Sunday, February 23, 2014

LASIK - Day 1

As I mentioned last month, I decided to finally undergo LASIK surgery to improve my eyesight. I had the surgery yesterday.

It really started on Wednesday three days ago, when I started on antibiotic eyedrops. The whole idea had felt distant up until then, but now it really hit me that yes, someone will soon clamp down my eyeballs, slice off the surface, then burn off bits of the eye with a laser(1). I know it's quite safe but that didn't stop me from worrying about it.

Saturday morning we took the train to Kobe and the clinic. I tried to be calm, but in just another hour I'd get tied up into a chair while a crazed madman in a bloodied butcher apron gouges out my eyeballs with a chainsaw, then sears the gaping holes with a blowtorch(2). I was actually more nervous than when I took out my impacted wisdom tooth last year. Your eyes feel very personal, very vulnerable. And with dental work I know what to expect(3) but this is the first time I've had anything medical happen to my eyes.

At the clinic I checked in, paid and gave them my consent form. The counsellor went through the procedure and possible consequences again. I got a pair of protective glasses for the first week and some eyedrops; in addition to the antibiotic I already used I got an anti-inflammatory drug and a moisturizer to take four times a day. She gave me a painkiller, then led me to the waiting area where I kept fidgeting nervously until my name was called(4).

In the dimly lit prep room I got a gown and a hair cover (no photography allowed, unfortunately). A nurse gave me a set of numbing and sterilizing drops, and checked that my name and procedure were correct. In the operating room itself the residing surgeon(5) checked my eyes a final time before I got into the chair. My head was clamped down, eye area covered up and one nurse held my hand(6) as the surgery started.

The actual procedure is quick, and all you need to do is keep still and look at the bright light. The eye is clamped down quite hard, while a laser cuts a flap with a series of small holes. It didn't hurt at all, but the clamp-down pressure is quite noticeable and I actually felt the laser as a series of faint pinpricks. With both flaps done the chair swings around to the other laser.

They lift the flap and give you more numbing drops. Everything goes completely blurry; the red blinking dot you're supposed to focus becomes a large, vague blob. The laser runs a series of pulses over thirty seconds or so that shapes your cornea. Finally the surgeon sets the flap back into place with a thin metal scraping bar and a squeegee. That was actually the scariest part, as you really see and sort-of feel the tools go across your own eye.

My left eye flap was quite thin and he had a little trouble setting it properly. To protect the flap the first few
hours he put in a pair of soft contact lenses that would be removed during the next-day check-up. He told me everything had gone well, and to expect fairly pronounced white halos for the first couple of days. I got out of the chair, he checked the eyes again — everything seemed fine — and I was free to leave.

I'm rocking the protective glasses. They don't look half-bad though; I could see myself in a pair of glasses like these. I still need glasses for close-up viewing of course, and sunglasses come in handy in summer.

On our way to lunch the world felt much wider and larger than before. Things were kind of blurry and shifting but already much better than before surgery. My right eye seemed fairly good already, while the left was blurry and with some double vision. I had strong halos and the white veiling glare I'd been warned about, and I really didn't see anything at all close up; it was much worse than I'd expect even with my presbyopia, and so bad I couldn't even use my phone.

By nightfall, after lunch and a nap, my vision had improved further. The left eye was still blurry and had double vision, but my close-up vision was more normal now, and the halos were not bad. A pair of 100-yen store reading glasses now let me use my computer.

There was never any pain. The first couple of hours my eyes felt gritty and tired, as if you've spent a long day wearing contact lenses in a dry, dusty environment. By evening they felt completely normal again; the eye drops really help here. I never got a headache from the sudden shift in vision, and I normally do whenever I change my glasses prescription. The pain killers I'd received remained unopened and unused.

So, I had decent sight in my right eye, blurry sight with double-vision in my left, lots of halos around everything, and I felt I was looking through a thin sheet of rice paper. Wearing both contacts and plastic protective glasses was of course not helping things. But I had no pain and no discomfort, and my vision was improving already. So far, so good.

#1 I might be exaggerating.

#2 Don't be ridiculous. Of course the madman would use a fresh, clean apron for each patient.

#4 I sometimes need to give my entire name — first, middle, and last — none of which are recognizable by Japanese. I frequently get into slightly silly situations where people desperately try to figure out which one could possibly be my family name and try to guess how to pronounce it.

I wish people would just ask. It never causes offence. I understand my name is hard to figure out, so I'm happy when someone asks. I ask too when I don't get a Japanese name right.

#5 He has worked in the US and spoke good English, so he offered to do the procedure in English if I wanted. The instructions to me were little more than "Hold still. Look at the light." so there was no particular reason, but it felt good to know we could fall back on it if needed.

#6 This seems to be standard procedure in most places, and I've seen on the net that some clinics offer a teddy-bear to hold as well. I bet there's research that shows this improves the end result; human contact calms people down, and perhaps that results in less fidgeting and lower risk of errors.


