Saturday, November 5, 2005

Fun at the eye doctor's (my LASIK surgery story)

Surgery Day

I woke up yesterday somewhat jittery. The past few nights, I hadn’t been getting much sleep. My nervousness was penetrating and multi-faceted: 'Will my $4,600 actually fix my eyes?' 'Am I doing the right thing?' ' Could I go blind from the surgery?' 'Will I see glare and haloes in lights until the end of time?' 'Can I keep my eyes still for a minute while the surgery is being done?'

For the last decade, I’d dreamed of having this surgery. So long I had to wait, but now that day was finally here. I had my consultation, I had my pre-op examination, and I even visited a retina specialist to ensure that the “white without pressure” in the periphery of my eyes wouldn't interfere with my operation. But the question of keeping my eyes still continued to haunt me. Thirty-nine seconds in the oculus dexter (right eye) and forty-five in the oculus sinister (left eye), so the doctor told me. The results I’d been waiting to achieve for the last ten years would depend on a mere 84 seconds in my life.

Some people also get nervous about having their eyeballs cut out. I wasn’t overly worried about that. Perhaps I’m somewhat foolhardy, but I put my faith in medical science and the thousands who had gone before me. My doctor alone has done over 1,000 surgeries under his belt, and he still has his pants on. (Ahem, the joke is that nobody’s sued the pants off him, yet.) And he was good, too: My mother, a former RN and currently the director of risk management and performance improvement at a nearby hospital, knows all the doctors in town and their reputations. When I told her that I wanted LASIK, she found out where the docs go for their refractive surgery. I didn’t want the guy who advertises in the subway for $200/eye: I wanted the doctors’ doctor. So to make a long story short, I chose Dr. Patrick Chin, MIT grad and NYU assistant professor. (I once heard someone call his practice "the Ivy League of eye doctors.")

I went online to check out my surgery. My glossy brochure from the laser eye center showed a very sterile diagram of the procedure, replete with lines, circles, pastel colors, and shiny, happy people with Krazy Glued smiles. Blah blah blah. I wanted gross anatomy...I wanted to know everything about the surgery short of how to operate the laser. So I went to Google to see what it really looked like:  pictures of a patient with tape on his eyelashes and a speculum on his eye to keep from blinking, à la A Clockwork Orange. Red tissue cushioning the eye from above and below, and a flap hanging off the cornea like an ocular dingleberry. It reminded me of a sci-fi movie I saw years ago where some guy got abducted by aliens and had his eyes drilled out. These were just the images I wanted.


Knowledge is power to me, so I felt empowered going into surgery. First thing was first, though: I had to get there. As it is strongly recommended that someone drive you from the surgery, my mother, the medical professional, accompanied me. MapQuest said 24 minutes, so we allowed 45. Between a phone call as we ran out the door, a gas fill up, and directions that said, “Exit 507” rather than "Exit Route 507,” we got to my 3:15 appointment at 3:23. After finding no fewer than three laser centers in the building, we finally located the right one. I had a very light lunch beforehand, and a quick ride up the elevator with a pizza delivery guy ensured that I wouldn’t soon forget my mistake. Somebody also burnt popcorn in the eye center, so I arrived late, frazzled, and hungry. All things you want when you’re about to undergo a life-changing operation.

First, the last-minute checks. (“Last-minute” is kind of a misnomer; I was there for four hours.) I rested my chin and forehead against three different instruments. The first was a wavefront analyzer for my CustomLASIK: It measures the higher order aberrations in the eye to minimize the possibility of glare and haloes when I stare at lights. We did the test over and over again because you have to keep your head and eye as still as possible for the best possible readings. I think the second and third machines measured the shape of my eye. Two different machines, each with alternating colored and black concentric circles narrowing down to a hole in the center. After completing the battery, a technician called me back again for the first test because the doc rejected my results. The second time was a charm. The technician apologized for the number of takes. “Don’t worry,” I said. “The more, the merrier.” If they wanted a thousand takes before they got the right one, I’d be the last one to complain.

