people who can’t be sedated. At some point, the other patient was asked to get up and step into the excimer laser room. “Okay”, she said while rising, “but I’m not sure the painkillers are working.” Minutes later, I knew exactly how she felt.

In retrospect, however, the tranquilizers were doing their job. I should have felt nervous and apprehensive. Instead, I went into the operating room with curiosity, obedience and the sense that everything was all right.

("Please sit in the chair."
"Oh, okay."
"Please stare up at the blinking light."
"Oh, okay."
"Please wait as we zap you in the eye with a high-powered laser."
"Oh, okay.")

I wish I could describe to you the excimer laser apparatus, but there’s not much looking around when it’s your turn on the chair. They make you sit in a long chair, fit you with a sterile cap and an inflatable wraparound pillow, recline the chair until you’re almost perfectly horizontal and then they put you (more specifically, one of your eyes) under the laser.

For the next ten or fifteen minutes, the whole world becomes a ring of light with a blinking orange light in the middle. (Cue “before you die you see… THE RING”) They adjust the positioning of the chair. They apply an optical speculum so that blinking becomes impossible. They ask you to keep staring at the blinking light. Something presses down your eyeball to make sure it doesn’t move (freaky!). They apply an alcohol solution to loosen up the top layer of epithelial cells. They push the layer to one side. Then the laser is pushed near your eye, at about a forty-five degree angle (you’re still looking at the ring and the blinking light). Then there’s the clicking sound, as every click is a laser incision made into your cornea. There is a smell in the air (they say it’s ozone, but there’s also a part of you burning up) and a faint fizzing in your eyeball, a not-unpleasant sensation that you nevertheless never want to experience again. Then they put cold water in your eye to cool down the cornea after the heat of the laser. (Remember what I said about the smell?). Then they refit the layer of cells that had been pushed away. Then they put a contact lens over your eye. All that time, the doctor is saying things like “you’re doing greeeat… couldn’t be better…” and so on. In many ways, it feels a lot like a David Lynch movie. (But, for reference, I’d rather see a David Lynch movie than getting zapped in the eye with a laser again.)

Then they do it again for the other eye.

You step out of the room ten or fifteen minutes later, with a bag of miscellaneous medicine and instructions to show up the next morning for the first post-operation check-up. You’re holding your old glasses in your hand. You gesture to your driver to accompany you.

But there’s something different. Your vision may be bad, blurry and watery, but you can move on your own. And if you look outside, through the windows, you can see more details than you could without your glasses before the operation.

 

The first two days: Monday and Tuesday

All told, the first few days aren’t all that awful, mostly because you’re too sedated to know any better, and you expect things to be so bad that it’s a pleasant surprise when they’re not. I spent a lot of time sleeping, and was happy to find out that I could still move around the house and remain relatively autonomous. It’s not as if I could do anything else, but it was a relief not to have to depend on anyone else during that period.

In between bouts of sleep, I listened to some radio, popped in an audio-book and tried to relax. Having never worn contact lenses before, I became a bit paranoid about them slipping out or even dislodging themselves from their initial position.

As it turned out, my left eye was markedly more irritated than the other one; while there was scarcely any irritation on the right one, the left kept bothering me during the entire first week, to various degrees. My first exam showed good results on the right eye, and markedly blurrier vision on the left one. Neither doctors seemed overly concerned about it. Results were much better during my second exam on Wednesday morning, though results in both eyes would continue to vary relative to one another during the entire recovery period.

 

The third and fourth days: Wednesday and Thursday

Everyone who underwent the PRK procedure warned me about the third and fourth days. Technically, I gather that it’s when the layer of epithelial cells on top of the eyes achieves its initial reconstruction, culminating in the center spot we use most for vision. In practice, it’s a pair of days that are characterized by constant irritation and hypersensitivity to light.

By “constant irritation”, I’m talking about a feeling much like having eyelashes stuck in your eye for a 48-hours period. No scratching is allowed (and you’ll regret it if you try, as I found out) and the eye-drops aren’t much help. It fades away, comes back, fades away slightly, etc.

By “hypersensitivity to light”, I mean that you flinch and turn away from any light source. I mean that you’ll find yourself duct-taping dark towels over closed plastic blinds. I mean that you turn down the brightness of your TV screen if you’re in the same room.

I once found myself pressing my forehead against the wall and wondering “is this going to end?” even knowing that this was a pretty lousy period for everyone. Doing research on the Internet, I once found this great post:

The pain that I experienced on that day was HUGE and my pain threshold is as tolerant as the next persons. At some point (…) I remember praying "please God, I don’t care if I am blind I just want this pain to go away" (AND I MEANT IT).

