Eye Correction/

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I recently had IntraLASIK corrective eye surgery. It's great! Now I can see under water with plain swimming goggles, I don't worry about losing or bending my glasses, I can wear a variety of cheap sunglasses, see the clock at night, etc. I tried contacts a few years ago, but they irritated my eyes too much, and anyway they're not cheap or easy either, nor are they as satisfying as just having no blurriness at all. It's a bit disturbing to consider eye surgery, and it's a big decision, but the good news is it isn't as barbaric as it was in 1930. For a long time, I didn't like the idea of LASIK simply because of the part where they slice your eye with a knife, however IntraLASIK uses a laser to do all the real work, including the initial cut. With IntraLASIK, the only parts they do by hand are lifting the flap and smoothing it back down.


Today I had a consultation with Dr. Larry Womack and Dr. John Mari at TLC Laser Eye Center in Fargo, ND. They did a number of exams, such as measuring my current required correction (about -6 myopia), checking whether my eyes are too dry, and measuring my pupil sizes. A really neat test they did makes an image of surfaces of my corneas and prints it for us to look at and later sends its output to the surgical laser. They said that according to the exams I couldn't be a better candidate; there were no warning signs that we'd have less than an excellent result. I chose Dr. Womack because he's one of the top surgeons in the country and performed something like 20,000 surgeries to date. Also, TLC Laser Eye Centers will provide a lifetime guarantee that they'll correct my vision again later free of charge if my eyes should change such that I need correction again (it'll cost $3500 total, and while I don't mind paying it once I'll be pretty disappointed if I had to pay for it again in 10 years). They also use the VISX CustomVue WaveFront guided vision correction system, which as I understand it, maps out the exact shapes of the corneas for more precise correction. As usual, there are risks of side-effects; some possibilities are permanent dry eye, night vision problems, glare around lights, being unable to correct to at least 20/20. They say I'll probably experience some of these during the healing period, but it's very unusual for them to last more than 6 months, and they're usually gone after a few weeks.


Today's the day of the surgery. It went exactly as the surgeon described, so I won't go into much detail. Basically, he had two machines. The first one was the laser for cutting the flaps, and the second was the laser for reshaping the corneas. Both machines required me to lay on my back. The surgeon cut both flaps on the first machine, after which I could only see light and dark. Then I stood up and they guided me to the other machine and I laid down again. The surgeon lifted the flap in one eye, the laser did its work, then he smoothed the flap back down with a soft spongy instrument. Then he repeated for the other eye. That was all; the whole thing took about 10 minutes. When I stood up, I could see pretty well, and my eyes didn't hurt much because they'd numbed them. We sat in a dark waiting room watching an aquarium for 20 minutes, since during the first minutes the flaps are most vulnerable as they seal back down. Then they examined my eyes again, and we went on our way. After about half an hour, my eyes started burning quite a bit. When we got home, I slept for awhile. (They say to keep your eyes closed or sleep for a few hours so they stay moist and start healing well.) Strangely, during the surgery, my left eye seemed more uncomfortable than my right, but my right seemed to take longer to get the flap back in place. When I woke up this evening, I could already see well enough to drive. I have to use two prescription eyedrops (Flarex, for steroid-responsive inflammatory conditions, and Vigamox, an antibiotic) 4 times a day for a week. Also, I have to use Systane (over-the-counter wetting drops) at least 4 times a day until the dryness goes away. I can't rub my eyes for a few weeks because that could dislodge the flaps, and at night I have to wear goofy protective goggles to prevent me from accidentally rubbing my eyes. Also, the whites of my eyes have huge red spots. So far, I'd say it was a huge success, but we'll have to wait and see how the healing goes. I'll have to go to an optometrist for exams after 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, then annually, but I can do those in town at my regular optometrist rather than driving to Fargo each time.


