Friday, 28 January 2011

My laser eye surgery consultation!


If you've had a chance to read my previous post (here), you might remember that I had finally taken the plunge and booked myself in for a laser eye surgery consultation. I had the consultation on Monday, decided I was ready to book the surgery while I was there, then had more tests and eye scans the following day. My surgery is booked for next Friday! Now I'm really hoping I've retained enough information to pass onto those of you interested in getting laser surgery yourselves.

I went to a place called Park Avenue Laser (the website is very "American" and garishly sales-y, which initially put me off going there, but after deciding I wanted LASEK not LASIK, it felt sensible to go to a centre which specialises in LASEK rather than a centre which offers LASEK as a secondary option.

In my consultation, it was mostly about me telling them why I wanted to get laser eye surgery, what concerns I had etc, and about them telling me more about the procedures and answering any questions I had. All in all, it was a very positive experience and made me feel like I was making the right decision to get LASEK. I spoke to several people, including the surgeon himself, one of the "refractive fellows" and an intern who had had the LASEK procedure himself recently.

Rather than walking you through my entire consultation (it was about 1.5 hours long), it's probably more useful if I go through some of the things I learnt while I was there when I bombarded them with questions...

Does the flap created in LASIK really never fully heal?

It heals, but the bond between the eye and the flap is never going to be as strong as when it was one piece (imagine slicing a block of glass then gluing it back together), which is why it is forever susceptible to being unstuck.

Why is LASIK still so popular if LASEK is "better"?

LASEK is a newer procedure than LASIK, and requires surgeons to retrain, which is a heavy investment of time, especially when there is no shortage of customers perfectly happy to go with LASIK (the recovery time is shorter). As with any relatively new treatment, it will take a while for LASEK to be fully phased in (as more and more people become qualified to perform it).

What is the difference between PRK and LASEK?

PRK (where the epithelium (skin) of the eye is scraped off before lasering) was an early procedure of "surface ablation" laser eye correction. LASIK (cutting a deeper flap under the surface) was introduced later and resulted in less patient discomfort and quicker recovery time. But LASIK created new problems, such as flap-related issues, permanent dry eyes and night glare. So surgeons revisited "surface ablation" methods, and came up with LASEK, which removes the epithelium in one clean piece, rather than scraping it off in bits (which heals less effectively).

Is it worth paying extra for Epi-LASEK over LASEK?

Epi-LASEK is where the epithelium is lifted using a special cutting blade, rather than the surgeon loosening it with an alcohol solution and then moving it to the side by hand. Epi-LASEK creates a cleaner, more precise cut, so the healing time is usually reduced by a day (from 3-4 days). Apart from the healing time, the final results are the same.

How soon will I be able to see clearly?

There will be minor discomfort and blurry vision for a few days after surgery until the epithelium (skin) of the eyes grows back and is fully healed and smooth. The blurry vision is nothing to do with the reshaped cornea, and is just down to the fact that the epithelium is growing back.

What are the chances of scarring?

Chances of the eye scarring after the surgery are virtually zero as long as the patient follows the medication instructions properly, and takes the prescribed steroid pills and uses the steroid eye drops for as long as instructed.

What happens if the eye scars?

Scarring of the eye will make vision cloudy, like a dirty glass. If caught early, it can be reversed using prescribed medication.

How long will the actual lasering take?

For my prescription, it will take about 45 seconds in each eye. It's less for lower prescriptions.


Those were the main questions I wanted to know and that I needed to be reassured about. Some other bits I learnt that I hadn't picked up in my mammoth research session on the internet were:

The prescription for glasses and contact lenses go up and down in increments of 0.25, meaning if you're somewhere in between, your glasses are going to either undercorrect or overcorrect your vision. Some "hi def" laser vision technologies can correct vision in much more precise increments of 0.01, meaning that you may actually achieve sharper vision after laser eye surgery than you had previously wearing glasses or contact lenses.

The night glare and halos that are common complaints from LASIK patients are most commonly caused by the eye and flap being two separate planes stuck together, which make light refract in two places rather than one (i.e. it has to pass through the join as well).

