Not To Be Trusted With Knives

The Low Down on Laser Eye Surgery

August 21, 2009 by Beth

So, it has occurred to me that despite having now had laser eye surgery twice (!), I have yet to give you a blow-by-blow of how the process actually goes down. I mean other than my live blog, of course.  I’m I’m guessing that people who come here by way of Googling “laser eye surgery” or “LASIK” might actually want to know what it’s like. And my regular readers – I know you are just dying to hear about it too, right?

The Consultation:
Before you can get surgery, you have to go for a consultation to make sure you are a good candidate.  They test your vision to see if your prescription is one they can fix with surgery, they tell you all the risks & benefits, they make you watch a cheesy “educational video” and they also test the thickness of your cornea.  The latter is done by freezing your eyeballs with an anesthetic drop and then touching the cornea with a little ultrasound device (sort of a thin tube hooked up to a machine). Due to the anaesthetic drops, you can’t feel it, but when they touched the little device to my cornea, I was actually able to see the thickness of the cornea as it sort of bends under the slightly pressure of being touched.  And, it was kind of neat, in an academic sort of way, to see my own cornea, as it’s not something you are usually aware of.  Anyway, if you have thick corneas, like I do, you can get the LASIK1 surgery; otherwise you have to have PRK2 (with thick corneas, you can actually chose between the two options).  With LASIK, a flap is cut in the cornea and flipped out of the way to allow the laser to zap the underlying corneal bed, and then the flap can be flipped back over the eye. This is why you need thick corneas for LASIK – there has to be enough cornea for there to be a flap cut. PRK, in contrast, involves stripping the outer epithelium (i.e., skin) of the cornea right off and just lasering the underlying cornea.  And although, when given the two options, the thought of having my cornea sliced through with a big knife freaked me out more than the idea of stripping the epithelium off, I opted for the LASIK because it heals much more quickly, your vision stabilizes much more quickly, and it is pain-free (whereas I’d heard stories of post-operative pain with PRK).

Before The Surgery:
In the week before the surgery, you have to stop wearing your contacts and you aren’t allowed to wear any makeup. The former is to ensure that your cornea is in its natural shape, as apparently contacts can change the shape of your cornea a bit. The latter is to minimize the chance that you have any makeup debris in your eyes on the day of.  Also, since I knew that I wouldn’t be able to rub my eyes for *three months* after surgery, I spent about a month before surgery making a concerted effort not to rub my eyes at all in order to get out of my eye-rubbing habit.

The Surgery:
On the day of the surgery, a number of things happen:

1. They re-test your eyes to make sure they have the best possible measurements to set the laser.
2. They give you drugs.  I honestly don’t think I could have gone through with the surgery without the drugs.  It was a cocktail of, if memory serves me, Gravol, Valium, and Ativan.  Not enough to knock you out, but enough to make you relaxed enough to let someone cut your eye open.
3. They lead you into the surgery room.  The surgery room where I went looks like somewhere that alien autopsies might be conducted3. But by this point (a) they have your $4,000, and (b) you are drugged up, so you just go with it.  Also, my surgeon has a very calming British accent and he calmly and patiently told me everything that was about to happen, so that helped too.
4. You lie down on the surgery bed and they put a pillow under your knees to make you comfy.  They put an eye patch over the eye they aren’t going to be operating on so that you can concentrate on the operative eye. At this point, you can pretend you are a pirate.
5. The laser is positioned above you and you can see a bright green light.  You will focus on this light for the duration of the surgery4.
6. They tape up your eyelids and then put an eyelid holder, a la Clockwork Oranage5, in place so that you won’t be able to blink.  You are also given anesthetic drops to prevent your eye from feeling stuff.
7. Next, they put a suction device on your eye.  And this is the only part of the procedure where I could really feel anything and I will admit that it was quite uncomfortable. It didn’t hurt exactly, but it was a really foreign feeling and I did not like it at all.  The suction device holds your eye steady so that they can cut a flap in your cornea. As the suction is applied, everything, mercifully, goes black.  I don’t think I could handle watching what comes next.
8. Next, you hear a buzzing noise, which is the “keratome” (i.e., knife) being run across your cornea, slicing it in order to make a nice flap.  The suction is turned off (thankfully!) and then the corneal flap is flipped over, exposing the corneal bed.  At this point, everything is fuzzy, because you no longer have the cornea in place to refract light.  So that green light you’ve been focusing on sort of becomes a green blur. [Note: when getting the surgery done the second time, even though it had been a year since I’d had the first surgery, the surgeon didn’t have to make another cut, as he was able to flip up the flap that seemed like it would have already healed, but was clearly still there6.  He just ran something over my eye (I think it may have been a needle, but my eye was frozen so I didn’t feel it and it was too close up for me to actually see it) to catch the edge of the flap and then was able just flip the flap open.  I was very, very happy about this, because it meant I didn’t have to endure that unpleasant suction again!]
9. Next they zap you with the laser.  The surgeon said “We are going to start now, focus on the green light” and then I heard a bunch of clicking noises. The first time, when they were correcting my massive prescription7 this took, I would guess, about 20-30 seconds. For surgery #2, where they were only correcting a tiny prescription8, it was more like 5-10 seconds.
10. The flap is flipped back into place, they make sure that it is positioned correctly and then the eyelid holder is removed.  [Note: for surgery #2, since they haven’t made a clean cut like the first time, they put a “bandage contact lens ” in your eye; basically, this is just a contact lens that holds your flap down for that first day.]
11. All of the above is repeated for eye #2. And then your surgery is done!

