01 July 2010

The Story of LASIK (updated)

I had been wanting to get LASIK for a long time. I felt an incredible freedom when I first got contacts, and anticipated a similar elation when getting rid of optical aids altogether. And knowing how common surgery is in Korea and how cheap things are compared to America, I thought it would be a good idea to get it done this year. Lizzie agreed, somewhat more tentatively.

Finding a clinic was first, but it was not a challenge. An internet search and word-of-mouth both confirmed that I should pick Kim Gi Su's clinic in Gu-Jeju. After a few false starts, we went in for an examination.

I had a vague idea of getting our eyes checked out and finding out some information, and then maybe getting the actual surgery sometime in the future. But when we actually went in for the exam last Saturday, we found out that the English translator (the doctor's daughter) would only be present for a week. It was now or never - since we wouldn't have been too happy with trying to work out things without any English. Lizzie had been becoming increasingly anxious, but she had the opportunity to witness the procedure and was immediately as happy as a clam about it.

We settled on coming back the next day and getting our eyes zapped.

I stayed determinedly ignorant of the goings-on, since I knew that the more I could imagine the unhappier I'd be. But I have since looked into it. And let me tell you that I am very happy I was unaware of what was going to be done. If you're thinking about doing this, maybe skip the next paragraph.

A factual summary of the procedure by Wikipedia:
A corneal suction ring is applied to the eye, holding the eye in place. ... Once the eye is immobilized, the flap is created. This process is achieved with a mechanical microkeratome using a metal blade[.] A hinge is left at one end of this flap. The flap is folded back, revealing the stroma, the middle section of the cornea. The process of lifting and folding back the flap can sometimes be uncomfortable.

The second step of the procedure is to use an Excimer laser (193 nm) to remodel the corneal stroma. The laser vaporizes tissue in a finely controlled manner without damaging the adjacent stroma. No burning with heat or actual cutting is required to ablate the tissue. The layers of tissue removed are tens of micrometres thick. Performing the laser ablation in the deeper corneal stroma typically provides for more rapid visual recovery and less pain than the earlier technique, photorefractive keratectomy (PRK).

During the second step, the patient's vision will become very blurry once the flap is lifted. They will be able to see only white light surrounding the orange light of the laser, which can lead to mild disorientation.

After the laser has reshaped the stromal layer, the LASIK flap is carefully repositioned over the treatment area by the surgeon and checked for the presence of air bubbles, debris, and proper fit on the eye. The flap remains in position by natural adhesion until healing is completed.
Yikes. Lizzie insists she could smell her eyeball being burnt.

For my own part, I experienced mostly just a variety of bizarre sensations. My head was strapped down and eyelids taped open. I now know that my eyeball was clamped in place, but since I didn't try to move this was unknown to me at the time. Then an incredibly cold series of drops were put into my eye - the anesthetic to numb and alcohol drops to dissolve the outer layer. Then there was varying levels of blurriness, strange scraping and motions, and finally a quiet command to lie still and look at the green light.

"Laser start."

There was no trouble looking at the light, since a fascinating pattern evolved on the laser projector's surface as it shot into my eye. It looked kind of like this picture, but went in and out of focus and swelled and glowed with red light from the center:

Our recovery time was been a bit uneven; Lizzie is recovering about a day faster than I am. This might be because she has less astigmatism, a weaker prescription, or had not worn contacts - or it might just be luck, I don't know. My recovery has been as follows:

Day of the surgery: Right after the surgery, vision is much better than natural, but much worse than with glasses. Very, very sensitive to light. No pain initially, building into irritation. By the end of the night, there was beginning to be significant pain. Mysteriously, a short nap eliminated all the pain, and we went to bed comfortably.
Day 1 of recovery: Woke up in very mild pain, and it got worse by degrees. Drops and painkillers ameliorate the discomfort somewhat. Eyes remain very sensitive to light, with vision improving slightly.
Day 2 of recovery: Pain peaks during the day, but still comparably mild. Vision is cloudy and indistinct.
Day 3 of recovery: Pain is slowly eliminated, but vision becomes double-vision and milky. I go back to teaching classes after calling in sick for two days. Can't see very well (night-blindness is particularly acute) but get by.
Day 4 of recovery (today): No pain at all, with reduced double-vision and steadily improving sight that continues to get better as the day progresses. I can finally consistently read!

I have to admit I expected some sort of superpower from having lasers shot into my eyes, but have been disappointed.  I will have to settle for the superpower of not stumbling around blindly looking for my glasses in the future.

N.B.:  Forgive any spelling or formatting errors.  It's still hard to see.

It's now been almost six months since the surgery.  As you can see, within a week the pain was gone and my vision was recovering.  Within two weeks, my eyes were almost fully pain-free, with minor itching and pain that was easily alleviated with provided drops.  And since then, I have been able to see!  I can see everything, picking out tiny details that escaped me even with contact lenses.  And the freedom of it - I still marvel at being able to live my life free of the hassle of glasses or contacts.

This surgery is by a wide margin the best investment I have ever made.  It has made my life permanently and wonderfully better.

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