While I never experienced that level of pain (irritation is a better word), I certainly understood the feeling.

The interesting thing is that the doctors will see you at the beginning of the third day (Wednesday), check out that everything is fantastic and then offer you the opportunity to skip the following day (Thursday, day four) and see you on Friday (day five). It is my belief that they don’t make the offer out of kindness; they make it because they know you’ll be a wreck on Thursday morning, and there’s nothing they can do to help you. In these circumstance, stay home if they suggest it and save everyone some trouble.

I spent those third and fourth days listening to audio-books, to radio, to the TV, and to DVD audio commentaries on movies I had already seen. It’s a bad time, but as you know, hey, no-pain-no-gain.

 

The fifth day and first weekend

Things sort of magically readjust themselves during the night between the fourth and fifth day. On Friday, things suddenly seem so much better: You can see a little bit more clearly, the hypersensitivity to light starts to fade (though it doesn’t go away until sometime during the weekend) and best of all, the irritation fades to a comparatively pleasant itchiness.

The Friday morning check-up is, like most of the check-ups, just a formality. In my case, things were going well (despite the fact that one eye was doing much better than the other one) and the doctors seemed pleased with t
he results. They didn’t take out the contacts, though, and that was a minor defeat: By that time, the contacts were getting dirty and uncomfortable, even more so for someone who hadn’t ever worn any. “But you don’t understand!” I wanted to say “I can’t keep those one for much longer!”

As it turned out, I could: The next check-up was scheduled for Monday morning. At least the weekend was uneventful. I still didn’t feel well enough to go play outside (someone else had to handle the lawn mower), but my vision kept generally improving and I was feeling a lot better than before. I continued to play the DVD commentaries on films I had already seen, though by this time it was possible to look at the TV for ever-longer period of times.

I could even start using the computer for brief periods, though my left eye kept suffering from diffuse luminescence (basically, often-sharper vision than the right eye, but it was if everything was covered in a veil of brighter light). I would come to recognize this as a precursor to longer-lasting halo problems.

There was one bad moment, though, during the night from Saturday to Sunday, where I basically couldn’t get to sleep: Not a physical problem (though the contacts were an issue) but an unintended consequence of spending a week napping and sleeping a lot: at some point, over-sleeping catches up and there’s not a lot you can do. Call it an unintended consequence of being flat on one’s back for a week. Another unintended consequence is that it’s difficult to switch to a completely-sedentary life and keep eating like before; it took me months to get rid of the extra weight accumulated during my convalescence.

Amusingly enough, I started noticing brief but amazingly encouraging moments of almost-perfect vision right after using eye-drops: The soft contact lenses, along with the liquid layer of eye-drop solution, briefly made sort of a “perfect lens” through which I could temporarily make out amazing detail. This was a welcome comfort as I kept wondering “is this going to improve?”

 

One week later

The Monday afternoon check-up went well: Doctors seemed satisfied with the progress of my recovery and removed my contacts. There wasn’t much of an improvement at longer range, but I immediately started noticing that my closer-range vision was far more stable than it had been with the contacts on.

I have discussed how my left eye kept giving me problems during the entire first week, but this time it’s my right eye that started acting up right after the removal of the contact lenses. Constant irritation, as if there was an eyelash stuck to the eyeball. Everything evens out, I guess…

The scariest thing about this one-week visit, however, was that the next one was scheduled three weeks later. I was warned of possible fluctuations in the weeks ahead and then sent home. Go ahead and fly, my little bird. "You don’t understand," I wanted to say, "I’m not ready to do anything!" ("Sure you are," they probably would have said, "Now shoo.")

After a brief stop at the General Hospital optometrist to buy my first-eve pair of sunglasses (during which the curious optometrist idly asked me to read a chart and generously estimated my vision to 20/25, though a weak 20/40 would have been closer to reality), I actually felt well enough for a brief bout of shopping. (I must have been quite a spectacle, squinting at DVDs half a meter away!)

 

The second week

When I asked doctors how long I had to take off from work in medical leave after undergoing the surgery, the answer essentially boiled down to “you must take off three or four days, you should take off at least one week and if you can do it, stay away for two weeks.” I concur; while the second week feels fantastic compared to the first, it’s also in many ways a very frustrating period.

For one thing, your initial progress slows down to a crawl. It takes time for the eye to rebuild itself, to re-adjust itself and for the brain to start being comfortable with this new pair of eyes. Even as expectations shoot up, progress becomes more erratic. Vision varies a lot, going from “wow! I can see that!” to “ooh no, it’s all blurry.” A lot of it becomes dependent on eye fatigue. Close-up vision will be fine one moment, and shaky the next one.