Today I had my day-after exam. Everything seems to be going well. I can see great, except that all the light sources have large halos around them. The doctor put a colored dye in my eyes that fluoresces so he can see bad stuff in his microscope more easily. He said the halos will go away as my eyes heal, and I'm healing better than average. They're caused by the incomplete bond between the flaps and the rest of my corneas. The bond is scattering some light causing brighter lights to obscure the darkness around them. It's especially noticable in high-contrast situations, such as approaching headlights or desk lamps. If I'm reading a book or in bright sunlight, they're entirely invisible. Computer monitors usually look pretty bad. Also, my eyes are pretty dry, and I sometimes need to use wetting drops once an hour or more, and my left eye still seems more uncomfortable than the right (although the doc wasn't worried about it). When they cut the flaps, they sever the nerves that sense how dry my eyes are, and that's what causes the dryness. That'll get better as the nerves grow back. It's not a big deal to me (as long as it gets better), and I can do most of my normal activities. I'm not supposed to do things that might dry out my eyes though, such as using a computer, watching TV, going outside in the cold wind, etc. For this reason I'm not going back to work until Monday. (Today is Thursday.)


Things are getting better, although it's so slow it took awhile to notice. The halos aren't as large as they were and the dryness seems to be getting better. At my last checkup, I can now see 20/15 with no correction, which is great!


Subconjunctival hemorrhaging in my eyes

I forgot to mention, that my eyes have these crazy looking red spots on them. These are called subconjunctival hemorrhages, and are a normal transient side effect. They have faded a bit, but it's taking a long time. I took this picture just yesterday, and it's been over two weeks now since the surgery.

How I measured the halos

I thought of a way to measure the halos. I wish I had measured them before to see progress. Oh well, I can still start now. In a dark room, a standard yellow Christmas tree light has a halo that's about 1 inch in diameter at 24 inches from my eyes. (The halo actually looks a lot like the one in the picture around the yellow bulb.) The halos are most visible in high-contrast situations. They are most visible around oncoming headlights while driving at night. (While very noticable, I can see through them without difficulty, so they don't cause a problem while driving.) They were quite distracting while using a computer two weeks ago, but now they are just barely visible on a computer. Looking around a well-lit room or while outside in sunlight, I don't notice them at all since everything is about the same brightness. Their angular size (or alternatively, their size in relation to my field of vision) seems to depend solely on the contrast, meaning a brighter light or a darker background makes it worse, and the distance to the light source doesn't matter much. Headlights on the interstate look huge, especially at a distance, and at times even bleen over to my side of the road when there's a ditch between me and oncoming traffic. In town they seem much smaller, but only because cars are much closer, so the road represents a much larger part of what I see; in other words, the angular size is about the same.


I recently realized that the halos and red spots are gone. They disappared quite awhile ago, but they faded slowly, so I didn't even notice. There's still some dryness. At my last exam, which was on 2008-01-02, the doctor said to keep using eye drops 4 times a day until the next exam, because they're still healing and because they heal better without dryness. At this point, the dryness is infrequent and minor enough I probably wouldn't bother with eye drops if he hadn't told me to. It takes up to 6 months to fully heal. My next exam is on 2008-04-02.


I had another followup exam last week. They just got this neat machine that can measure higher-order aberrations, such as the halos I saw. I still have some very minor halos that this machine can measure, but I don't notice them normally. Things like dust and ice particles in the air cause far more noticable halos (the type everyone can see, for example on a dusty night), even up close. At this point, the only noticable side-effect is occasional dryness, and there's still time for that to get better.


I quit using eye drops entirely two months ago, and have no dryness. An eye exam today confirmed no problems. I'd say this concludes the adventure.

I like the results. Glasses caused far more artifacts than the tiny bit of aberration that remains (halos). I can definitely see better now than I could with glasses, because there are no scratched lenses, etc. The only care my eyes need is a yearly exam, now that the dryness is gone. I was a low-risk candidate to begin with, and I would have been reluctant otherwise, because vision is one of the worst things to lose. Some people asked about my night vision. It's at least as good as it was before. I hear there's a risk of difficulty seeing in the dark, but I never had any difficulties with that. As expected, my eyes took awhile to fully heal after the procedure, but it was definitely worth both the hassle and the money. Eventually I'll need reading glasses like everyone else with good distance vision, but that's far better than needing bifocals.

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