After that, they put me in an exam room with a projected eye chart and that swing-down device with all the dials and lenses on it. I played Solitaire on my phone and waited. The tech that came in caught me in the middle of a winning game.

“Hey, what are you doing?” she said.

“Playing Solitaire on my phone,” I answered.

“Well, give it to me – I want to play it during the operation!”

“What’s your job in the procedure?”

“I operate the laser.”

She was there for my favorite pre-op test. I had this one done once before at my initial consultation: the corneal thickness test. This is where they stick you in the eye to make sure your cornea can handle being cut open. It's the awesomest test! First, she dropped numbing solution into my eyes -- a bizarre sensation that caused me to become keenly aware of the muscles behind my eye. Then, she touched the end of an instrument on top of my cornea. For most people, sticking something akin to a ball-point pen in your eye would really suck. But when you can’t feel it, it’s pretty cool! I could see the ripples right on top of my field of vision, as if somebody tapped jelly with a fork. It was all rather fun, really.

Last thing before the procedure: paperwork and payment. I paid for $3,006.45 of it with my credit card (and I can’t wait to get those airline miles!). The remaining $1,593.55 was exactly the amount I had in my flex spending account. Paperwork: Do you agree to post-treatment care? Do you promise not to sue? Do you care if we keep the blinds open so that other people can watch? (I though that was so cool! I’d love to watch another surgery.) I told my mom she could watch, but she was too nervous. Finally: Would you like some Valium? Nope. I wanted my wits about me. This was gonna be awesome!

I also got my accessory kit: Pred Forte eye drops, an anti-inflammatory to complement the Zymar antibiotic eye drops I got a week ago. Refresh Plus tears to keep my eyes wet (and maybe to supplement my real ones if my surgery went to Hell). A set of gas station-quality sunglasses. And surgical tape and plastic transparent eye shields so I don't accidentally rip my corneas off! Finally, a name tag so that another patient didn’t receive my surgery.


Off to the surgery! I sat in another exam room and my favorite tech came in with a shower cap for my head and some booties for my Doc Maartens.

“Close your eyes. I need to put some more numbing drops in.”

“Don’t you mean, ‘Open your eyes?’”

“Oh yeah. I was just testing to see if you were awake.”

“Perhaps I should do the same.” (…I should’ve said that.)

“Okay, now close your eyes. I need to paint your eyelids with iodine.”

“What’s that for?”

“You need your mascara.”

“Well, I certainly want to look my prettiest for the doc.” (…I did say that.)

Now all that was left to do was wait. They were busy with another surgery, but unfortunately, the blinds were closed. I didn’t get to see it except through a TV in the O.R. through the blinds. Several minutes passed, and finally, the patient emerged and staggered into a dark room with comfy chairs. I knew I’d be sitting in one soon, too.

The doc came in and apologized for the wait. No problem. The last thing I wanted was for him to feel rushed. Before I walked into the O.R., he dotted the eyes.

“What is that, a ball-point pen?” I joked.

“Medical Sharpie,” he replied. It would help the laser to track my eye movement. After he put two tiny dots on my eye with the pen, he threw it in the garbage. It made me think of the mountains of medical waste we create every day. A pen whose sole purpose is to put two dots on my eyes.

Then, he presented me with a squeezable stress ball. It reminded me of the bullets they’d give 18th-century wounded soldiers to bite when they amputated legs. (Though, given the choice, I'd rather have a 2005 LASIK surgery than a 1775 amputation surgery.)  Hopefully I wouldn't find myself gnawing on it.

The O.R. was a pretty small room, no bigger than a college dorm room double. As the guest of honor, I plopped myself on the throne: a padded chair that reclined to 180 degrees. Kinda like first-class seats on inter-continental flights. But this was a trip that beat them all, a one-way ticket to Good Vision Land. (Hopefully without an emergency landing in Abnormal Complication-ville.)