The only remedy is to stay home, keep listening to things and slowly reintegrate normal life. The second week is a preview of what the next few months will be. No one recovers from PRK/LASEK eye laser surgery in a few days: it takes time, there’s not much to do to hurry the process and it’s difficult to avoid frustration even in the best of circumstances.

I was warned against this second week as much as I was warned about the third-fourth days combo. I wanted to get back to reading and normal living, but I found myself stuck against blurry and inconsistent vision.

Still, I was able to drive to work on Wednesday (day ten) without problems and deliver a well-received presentation that had been scheduled before my surgery. Satisfying, but exhausting: all told, take at least those two weeks off and enjoy the leave.

 

Back at work: Third, fourth and fifth week

Those two weeks off are not the end of recovery. They’re the bare minimum it takes before being able to function again in an office environment, and even then my return back to work on the third week was shaky. My vision was simultaneously good enough to allow me to work again, and bad enough that I had to bump down the resolution on my monitor, stick reading material far closer to my eyes than previously and go "ergh!" while moving through the blurry corridors. Low-light vision was also pretty bad, what with starbursts and halos bathing everything in soft white gauze in soft interior lighting conditions. Movie-watching also became difficult due to the halos: a definitive pain for someone who actually reviews movies professionally. I tried (and succeeded) not to be stuck driving at night.

These are all normal symptoms. Basically, you’re still recovering and shouldn’t expect much. It’s already a minor miracle that you’re back to work; don’t complain too much. Everyone undergoes the same thing.

Still, it is immensely frustrating. I my case, difficulties were compounded by some pretty bad vertical ghosting in the left eye (along with some not-so bad horizontal ghosting in the right): The ghosting effect wasn’t too bad in natural-color vision, but precise visual cues, like letters, were frustratingly difficult to read. Leisure reading was possible, but for the entire third week, I could only read large-format hard-covers in good lighting conditions, and even then rely on context to form word-pictures. Part of the frustration of ghosting was its steady-but-flickering nature. I remember reading something on the bus and then, for a glorious ten-second moment, marveling at how the ghosting had disappeared and I could see the grain of the paper. Cautious experimentation lessened the effect of ghosting through the eyeball-pressure trick and the light-bending finger trick. (Those are old "I forgot my glasses" tricks; don’t try them at home!) I admit that the ghosting was the worst part of this middle-stage recovery: It messed with reading and was a constant reminder that something was definitely wrong.

I thought at some point that my peripheral vision had a wavy quality, but upon investigation it turned out that those were simply my eyelashes interfering with my squinty peripheral vision. I had simply never noticed that issue before while I had glasses. (Squint and try it!)

My brand-new sunglasses proved very, very useful. While my photosensitivity never attained the levels of my first few days, some of it stayed and I found myself preferring sunglasses even on overcast days.

One symptom I expected and d
id not
experience was headaches from vision problems. From the start of the third week, I was able to go back to my thirty-minutes reading regimen on the bus at a slower pace, but without any of the headaches I was expecting. Work wasn’t a problem either: at the end of my eight-hour days, my vision was a bit more inconsistent, but still no headaches.

My first-month checkup took place on June 4th, and went quite well: tests revealed no problems, and my recovery curve was exactly where it should have been at the time. Eye tests suggested that I had 20/20 vision in my "good" right eye and 20/25 in the left eye most afflicted by ghosting. Not bad, but still a way away from the 20/16 I was used to.

As you might expect, I used my first-month checkup to complain copiously about the problems I was having. The doctor chuckled at my analogy of the frog thrown in a cooling pot and said "you realize that all of this is normal at this point, right?" "Yes, I know. But I still want to complain!"

 

The second month: fifth through ninth weeks

As the universe had it, my worst ghosting (vertical in the left eye) issues abated over a thirty-six hours period right after my first-month checkup. While traces of it remained (and some horizontal ghosting in the right eye) for some time, the worst was over, and I saw the difference immediately in how easier my reading suddenly became.

This being out of the way, the second month was much easier to bear. Some ghosting, some photosensitivity, some fatigue remained, but the biggest issue for some time remained the halos. A trip to Calgary for tourism during the eighth week proved that I was back to more-or-less normal vision in normal light: I had been mildly concerned that my bit of tourism in the Rockies would be negatively affected by my recovery, but I spent my day mostly not thinking about it. The only time where I did think about it was in the low-light meeting rooms of the conference I was attending: haloes struck back!