There is a LOT of medication to take before the surgery and after the surgery. This really scares me because it suddenly makes me realise that the surgery is no small deal and I'm messing around with nature. I was given a (literal) stack of prescriptions to take to the pharmacy for various medications such as antibiotic drops, anti-pain drops, weak steroid drops, strong steroid drops, steroid pills, valium, drops to increase tear production. Some of these meds need to be taken/used for several months after the surgery.

For one to two weeks before the surgery, contacts cannot be worn because time needs to be allowed for the cornea to get back to normal "topography" (i.e. get back to a normal shape). Contact lenses can warp the cornea, meaning that the laser correction won't be as accurate.

Starting at least one week before the surgery and continuing for three months afterwards, vitamin C tablets need to be taken to help prevent scarring, and aid healing.

In preparation for the surgery, preservative-free artificial tears eye drops (in vials) need to be used frequently in the days/weeks leading up to the surgery, to get the surface of the eye as smooth and healthy as possible so that the laser can achieve more precise results.

During the laser surgery, the laser tracks the eye's movement and stops if the eye moves too much. But results are much more accurate if the patient fixates fully on the red dot of the laser. I'm really worried that I might not be able to fixate the whole time. What if some strange reflex makes my eyes dart around?  I do find it really hard to focus normally...

It's not physically possible for the cornea to regrow or retreat to its previous shape. The laser has reshaped it permanently. Any minor changes in prescription in the years to follow are due to other issues, like age.

It is common for surgeons to purposely overcorrect a patient's vision to account for future degeneration of sight due to age. For example, they plan to slightly overcorrect my vision, because they expect it to then be perfect in three years time. At first it will feel like wearing glasses that are a tiny bit too strong, but just like glasses, the eyes adjust and vision feels normal quickly.

It's a requirement (not a suggestion) to have a friend there with you during the surgery, and to take you home as you'll be all drugged up. If you can't bring a friend, this particular centre charges $100 for the use of an intern to be your "friend" (it's kind of depressing to have to resort to that, so I'm having my surgery next week when my husband is in town).


What next?


I was given a choice of five different "tiers" of surgery packages during my consultation, ranging from I think $3,000 to $7,000. I definitely wanted the "hi def" procedure, which strives to correct eyes to 0.01 of my prescription, so that left me with the packages from $5,000 upwards. I had gone in with a price in mind of $5,000, but I hate that there are tiers of healthcare. They make me feel like I am compromising on my health if I don't get the top package.

The next tier up ($6,000) was Epi-LASEK, which was why I asked them whether it was worth paying extra for. I was told that the surgeon has performed the LASEK procedure so many times (over 15,000 patients), that he can lift the epithelium almost as cleanly as a blade and the healing time is thus sped up anyway. So I went for the $5,000 "Gold" LASEK package. If you're wondering what the top package included, it was just loads of extra drugs thrown in, plus free "enhancements" over a longer period of time (the lower packages included free "enhancements" required in just the first year).

I had to read and sign a consent form of about 20 pages long. It was very scary reading. As with any surgery, you have to accept that there are small risks of infection, blindness, death etc. Horrible.

I've swapped my contact lenses for glasses since Saturday, which is the longest period I've ever worn glasses for. It actually feels really good to let my eyes breathe. I've started taking vitamin C tablets and these smelly "fish, flax and borage" oil tablets which I've heard help with tear production. I'm also using eye drops throughout the day and before I go to bed.

I've booked Friday and Monday off work, to give myself four days of recovery. In that time, I have to keep my eyes closed as much as possible because the eyes won't heal if they're open. It's going to be booooooring!

I have a bit of a phobia of medical stuff, so I felt slightly nauseated leaving the centre on my second appointment there. I'd had countless drops put into my eyes, including numbing drops to stop me blinking so much when they were trying to take scans of my eyes. That was a yucky feeling, having numb eyes. It's like when the dentist anaesthetises your mouth and everything feels numb and big, but it's your eyes instead... *shudder*

So wish me luck! If I felt like that after just the tests, what will I be like when I'm having my eyes clamped open and someone poking at my eyes...? I have to keep reminding myself that millions of people have had laser eye surgery and recommend it! Thank you to everyone who left comments on my blog post, Facebook and Twitter with your testimonials!

Sunday, 23 January 2011

Getting laser eye surgery...


