Ahoy! Six days ago I finally put my eyeballs in front of a laser and got my vision corrected. It’s something that I’ve wanted to do for years, but never got around to doing because of the cost, the worry that I’d miss out on a new technology, and the uncertainty of which procedure to get. As I’m known to do, I researched everything on the subject (… and was then corrected by my friend Hayden who had read even more…) and I’m confident that I got the absolute best procedure.
How does Laser Surgery work?
Your eyball is a disaster. It’s not perfectly round. It’s probably too squished or too oblong, and the surface has little imperfect bumps on it. The part that laser surgeries deal with is the cornea – the layer of your eye that covers your iris and pupils. The cornea is responsible for focusing light onto the retina in the back of the eyeball, so it makes sense that this is where we focus.
Both PRK and Lasik (the two most popular surgeries) zap off chunks of your cornea to make a nice smooth cornea that perfectly focuses text from tynan.net onto your retina.
The problem is that the outer layer of the cornea, the epithelium, is extremely resilient and grows back quickly (as I’ll discuss later). To have a surgery that lasts longer than a few days we need to zap away somewhere in the middle of the cornea.
PRK vs. Lasik
PRK and Lasik are not as different as people think. They cost the same amount usually and are done with the exact same layer. The only difference is how deep into the cornea the surgery is performed, and how the surgeon gets to the treated area. Everything else is exactly the same.
Lasik is by far the most popular choice in the US for one reason – it’s a quick and painless recovery. Maybe that’s two reasons. It’s also highly effective and the chances of something going wrong are not worth considering in my opinion. With Lasik the surgeon uses something called a micro-keratome (think of it as an eyeball razor) to cut a little flap in your cornea. The flap is lifted, the laser does its business underneath it, and then the flap gets put back down on your eyeball.
Here’s what people don’t understand about Lasik – the flap NEVER heals! For the rest of your life you will have a flap cut in your eye. This is almost never a big deal – the suction power keeps it attached properly and you don’t notice that you have it there. However, when complications do occur with Lasik, they’re usually due to a miscut flap, or one that’s cut entirely off! If that happens, you need a corneal transplant. Risks of this happening are very low, negligible if you have a good doctor. The nice thing about Lasik is that you have no pain and your vision is restored 100% the day of the surgery.
PRK, which has been around for longer than Lasik, doesn’t create a flap. Instead some crazy solution is applied to your eyes and then the epithelium (outer layer of the cornea) is scrubbed off with something that looks like an electric toothbrush. Lasers then do their magic on the exposed deeper layer of the cornea and you go home to heal. Over the next two days your epithelium heals over the new and improved cornea, but it takes up to two months for it to return to its normal thickness and focus light correctly.
PRK is generally accepted to have less chance of complications, and probably has slightly better results. However, the healing process is very long (it’s now a week after I had mine and using the computer is not totally comfortable. The period in which the epithelium heals is also very painful. Pain medication is given for it which may help.
Another problem with Lasik is that the flap is usually cut through the nerve that tells your eyes when to water. That’s why people with Lasik often have dry eyes. PRK can cause dry eyes as well, but it usually goes away within months rather than years (or never).
What I think is particularly cool about PRK is that the end result is a perfect eyeball with no damage to it. If a new surgery comes out in twenty years when I need reading glasses, chances are that I will be able to get it. If I had a flap on my eye, that may interfere with the procedure.
Wavefront vs. Normal
Wavefront is a newer technology that can be used with PRK or Lasik since both use the same lasers. With a traditional laser, a single prescription is applied uniformly to your eye, meaning the same amount is lasered off of the entire treatment area. This yields the same results as getting a contact (since a contact is uniform as well), which is pretty good.
Wavefront is better. It makes a 3D map of your eye and feeds the map into the laser, which automatically zaps out any imperfections to make a perfectly smooth cornea. That means that your vision is very likely going to be better than people who have had no surgery at all. The wavefront machines use a variable size laser that jumps around your eye zapping each imperfection, rather than a wide laser that zaps a certain amount of times to remove the correct thickness.
Wavefront always gives better results, but is much more expensive. Regular Lasik can be had for $299 an eye, but Wavefront typically costs at least $2500 per eye. That’s a pretty huge difference in price, but my rationale is that this is something that will help you for the rest of your life – you may as well buy the best service available.
It is extremely common to have better than 20/20 with wavefront. In fact, more than half of the poeple who have had it get 20/15 or better. This may not seem like a big difference, but it means that you can see things at 20 feet that normal people can see at 15. Considering how many things we look at in that range, this is very practical.
