Not To Be Trusted With Knives

The Internet’s leading authority on radicalized geese

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Wish Dan Luck

Today I take a break from blogging about my trip to Oregon to ask a favour. My friend Dan is having surgery to repair a hiatal hernia. He’s going to be laid up for a few days/weeks recovering and requires entertainment for said laying around to recove. So, if you have a minute, why not wander over to Dan’s blog and wish him luck on his surgery and maybe post him a link to something entertaining for him to read or watch while he recovers?

Thanks, y’all!

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The Low Down on Laser Eye Surgery

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.

IMGP0079 by you.

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

IMG_3962 by you.

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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Frailty, thy name is retina!*

Last night, for the last time ever1, I took out my contact lenses.

As you may recall, I’m not allowed to wear my contacts for an entire week before my laser eye surgery.  And my surgery is one week from today!  So I have to spend the next week wearing my stupid glasses.  Which I’m not looking forward to, since (a) I hate how I look in glasses and (b) the prescription is a decade old and, according to my optometrist who checked them out at my recent pre-op visit, just barely squeaks by the level of vision required to drive.


This, I believe, is what the laser eye surgery process looks like.

This, I believe, is what the laser eye surgery procedure looks like.


Also discovered at my recent pre-op visit was the fact that I have some slight retinal “latticing,” i.e., my retina is thinning on the bottom. Apparently it is relatively common for someone with my ridiculously high level of nearsightedness2 – since nearsightedness results from your eyeballs being too long, meaning that my retina is being pulled tighter than it should be and, viola, you have a thinned retina.   It sounds kinda gruesome to me, but I’m told that it’s nothing to worry about (although thinned retinas can then become detached, apparently it’s a good sign that (a) it’s thinned at the bottom rather than the top3 and (b) it’s evenly thinned in both eyes4).  At any rate, the latticing of the retina doesn’t affect my eligibility for getting laser eye surgery, so the countdown to lasers in my eyes remains at T minus 7 days.

Which also means that there is still time for any rich philanthropists or other people who have money burning a hole in their pocket to donate to the “Fund raiser for Dr. Beth’s Peepers“:


*Since two of my other blog postings on my laser eye surgery used Hamlet quotations, I thought I’d continue the trend here.
1Assuming, of course, that everything goes well during the surgery. Knock on wood.
2-7.5 in one eye, -8.5 in the other eye.
3since thinned retinas at the top can become detached due to the weight of the rest of the retina pulling it down.
4Why does this just not sound like a good thing to me?

Photo credit: Posted by TheAlieness GiselaGiardino²³ on Flickr under a Creative Commons license. All hail CC!

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Booked it!

It’s official! I will be have laser beams in my eyes on August 15th.

I was given a set of instructions. You have to arrive an hour before the surgery for them to get you all ready. Wear a button down shirt so you don’t have to pull the shirt off over your head that night. You have to wear those giant sunglasses for a day after surgery, including to bed, both because you will be extra sensitive to light and to make sure you don’t rub your eyes, even in your sleep. I tend to rub my eyes a fair bit, so I’m trying to get in the habit of not rubbing my eyes in preparation.

Probably the most difficult thing will be that I can’t wear my contacts for a week before the surgery. I *always* wear my contacts. I hate wearing glasses. This is due to a combination of my vanity1 and the fact that my glasses are almost a decade old. The thing is, with my ridiculously strong prescription, my glasses end up costing $500-$600. And where the hell was a starving student supposed to come up with that kind of dough? I could barely scrape together $100 every second year to buy a pair of contacts2. The glasses that I currently wear were purchased when I was doing my Masters at the University of Guelph, because the student health plan there covered them. That was back in 1999-2000. In the intervening years, my ‘script has changed, the glasses have been banged up, scratched up, stepped on, and so forth. Basically, I can barely see with them on. So that should be an interesting week, to see if I can function without my contacts.

Other instructions tell you that you need to:

  • “shampoo your hair and wash face and eyelids” on the morning of surgery. Do people really need to be told to wash their face? I mean, we’ve been over the whole “do you wash your hair every day” thing here recently, but shouldn’t washing your face just be a given?
  • “keep your eyes closed for the rest of the day after surgery.” Sounds like I’ll be listening to lots of podcasts that day!
  • have a “responsible adult” escort you home from surgery and back to the clinic the next day for a post-op check up. Man, I’m sooo glad they specified that, because I was going to ask an irresponsible adult to escort me. Or perhaps a responsible child. Now I know better, so I’ve arranged for a responsible adult to be my escort.