Yesterday was one of those days (that I have about once a year) where I spent an entire afternoon researching laser eye surgery online. I usually start off excitedly thinking "I'm going to do it! I'm going to call up and make an appointment right now!" and then after a few hours of reading about what it actually involves, and then all the potential side effects, I get burned out and decide to leave it for the time being. After all, we only get one set of eyes in our lifetime.

But, this time, I think I really am going to do it. I've booked a consultation at least (for tomorrow no less).

Just to give you a background, I am very short-sighted. I think it's from being a bookworm as a kid (I used to read titles such as "50,000 Facts about the World, with 10,000 Extra Facts about Space", cover to cover, in a day). My prescription is -5.00 in one eye, and -4.75 in the other. I've been wearing contact lenses for 14 years. When I'm not wearing my lenses, I have to hold things up about 6 inches away from my face to see them in focus.

Wearing contact lenses has never been a big deal for me. I've always suffered from dry eyes, but I've tried out most lenses on the market in order to find the most comfortable ones for me (currently, Acuvue Oasys). I never wear glasses out in public. At my prescription, it doesn't matter how expensive the lenses are, they're still thick and heavy at the edges. And I have lop-sided ears, so my glasses end up all wonky on my face.


Why I'm considering laser eye surgery...


Waking up and not being able to see anything makes me feel so lethargic. It's easier to stay in bed and keep my eyes closed than face the blurry day.

Travelling and having to constantly make sure I've got spare contact lenses, a lens case and enough lens solution gets boring after a while. Not to mention the fact that I have to wear my dreaded glasses out in public on the flight. As if I don't feel awful enough with the dehydrated (but shiny at the same time) skin, and badgers' breath.

My overuse of contact lenses has resulted in lots of little red veins on the whites of my eyes, where I am depriving my eyes of oxygen. I hear that these "veins" are actually new blood vessels that have been created to try to take in more oxygen. I've had these veins for several years now. I don't know if they're reversible. I really hope so.

I just want the freedom of being able to see clearly, all the time. It's fine when I'm in familiar surroundings because I know exactly where everything is, so I can feel my way around when I don't have my lenses in. But when I'm somewhere new, I bump into and trip up over everything. The other day, I couldn't find my glasses after moving apartments, but I couldn't see anything to find them. Argh!

Oh, I almost forgot to add about the annoyance of wearing contact lenses on holiday (aside from the travelling). I always avoid going into the pool or sea, fearing that I'll get an infection in my eyes from bacteria getting under my lenses, or my lenses will fall out, or that the chlorinated/salt water will just dry my lenses to a crisp. Then during the day, when I need to shower and freshen up, I have to remove my lenses before removing make-up or washing my face, and it just makes me feel like a slave to my lenses. And if I dare to nap even for a few minutes, the lenses dry out and sucker themselves to my eyeballs... *sigh*


Why I've been put off having laser eye surgery in the past...


I'd heard that the surgery makes dry eyes even more dry where it cuts off the corneal nerves that tell the eye to blink.

I've never liked the sound of zapping away bits of my cornea, leaving it permanently thinner. As laser eye surgery hasn't been around that long really, no-one really knows what the effects are after say, 30 years.

Vision can still deteriorate years after the surgery (or maybe not achieve 20:20 vision first time round), meaning that I'd either have to go back to using contacts/glasses anyway, or get more laser eye surgery and once again reshape the already thinned out cornea.

I've heard that the flap on the surface of the eye that is cut in the LASIK procedure never really fully heals ever. So if the wind blows a little too strongly, or if someone whacks you in the eye with their elbow, the flap can swing open again (gross).

Apparently it's common that night vision is impaired long after the surgery, where glare and halos around light (e.g. car headlights) can become quite uncomfortable.

I've needed to wait until my sight prescription becomes stable (it's been the same for a few years now, finally).

There's more chance of not achieving 20:20 vision the higher the original sight prescription.

Watching videos or hearing stories about laser surgery makes me gag.

It's hard knowing where to go to get the treatment done. The popular, mass-market laser surgery centres sound a bit cowboy-ish based on the reviews I've read. Who can I trust with my eyes instead?


Options available...