As the doc put a blinder over my left eye, I asked him if anyone had ever freaked out in the chair. He couldn’t think of any incidents, but apparently, one of the tech’s girlfriends totally freaked out and ran from the building.

At this point, Dr. Chin explained everything that was going to happen. There was a pulsating red light on top of me. It’s not the beam that would do the surgery, just the beam I’d be required to look at at all times. I asked if I had to stare or if I could casually look. “Whatever works for you.”

The giant machine on top of me pumped out an amazing racket. “We’re loading up the laser with your profile right now, so that’s what that sound is,” one of the two techs said. I don’t have anything to compare the sound to, but the fact that it’s a large piece of really expensive machinery should give you some idea.

The doc then clamped open my eye and stuck a sponge around it. Then, he and a tech attached a suction instrument to my eye and turned it on. Fade to black. “Good suction,” said one of the techs. My vision in my right eye disappeared the same way a TV would.

“You’re going to hear something that sounds like this.” I heard a loud shrill noise like that of a dentist’s drill. But I knew that it was the microkeratome; no actual drilling of my eyes today. I wouldn’t be able to see him cut my eye open. Too bad.

Vvvrrrrmmmmm! “Good flap,” proclaimed the doc. And it was done. No pain.

“I guess we’re committed now,” I mused.

“Not really, but why don’t we continue. Okay, we’re going to lift the flap now. You’ll experience a little blurriness.”

A little! Ha. Try an order of magnitude worse than my -7- and -8-diopter myopic eyes had seen in their lives. You don’t want to go through life with a flap cut out of your cornea.

He then brushed my eye over a few times to ensure that everything was where it should be and in good working order. Now on to the good stuff.

The excimer laser was originally designed by IBM to etch patterns in computer chips, but IBM found that it was also adept at shaping human tissue. It’s quite precise; if you go on, you can find a picture of the IBM logo inscribed on a human hair. Today it would be used to inscribe my prescription onto my eyeballs.

“Thirty-nine seconds of laser treatment beginning right now,” said the tech. The lights in the room dimmed, and the machine roared to life. It made ungodly noises. I kept my eyes as rigid as I could. Precise, thin, blue lights flashed over my eye. First, it made a ring around my eye and then danced all over it. It was a laser light show, with all kinds of moving patterns on the planetarium of my oculus dexter. I wanted to focus on the light to witness what was really happening, but at the same time I was petrified to move. This was the moment of judgment. The smell of burning human hair wafted into my nose. Of course, it was really the smell of burning cornea. Think: moth in a bug light smell.

The ungodly machine quit rumbling, the lights came back up, and my right eye was done. “We’re putting your flap back on now.” And so they did. They left my eye in the speculum a little while longer while they waited for the natural suction in my eye to keep my flap in place. They also dropped some more medicine in my eye before removing all the medical paraphernalia. “You can blink, but don’t squeeze your eyelids together.”

“This looks really good.” Dr. Chin pronounced. “One down.”

‘One to go,’ I thought. My eye stung like hell. My Solitaire-playing, joke-cracking technician told me before the surgery that it would feel as though I had sprayed my eyes with ocean water. That was a good approximation. Here's another: it stung like a bitch. One of my cousins got the surgery earlier this year, and she said that after the surgery I really wouldn’t feel like opening my eyes very much. Correct!

So we proceeded with my oculus sinister. Eye patch on the right eye. Arrrr, mateys.

Speculum. Sponge. Instrument on my eye. “Good suction.” Fade to black. Vvvrrrrmmmmm! “Good flap.” Brushing. “You know, no matter what we do, patients always say that doing the second eye hurts them more than doing the first.” “Ted, that was too much eye movement. I have to re-set the eye clips and sponge.” Speculum. Sponge. “Forty-five seconds of laser treatment beginning right now.” Dim the lights. God. Blue laser show. Planetarium. Moth in a bug light. Cue the lights. Flap back in place. Brush. Eye drops. Wait for the eye to seal itself. Sponge. Speculum. Eye patch off my right eye. “The worst of it’s over.” (Explitive deleted), this one also stung like a bitch.