Also interesting was that the consent form, which they emailed for me to read before the surgery, says that “Laser-Assisted Intrastromal Keratoplasty [LASIK] and Photorefractive Keratectomy [PRK] are classified as investigational by the Canadian Health Protection Branch” (emphasis added). I don’t know the ins and outs of what “investigational” means exactly (I mean, I’m sure it means that it’s not like full status approved and they are still doing research, but I don’t know what it takes to become post-investigational), but it’s interested that this was never mentioned in the consultation, nor did I see in on their website.

Anyway, I’m excited and a bit nervous. But the promise of being able to see properly every morning when I awake, of being able to go surfing without worrying about losing a contact and go swimming and be able to see people on the other side of the pool will make it all worth while. Plus, I know you all can’t wait ’til the live blog of the surgery.

1I want everyone to be able to see my big beautiful blue eyes.
2Because I used to wear the non-disposable kind, so I’d keep the same pair for 2 years.

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This above all: to thine own eyes be true

So, I think I’m going to go with the expensive place for my laser eye surgery. I really did like the doc there and a few things about the cheaper place kind of freak me out. First, on their website they explain that the reason they are so cheap is because they do a “high volume” of surgeries. They spin it as “high volume = more experience = better surgery,” but “high volume” suggests “assembly line” to me. The second strike against the cheap place was an email exchange I had with them. I emailed to ask for their success rates and rates of complications, since this information is not provided on their website. The email I received back was atrocious. They provided limited success data and completely ignored my request for complication rates. Then they told me to phone if I had more questions, with the tone of it making me feel as if they were really put out by my having emailed. I’m sorry, but you are in customer service and if the customer prefers email, you should provide courteous, accurate answers by email and make them feel welcome to email back if they have more questions. And, for the love of all that is good in the world, your email should be professional. In their 9 sentence reply, they committed the following grammatical transgressions:

  • hyphenating “with-out”
  • hyphenating “thank-you”
  • spelling the word “merit” as “merrit”
  • not capitalizing the first word in a sentence (twice)

This email does not give me confidence in their clinic. I realize that it is not the surgeon who is writing such an atrocious email, but in my opinion, it reflects the unprofessional nature of the place1. In a last effort, I emailed back to ask, yet again, what their complication rates are. Their reply: “We have done over 46,000 procedures and we have never had a serious complication. The pre-operative screening eliminates those patients that might be a complication. Our turn down rate is about 4%. Phone if you have any other questions to [number redacted].” First of all – I didn’t ask if they had any “serious” complications. Their definition of “serious” may not be the same as mine. Twice avoiding my request for complication rates makes me feel like they are hiding something. Secondly, I don’t think they really meant that the patient might themselves BE a complication2. And third, wtf is up with their not wanting email? “Phone…” is a command. And it’s not inviting at all. I consulted with my mom and she agrees that I shouldn’t let anyone with such poor grammar anywhere near my eyes. So expensive surgery it is!

And since I’m going with expensive surgery, I’m following my friend Dan’s3 advice:

Definitely don’t go cheap on your peepers. Maybe you should start a “fund raiser for Dr. Beth’s Peepers”. After all, you have been entertaining many of us in the internets for a while now. Plus, if you can’t see how are you supposed to blog? So really, it’s not about your eyes so much as it is about our entertainment. (Dan’s comment on my recent bog post)

So now I’m putting a “donate” button on the sidebar of my blog – all proceeds to go to the “Fund raiser for Dr. Beth’s Peepers.” A button that looks like this:

Also, I’m going to follow Dave‘s suggestion and live blog the surgery. No, really.

1sort of like that whole “if the bathroom in a restaurant is dirty, you can bet their kitchen is too” kind of thing.
2Although that is kind of funny.
3You may remember Dan as my co-author on the Snow, Snow & Gillis (2007) paper about the Count and mathematics.