LASIK


This seems the most commonplace and cheapest procedure, having been around the longest (I think it's up to £3,000 for both eyes depending where you go). A thin flap is cut into the eye's surface using either a blade or a laser, and then lifted up. A laser then reshapes the cornea (basically by chipping off bits of it), then the flap is replaced and remains in position by natural adhesion until it heals. Recovery time is reputedly fast, and some patients manage to go back to work the next day. The actual surgircal procedure takes just minutes.

PRK


Rather than the surgeon cutting a thicker flap into the eye's surface (as in LASIK), the surface cells of just the ultra-thin, "epithelium" layer are scraped off. The laser is then applied to reshape the cornea, before a no-prescription contact lens is placed over the eye to act as a bandage until the epithelium grows back (about 2-4 days supposedly). The recovery time is longer and more uncomfortable than with LASIK, with vision taking weeks or months to become clear, while the epithelium heals fully. But at least there's no flap cut into the eye, and the corneal nerves are also left intact.

LASEK


LASEK is similar to the PRK procedure above, in that the thicker LASIK-style flap is not cut into the eye. But unlike PRK, instead of the epithelium layer being scraped off and removed completely, in LASEK the epithelium layer is simply loosened using a weak alcohol solution, which the surgeon can then peel back, before lasering. The epithelium is then moved back into place to act as a natural bandage (although a "contact lens" would still need to be worn for a few days until the new epithelium grows back). Again, the recovery time is longer and more painful than with LASIK. The advantage of PRK and LASEK over LASIK is that there is never a thicker flap cut, which means less flap-related complications (e.g. the flap lifting up, or wrinkling) and more cornea is preserved.

Epi-LASEK


From what I've seen, Epi-LASEK is similar to LASEK, except that the thin epithelium flap is lifted using a special blade/tool.

ICL (implantable contact lenses)


Also known as "intraocular contact lenses", ICL is a much newer procedure. Plastic "contact lenses" are implanted in the eye in place or on top of the natural lens. The procedure is supposedly quick, less risky and reversible. I don't know what makes me more uncomfortable - having plastic bits implanted into my eyes, or having a laser resurface my corneas. Anyway, ICLs are expensive - around £6,000 per eye, so that's that ruled out.


My next steps...


Tomorrow I have my consultation at a place which specialises in the LASEK / Epi-LASEK procedures. From my laywoman's point of view, it sounds like LASEK would alleviate some of the concerns I've always had with laser eye surgery. It sounds like it would put me out of action for maybe a week (eyes need to be closed as much as possible, no work and no looking at screens), but I prefer the idea of not having a thick flap cut into my eye, lessening the chance of even drier eyes, and leaving a thicker cornea (in case I ever need follow-up treatments).

Obviously, all this is from just what I've read on the Internet... so I might be completely wrong. Or, maybe I'll speak to the doctor, hear some hard facts and decide once again not to have laser eye surgery because my eyes are too precious to mess around with (although apparently laser surgery is safer than wearing contact lenses every day).

I will come back and report after the consultation. In the meantime, what are your thoughts on laser eye surgery? Have you ever considered it or even had it done?


Disclaimer: I am in no way a "medical" person, so no quoting of anything I've written in this post please! Any information I've typed up is just a summary of about a hundred pages I've read and a few videos I've watched from the magical place they call The Internet.

Friday, 21 January 2011

Back on air shortly!

I realised I've been away from the blog for well over a month with no explanation, and even my posts just before "the holidays" were a bit lacklustre. Everything is going great in New York and I've settled in much faster than I'd imagined. But my day job is more of a "day + night" job at the moment, giving me literally zero life outside of the office.

I really miss the blogging, the community and responding to all your comments and emails (I've had such a sweet bunch of them lately!). I know I have a load of comments I still need to reply to. I'm sorry to everyone who has commented over the last couple of months and have given up coming back to see if I've answered. If it's any consolation, this plays on my mind constantly!

I moved into a new apartment last week, with no furniture except an airbed I bought to tide me over until some furniture arrives from the UK. So it's kind of difficult to blog at the moment... the effort involved to get the camera out, find decent lighting and edit my thoughts into something presentable is just a bit too overwhelming!

BUT I will be back soon!

I hope you all had an amazing Christmas and new year / "holiday"! (I totally got used to saying "happy holidays" by the way. I quite liked it too.)
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