The wavefront machines also track your eyeball 400 times a second, so if you move slightly it will compensate. Since the regular laser is lasering the whole surface evenly, it’s not as critical for it to do that.
Halos and Night Vision
The two most common side effects associated with Lasik and PRK are halos and poor night vision. With wavefront, these are non-issues now. The problem was that a large enough area on the eye wasn’t being treated. When it was really dark the pupil would grow larger than the treated area, letting some light come in through the untreated cornea. The light coming through the outside area would cause a second image to be projected onto your retina, which would come in the form of a halo.
Night vision issues were also due to the small treatment area. You need all available light to see at night, but if it’s coming in outside of the treated area then it’s not being added to the picture that you’re trying to make out.
If you haven’t gotten the point yet, the best option in the land is to get PRK with wavefront. It’s also important to go to a good doctor, since parts of the procedure are still done by hand.
I went to a doctor named Dr. Singla in Port Arthur, TX, because he was a friend of my friend Todd’s father and he had the latest wavefront machinery. Todd went to get it done as well. He had one very bad eye and a very good eye which didn’t need treatment. I had two mildly bad eyes.
We went in on a Friday afternoon to have the procedure done. They mapped our eyes again to make sure they hadn’t changed since the initial consultation. That made me happy. Todd and I were both extremely concerned with everything his staff were doing. We’d say things like, “are you sure I didn’t move my eyes? Do you want to measure again?”
I went first and was brought into the operating room. They tried to get me to take valium to calm my anxiety, but I had no apprehension at all so I insisted on not taking it.
They laid me down on a flat chair and went to work. Numbing drops were put into my right eye and a device was slipped under my eyelids to keep them open. The worst part was that there was a super bright light focused on my eyes, so I couldn’t really see. They used some fancy instruments to draw a circle on my eye.
Then they busted out the epithelium scraper. It looks identical to a battery powered spinning electric toothbrush. They pressed it on my eye to grind off the epithelium. This sounds painful, but it’s only mildly uncomfortable. The hard part is trying to keep your eye steady while a spinning brush presses against it.
After the epithelium was gone my vision got slightly blurry and it was time for zapping. I had to focus on an orange LED, which was slightly difficult only because I was concentrating so hard on not moving my eyes at all.
The laser began to make really loud zapping noises not unlike storm trooper guns as it danced across my cornea. Fifteen seconds later I was done and the procedure was repeated on my other eye. Contacts were put over the treated area to act as bandages and I was sent on my way. I had no pain at all for about fifteen minutes. Then the numbing drops wore off and I found it uncomfortable to keep my eyes open.
Todd only had one eye treated, but the laser worked on him for a minute and a half! He even asked questions while being zapped, which seems crazy to me.
We went home to Todd’s parents’ house and rested. Todd felt no pain at all and started using his computer again with the good eye. His other eye was blurry. My eyes seemed amazingly perfect, but were starting to sting. I could keep them open only for a few seconds at a time and they watered constantly. I went to sleep to let them heal.
The next morning Todd still had no pain, but my pain was escalating. By that night it felt like rusty thumbtacks were stuck in both of my eyes and I was having trouble staying asleep. They prescribed us Tylenol with Codeine, which I briefly considered taking (a HUGE step for someone who’s never tried any drug or swallowed any pill), but I decided not to when I found out that codeine is an opiate that people really liked.
The pain got so bad that I finally took some pain relieving eye drops that did absolutely nothing. The next day the pain was slightly lessened, but still pretty bad. It was painful to be awake and my eyes were bloodshot. Todd still had no pain (and no, he wasn’t taking the medicine either.)
Monday morning we had a checkup at the doctor’s office. I was so light sensitive that I could only open my eyes for a second at a time. The pain wasn’t as bad as the second night, but it was still pretty bad. He looked at our eyes and decided we could take the contacts off. Immediately my pain was gone. Stupid contacts.
That night I felt ok enough to keep my eyes open and use my computer, but my vision was blurry enough that I couldn’t really see the screen (even now I can’t see it very well, but it’s not that hard to just type without looking.). Every day I can notice my vision getting better. My distance vision is better than before, but my closeup vision (which used to be perfect) is now pretty bad. It may take up to 2 months to have 20/15 (which is what I tested at the day after the surgery).
More updates to come, along with a video of the entire procedure INCLUDING seeing the laser zap my eyes!