My second-month check-up also went well, the doctors being quite pleased with my recovery at that point in time. I checked out at 20/20 in both eyes and even kept my complaining to a minimal level. I was told (again) that the haloes were a normal occurrence given my large pupils.

 

End of recovery: Third through sixth months

My next check-up took place on August 2nd, exactly three months after the surgery. I wasn’t in the best of mood (had to wait an hour and 45 minutes in the aptly-named "waiting room" as one senior doctor had to shoulder the workload of two senior doctors) and I felt inclined to be pickier than usual (halo problems stable, more vertical ghosting in the right eye), but the news were good, all things considered.

For one thing, the numbers indicated that the eyes themselves were in excellent shape. For another, I was evaluated at 20/20 in my (ghosting-afflicted) right eye, and 20/15 in the other. The harried doctor seemed amused at my concerns and explained that ghosting is usually a perception problem rather than an optical problem, caused by visual re-adaptation of the mind more than tissue recovery. In other words, my eyes were fine but my brain was not, which threw my whole self-image upside down.

The next meeting was scheduled for November, at the six-months mark. Needless to say, I spent most of that time hoping to get rid of the remaining halo and ghosting issues. As far as success went, however…

 

One year later: The new normal

If this was a Hollywood movie, the laser surgery would either have given me superpowers, or the self-confidence to change my life, make millions, marry the girl and end up on the cover of Time Magazine.

The reality is very different. At some point, things stop improving and it’s time to get used to the new normal.

The new normal, in my case, is something between 20/20 and 20/25 vision with a number of optical artefacts. It varies a lot: My left eye remains markedly better than the right one, and my vision is usually far better during the mornings than the evenings. Some days are better than others, and the summers are proving to be better than the ultra-dry winters.

Basically, here are the remaining problems:

Eye fatigue: My eyes are now the first part of me to feel when I’m tired. Worse: they’re now far less easy to adapt going from long sessions of computer work to normal vision: My colleagues can be quite blurred at times. My vision while driving to work is far better than coming back.

Dry eyes: If I recall correctly, laser surgery ends up damaging many of the nerve endings in the eye that tell the rest of the body to produce tears. The result of that particular bti of damage is that it’s far more frequent to feel dry eyes, whether it’s when waking up (don’t open your eyes too quickly!) or at the end of the day. Liquid tears can produce some spectacular improvements, but it’s not cool to depend on such things.

Haloes: Due to the pupil-size issue, the laser surgery affects most of the cornea, but not the outer edges that are essential when your pupils expand. As a result, I see haloes in low-light conditions. What’s low-light? Basically, any situation in which a camera will flash is a situation where my vision is afflicted by starbursts (precise light sources) and haleos (diffuse or large light sources.) There isn’t much to do to correct this, though I have notices that haloes are part of the whole "package deal" of issues that are either worse or better based on eye fatigue, dryness, etc.

Ghosting: I’m pretty sure that the assymetrical astigmatism issue is to blame for this. Basically, I still see some ghosting, though the degree of it varies according to the time of the day and the amount of ambient light. Ghosting is somewhat lessened by eye-drops.

Slight myopia: *sigh*… there’s no getting around it: I still have some residual myopia, especially in my left eye. No amount of rest or eye drops will cure that particular annoyance, though it’s slight enough that I would basically need the smallest degree of correction in any potential glasses.

Amusingly enough, I once described my symptoms to an older acquaintance who never underwent laser surgery, and they basically said "what you’re describing is being old". Maybe there’s something to this: does laser eye surgery age your eyes by a good ten to fifteen years?

 

Conclusion?

Well, the good news are that I don’t regret the surgery. I see well enough to function well without glasses, and that *was* my original wish. The remaining problems are very annoying, but I’ll live with them.

On the other hand, I can see me getting new "optional" glasses shortly, if only because I still can’t stand having a vision that’s less than completely perfect.

If you’re thinking about getting the surgery yourself, I won’t try to sway you one side or the other. Do your research, scare yourself silly with the worst-case scenario and ask plenty of questions. Ask even more questions if, like me, you suffer from the large-pupil/assymetrical-astigmatism combo. Grill your doctor on the latest innovations. I remain convinced that the technology is getting better all the time, and that my problems are probably artefacts of the technology as it existed in early 2005. Heck, it’s entirely possible that I may go under the laser again in ten or twenty years to fix those lasting artefacts.

And that time, I may end up with a Hollywood ending.

 

 

Last Updated:
October 2006

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