  1. Funny coincidence. I just booked my appointed yesterday for the second weekend of March...

    Got one question for you: were you somewhat functional (i.e. able to walk on your own without a white cane, seeing eye-dog or helpful partner) after the procedure when you left the clinic?

  2. I guess the madman part was inspired by seeing a few videos of the procedure around plus it being a doctor thing, which is scary by itself.

    Last week I ended in a short video spree again, even watching a video of a procedure gone wrong. Still, I don't like the flap part.

    Hope for a quick recovery. Certainly the first days after (any) surgery are the most annoying ones, to put it in a way. And those protective glasses are quite nice.

  3. @Dave, I was fully functional. I stepped out of the surgery, talked briefly with the counsellor, then we walked about ten minutes to our favourite restaurant for lunch. We stopped by a department store for some fruit, then on to the local train home. We walked the final twenty minutes, and I stopped by a 100-yen store for a pair of reading glasses.

    My eyes were pretty tired (it feels like I had a long day with contact lenses) so I did sleep on the train, and I also took a nap for almost two hours when we got home. But that was in part because I'd been worrying and sleeping badly the previous night, I think. I know one person (a restaurant owner) who was back at work two hours after surgery. And I know of one person that crashed and slept through the rest of the day.

    It depends on the exact medication you get too; I didn't get a sedative so I stayed completely clear throughout. If they prescribe a mild sedative to calm you down you're probably going to have a harder time being active right afterwards.

    I would not have been able to work the next day, simply because I didn't see well enough to work on a computer or read text for any length of time. Close-up vision is temporarily much worse than it would usually be, so anything detailed becomes a complete blur. But I had no problem getting around or doing normal stuff.

    @Jordi, yes, I was mostly trying to verbalize the irrational worry I felt before :) I did go through a fair number of papers on the flap thing. What I think I learned (not sure enough about this to actually post on the blog itself):

    * The flap edge never heals, but the flap does grow back together with the underlying layer over time. It's only actually loose for the first day or so, and it slowly becomes more securely attached over the course of a year.

    * Once it has reattached properly after a few months, the only way to dislodge it is either to grab, lift and peel it off the same way they do during LASIK, or though violent contact. The violence needed to get a dislodged flap at that point is generally enough to damage the eye itself, flap or not.

    We're talking traffic accidents, being hit over the eye in a fight or things like that, and a dislodged flap will be a very minor medical worry in such cases. Getting bumped on the head or something is not enough.

    * If you are doing full-contact sports — budo, boxing or things like that — they recommend you do PRK or LASEK instead. There you don't cut a flap, but just remove the outermost cell layer and reshape the surface of the cornea. Results and side effects are comparable, but PRK is a lot more painful and takes much longer to heal.

    It's noteworthy that baseball players — who jump, slide, run into each other and do risk getting hit by a small hard ball — almost always do LASIK, not PRK. Something like baseball or basketball is not too violent for LASIK.

  4. Cool. Good to know.

    Interesting stuff about the flap: my readings had indicated that people considered PRK better in the long term (less regression), but that LASIK had pretty much caught up nowadays to the point where results should be the same (and pain/discomfort/recovery time much lower for LASIK). Didn't know about the flap dislodging risk (and does explain why the doctor specifically asked me if I had or was considering having a career in MMA).

    The biggest head scratch I had when considering the surgery, was the choice of specific procedure: dunno about yours, but my clinic has a dizzying array of combinations involving machines of varying precision/power/speed for both the flap-cutting and the actual reshaping, with prices going from about 15万 to 35万. Each one incrementally "better" (for some very hazy definition of better) than the previous. And who wants to be the guy who who lost half their vision because they wanted to save a couple thousand yens...

    While getting the most-accurate possible flap cutting seems like a no-brainer, they still had a 7万 difference between the version involving laser pulses at 500Hz vs. 750Hz (for the reshaping). None of the papers I could find seemed to offer serious benefits, beyond the surgery taking 30s less...

    Did you clinic have all these options, or was it more straightforward?

  5. It's perhaps a bit more straightforward at my clinic. Not different laser options, but plenty of other variants. I guess that they have the machinery and the experience to do the older variants very well, so why not offer them? For instance, wavefront-guided LASIK maybe doesn't make a lot of sense if you don't have any astigmatism, and in such a case regular LASIK is a lot cheaper (and arguably a lot more tested) for much the same result.

    In your case it may simply be that the newer, faster machine has to be amortized — and the clinic probably pays a per-patient royalty fee to the maker — so you end up paying more if you want it. The alternative would be that patients using the slower machine end up subsidizing the newer one.

    In my case my astigmatism was of the same order as my regular nearsightedness, so I've been waiting for wavefront-analysis to become available. I went there knowing exactly what I wanted already.


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