After The Surgery:
Immediately after the surgery, I could see quite clearly. Seriously, it was the most amazing thing. Before my first surgery, I was very, very blind. Very. Like can-only-read-the-giant-E-at-the-top-of-the-eye-chart blind.  But right after surgery, when I very slowly opened my eyes in order to walk to the next room, I remember thinking “omg! I can see the technician’s face!” Before surgery, without glasses or contacts his face would have been a blur.

After they lead you into the recovery area, you rest there for a while and then they check your eyes to make sure all looks good before you go home.  At home, you are supposed to keep your eyes closed as much as possible for the day.  There is a slight risk of the flap becoming dislodged, so keeping your eyes closed for the day gives the flap time to heal down.  When you do have to open your eyes – to walk out of the surgery room or to put eye drops in, for example, you have to do it very, very slowly and no more than halfway.

Eyedropapalooza
And then there’s the eye drops.

The first two days after surgery, you’ll be putting in eye drops more than 20 times per day.  These include:

• Prednisolone: a steroid to promote healing
• Tobradex: an antibiotic to prevent infection
• A preservative-free eye drop lubricant, such as Celluvisc or Endura: because your eyes will feel a bit dry after surgery [although I’ve found it to be much, much less after surgery #2 than surgery #1].
• Saline: to rinse eyes out if necessary and to unstick your eyelashes, which tend to get all goopy with all the drops and you can’t get the goop out because you aren’t allowed to touch your eyes9.

The Days and Weeks Following Surgery:
In addition to the eye drops, there are a few other things you need to do following surgery:

• wear either sunglasses or the sexy eye shields (below) to bed for the first two nights

If you choose to wear sunglasses to bed instead of eye shields, which I did every night except the one wear I took the above photo, it is required that you sing “I Wear My Sunglasses At Night.”

• no rubbing your eyes for 3 months (as you don’t want to dislodge the corneal flaps)
• no eye makeup for 2 weeks10
• sunglasses at all times outside, even if it’s cloudy, for two weeks11
• no water in your eyes for 2 weeks12

You also have to do a number of post-op follow up visits. First, you have a one-day post-op visit with the surgeon to test your vision and to make sure your corneal flaps are still in place and, if all looks good, you are free to keep your eyes open from then on. [And, in the case of my second surgery, to take out the bandage contact lens.  The contact lenses make your eyes swell a bit, so everything is blurry for about 8 hours after they are taken out and thus I had to see the surgeon again three days after surgery to make sure I could see]. Then you have follow up visits with your optometrist at 1 week, 1 month, 3 months, 6 months, 9 months and a year. These visits are fairly standard eye exams – they check your vision, check your your flaps to see that they are healing and look at the level of dryness in your eyes.

So, there you have it. All the nitty gritty details of getting laser eye surgery!

And now, a video of the LASIK procedure ((not mine. I didn’t even think to ask if they could video record it.  I totally wish I had!)). Not for the squeamish!

1. Laser-assisted Intrastromal Keratoplasty [↩]
2. Photorefractive Keratectomy [↩]
3. I have been re-reading The Golden Compass, so when I went into the surgery room this time I thought “Wow, this totally looks like a place where they would cut away one’s dæmon” [↩]
4. well, at least for the portions of the surgery where you have vision [↩]
5. OK, they weren’t quite as sharp as the Clockwork Orange ones look, but the idea is the same [↩]
6. which, now that I think about it, I’m pretty sure they told me the first time I had the surgery. It was something like, “it’s mostly healed down after the first few days and weeks, but it’s not fully healed back down for more than a year” [↩]
7. I believe it was -7 in one eye and -8.5 in the other eye [↩]
8. about -1.25 in one eye and -2 in the other eye [↩]
9. I’m usually very proud of my long luxurious eyelashes, but in this case they seem to be a hindrance as they sure hold a lot of icky white goop from the drops! [↩]
10. although I don’t really understand how you can wear eye makeup in that first 3 months, since you have to *rub* your eyes with eye makeup remover to get the make up off! [↩]
11. I wear my sunglasses most of the time outside anyway. I figure if the sun can burn your flesh, it can’t be too good for the old eyeballs either [↩]
12. I even wear my sunglasses  in the shower, just in case [↩]

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