Opening my eyes was about as fun as staring at the sun. Now that it was over, I was worried.  I felt like that woman in the "Eye of the Beholder" episode of The Twilight Zone where the docs take all the bandages off her head only to find that my surgery was a complete failure. How could a few seconds of laser pulses possibly change my vision forever? I expected the worst.

I took a cursory glance and noticed that, wow!, something really had changed in my eyes. It wasn’t great vision, but it was good vision, and certainly the best I’d ever had without glasses or contacts. My cousin told me not to worry if my eyes weren’t great at first; they'd get better. I didn’t care at the moment. My eyes had that marinating-in-ocean-water feeling, and my mind retreated to the guy who stumbled out of the O.R. before me. How desperately I wanted to stumble onto my own comfy chair.


Before comfy chair time, I moved myself from the operating room to another room so Dr. Chin could examine my eye under a scope with a big, bright-ass light. Imagine the fun of staring at a magnesium arc welder at arm’s length…that’s what opening my eyes meant to me. But, he needed to do it to ensure that my flap was still sitting pretty. So I let him.

Then I was off to the comfy chairs, where I sat and squirmed and kicked and threw a blanket over my head.

Twenty minutes passed in the blink of an eye…or perhaps a few thousand uncomfortable blinks. If they could put LASIK surgery in a spray can, they could replace Mace. I got another bright light in the eye while my doctor examined the flap one last time. He explained to me that a short nap would cure all that ailed me. I had a head start on that nap: my eyelids may as well have been stapled shut.

“Ted?” he said. Why did he put a question mark after my name? I opened my eyes to see his outstretched hand. I extended mine to his. As he walked away from me, down the hall, I stopped him.

“Hey Doctor.” He spun around.

“Thank you.”

“You’re welcome.”

My mother escorted me through the parking lot. She needed help navigating home, which was unfortunate for me because I had no immediate interest in seeing. To put the sensitivity into context, car tail lights in an otherwise black night drove me nuts. Moaning and groaning, I got us back to the Garden State Parkway and shut my eyes for the rest of the trip home. Closed eyes in a car get me nauseated, so I wanted to vomit. I still felt ocean water in my eyes, too, and by this point I was hungry enough to eat a human heart. All I wanted to do was shove some food in my mouth and lie on my back completely still.

With my luck, we caught a train on the only set of railroad tracks we’d have to cross. When we got to my parents' house, I dove onto the nearest couch. My dad poked his head into the room. “So how is he?” he asked my mom.

That I was kicking the sofa with the back of my heels while holding a pillow over my head should’ve answered the question. “DO NOT turn on the lights!” I pleaded.

After I blacked out and came to nearly an hour later, the the pain in my eyes was gone. In fact, I felt as though nothing had happened at all. I ate dinner in absolute peace.

Day One

Today is Saturday, November 5, 2005, day one after my surgery. My eyesight is 20/30 in my right eye and 20/40 in my left. Both eyes are still improving, and I can expect them to improve over the next week, and over the next month. I can drive without glasses or contacts. In fact, if I look through the glasses that clarified my world yesterday, the world becomes a fun house today. If you look at my right eye in the mirror, you see splotches of blood where my cornea was cut the night before. Under normal circumstances, my reflection in the mirror would be a good reason to run to the emergency room.

Strange how the surgery didn’t hurt at all: All the fun starts afterward. Luckily, the memory dwells not on the bad, but on the good, and in retrospect, it wasn't all that bad . After years of putting up with contacts, sticking my fingers in my eyes twice a day, breaking lenses at inopportune times (while on vacation or in the middle of nowhere), and falling asleep with them soldered to my eyes, I was finally free!  Free of both the pain and pain in the a** that wearing contacts can bring.  Would I do this again?  Oh, yes I would.

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