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Weekend Update

  1. Went to my laser eye surgery consultation on Friday and after watching a cheesy “educational” video – some of which was about the surgery, some of which told me such non-informative things as “hey, did you know glasses and contacts are really annoying?” – and having an ultrasound measurement taken on my eyes, I was informed that I’m a good candidate for either PRK or LASIK due to my above average corneal thickness.  I’m thinking I’ll go with LASIK as it has a much shorter healing time (2-3 days vs. 10 days).  Although I have to admit that I am a bit freaked out by the idea of having a flap cut in my cornea (which is what they do in LASIK; in PRK, they do the surgery without cutting a flap first).  Also, I’m leaning towards going to the more expensive place.  The surgeon is super experienced and I liked him, so I’m thinking it’s worth the money.  I may think differently when I can’t afford to eat because I spent all my money on eye surgery, but I’ll cross that bridge when I get to it.
  2. Finished watching Season 4 of 24.  In celebration, I suggest you check out this pie chart.
  3. Booked a flight to Ontario for the end of the month to visit the fam.  My sister has vacation then, so I figured I could take some vacation days as well and hang out with her.  And my wee niece, who we all know is the greatest child ever to have lived.
  4. Won our hockey game last night!  I got an assist!  I can haz 3 game point streak?
  5. Also in the hockey game, I got the flukiest injury ever.  Correction – *before* the hockey game I got the flukiest injury ever.  While getting dressed for the game, just as I reached down to tie up my skate laces, my friend Kim kicked her foot up to tie up her skate laces and nicked my wrist with her skate blade.  Thankfully it was on the side of my wrist and was just a nick – but if I had my hand turned just slightly the other way and if she’d kicked her foot up just a bit higher, that could have been right nasty!
  6. Spent the evening, after the hockey game, playing with Wesabe.  I’ll have more to report later, once I’ve played with it some more, but so far, it’s pretty damn cool.
  7. It’s my dad’s birthday today.  Happy birthday, Daddy!

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To See or Not to See

Photo by Jorge

So, for a long, long time I’ve wanted laser eye surgery. And since I made a little bit of extra cash by working way too many jobs over the past few months, I figure I deserve a reward and what better reward than vision, right?I know a fair number of people who have had it done and every single one of them¹ has described it the same way: It’s a life changing experience. You can wake up in the morning and see the alarm clock across the room. You can go swimming without worrying whether you will lose a contact lens. You don’t have to think about bringing your lens case and solution and glasses if you want to spend the night somewhere other than your home. You never again have to deal with fogged up glasses when coming in from the cold in the winter or the surprisingly excruciating pain of getting an eyelash caught under your contact lens or… well, the list goes on.
And make no mistake, my vision really is terrible. My prescription is -7.5 in one eye and -8.5 in the other. To translate that into laypeople terms, that means that when I walk into the optometrist’s office and they say “Read the smallest line you can read,” I say, “E.” Seriously. I can’t read the second line on the eye chart without my glasses or contacts. Having such terrible vision also means that my glasses are exorbitantly priced. So much so that I’m still wearing the pair I bought when I wen to the U of Guelph², 8 years ago. I haven’t had enough money to buy both glasses *and* contacts since then… even under my current benefits package, I only get enough to buy a year’s worth of contacts, or half a pair of glasses, every second year. And seeing as how I’m so vain and don’t like how I look in glasses, I always go for the contacts.

So now I’m going to go in for some consultations to see if I’m even a candidate for surgery, as apparently not everyone is. I’m not planning to get the surgery done until August, after the summer hockey season starts but before the winter hockey season begins, but I’d rather find out now if I not suitable for surgery rather than having my hopes up all summer.

The two places I’m considering are:

Photo credit: deqalb on Flickr

My own optometrist got her surgery done at Pacific and I’m thinking that if she trusts them with her eyes, they must be good! However, if I go there it will cost me $3900, plus post-surgery follow up visits. If I go to Coal Harbour, which I’ve also heard very good things about, it will only cost me $2400, including follow up visits. Now, I don’t want to cheap out when it comes to my vision, but I also don’t want to pay twice as much as I have to if it’s not actually a better service. My plan right now is to go to consultations at both and to ask the doctors at both places why there is such a price discrepancy. I’m especially curious as to why the former charges more if you have a higher prescription, while the later charges a flat fee regardless of your prescription. I can’t see why the cost should change depending on your ‘script… doesn’t the surgery take the same amount of time and effort regardless? I suppose I’ll know more once I talk to the docs.

In the meantime, does anyone out there have any thoughts on this? Does anyone know one or the other (or both) of these Centres? Any thoughts?

¹I have heard two stories of a friend-of-a-friend who had problems, but not about anyone in who is in Canada.
² where the student health plan covered glasses